“Takt” is a German word that means “beat” or “pace.” My foundational understanding of pace takes me back to my early days of studying piano and using the mechanical metronome — a pace-setting tool that helps musicians play music to the tempo the composer intended. After setting the metronome to the beats per minute as written by the composer, the musician follows the sequence of notes on the page, playing each note’s predetermined tonal length. This standard approach allows the musical work to be played as intended with each note flowing at just the right moment in a coordinated sequence of sound.
Why is takt time important for patient care?
Like composed music, lean methods in health care also use a prescribed pace — known as takt time — to inform and guide the pace of production so that health care organizations can meet customer demand. Imagine for a moment that musical notes with their unique tonal length, rapid or long, equate to different patient types with unique attributes. Some patients are complex, requiring more time for care, and some are less complex, moving through their care delivery steps rapidly. To achieve synchronized flow and a quality result, patient care must be sequenced at just the right time and in just the right amount to achieve a harmonious result.
In its simplest form, takt time is a calculation: time available divided by demand. Without a thoughtful takt time awareness, it is impossible to analyze patient demand and use that information to redesign a process to meet or exceed patient and organizational expectations. Because there are a discrete number of hours per day, staff have a certain amount of allotted time to deliver a service or product to their patients. Therefore, if their cycles of work are designed and paced to takt time, and the wastes inherent in their work are eliminated — wastes like waiting, walking and managing defects — their work will flow smoothly without patient or product backups or waits. When work is designed and executed in this fashion, our providers, staff and patients experience fewer defects, a decreased burden of work and less frequent delays.
Thinking about takt time in an outpatient pharmacy
Let’s say there’s an outpatient pharmacy that is open 8 hours each day, or 480 working minutes. This pharmacy has 200 new prescription fill requests per day. The calculated new prescription takt time is therefore 480/200, or 2 minutes, 24 seconds. What does this mean? A common misconception is that 2 minutes, 24 seconds is the total time it takes for one prescription to be filled from beginning to end, but nothing could be further from the truth! It actually means that to meet new prescription demand, each cycle of work within the prescription-filling process should be designed and standardized so that every 2 minutes and 24 seconds, a filled prescription comes off the production line ready for patient pickup.
Using takt time to improve a nursing model of care
Many years ago, the nursing model of care at Virginia Mason moved from a group shift report at the nurses’ station, which could last upwards of 45 minutes, to the best practice of handing off care at the patient’s bedside.
In the previous model, all oncoming and offgoing nursing staff exchanged timely care information in a back room directly adjacent to the patient care area. This centralized location moved staff farther away from patients, inhibiting the direct monitoring and line-of-sight surveillance that is critical for ongoing inpatient safety. Additional consequences of this ill-designed process were delays in morning patient care and overtime costs for offgoing nurses.
Nursing leaders, who were aware of the necessity to be accountable for responsible nursing resource allocation, leveraged lean practices to inform process redesign, with the objective of moving nursing care ever closer to value-added defect-free delivery. They calculated that the time allotted for shift report handoff was 30 minutes for 27 patients. At handoff, five oncoming nurses were readying themselves for a day of patient care. If handoff occurred at the bedside, each nurse would have no more than 6 patients to discuss in the 30-minute time block, resulting in 30 minutes/6 patients, or a takt time of 5 minutes. Through iterative process improvement learning cycles, using lean methods and the PDSA (plan-do-study-act) framework, engaged frontline nurses created bedside handoff standard work so they could meet demand. The result was a bedside handoff process that allowed for a standardized and sequenced cycle of work for a nurse that met the 5-minute pace of care.
What takt time means for health care quality
Today, during the improved bedside shift handoff, the offgoing nurse and oncoming nurse share pertinent information at the bedside, encouraging the patient’s participation in planning and care coordination. They also perform critical safety and quality checks. Offgoing nurses are able to get home on time, safety is maintained at the bedside and overtime costs are decreased.
An understanding of takt time allows stewards of improvement to use data to craft processes to meet demand with a realization that if we study the patterns and tempo of our work, quality health care will become more predictable and more improvable than we ever imagined.
Ellen Noel, MN, RN, CPHQ, is a faculty member at Virginia Mason Institute. Her in-depth knowledge of clinical processes, team development, health care outcomes and regulatory performance provides a solid foundation for an extraordinary customer learning experience. At Virginia Mason, Ellen worked as an adult clinical nurse specialist and director of quality and safety. As an improvement leader, she led system-level improvement work in medication safety, nursing and care team workflow efficiencies, pain management and patient safety.
This workshop shows participants how to apply lean tools and methods in their day-to-day business to drive improvements that create value, eliminate waste and reduce staff’s burden of work — all in pursuit of the perfect patient experience.
Creating Flow in the Ambulatory Setting
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