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90 SMT Magazine • April 2015 such levels of any problem can be looked at si- multaneously when applying Lean principles. In practice, however, the application of Lean to the different levels of the problem hits an im- posed ceiling. In our example, the resource to work the counters is limited in the short term by the num- ber of counter staff present, unless the manager steps in at peak times. In the longer term, the post office does not want to employ staff if the budget does not allow it and their time will not be fully utilized. Fixed management principles get in the way of process improve - ment. The cost of having ex- cess counter staff would be more significant to the busi- ness than the cost of the lon- ger queues for extended peri- ods throughout the day, the majority of which is borne by customers or the public infra- structure. Applying this queue theo- ry to a problem with a com- plexity similar to that of man- ufacturing is illustrated by a recent trip to the emergency room. The average waiting time to be seen was four hours, which has become normal in the United Kingdom. Instead of taking the four-hour wait, a suggestion was made to go and "take your chances" at a nearby Minor Injury Unit (MIU). Even a 30-minute drive each way sounded better than four hours queuing, so it seemed worth a try. The MIU was totally unlike the emergency room scenario. In, processed, X-rayed, splinted up and out in 20 minutes. Barely time to check any emails. Queue size: one. This was not unusual. The MIU deals with a focused range of issues, mainly sus- pected broken bones or minor burns. The staff, who are all nurses, simply deal with cases one by one like a simple production line. Even busy times do not seem to put a strain on the opera- tion because the flow is continuous, similar to a high-volume SMT production line. The key difference in the emergency room is the high mix of issues and severities. Some- one who comes in with serious injuries will be moved to the front of the queue immediately. If there are many serious injuries coming in, wait- ing times for those with less serious conditions become open ended. The resulting sense of helplessness is significant for people, especially at a time when they are in pain and concerned about the effects of their injuries becoming worse. Some injuries also cause bottlenecks in the process because any key resource issue for one type of injury effec- tively blocks the processing of other patients, even those who are not dependent on that re- source. This is a critical point. If the bottleneck is because there are no beds available for patients, then those who don't need them can be pro- cessed. Similar to the post of- fice, if there are many people in the queue just there to buy stamps, then what they need is a stamp machine out front. The idea that everything and everyone needs to go through the same process becomes in- creasingly flawed as variation in the process increases. Prioritization needs to evolve so that immediate re- quirements that may not be serious can be dealt with in paral- lel to those that are. In the emergency room, unlike that of the post office, the cost of inef- ficiency is born by the hospital. Consider the waiting room, large but full, with heating, light- ing, toilet facilities, and cleaning expenses. The car park is completely full and people have to park in no-wait zones blocking access for es- sential services. Requests are put in to purchase more land for parking or to build a multi-story car park. A huge amount of resource that could be applied to taking care of people is actually spent on the excess infrastructure to support a wasteful system, when the majority of people attending the hospital at any one time need not be there. the essentiAl Pioneer's surViVAl Guide similar to the post office, if there are many people in the queue just there to buy stamps, then what they need is a stamp machine out front. the idea that everything and everyone needs to go through the same process becomes increasingly flawed as variation in the process increases. " " TO BE lEaN iS TO BE HuMaN continues

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