Single Minute Exchange of…. Simulation #WILTW

This is the 184th #WILTW

I am wary of citing business examples as a means of improving healthcare processes, however it’s always useful to look at something with a different frame.

One of our non-executive directors, who has a background in industry, highlighted “Single Minute Exchange of Die (SMED)” to me after a talk I delivered this week on simulation. SMED is designed for manufacturing processes and aims to reduce time taken for transitions in assembly lines. The name comes from the ‘dies’ on the large stamping machines that produced car vehicle parts. These are heavy blocks which precisely set the stamp for the next ‘press’; to create a new door for example.


The idea is that the process is reduced to a single minute (although in practice it is recognised not all things can be done in less than 60 seconds). The relevance for medicine comes from the processes that are used to deliver SMED. One of the techniques is to video a changeover, or simulated changeover, and extract behavioural data from the video in conjunction with the team involved in order to improve the process. The frame for discussion is to differentiate Internal and External processes, essentially those that can be prepared for, and those that can’t.

While I am not convinced the SMED objective is an implementation strategy to be pursued in medicine, the concept of internal and external processes is useful for simulation debrief. For example in Emergency Medicine, what could the team have prepared for, given the limited information they have before a patient arrives, and what do they have no control over? If they ran the simulation again – could they have altered preparations of drugs, deployed staff differently or changed communication cascades? This is a useful feedback approach to highlight to participants how processes are linked together and which can be co-ordinated.

What have you learnt this week? #WILTW

Many thanks to Andrew Johnson, University Hospitals of Leicester non-executive director and Chair of the People, Process and Performance committee for his contribution this week’s #WILTW!

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