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Introduction to A LEANer Healthcare System Leadership Assembly September 22 -23, 2011.

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Presentation on theme: "Introduction to A LEANer Healthcare System Leadership Assembly September 22 -23, 2011."— Presentation transcript:

1 Introduction to A LEANer Healthcare System Leadership Assembly September 22 -23, 2011

2 Please “Be Here Now”

3 Objectives Participants will be able to: Discover how Lean applies to health care Recognize the basic concepts, principles and tools of Lean

4 Current Condition in Healthcare USA Healthcare Issues – # 37 in outcomes – # 1 in costs – 100,000 deaths per year due to errors – Quality metrics of national and public reporting efforts have shown no gains – At least 47 million Americans have no health insurance – Less than 50% of patients with chronic disease receive evidence based treatment DOH Health Care Workforce Survey Data (2008-2009) & statewide projections from CWIA (2008-2018)

5 Current Condition in Healthcare Pennsylvania Healthcare Issues – 2011 estimated nursing shortage - 3,500 – 2016 estimated nursing shortage – 8,500 – More than one-third of all hospitals are presently in significant financial distress – 1,196,000 Pennsylvanians have no health insurance

6 Lean Method for redesigning systems to focus on giving 100% value to the customer, ultimately the patient Based on The Toyota Production System Applied regularly in the course of work by those that do the work

7 Lean is Not… A workforce reduction tactic A resource reduction effort A cost reduction program

8 Lean is… Understanding the customers definition of value and focusing on key processes to continuously increase that value Providing perfect value to the customer through a perfect process that has zero waste Respecting people

9 What is value? What is waste? Value added: – Activities or actions taken that add real value to the servicereal value Non-Value added work: – Activities or actions taken that add no real value to the service, making such activities or action a form of wastereal value waste Non-Value added but necessary work: – Work that must be completed but the patient doesn’t view as value added

10 Waste of Waiting To stay in place in expectation of an event Examples: – Patients waiting for beds to be available – Waiting for test results – Waiting for a procedure

11 Waste of Defects Work that contains errors or lacks something of value Examples: – Medication errors – Redoing lab specimens when applied incorrectly – Incorrect charges/billing – Surgical errors

12 Waste of Unnecessary Motion Movements of people that do not add value Examples: – Equipment/supplies located far from the work – Looking for supplies – Looking for information – Looking for people

13 Waste of Unnecessary Conveyance Unnecessary transporting, storing or rearranging of items, equipment, people, etc. Examples: – Unloading of supplies from one bin to another – Linen brought to a unit that is not used

14 Waste of Over Production Generating excess supplies, information, etc. Examples: – 24 hour medication fills – Multiple forms with same information – Duplicate charting

15 Waste of Over Processing Activities that do not add value from the customers perspective Examples: – Regulatory paperwork – Missing medications – Clarifying orders – Redundant information gathering/charting

16 Waste of Inventory More materials on hand than are required to do the work Examples: – Overstocked medications – Overstocked supplies on units – Duplicate items due to personal preference

17 Waste of Unused Employee Creativity Losing time, ideas, skills, improvements, and learning opportunities by not engaging or listening to employees

18 How can Lean be applied to eliminate waste and meet the current needs? Everyone Agrees on the Goals Everyone Agrees on “The Way We Do Things” Rules of Work Design Patient Focus Ideal Care

19 Add Value by Thinking About 4 Rules of Work Design 1.How people work 2.How people interact with each other 3.How services flow 4.How problems are identified and addressed Together they form the foundation of Lean systems

20 Activities (work) must be highly specified as to: Content Sequence Timing Location Expected outcome Rules in Use: Activities S. Spear and H.K. Bowen, “Decoding the DNA of the Toyota Production System,”Harvard Business Review (September-October 1999): 97-106

21 Connections between customers and suppliers must be: Highly specified Direct link Clear yes/no signals back and forth Rules in Use: ConnectionsRequestResponse S. Spear and H.K. Bowen, “Decoding the DNA of the Toyota Production System,”Harvard Business Review (September-October 1999): 97-106

22 Pathways must be: Highly specified Predefined, single path Simple and direct No loops or forks Rules in Use: Pathways S. Spear and H.K. Bowen, “Decoding the DNA of the Toyota Production System," Harvard Business Review (September-October 1999): 97-106

23 Improvements made using data-driven scientific methods Made as close as possible to the work By those doing the actual work Guided by a teacher/coach Aiming toward the ideal Improvements are treated as mini- experiments Rules in Use: Improvement

