implementing lean in healthcare – leading change · 2019-12-19 · implementing lean in...
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Implementing Lean in Healthcare – Leading Change
Cynthia Chiarappa, VP Strategy Children’s Hospital & Research Center
Oakland Viral Mehta, Kaizen Promotion Officer
San Mateo Medical Center
How safe is healthcare?
Driving
Mountain Climbing
Bungee Jumping
Chemical Manufacturing
Scheduled Airlines
European Railroads
Nuclear Power
Chartered Flights
Regulated
100,000
10,000
1,000
100
10
1 1 10 100 1,000 10,000 100,000 1,000,000 10,000,000
Number of encounters for each fatality
Tota
l liv
es lo
st p
er y
ear
Dangerous > 1 / 1000
Ultra Safe < 1 / 100K
2
Per capita health care spending
Are our outcomes that much better???
A prescription for change
Taichi Ohno
Father of the Toyota Management System
Lean…
process cycle times
process step
wait time
process lead time
process step
wait time
process cycle times
CT = 47:36
LT = 117:15
Map the value stream
Go see for yourself
Brainstorm ideas on the current state map
A new way to manage
plan
check
do act
Continuously improve
• The right process = the right results
• Create continuous flow
• Build a culture of stopping to fix problems
• Standardize tasks to improve continually
• Use visual control so no problem is hidden
• Grow leaders
• Go and see the work for yourself
• Make decisions by consensus but implement rapidly
• Become a learning organization
Lean is a long-term philosophy
"You should submit wisdom to the company.
If you don’t have any wisdom to contribute, submit sweat.
If nothing else, work hard and don’t sleep.
Or resign.”
Taichi Ohno
LEAN AT CHILDREN’S OAKLAND “Quality Built-In”
Our QBI Journey
7 value streams Revenue Cycle Hematology-Oncology Primary Care Surgical Services Endocrinology Clinic Patient Safety Chemotherapy Ordering and Administration
Mini-value streams for Epic FMEA Kaizen on Tubing Connections Hoshin Kanri
PATIENT SAFETY ALERT SYSTEM Children’s Oakland Example
Current State – Adverse Event RCA
Future State
Idea-Generation
Documenting Ideas
Testing
Rapid Response
Standard Work for Team Members Tools
RCA process starts within 48 hours from event notification RCA meeting complete within 4 hours
Immediate response on the gemba
Clear accountability for action items Action items scoped to causes of event
Complete action plan within 30 days Closure criteria and process with gemba validation
Redesigned Process Flow
Ongoing Monitoring
Serious Adverse Event Tracking for Patient Safety Kaizen updated: 10/12/12
RCA # Date of Event (D) Date of Notification of
Event (T) Date of Patient
Safety Stat Date of RCA
Days Elapsed Between Notification of Event &
RCA
Date of Completion of RCA Action Plan
Days Elapsed Between Notification of Event &
RCA Completion General Description of Event
Status/ Comments
Goal: T=D Goal: T Goal: <= T + 2 days Goal: <= 2 Goal: <= T + 32 days
06.12A 6/12/2012 6/13/2012 na 6/15/2012 2 7/13/2012 30 Unsterile surgical tray Action plan implemented.
06.12B 6/19/2012 6/21/2012 na 6/28/2012 7 7/18/2012 27 Inappropriate behavior by mother of
roommate Action plan implemented.
07.12 7/9/2012 7/19/2012 na 8/2/2012 14 10/17/2012 90 High risk patient not given Vanco -
readmit with MRSA Action plan complete. All but two sub
items have been implemented.
08.12 8/28/2012 8/28/2012 8/28/2012 8/30/2012 2 9/24/2012 27 Possible breach of sterility related to
fluid warmer in OR Action plan implemented.
09.12.A 9/5/2012 9/5/2012 9/5/2012 9/7/2012 2 10/5/2012 30 Near fall in the OR Action plan complete. Implementation in
progress
09.12.B 9/10/2012 9/10/2012 9/11/2012 9/21/2012 11 10/10/2012 30 Burn during neurosurgical case Action plan complete. Implementation in
progress, and on track
09.12.C 9/18/2012 9/18/2012 9/18/2012 9/20/2012 2 10/18/2012 28 Burn during MRI Action plan complete. Implementation in
progress
10.5.A 10/5/2012 10/5/2012 10/5/2012 10/9/2012 4 OR delay due to unavailable
instrument Action plan complete and being
implemented