While thinking about the concept of “white space” in patient care, we ran across this fascinating* article about efficient manufacturing methods, with this description of white space applied to making custom metal springs and wires:
“We distinguish that using the terms white space and gray space. The actual machining process, metal cutting time, welding time, or molding time, is the gray space. The rest of the time a job is waiting to get on a machine, waiting for a designer to work on it, waiting for information from the customer, is called the white space. So, if you take a total lead time for satisfying an order, let’s say 12 weeks, the actual gray space machine cutting time is only about 5 percent, maybe three or four days, but the rest of the time is just waiting because of inefficiencies in the organization.”
This is remarkably similar to the way we discuss white space in patient care. Simply put, white space is any time spent on activities that don’t add value or contribute to care. For hospitals, white space might be time spent waiting for beds or patients to be ready, or making multiple phone calls coordinating transport or services. Productive time would be doctors diagnosing and treating patients or speaking to families, nurses providing the right timely care, or transport arriving on time to take patients to needed procedures.
My much smarter colleagues Ben Sawyer and Jim Rosenblum discuss the concept of white space in patient care much more eloquently in the second video on this page.
And this slide illustrates the concept well (click to enlarge):
The average hospital patient length of stay is 4.9 days–time that include lots of white space. Everyone demands limited resources with equal urgency. And when everything is urgent, nothing is urgent. To improve throughput and compress and cut out the white space, hospitals must set priorities as a system (not individual departments with conflicting incentives). They must apply logistics across all people and departments to ensure that beds and transport are ready on time, and ensure that orders and services are timely and serve hospital throughput goals. They need logistics to pull patients to the next ready destination or service, and not push them when the system isn’t ready for them. (How satisfied is that patient going to be who sat on an ER gurney for four hours waiting for a bed? That’s what we mean by pushing instead of pulling.)
With these logistical controls in place to assure peak efficiency, hospitals can begin to predict and rely on better throughput performance–just like that shop making metal springs.
POSTED BY Doug Walker
* OK, I’m exaggerating my level of fascination a little bit; it is, after all, an article about manufacturing methodology. But the concept of improving efficiency by eliminating non-valuable time applies to patient movement as surely as it does to custom metal fabrication.