1. LEAN Principles as Management Mindset & Improvement Tool Set

2. A system: flow, pull and strive for excellence ◦ Not a set of isolated practices A process, a journey ◦ Not an end state A thought revolution What is Lean? A philosophy that shortens the time between the customer order and delivery by eliminating waste

3. Lean as a Thought Revolution Traditional Thinking Lean Enterprise Thinking Attack direct laborAttack waste, complexity and variation Quality, cost and cycle time (speed) are addressed individually and often seen as conflicting Quality, cost and cycle time (speed) are addressed concurrently and are seen as highly related Optimize subsystemsOptimize the whole system (including suppliers and customers) Use information technology as “the answer” Use information technology as an enabler of lean processing

4. Myth or Reality? It’s more efficient to process in batches Zero defects is not a realistic target End of process inspection will always protect patients from harm A healthy clinical practice has a full waiting room and backlog of patients Standard methods (procedures, protocols, methods) stifle creativity and are not a good cultural fit in medicine

5. Lean Challenges Us to Cut Waste in Half Today! Half the errors Half the cost Half the space Half the labor Half the time Half the complexity Half the steps Half the…….

6. Requires a Horizontal View Traditional Improvement Approach Value Stream Approach AdmissionEvaluation Ancillary Service DischargeBilling

7. What Is a Value Stream? Everything, including non-value added activities, that achieves the transformation from raw information/material into what the customer is willing to pay for Network of processes and operations that make materials and information flow Includes the communication of current and future demand throughout the value stream

8. Types of Waste

9. Value-Added (VA) Value-Added Timeline Non-Value- Added (NVA) Total time = 70 minutes VA time = 6.5 minutes Percent of NVA time = 91% Travel distance =.25 mile Number of Process steps = 25 Value-added steps = 4 Number of Inspection steps = 4 Number of queues = 11 Write Order Dispense In Pharmacy Enter Data Administer To Patient

10. Why Focus on Waste? Because most processes are 95–99% non-value-added, a focus on eliminating waste is the best leverage for an improvement effort. NVA 95% VA 5%

11. Requires Us To Think Differently… VAVA NVA VANVA VA Typical Organization Traditional Improvement With Traditional Investment Strategy Lean Waste Reduction NVA Minor Improvement Original Lead Time Major Improvement Speed up value added steps Add capacity

12. Is it possible to get all the waste out?

13. Lean Methods / Language 5S ◦ 5S is a visually-oriented system used to create and maintain greater organization, efficiency and safety while reducing training time, search time, wasted time and resources Rapid Process Improvement Value Stream Mapping

14. Simplify Sort Separate the needed from unneeded items Create a place for everything and a way to keep everything in its place Visually examine the work area to differentiate normal from abnormal conditions Document and use consistent work methods Hold the gains Sweep Standardize Sustain

15. Tell at a glance if things are normal or abnormal

16. Rapid Process Improvement (RPI) A fast-cycle METHOD for implementing lean practices within a particular process Modeled after Toyota workshops for suppliers “Five Days and One Night”

17. RPI Workshops are…. Focused, intense one week events Targeted process All areas of process represented Vision developed Changes are identified and made during the workshop Little or no money is spent

18. Four Phases of RPI Workshops

19. All Areas Represented

20. Common Goal of Removing Waste

21. Which Management Problem Would You Rather Have? Problem 1Problem 2 Performance Target

22. Level 3: Work Unit Inspect Level 2: Company Inspects Level 1: Customer Inspects Level 5: Eliminate Opportunities for Errors Levels of Quality System Prevent Errors Level 4: Self Inspection Check for Defects Detect Errors Level 5 Level 4 Level 3 Level 2 Level 1

23. .You have 60 seconds to inspect this document..Count the o’s..Score the number at the bottom of the page. To be, or not to be; that is the question: Whether ‘tis nobler in the mind to suffer The slings and arrows of outrageous fortune, Or to take arms against a sea of troubles, And, by opposing, end them. To die, to sleep— No more—and by a sleep to say we end The heartache and the thousand natural shocks That flesh is heir to—‘tis a consummation Devoutly to be wished. To die, to sleep.— To sleep, perchance to dream. Ay, there’s the rub. adapted from Hamlet, William Shakespeare ____ Total

24. What did we do?  1 st Implementation of RPI at VUMC  Pre-work with planning team  Development of charter  4 day intensive workshop  Includes all segments of Department  Focus on Transition Bundles  Report out to Management Guidance Team  Creation of reliable processes  Measureable metrics for continual improvement

25. Questions