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A New Tool for Physicians Managing Work-life Balance


This will be Part 1 of a several-part series on applying “Lean” principles to my medical practice.

I work for a “Lean” organization. If you’re scratching your head, this means my organization tries to put principles of Lean manufacturing developed by Toyota into our organizational culture.

Presently, I am attending a two-month course on Lean principles and continuous quality improvement.  

It is the rare physician who can escape some form of quality improvement work. If you’re like me, most of that “QI” stuff has been a categorical waste of time. I am impressed, though, with how my organization successfully incorporates quality-improvement initiatives to bring about actual improvement in quality.

As I’m learning about these principles in depth, I realize that the applicability extends beyond making cars and moving patients through a hospital. Just as its developers intended, Lean is a philosophy - a way of looking at what we do and making it better. I thought I’d take a stab at using Lean principles in improving work-life balance. This will be Part 1 of a several-part series examining a specific aspect of Lean.

Today, I wanted to talk about one-piece flow. This is the opposite of the multi-tasking so many of us thrive on. I tried it today just getting some stuff done at home. I had three packages to mail out, which involved packing everything up, printing off the mailing labels, cutting out the label, taping the whole thing together and getting it to the mailbox. Usually with something like this, I will do a part of one before I remember that I wanted to get laundry done or that I should probably check my electronic in-box. Then I’ll come back to it sometime later and need to remember where I left off and start again. Of course, I’ll be interrupted with something   else and so on. It can take me many hours or even days to finish a project that should actually take about 15 minutes.

Instead of my usual approach, I decided to do the entire project start-to-finish at one time. I didn’t even batch printing the labels or cutting off pieces of mailing tape.  I treated each package like it was the only thing I had to do. I confess that I walked all three packages to the mailbox together, but by that time the project was done, so I still count the venture as a successful venture into one-piece flow.

One-piece flow is doing the job from start to finish. In patient care, it means that you see the patient, order all the labs, medications, etc., and complete the note before you move on to the next patient. It’s hard to do but when you try it, you discover that your brain does not need to continually disengage and re-engage in activity after activity. Instead, you can concentrate on the single task at hand, even if that task is quite complex.

The application to work-life balance is in the focus on what you are doing. One-piece flow has many elements to uni-tasking. When we engage in one-piece flow, we decide not to check e-mails under the table on our smartphone while our child is discussing their school day over dinner. We see something - whether that’s a work project, a home project, or simply bathing a toddler - through from start to finish.  I suspect that it takes less time and energy to do things this way and that the opportunity for error is less. 

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