Second, our outpatient clinic, like most hospital outpatient clinics at that time,
and even now in many parts of the world, was plagued by inefficiencies and
long waiting lists. The more we fought the inefficiencies, the more money we
poured into the system, the longer the waiting lists seemed to become. This is
the problem with the national health system in Britain as we speak. Now in
my department, it seemed to me as though the
processing of patients by
doctors could really be viewed as a production line, just as in
The Goal
. The
times are different, and obviously people aren’t machines. All of those issues
I acknowledged. But I saw that parallel.
DW: How did you attack the problem?
AV: The manager in charge of that clinic and I sat down and I told her about
the principles used in
The Goal
. Between the two of us—with her doing most
of the work—we identified our constraint. We realized that we lost a
tremendous amount of capacity whenever patients or doctors wouldn’t show
up for scheduled appointments. That time lost was not recoverable. So we
developed
a call-in list, which we called the patient buffer. A day or two
before a scheduled appointment we would phone patients and make sure that
they would be coming into the clinic. If not,
we would find substitute
patients. The result was less loss of capacity. Our waiting list at that time was
about eight or nine months long, which is common
for this type of waiting
list. As a matter of fact in the UK now some of these waiting lists are over
one year. In about a six month period we got
our waiting list below four
months, which was roughly half of what most other hospitals were doing in
South Africa at that time.
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