24 Toward the Ideal Experiment Each improvement moves the organization closer to the ideal Problem Ideal Care

25 A Tool of Lean: 5S A Process to Help: Reduce Waste Create Continuous Flow Standardize Utilize Visual Controls

26 The 5S Process 1.Sort 2.Set in Order 3.Shine 4.Standardize 5.Sustain

27 How to Start Pick a space, it’s a good ides to start in your own work space Pick a team, anyone who touches the process should be included Choose something that will make life easier for the team, this can be motivating Make this activity the way to help people understand Lean, communicate the purpose of 5S and Lean as often as you can

28 Before 5S



31 A Tool of Lean: Understanding the Problem by Observing Lets you see work firsthand Ensures objectivity Allows a deep understanding of the current process

32 Observation of Work Observe the work performed What are the problems you see? – Activities – Connections – Pathways Change how you see work performed – No blame – System perspective


34 What problems did Lucy and Ethel experience related to their: – Activities – Connections – Pathway How would you recommend they make improvements? Observation of Work

35 A Tool of Lean: Map the Process Graphic representation of steps that occur within a specific process Helps to explore a process across departmental boundaries Provides ability to identify opportunities to reduce waste Easily identifies where there are problems Guides toward the future desired state

36 Wrapping Lucy Process Map Kitchen Wrapping Packing Staff frustration Candy not wrapped No way for wrapping to tell kitchen of their needs Packing can’t do their work No communication between process steps Candy placement not consistent on belt

37 Sign InCleaningX-Ray Exam Discharge Delay Value Stream Map Dental Exam Barbara Jennion 9.03.09 Delay  Patient Signs in independently in waiting room  Dental Hygienist Takes patient to room Cleans teeth  Dental Tech Takes X-rays  Dentist Performs dental check  Receptionist Collects payment Not able to make next appointment Taken from waiting room to cleaning then back to waiting room Multiple waits Dental Tech friendly Delay 1.5 min.. (1 – 2) min. 17 min. (5- 25 min.) 21 min. (16 – 28 min.) 43 min. (10 – 62 min.) 7 min. (5 – 9 min.) 11 min. (5 – 15 min.) 8 min. (6 – 15 min.) 4 min. (1 – 6 min.) 2 min. (1 – 5 min.) Value Quotient = Value Added Time = 36 min. = 31.44% Total Time 114.5 min. Value Added Time Non Value Added Time 3 month wait Appoint. Center

38 Exercise Value Stream Mapping Exercise – Read the case study – Develop a map with your team

39 A Tool of Lean: A3 Report A tool that is used to record the continuous improvement process Eases team communication, helping to share the problem solving process Provides documentation and communication of work that is in progress and work completed Helps focus the efforts of the team



42 Title Author/Date Business Case Current Condition (Go and See) Problem Identification Root Cause Analysis Target Condition – Countermeasures Implementation Plan Follow up Measurement Learnings PLAN: Clarify the problem Break down the problem Target Setting Root cause analysis DO: Develop countermeasures See countermeasures through (with the use of the implementation plan) Act: Standardize or start Act: Standardize or start Check: Monitor both the results and the processes

43 Dos and Don’ts of A3 Reports Do put pencil to paper, pen to paper… Don’t get hung up on formal elements Do get your message across, persuade others by capturing the right story Do get messy Do use the A3 to control meetings Do use the A3 to lock down agreements Do store learnings for later reference and sharing

44 End Day 1 Thank you for participating! See you tomorrow!


46 Next Steps: What do I do now?

47 Ideally… Lean is a philosophy and a long-term approach that aligns everything in your organization to deliver increasing customer value. Lean is an everyday practice at all levels of the organization to consistently improve performance.

48 Starting a Lean Initiative: Step-by-Step A PROJECT BASED APPROACH Sit down with senior management to discuss lean and how it fits with their vision for the organization Brainstorm to identify places to start a project Communicate plan and vision to the workforce

49 Starting a Lean Initiative: Step-by-Step A PROJECT BASED APPROACH Ask for volunteers to form the Lean Implementation Team Identify a coach Train the Implementation Team on Lean Select a Pilot Project to implement Run the pilot for 2–3 months - evaluate, review and learn from your mistakes

50 Starting a Lean Initiative: Step-by-Step A PROJECT BASED APPROACH Roll out pilot to other areas Evaluate results, encourage feedback Stabilize the positive results by teaching supervisors how to train the new standards you've developed Select another project…

51 Questions and Answers

52 DO YOU WANT TO START A QUALITY IMPROVEMENT INTITIATIVE? Contact: Zach Zobrist, Vice-President, Health Systems Barbara Jennion, RN Quality Care Training Program Coordinator

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