Posted by: knightbird | January 12, 2011

The Spaghetti Diagram

One of the really fun tools in the Lean practitioners toolbox is the Spaghetti Diagram. When we were learning how to use Lean in 2005, we had a break during a 5S Event in one of our Village Health Clinics. We thought it would be a nice diversion to practice using a Spaghetti Diagram. We selected a process to review: a routine blood draw. We set up one of our health care providers as the patient, and another as the provider. The provider was familiar with our clinic procedures in that particular clinic, so we have some assurance that we were performing standard procedures. Two of our staff recorded: one did the Spaghetti Diagram, and the other took time data. The results were astounding, and beneficial.

As we started the procedure, the provider spent a great deal of time finding the resources for a blood draw. She walked in and out of the exam room looking for materials and equipment. Halfway through she was apologizing profusely to the faux patient. At the end, she commented about looking completely incompetent. We talked about how the patient must feel to be in the middle of such a disorganized process. The provider went through in excess of 70 process steps before completing the blood draw.

We analyzed the data, and found a simple solution—a blood draw kit with all of the supplies and equipment required in the exam room. We reduced the number of steps required to approximately 6. What an eye opener for us. We standardized this work and deployed it to the rest of our clinics quickly. Then we tried 2 additional processes. Again, we were able to see what goes on during the procedure and make improvements.

I know some folk are probably asking about how such inefficiencies could be tolerated for as long as they have been. I think the same when I see an organization that isn’t using Lean. The waste is there, but we need to inspire a culture of Continuous Improvement, and teach the tools to support that Culture.

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