1. Value Stream Management for Lean Healthcare ISE 491 Fall 2009 The Elimination of Waste in Healthcare - Lecture 5

2. Fall 2009ISE 491 Dr. Burtner Lecture 5 Slide 2 Eight Categories of Waste (in Healthcare) Overproduction Waiting Excess Motion Excess Conveyance Over-processing Inventory Defects Unused Creativity Fall 2009ISE 491 Dr. Burtner

3. Fall 2009ISE 491 Dr. Burtner Lecture 5 Slide 3 Overproduction (Unnecessary Services) Producing work or providing a service before it is required or requested Some Elimination Strategies  Establish continuous work flow in terms of product or service needed at the appropriate time (for the downstream customer)  Create visual controls to prevent early processing of information or services  Ensure information is only entered into one common database for authorized users  Create checklists to ensure all necessary information is collected at the appropriate time  Ensure email distribution lists and reports are distributed to necessary staff only Fall 2009ISE 491 Dr. Burtner

4. Fall 2009ISE 491 Dr. Burtner Lecture 5 Slide 4 Waiting Waiting for people, equipment, signatures, supplies, information, etc. Some Elimination Strategies  Review and standardize signature and approval requirements.  Cross-train staff to accommodate changes in service demands  Balance workloads throughout the day and ensure staff members are working optimally.  Ensure equipment and supplies are located in close proximity to their required use.  Ensure work items are labeled and a point-of-use (as appropriate) Fall 2009ISE 491 Dr. Burtner

5. Fall 2009ISE 491 Dr. Burtner Lecture 5 Slide 5 Excess Motion Excess movement of people, equipment, paperwork, electronic communication that does not add value Some Elimination Strategies  Ensure supply areas are well organized utilizing color codes and labels for quick access  Organize computer files for easy retrieval  Establish file naming conventions within departments  Establish standards of communication ensuring doctor’s orders and charts are easily accessible for authorized staff.  Relocate staff, equipment, to closest area that requires service Fall 2009ISE 491 Dr. Burtner

6. Fall 2009ISE 491 Dr. Burtner Lecture 5 Slide 6 Excessive Conveyance (Excessive Transportation) Delivering work products without adding value In the healthcare environment, the patient is a “work product” that flows through the system Examples  Delivery of equipment too early or too late  Transporting patients to surgery prematurely  Moving samples or specimens to the wrong location  “Placing a gurney in the hall and constantly having to more it” Fall 2009ISE 491 Dr. Burtner

7. Fall 2009ISE 491 Dr. Burtner Lecture 5 Slide 7 Overprocessing Putting work into accomplishing something that the patient, physician, or healthcare provider either does not ask for or does not want Results in non-value added work that the customer does not want to pay for Examples  Retesting (eg. Performing a second 24-hour urine test because a staff member obtained the first specimen incorrectly)  Ordering more diagnostic tests than the diagnosis warrants (eg. ordering a Chem 24 when a Chem 6 will suffice  Entering repetitive form information  Completing excessive paperwork Fall 2009ISE 491 Dr. Burtner

8. Fall 2009ISE 491 Dr. Burtner Lecture 5 Slide 8 Inventory Excess or outdated supplies; excess work piles Elimination of inventory frees up space and makes it easier to find essential items quickly Examples  Duplicate medications and supplies in excess of normal usage  Obsolete office equipment  Excessive office supplies  Obsolete charts, files, and medical equipment  Extra or outdated manuals, newsletters, or magazines Fall 2009ISE 491 Dr. Burtner

9. Fall 2009ISE 491 Dr. Burtner Lecture 5 Slide 9 Defects Also known as mistakes or errors Defect waste includes all processing required to correct a defect or mistake It takes less time to do it right the first time than to discover and correct the mistakes Examples  Medication errors  Incorrect patient information  Incorrect procedure  Missing information  Redraws Fall 2009ISE 491 Dr. Burtner

10. Fall 2009ISE 491 Dr. Burtner Lecture 5 Slide 10 Unused Creativity Not utilizing the available talents and skills of the staff to their fullest Examples  Insufficient cross-training of staff  Reluctance to elicit process improvement ideas from workers closest to the process  Design of policies, procedures, and practices without sufficient input from workers Fall 2009ISE 491 Dr. Burtner

11. Fall 2009ISE 491 Dr. Burtner Lecture 5 Slide 11 Primary Sources The Lean Healthcare Pocket Guide XL (2008) Authors: Debra Hadfield, RN MSN and Shelagh Holmes, RN Value Stream Management for Lean Healthcare (2009) Authors: Don Tapping, Sue Kozlowski (CSSBB), Laura Archbold (RN, BSN,MBA), and Todd Sperl (MBB)