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1 Introduction to Continuous Improvement in Healthcare Why Lean? Why Lean in Healthcare? Lean Philosophy Seven Wastes Reliable Methods as Countermeasures.

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Presentation on theme: "1 Introduction to Continuous Improvement in Healthcare Why Lean? Why Lean in Healthcare? Lean Philosophy Seven Wastes Reliable Methods as Countermeasures."— Presentation transcript:

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2 1 Introduction to Continuous Improvement in Healthcare Why Lean? Why Lean in Healthcare? Lean Philosophy Seven Wastes Reliable Methods as Countermeasures

3 Hands-on consulting/training in Continuous Improvement Award winning Training Products Lean practitioners with a passion for Gemba-based learning Promoting a culture of improvement Not-for-Profit Organization © Greater Boston Manufacturing Partnership Our Mission Is Simple: to help companies become more productive and competitive through Continuous Improvement education and implementation. Shingo Prize Shingo Prize www.gbmp.org 617-287-7737 Home of the Old Lean Dude, lean blogger - a lifetime of lean stories to share - Sign up at www.oldleandude.org “I would recommend participation to all healthcare department heads and quality improvement practitioners. GBMP did a great job applying the material to healthcare, "going to the gemba" after learning lean concepts and tools in order to apply knowledge learned in the classroom.” - Christine McMullan, Director of Continuous Quality Improvement, Stony Brook University Hospital

4 Introductions Pat Wardwell, GBMPPat Wardwell, GBMP Chief Operating OfficerChief Operating Officer 25+ years Operations and Improvement Roles25+ years Operations and Improvement Roles Lean Gold CertifiedLean Gold Certified Shingo Prize RecipientShingo Prize Recipient Shingo Prize ExaminerShingo Prize Examiner AME Excellence Award Council and AssessorAME Excellence Award Council and Assessor 3

5 4 Why Lean in Healthcare? Why Lean in Healthcare? “While technologies and treatments have made enormous strides during my career, nuts-and-bolts hospital operations haven't.” – Dr. Patricia Gabow. National Healthcare Reform Insurance Coverage Desire to Improve Quality, Cost, Delivery and Safety of Care Payment Systems Reporting Requirements Waste Errors Cost Staff Frustration Waiting Work-Arounds Silos 4

6 5 Lean in Healthcare Affinity Healthcare – A Healthcare Remedy

7 6 What Is “Traditional”?

8 7 What Is “Traditional Operating Methods”? Customer requirements not known Customer requirements not known Batch processing Batch processing Pacing to “maximize” resources Pacing to “maximize” resources Processes/Equipment keep running despite defects Processes/Equipment keep running despite defects Lack of standardization Lack of standardization Questionable quality Questionable quality Operator’s work out of control Operator’s work out of control Operators not working together Operators not working together Limited communication between operators and management. Limited communication between operators and management. Management occasionally present Management occasionally present

9 88 What Is “Traditional Healthcare”? Patient requirements poorly communicated Patient requirements poorly communicated Batch processing Batch processing Unnecessary procedures and tests Unnecessary procedures and tests Lack of standardization Lack of standardization Long wait times expected Long wait times expected Questionable quality Questionable quality Staff working out of control Staff working out of control Dr., nurse, and staff not working together Dr., nurse, and staff not working together Limited communication between staff and management Limited communication between staff and management Management occasionally present Management occasionally present

10 9 What is Continuous Improvement? An approach to healthcare which strives to maximize value to the patient by maximizing the value of employees.An approach to healthcare which strives to maximize value to the patient by maximizing the value of employees. Stability Standardization Autonomation JIT

11 10 What is Continuous Improvement? Connects employees and patients.

12 11 Concept of Value and Waste Value Added Value Added – Activities involved with the direct care of the patient – Activities the customer (Patient or Payer) is willing to pay for Waste (Non-Value Added) Waste (Non-Value Added) – Activities that do not benefit the patient – Activities that fall under the 7 forms of waste – Activities not performed right the first time Necessary Non-Value Added (Incidental Work) Necessary Non-Value Added (Incidental Work) – Activities causing no value to be created but which cannot be eliminated based on current technology or regulations

13 What is Continuous Improvement? What is CI in Healthcare? The primary focus of lean or CI is in developing people as problem solvers and participants in process improvement.The primary focus of lean or CI is in developing people as problem solvers and participants in process improvement. CI or lean is the creation of value for the customer through the relentless and iterative elimination of waste (muda), variation (mura) and strain (muri).CI or lean is the creation of value for the customer through the relentless and iterative elimination of waste (muda), variation (mura) and strain (muri). Value is defined as any action or process for which the customer would be willing to pay.Value is defined as any action or process for which the customer would be willing to pay. In Healthcare, value is defined as any action or process that directly contributes to the care of the patient.In Healthcare, value is defined as any action or process that directly contributes to the care of the patient. “Care that is patient-focused, with less waste and cost and better medical outcomes” - John Toussaint, On the Mend 12

