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
Lean as a Thought Revolution
Traditional Thinking
Lean Enterprise Thinking
• Attack direct labor • Attack 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 subsystems • Optimize the whole system (including suppliers and customers)
• Use information technology as “the answer”
• Use information technology as an enabler of lean processing
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
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…….
Requires a Horizontal View
Traditional Improvement Approach
Value Stream Approach
Admission EvaluationAncillaryService
Discharge Billing
Admission EvaluationAncillaryService
Discharge Billing
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
Types of Waste Waste Comes in Many Forms
Processing - Redundant and unnecessary process steps, excess processing (over utilization), excess checking and inspection. Excess use of energy of all types.
Correction - Re-do’s, fix-ups, returns, mark-downs, managing customer complaints.
Inventory - Idle in progress or finished materials, ingredients, supplies, or information.
Wait Time - Delays and queues of all types.
Search Time - Time spent looking for information, people, supplies and equipment.
Transportation - Multiple handling steps and needless movement of material and information.
Space - Storage of unneeded items, excess inventory or the general “mess” that builds up over time. Excess space required due to inefficient process flow.
Complexity - Complex process flows. Product choices that confuse customers. Organization boundaries which introduce inefficiencies and frustrates customers.
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
First Unit Dose for Medication on Nursing Unit
Write OrderDispense In
PharmacyEnter Data Administer
To Patient
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%
Requires Us To Think Differently…
VA
NVA
VA NVA
VATypicalOrganization
TraditionalImprovementWith Traditional Investment Strategy
Lean WasteReduction
NVA
MinorImprovement
OriginalLead Time
MajorImprovement
•Speed up value added steps•Add capacity
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 ImprovementValue Stream Mapping
Simplify
SortSeparate 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
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”
RPI Workshops are….
Focused, intense one week events
Targeted processAll areas of process representedVision developedChanges are identified and made
during the workshopLittle or no money is spent
Level 3: Work Unit Inspect
Level 2: Company Inspects
Level 1: Customer Inspects
Level 5: Eliminate
Opportunities for Errors
Levels of Quality System
PreventErrors
Level 4: Self Inspection
Check forDefects
Detect Errors
Level 5
Level 4
Level 3
Level 2
Level 1
.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
What did we do?
1st 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