Testing, Testing … (for Covid 19)3 August 2020
Anyone who has heard me talk about lean would have no doubt heard me declare that I had a revelation about what lean is truly about quite a few years into being fully immersed in lean practice. When the penny finally dropped suddenly everything clicked into place. Lean is about increasing speed of delivery. It’s about reducing lead time and maximizing end to end value. All of the tools that we have, all of the concepts that we are taught, overtly or covertly, facilitate a relentless pursuit of speed.
You might wonder why it took me so long to fully grasp this truth, even when I was fortunate to learn about lean whilst working at the Lean Enterprise Research Centre with some of the world’s leading lean experts, and the answer is, I don’t really know?! I was shadowing some fantastically knowledgeable people, was lucky enough to go on some groundbreaking programmes of learning – all I had to worry about was trying to better understand what lean was from a research perspective. So I set about grasping concepts such as standard operating procedures, team information boards, levelling and takt time and what these meant (or didn’t mean) to the world of service, but even so, I kind of missed the bigger picture. I knew that all of these things were about making work better, I knew that my brain was being blown by looking at all of the possibilities to improve working practices, but I guess I didn’t really consider the most important reason enough, how all of these elements fitted together, and why? Maybe the lean experts didn’t appreciate how important it was or maybe they just took it as a given, whatever it was, the revelation that speed was the most important thing was SO important to me, I now design all of our lean learning programmes around it.
As I write this, the importance of an ability to deliver speed has been really pulled sharply into view.
In life, I definitely loiter around the ‘paranoid’ end of the spectrum suffering from more than my fair share of health anxieties – so deadly pandemics of a highly transmissible virus have shaken me somewhat. That said, I have been relatively stoic, all things considered, and whilst I would consider myself as already possessing a core ‘pro-hygiene’ belief system, when the news of the virus started to build in January/February, I instantly upped my anti-bacterialising considerably and started opening doors in the Business School with my elbows. Once in lockdown I completely played by the rules for the vast majority of it (unlike certain Governmental advisors). All of the post I’ve received has had to spend time in quarantine and I am not ashamed of shouting ‘TWO METRES’ aggressively at all those who have been foolish enough to knock at my door. But in the last week or so, I’ve started to ‘re-emerge’ and see people outside again, buoyed by the relaxing of the rules, by my daughter’s days back at school, by an appreciation that the virus in Wales, right now, is probably, ‘as good as its going to get’ and also frankly, by a deep longing to be with people again.
My daughter has missed other children so incredibly much, so we have been on a playdate or two outside, adults all socially distanced – children, not so much. I have again been further reassured when Welsh Government recently stated that children under 11 do not have to socially distance. A few days later however, my friend texted to say that her young son had a high temperature so she had got him tested. Instantly, the nervousness rose up through my veins and I wondered how close to COVID -19 my relaxation had gotten us.
My friend said that she filled in the online form on NHS Wales and got a drive through appointment within the hour. Brilliant. She texted me after returning from the test that she thought she should let me know. The people who took the tests said that she would be texted the results by the end of the next day.
And so we waited.
I was meant to go to my friend’s garden for a socially distanced cream tea. I was meant to go to lunch outside with mum and dad for the first time, the closest I’ve been to them since the beginning of March, but now that I knew that someone that I had been nearish to had been tested, could I, should I, risk it?
As time went on waiting for their test results, I could feel my resolve slipping. “Oh I bet he hasn’t got it, there are so few new cases being detected. I didn’t go near him I’m sure, I only have to isolate if there has been a positive test” – the complete opposite to how I felt at 8pm the day before when I first saw the text.
“Time is a great healer”. Yes it is, and yet with this virus, time is what we simply do not have. Its gestation period is so sneaky and divisive and yes, so misleading. What’s fascinating, and worrying to me, is that time seems to be working in the opposite way to most of my other health worries. Most of the time, the longer an ache goes on, the more concerned I get but this is the reverse, the longer the nothingness, the less concerned I am. Which you could kind of say is natural and obvious, but that’s completely the problem. One thing that we cannot afford to be with this virus, is complacent. The ‘I’m fine”, “You’re fine”, “We haven’t heard anything, we’re fine!” isn’t how this thing works.