14 13 Lean – The Big Picture 10% Techniques & 90% People Before strategy there is Philosophy. Techniques are the means, not the ends Management must lead. At the center is Human Development. Philosophy Techniques Management Human Development

15 14 Lean Philosophy Patient is First... Patients expect zero errorsPatients expect zero errors At an affordable priceAt an affordable price With no waiting.With no waiting. Old Thinking New Thinking Errors Expected Profit = Price - Cost Maximize for Physician Price = Cost + Profit Zero Defects No Patient Waiting

16 15 Lean Philosophy Employees are the most valuable resource. People want to make valuable contributions to the world.People want to make valuable contributions to the world. Dissatisfaction is a normal and necessary condition for improvement.Dissatisfaction is a normal and necessary condition for improvement. 95% of objection is cautionary.95% of objection is cautionary. If employees truly understand value, they will gladly provide it.If employees truly understand value, they will gladly provide it. People have limitless capability.People have limitless capability.

17 16 Lean Philosophy Direct Observation Direct observation on regular basis is critical to understanding.Direct observation on regular basis is critical to understanding. Best information for continuous improvement comes from direct observation and involvement with the people who do the work.Best information for continuous improvement comes from direct observation and involvement with the people who do the work. Workplace is dynamic.Workplace is dynamic. Go to Gemba often!Go to Gemba often!

18 17 Lean Philosophy Kaizen (continuous improvement) is for everybody, everyday. Kaizen is small changes for the better that come from the common sense and experience of the people who do the work.Kaizen is small changes for the better that come from the common sense and experience of the people who do the work. The more employees learn and use CI the better they become at problem-solving (tacit learning.)The more employees learn and use CI the better they become at problem-solving (tacit learning.) Continuous improvement never ends.Continuous improvement never ends.

19 18 Toast Kaizen

20 19 Toast Kaizen Event Metrics

21 20 Lean Summary Everybody, everyday!Everybody, everyday! Patient focused.Patient focused. 10% techniques & 90% people.10% techniques & 90% people. Is taken in small steps.Is taken in small steps. Produces orders of magnitude benefits.Produces orders of magnitude benefits. Is not consistent with traditional approach.Is not consistent with traditional approach.

22 21 Benefits of Lean Highest QualityHighest Quality Lowest CostLowest Cost Shortest TimeShortest Time Safer for PatientSafer for Patient Least Strain for CaregiverLeast Strain for Caregiver Greatest ProductivityGreatest Productivity Better use of SpaceBetter use of Space Greatest Margin FlexibilityGreatest Margin Flexibility There are no limits to improvement!There are no limits to improvement! Connects Patient to Staff

23 22 Process - Operation Model ProcessProcessProcessProcess Operation Admissions Screening Reading Feedback Patient A Patient B Patient C Main Reception

24 23 Process - Operation Model Main Reception Admissions Screening Reading Feedback Waste 95% of process is waste.

25 24 Seven Wastes 3. Waiting To get in To get out For results For medication, for food Searching, walking, backtracking, reaching, bending, climbing, taking eyes off of work 4. Motion Patients and providers Information Supplies 2. Transportation In patient rooms In stockrooms Between departments In hallways 1. Inventory

26 25 Seven Wastes Patient being asked the same questions, unsafe or strain producing, Unnecessary, irrational 5. Processing Infections, wrong site surgeries, medication errors 6. Defects Excessive tests, unnecessary treatment 7. Over-production Worst Waste

27 26 Reliable Methods 5S - Workplace Organization5S - Workplace Organization Problem Solving for CI TeamsProblem Solving for CI Teams Value Stream MappingValue Stream Mapping Continuous FlowContinuous Flow Standardized WorkStandardized Work Kanban/ Pull SystemsKanban/ Pull Systems Visual Control SystemsVisual Control Systems Set up ReductionSet up Reduction Poka-yoke/ Error ProofingPoka-yoke/ Error Proofing Heijunka/ Level SchedulingHeijunka/ Level Scheduling Identify reliable methods. Keep all employees practiced. Create a favorable environment.

