Alan MacDonald, Health Care Systems Engineer at Badger Health Group, talks to Professor Terry Young about the challenge of building a drive through clinic for face-to-face consultations under lockdown.
January 21st, 2021. I arrived at the abandoned site, making my way towards a dilapidated warehouse. Passing through the hangar doors, I noticed a group of colleagues on the far side, sipping coffee from steaming mugs while, my footsteps echoed through the cold empty space, its floors littered with scattered screws, nails and bits of wood. Faded markings and an old blueprint we found in the rubble revealed what it once was.
As we scouted around, I was gripped by the size of the building and overawed by the task of reinventing this place into something revolutionary. The blank canvas that lay in front filled me with excitement, apprehension, and a sense of déjà vu, for we had been here before…
In an overcast, empty car park nine months earlier at the National Exhibtion Centre (NEC), the same huddled faces had assessed a similarly blank canvas. Back then, we had less than 3 weeks to create the country’s first 12-lane drive through service for COVID-positive patients. Our anxiety grew as questions peppered our thoughts; how would we do this, would it be safe, would it flow without queues?
Only one of us was confident that this would work as intended and his air of reassurance was a welcome comfort. But why was he so relaxed? This was my first encounter with a Health Care Systems Engineer (HCSE) and the 6M® design framework. On time, the service had opened, worked safely right out of the box and without queues.
Back to the warehouse… This time the rest of the team would be able to apply the 6M® design framework with the same confidence that had brought the NEC car park experiment in so successfully, months earlier.
6M® is a framework based around systems engineering, geared towards a systematic approach to understanding Safety, Flow, Quality and Productivity. It has 6 steps and here’s how we applied them.
We started on the right-hand edge of our map (where we expected to be by the end of the project) and worked backward from there, creating a right-to-left diagram, by repeatedly asking the question, ‘What do I need to do or to have achieved in order to have reached what I have just written down?’ We created a stakeholder map too, showing the level of influence different groups had on patients.
These diagrams guided our weekly reviews, where we would take stock, unclip the safety harness and move towards the next waypoint, zooming in, or looking ahead as needed.
As our experience grew, we used measurements from previous drive throughs to inform our design this time. We identified physical routes and used alarm clocks to time the duration of critical events.
Our 4N feedback tool (described here) was used to probe users’ experiences: what worked (Nuggets); what didn’t (Niggles); what they wanted (Nice Ifs); and what must always be prevented (No Nos).
We produced Gantt charts, patient flow charts, and run charts of demand against activity (where mismatches led to queues).
This enabled us to build a complete diagnostic picture, which, when combined with our measurements, left us ready to build virtual models of the service.
We built the models and used them to explore different designs and road-tested various configurations using an excel spreadsheet that helped us hone in on the sweet spot for our final design.
Next, we prototyped our preferred design in the warehouse space using cardboard boxes and tape.
This time our simulations were walked through as a dress rehearsal.
Once we were satisfied with our final design, we were ready to set up the cabins, lanes and car parking in the right places, and go live.
After launch, we tracked how well the performance of the new drive through centre matched what was expected. We were able to prove that the design was safe, that throughput was as planned and that no unintended consequences emerged.
Once up and running, we used our run charts and other diagnostics to forestall problems and to manage a process of continuously improving safety, patient flow, quality of care and productivity.
Many projects employ a ‘let’s build it’ approach with less design and more (sometimes infinite) modification. However, this systematic approach is quicker overall, delivers better safety and provides the basis for ramping up quality and productivity from day 1. It could revolutionize a Healthcare System near you!
Alan wishes to thank Mr Simon Dodds, Surgeon and Health Care Systems Engineer, for his continuing
mentorship and support. He also wishes to thank Badger (Birmingham and District GP Emergency Room)
Health Group for continuous sponsorship of his Health Care System Engineering training with SAASoft
and his mentorship by Mr Dodds.
6M® is a registered trademark of SAASoft Ltd (see www.6mdesign.uk)