Back to Lean
So I stuck my toe in the socializing-again water and very soon afterwards limboland … waiting … waiting. A glimpse into what our life is going to be like for the foreseeable I think. I don’t know how long the test takes to actually enact, some googling suggests 4 hours to increase the amount of DNA in the sample, but that some tests are quicker than that. There’s the transportation time to get the sample to the lab, probably done in batches, so it’ll wait in a batch to travel and it’ll wait when travelling. There’ll be a queue before processing the test, a wait, and then the test itself. I understand that the test results are automated and digitized. I’m not sure whether the result from the testing equipment goes straight to the patient, or goes to a medical professional to be ratified somehow, if so, again it’s another wait. So much of what’s discussed is our capacity to test, capacity is a very important factor, but so too is speed. They are of course, related, but speed can be facilitated by ‘little and often’, not simply by creating vast capacity.
After days of waiting they still hadn’t received a result so they decided to go for another test. Not good. A focus on reducing lead time in testing is definitely required if we’re going to try to beat this thing. Not losing the test would be handy as well. I appreciate that it is unfortunate, for all concerned, that my first approximate foray into the world of COVID 19 testing has ended in this way, AND at the same time as needing to write a new blog, but such is life! Sorry folks! This actually happened I swear.
What Might Have Gone Wrong?
Well, lots of things unfortunately. Here are just a few ideas.
1. If each step is exposed to an element of failure, e.g. a human has been involved (again, apologies), then that means that the more steps there are, the more chance there is that there will, indeed be some kind of problem, the less likely a result will be ‘right first time’. Machines aren’t immune of course because a) they are programmed by humans and b) sometimes humans don’t maintain / calibrate them correctly and c) sometimes they do breakdown (mostly because of b) and a)). There are lots of things that can be done at every stage to minimise errors, from visual management to mistake proofing devices to Total Preventative Maintenance. I hope that even in the rush to ramp up provision, these fantastic operations management tools will have been given proper consideration.
2. Linked to above, much has been written about how important collecting the sample is, failure to do so incorrectly will lead to an inconclusive result. Is that why the test result had gone missing or was so super delayed?
3. One of the great counter-intuitives of lean is humans desire to batch, that we believe big batches are more efficient, because they are for the people doing the processing. The problem being that these ‘economies of scale’ efficiencies is that they make the customer / patient wait for the batch to build and be processed. One piece flow, or ‘one thing at a time’ is the ideal. One swab – one test – one result – in as short a lead time as possible. Within organisations, one piece flow is not achieved most of the time for financial reasons – it’s just too expensive, but given everything, I think that COVID 19 is one scenario where one piece flow testing must be worked towards.
4. Testing should take place as close to where the sample is taken as possible. How far has the test travelled to get to its analysis point? Perhaps further than you might think if tests are routed to somewhere that has ‘big capacity’ (see above). I hope that the power of ‘little and often’ has not been forgotten about in the pursuit of capacity at a ‘massive scale’.
5. Who is watching the clock? Time and time again in service organisations I’ve seen that each step of the process might have a grip on how long their work should take, but that there is little awareness of the end to end time, which as a consequence, is then often left to languish and ever expand. If ever a process required a stopclock being started at the beginning, whilst everyone in the end to end process counts down the ticks, it’s this one.
Of course, many limitations might be caused because this virus is so new, tests are so new, scientists and medical professionals are learning all the time, and the kit and expertise just isn’t there yet, plus errors within anything aren’t ever completely unavoidable, but again I hope that teams are being equipped with the tools and time to continually improve and that new and better testing machines will keep being introduced.
Indeed, this New York Times article suggests that some companies have developed equipment to test in under 30 minutes, recent news suggests that a new 90 minute test will be rolled out across the UK shortly – amazing. These developments will hopefully provide the near, ‘little and often’, closer to the ‘one swab, one test, one result’ ideal.
So anyway, let’s just say I’m itching to have a look at the current testing process to see if I could identify some points for improvement. If ever a process needed speed, it’s this one, and unfortunately perhaps something isn’t working. We must sort out any problems now before the winter starts to creep in.
Update and in the interest of balance: upon sharing this blog with friends another mum’s child had their test result returned in 17 hours – negative thankfully. A different mum knew someone who received a postal kit the next day following request and again had a result within 24 hours.