28 27 S1 – Sort Out S2 – Set Locations S3 – Shine S4 – Standardize S5 – Sustain 5S - The First Improvement

29 5S Video Essay 28

30 CEDAC Team Based Problem Solving Technique 29

31 30 Value Stream Mapping Good Process  Good Result

32 Continuous Flow (Cells) Reorganizing physically and organizationally for improved flow.Reorganizing physically and organizationally for improved flow. All steps used to complete a prcess are placed in sequence of production. No space between steps.All steps used to complete a prcess are placed in sequence of production. No space between steps. No material build-up between operations.No material build-up between operations. One piece flow.One piece flow. 31 Spaghetti Diagram Lab Flow

33 32 Standardized Work Best (current) combination of people, machines and material to complete process for patient demand.Best (current) combination of people, machines and material to complete process for patient demand. Takt Time – time allowed by customer to complete the processTakt Time – time allowed by customer to complete the process Cycle time - time to perform the process, including machine and manual timeCycle time - time to perform the process, including machine and manual time Work Sequence - order of operations to complete the processWork Sequence - order of operations to complete the process Stock on Hand – inventory required to maintain flowStock on Hand – inventory required to maintain flow Key safety and inspection pointsKey safety and inspection points

34 33 Kanban Kanban eliminates overproduction.Kanban eliminates overproduction. Kanban re-integrates inventory data with material.Kanban re-integrates inventory data with material. Number of kanban cards controls level of inventory.Number of kanban cards controls level of inventory. Delays (unavailable kanban) are highlighted immediately.Delays (unavailable kanban) are highlighted immediately. Kanban is like money, always try for less money in system.Kanban is like money, always try for less money in system.

35 34 Visual Control Systems Letting the Process Speak VisualIndicator VisualSignal VisualControl VisualGuarantee

36 35 Reducing Interruptions and Improving Patient Safety A study involving nine San Francisco Bay Area hospitals focused on improving accuracy in administering drugs - with particular emphasis on reducing interruptions that often lead to mistakes - resulted in a nearly 88 percent drop in errors over 36 months at those hospitals.A study involving nine San Francisco Bay Area hospitals focused on improving accuracy in administering drugs - with particular emphasis on reducing interruptions that often lead to mistakes - resulted in a nearly 88 percent drop in errors over 36 months at those hospitals.

37 36 Set-up Reduction Reduce every set-up by “59/60th’s”Reduce every set-up by “59/60th’s” Separation of external from internal tasksSeparation of external from internal tasks external = process running internal = process stoppedexternal = process running internal = process stopped Convert internal to external tasksConvert internal to external tasks Minimize adjustmentsMinimize adjustments Improve overall set upImprove overall set up Focus on waste, not operationFocus on waste, not operation Patient Room RoomOperatingRoom Equipment

38 71Poka-yoke Poka-yoke means to avoid (yokeru) inadvertent errors (poka).Poka-yoke means to avoid (yokeru) inadvertent errors (poka). “Preventing the act of forgetting what you have forgotten” -- Shigeo Shingo.“Preventing the act of forgetting what you have forgotten” -- Shigeo Shingo. Respect the intelligence of staff by taking the judgment out of repetitive tasks where errors are likely to occur.Respect the intelligence of staff by taking the judgment out of repetitive tasks where errors are likely to occur. Defects = 0 Cannot connect to the wrong tank!

39 38 Continuous Improvement Summary Develop from NeedDevelop from Need 90% People (Patients and Employees)90% People (Patients and Employees) Focus on WorkplaceFocus on Workplace Create Kaizen WayCreate Kaizen Way Incremental use of reliable methods to counter 7 wastesIncremental use of reliable methods to counter 7 wastes 5S and VSM Continuous Flow Standardized Work Pull Systems

40 39 Key Points Three aspects to TPSThree aspects to TPS Technical – tools like 5S, Kanban, Set Up ReductionTechnical – tools like 5S, Kanban, Set Up Reduction Philosophy (see below)Philosophy (see below) Management – new strategy, policy and organizationManagement – new strategy, policy and organization TPS (Lean) Philosophy:TPS (Lean) Philosophy: Patient FirstPatient First Employees most important resourceEmployees most important resource Direct observation. (Go see!)Direct observation. (Go see!) Kaizen – small changes for the better, everybody, everydayKaizen – small changes for the better, everybody, everyday 7 Wastes7 Wastes StorageStorage TransportationTransportation OverproductionOverproduction ProcessingProcessing MotionMotion DefectsDefects WaitingWaiting Basic hierarchy of improvementBasic hierarchy of improvement JITJIT AutonomationAutonomation StandardizationStandardization StabilityStability Create a favorable environment: 90% people,10% methods!

41 Thank you! Questions 40


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