OM Blog 7: January 13, 2009
GUEST BLOG: Michael Dixon, Cornell University
Michael Dixon is a PhD candidate at Cornell University School of Hotel Administration studying Service Operations Management. His research interests include understanding how process management decisions of service firms impact customer long term behaviors.
Recently I was contacted by a volunteer from the American Red Cross and asked to sign up to donate blood during a blood drive on campus. I have donated blood several times during my life and have never had a reason to turn down such requests, so I signed up for a 1:30 pm appointment on a Monday. I arrived at 1:30 pm sharp and started the process of the donation. Their website recognizes the 4 step process to donation:
- Registration: read about the donation process and eligibility requirement.
- Health History and Mini Physical: personal health history questions, temperature, blood pressure, etc.
- Donation: Approximately 1 pint of blood is drawn from your arm
- Refreshments: Spend a few minutes eating sweets and drinking fluids
Again, from their website: “The donation process, from the time you arrive until the time you leave takes about an hour. The donation itself takes about ten minutes.” From a purely process management standpoint, this statement might raise an eyebrow. If it only takes 10 minutes to draw the blood, why do donors have to spend an hour to donate? The other three process steps surely don’t take 50 minutes. Answer: there is a lot of waiting done by the donors. In my case the process took nearly two hours while the donation itself took about three minutes.
I had lot of time thinking about their process and had a hard time not seeing potential process improvements during my long wait.
Reservation/Appointment Management: As I arrived, there were about 8 donors in front of me in the registration area. It appeared that there were two separate appointment books: one from the phone calls made by a regional headquarters and one from the local blood drive supporters. My guess is that they did not synchronize the two appointment books and overbooked. In addition, they were taking walk-ins and everyone was served on a first come first serve basis; reservations did not get any priority over walk-ins.
Bottleneck and Capacity Management: With a quick glance to the donation process area, I saw six beds. If the actual donation time takes an average of ten minutes, then the capacity of the donation process is 6 beds * 60 minutes in an hour divided by 10 minutes per donation = 36 donations per hour assuming the area is properly staffed. The health history/ mini physical area also has enough space for 6 donors being service at one time and a 10 minutes average time for this process is probably reasonable. However, there was only 1 dedicated employee in this area restricting the capacity down to 6 donations per hour.
Labor Scheduling & Capacity Planning: At 1:30 employees were coming and going taking lunch breaks. I suspect that the reason there was only 1 staff member working the health history / mini physical step was because someone was on break. Labor scheduling is essentially matching system capacity with expected demand. In the case of a blood drive, the expected demand could be managed by allowing for more appointments during fully staffed times and less appointments during periods of breaks (e.g., lunch time); however, it appeared that blood drive volunteers were asked to find the same number of donors for each time period, e.g., for each half hour block find 4 donors. Perhaps the actual capacity during periods of full staff is higher than what they ask for and much lower during lunch times. This means that donors in the morning and late afternoons will be serviced very fast (maybe 30 to 40 minutes) while the donors during the lunch hours can expect long queues and much longer waits (like mine: 2 hours). The average wait may indeed be 1 hour but the variability in what is experienced by donors varies widely. Perhaps the American Red Cross tries to determine its daily capacity and asks blood drive volunteers to fill this uniformly throughout the day; however, labor scheduling forces the capacity to fluctuate throughout the day and reservations should be scheduled to match the capacity fluctuations.
What is the goal?
Again, according to their website, the number 2 reason people don’t donate after “I don’t like needles” is “I’m too busy”. Only 43% of donors are “repeat and loyal donors.” Perhaps a large percentage of the remaining 57% realized that they didn’t like needles after their first donation, but certainly some of them stopped coming because they were “too busy” which is a nice way of saying “it takes too long”. Blood is highly perishable and donations are needed every day in order to maintain adequate supply for medical patients who need blood. A top priority for the American Red Cross should be to increase the percentage of loyal donors in order to maintain the need blood supply. Any marketer will tell you it is easier and cheaper to maintain an old customer than to win a new one; however, the American Red Cross spends a great deal of its effort in finding new donors.
Questions:
How can the principles of operations management improve donor loyalty?
Where was the bottleneck in my process? Where should it have been if donations where to me maximized?
What could the American Red Cross do to manage their appointment system better? How could they handle walk-ins?
