Makigami for treatment of ‘lumbosacral radicular syndrome (LRS)’

Neurosurgical Science Centre Tilburg (St Elisabeth Hospital)

used Makigami to reduce treatment of lumbosacral radicular syndrome (LRS, ‘Hernia’) from an average 107 days to 14 days!

 Two multi disciplinary teams of each 6 people went December 11 and 12, 2006 through a Makigami analysis of the treatment of ‘a hernia’. The process starts with the visit at a neurologist and ends when the patient is correctly being treated.

Both teams came up with more than 10 meters of analysis each! Although involved in the process at a daily basis, they where flabbergasted about the complexity of such a ‘regular, standard treatment’. On average a patient is ‘on the way’ for 107 days, with fluctuations between 37 and 270 days.

In the teams participated:

  • hospital manager,
  • manager neurosurgery,
  • floor manager,
  • nurses,
  • secretaries,
  • department assistants,
  • and neurosurgeons.

None of them had knowledge of the whole process, most where even not aware of parts of the process.

It took the teams about 1,5 days to fully understand and describe the current process. During this phase many ideas where raised and discussed. Valuable issues where parked for further investigation. Sharing different perspectives is a crucial goal in this ‘exercise’. Many ideas for the future state of the process are born in this phase.
 At the end of the second day, both teams presented the results at each other and invited guests. They all firmly believed it should be possible to go through the whole process in between 4 to 14 days, depending the route it would take.

The future state of the process could be described at 1,5 Makigami sheets, compared to 9 sheets in the current situation. Lots of complexity is eliminated!

The implementation was realized within 3 months.

The project was so successful, that the hospital was flooded with patients from all over the country, causing an unexpected new challenge to the team!

After this first pilot in 2006, the makigami methodology was soon being used by one of the teammembers (a nurse) to improve other processes.

It has also succesfully been implemented in other medical disciplines. Where expensive equipment is being used -like MRI scanners, gamma knives or other radio-therapy equipment- the combination of makigami and OEE (see will show spectacular results!

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