Reducing the waiting time for Orthotics


Faced with continuing delays in the supply of Orthotics – from receipt of prescription to delivery – caused this healthcare provider to undertake a Lean Six Sigma project. In simple terms, the lead time had increased from typically 1-2 weeks to as much as 6 weeks. This was forecast to further increase by one week per month if no action was taken and demand remained constant.

The real impact of this was profound which fell under three key headings:

  • Impact on patient care
  • Impact on lab technicians
  • Impact on the business

Combined, the team established that there were a total of 17 primary causes for concern under the current level of service. These included such issues as: risk of ulceration/amputation for high risk patients; increase in waiting time, delaying treatment; lower standards of quality; increased costs and loss of revenue to name but a few.

Armed with this information, the team set out with a goal statement.

The Goal Statement

“For all podiatry localities within the organisation to have their orthotics manufactured at the same site with a sustainable turnaround time of no greater than two weeks.”

The Process

As with all good Lean Six Sigma projects, the starting point was listening to the Voice of The Customer (VOC). This included talking with patients, lab technicians and stakeholders in order to determine the real extent of the problem. Was the problem as big as they thought? Was it a bigger problem? Unsurprisingly, as is often the case with LSS projects, the problem was actually bigger than first imagined.

As part of the DEFINE phase of LSS, and in addition to the VOC, the team deployed a number of the tools available to gather as much customer information as possible including the Kano model which helps to determine the level of satisfaction for the customer.

The Main Findings

There were a number of key findings through the applications of the MEASURE and ANALYSE phases – the second and third phases in the DMAIC methodology, with some of the more profound ones being:

  • Basic insoles was 37% current workload
  • Bottlenecks – multiple touch points in the process with, for example 24 touch points which could be reduced to just 4
  • The cost of posting out insoles per year = £52k
  • Excess stock/equipment
  • Loss of income from private prescriptions
  • Writing patient addresses – 641 hours per year with an estimated cost of £6.3k
  • And more……

Through the creation of Value Stream Maps and process mapping, the team were able to identify substantial waste within the value stream. Additionally, the implementation of controlled 5S processes, further benefits were realised which in turn generated additional time for value adding activity.

Overall, the team had ultimately evaluated that there were huge benefits to be had by improving the processes across this operation. Collectively, the benefits were:

A reduction in specific process steps from 24 to 4
Unit time reduced from 30 minutes to 10 minutes
Lead time for basic insoles from 43 days to 1 day
Increased throughput of estimated 37% through effective management of bottlenecks (Theory of Constraints)
Reduction in overall lead time for modified insoles
A saving of £52k in service costs
Introduction of a text messaging service to patients for collection of insoles
Point of collection of insoles at healthcare reception
Reduction of £6.3k in patient information processing
Saving of 641 hours in process time
The deployment of 5S (regularly audited) reduced process time by 42%

Beautiful medical nurses are showing okay with fingers.

The team continue to monitor the progress of these new ways of working (after all it is continuous improvement!) and feedback from stakeholders and customers is joyous!

It is important to note that these benefits have been realised with an investment of less than £3k. When you consider this, then the (conservative) return on investment has a ratio of around 30:1!

Impressive results from a small investment in training!