Sources:
The blood donation process:
http://www.givelife2.org/donor/process.asp
Top 10 reason people don’t give blood:
http://www.givelife2.org/donor/top10excuses.asp
50 quick facts about donating blood (including loyalty percentages): http://www.givelife2.org/sponsor/quickfacts.asp
Advances in Medicine: The Checklist
OM Blog 6: January 5, 2010
By Ken Boyer, Fisher College of Business, Ohio State University and Rohit Verma, Cornell University
Authors: Operations and Supply Chain Management for the 21st Century, 2009, Southwestern Cengage Publishing
Magnetic Resonance Imaging (MRI), Image-guided Radiofrequency Ablation (RFA), Computed Tomography Angiography (CT) and Checklists. In this list of the “latest and greatest” in medical treatments, which one would seem not to belong? Checklists? Really? In 2009 with all the DNA mapping, computer assisted and imaging technologies that have contributed to improved medicine (and often substantially increased costs), simple checklists are being proffered as a critical tool for improving medical care and outcomes.
In a new book released in mid-December (The Checklist Manifesto: How to Get Things Right, Metropolitan Books, 2009), Dr. Atul Gawande, explores the nature of complexity in our lives and in medicine in particular. Gawande, bestselling author of Better and Complications, MacArthur Fellow, general and endocrine surgeon at Boston’s Brigham and Women’s Hospital and an associate professor at the Harvard Medical School offers his observations, experiences and research on the use of checklists. His central argument: medicine has advanced to a point where there is tremendous know how an ability to effectively treat many medical conditions, yet there are over 150,000 deaths from surgery every year – at least half of which are attributable to preventable error. Why so many errors? Because medicine is complicated and with many complex pressures it is common for doctors, nurses or other medical professionals to either forget a step or perform a critical step out of order. A powerful illustration of this can be drawn from Gawande’s writing:
Central Line Infections:
In 2001, Dr. Peter Pronovost, a critical care specialist at Johns Hopkins Hospital decided to tackle the challenge of reducing (preventing) infections when patients received a central line. He wrote the following steps on a piece of paper:
- Wash hands with soap
- Clean patient’s skin with Chlorhexidene Antiseptic
- Place sterile drapes over the entire patient
- Wear a mask, hat, sterile gown and gloves
- Put a sterile dressing over the insertion site once the line is in.
As Gawande writes, “These steps are no brainers: they have been known and taught for years”. And yet, when Pronovost recruited nurses in the ICU to observe doctors for one month, he found that in more than one third of the patients, AT LEAST ONE STEP WAS SKIPPED!
Dr. Patchen “Patch” Dellinger reads off of a checklist for surgery at the University of Washington Medical Center
The next step involved Pronovost and his team persuading administrators at Johns Hopkins to authorize nurses to stop nurses if they saw doctors skipping a step. Nurses were also encouraged to ask doctors each day whether any lines should be removed – thus not leaving them in any longer than necessary. Now, Gawande being a surgeon has better authority regarding medical practices than any non-medical professional has, but essentially he writes that nurses have always had ways of nudging physicians and reminding them to perform critical steps. Yet, this approach was revolutionary – encouraging nurses to intervene and “checklist” the doctors. The results were amazing – the ten day infection rate dropped from 11 percent to zero. Pronovost and colleagues calculated that in just one hospital, the new checklist had prevented forty-three infections and eight (8) deaths and saved $2 million in costs.
I will not reveal more of Gawande’s writing here – I highly encourage you to buy or borrow a copy of the book and read it yourself. The point is – technology does not have to be complicated to be effective. Operations management professionals in a variety of service and manufacturing industries have been employing checklists for years. Other basic, yet effective tools covered in most textbooks include:
- Pareto Analysis
- Bar charts
- Histograms
- Scatter Diagrams
- Run charts
- The Five S: sort, straighten, shine, standardize, sustain
- Poka-yoke
While people often fall for the fancy and impressive technologies and medical treatments, often getting the simple stuff right can be more important. So, think of ways that you use checklists in your daily life – both for personal use and for business use. Maybe you should have one for your doctor the next time you see him or her?
Discussion Questions:
Sources:
Dr. Atul Gawande, The Checklist Manifesto: How to Get Things Right, Metropolitan Books, 2009)
Pronovost, P.J., et al., 2003, “Improving Communication in the ICU Using Daily Goals” Journal of Critical Care, V. 18, pp. 71-75.
“UW Medical Center Using Surgical Checklist to Improve Safety”, Carol M. Ostrom, Seattle Times, June 26, 2008
