overview of lean principles and continuous improvement lean in healthcare

Overview of Lean Principles Overview of Lean Principles and Continuous and Continuous ImprovementImprovement

Lean in HealthcareLean in Healthcare

What is Lean?What is Lean?

Definition-Definition-”The endless ”The endless transformation of waste into value transformation of waste into value from the customer’s perspective.”from the customer’s perspective.”

IT is a System Thinking Concept.IT is a System Thinking Concept.

A little HistoryA little History

The “4P” modelThe “4P” modelProblem Solving

(ContinuousImprovement

AndLearning)

Process(Eliminate Waste)

People and Partners(Respect, Challenge, and Grow

Them)

Philosophy(Long-Term Thinking)

Impact of Lean in the Impact of Lean in the IndustryIndustry

Direct Labor/productivity Direct Labor/productivity improvedimproved

45-45-75%75%

Cost ReducedCost Reduced 25-25-55%55%

Throughput/Flow IncreasedThroughput/Flow Increased 60-60-90%90%

Quality (Defects/Scrap) Quality (Defects/Scrap) ReducedReduced

50-50-90%90%

Inventory ReducedInventory Reduced 60-60-90%90%

Space ReducedSpace Reduced 35-35-50%50%

Lead Time ReducedLead Time Reduced 50-50-90%90%

Source: Virginia Mason Medical CenterSource: Virginia Mason Medical Center

Examples of Lean in Examples of Lean in HealthcareHealthcare

Adding greater “value-added” Adding greater “value-added” services services Same day office visitsSame day office visits Next day outpatient surgeryNext day outpatient surgery Next day mammogramNext day mammogram Quick & errorless billingQuick & errorless billing No wait emergency roomNo wait emergency room

TRADITIONAL CULTURE VS. LEAN TRADITIONAL CULTURE VS. LEAN CULTURECULTURE

TRADITIONALTRADITIONAL LEANLEAN

Functional SilosFunctional Silos Interdisciplinary teamsInterdisciplinary teams

Managers directManagers direct Managers teach/enableManagers teach/enable

Benchmark to justify not Benchmark to justify not improving; “just as improving; “just as good”good”

Seek the ultimate Seek the ultimate performance, the performance, the absence of wasteabsence of waste

Blame peopleBlame people Root cause analysisRoot cause analysis

Rewards: individualRewards: individual Rewards: group sharingRewards: group sharing

Supplier is enemySupplier is enemy Supplier is allySupplier is ally

Guard InformationGuard Information Share informationShare information

Volume lowers costVolume lowers cost Removing waste lowers Removing waste lowers costcost

Internal focusInternal focus Customer focusCustomer focus

Expert drivenExpert driven Process drivenProcess driven

Examples of process Examples of process improvement toolsimprovement tools

A3 reportingA3 reporting

Clean it up, Make it Clean it up, Make it VisualVisual

STRAIGHTEN

SHINE

STANDARDIZE

SUSTAIN

SORT

What is Waste in What is Waste in Healthcare?Healthcare?

Eliminating WasteEliminating Waste

OverproductioOverproductionn

Pills given out Pills given out early early

Treatments Treatments done to done to balance staffbalance staff

Duplication of Duplication of testtest


TransportationTransportation

Moving sameMoving same

patient, patient,

specimens, orspecimens, or

supplies, supplies,

workersworkers


MotionMotion Searching for Searching for

patients, patients, needed meds,needed meds, right charts, right charts, suppliessupplies


WaitingWaitingfor bed for bed

assignments assignments

or or

discharge, discharge,

or or

testing resultstesting results


ProcessingProcessing

RetestingRetesting More paperworkMore paperwork Duplicate Duplicate

proceduresprocedures


InventoryInventoryLinen (laundry)Linen (laundry)

Pharmacy stockPharmacy stock SuppliesSupplies Specimens waiting Specimens waiting

for analysisfor analysis


DefectsDefects

Medication errorMedication error Wrong Wrong

procedureprocedure Wrong patientWrong patient Missing Missing

informationinformation

The Toyota WayThe Toyota Way1414 Management PrinciplesManagement Principles

to LEAN Development Processto LEAN Development Process

LEAN Development LEAN Development ProcessProcess

1.1. Establish the vision for the Establish the vision for the futurefuture

Focus the organization on the PATIENTSFocus the organization on the PATIENTS Align Performance MeasurementsAlign Performance Measurements Set high expectations for success and Set high expectations for success and

low tolerance for failurelow tolerance for failureMethod:Method: Establish a core team of implementersEstablish a core team of implementers Focused training, reading, and Focused training, reading, and

benchmarkingbenchmarking Standardized, systematic, methodical Standardized, systematic, methodical

approachapproach Clearly define objectives and time tableClearly define objectives and time table Create success through pilots and spreadCreate success through pilots and spread

Mission StatementMission Statement

Develop the abilityDevelop the ability::To recognize and identify wasteTo recognize and identify wasteTo have the courage to call it wasteTo have the courage to call it wasteTo have the desire to eliminate itTo have the desire to eliminate itEliminate the wasteEliminate the wasteUnderstand that waste simplyUnderstand that waste simply

Raises costsRaises costsProduces no corresponding benefitProduces no corresponding benefitThreatens all of our jobsThreatens all of our jobs

You get what you expect and you You get what you expect and you deserve what you tolerate.deserve what you tolerate.


2.2. Develop your objectivesDevelop your objectives Look at your key processes or Look at your key processes or VALUE VALUE

STREAMSSTREAMS Patient Journey (ERPatient Journey (ERRadiologyRadiologyClinicClinicORORBilling)Billing) Charge capture (Clinical ServiceCharge capture (Clinical ServiceBilling Billing

Insurance)Insurance) Operating Room flow (Scheduling, consent, pre-Operating Room flow (Scheduling, consent, pre-

op visit, prep,….)op visit, prep,….) These support your “These support your “ProductsProducts” which ” which

might be might be Office visitOffice visit Inpatient stayInpatient stay Visit to the EDVisit to the ED

How do your Internal and External How do your Internal and External Customers define ValueCustomers define Value


3.3. Selection of Team MembersSelection of Team MembersCharacteristics:Characteristics:

Technology curiosityTechnology curiosityCommon senseCommon senseInner confidenceInner confidence

(create structure, Win allegiance, (create structure, Win allegiance, instinctive reactions)instinctive reactions)

Cross Functional Team:Cross Functional Team:Manager/Supervisor from the areaManager/Supervisor from the areaOperators from areaOperators from areaFunctional departmentsFunctional departments

(HR, Lab, Pharmacy, Admitting, (HR, Lab, Pharmacy, Admitting, Surgery, Materials Management,etc.)Surgery, Materials Management,etc.)

RESOURCE MATRIXRESOURCE MATRIX

NAMENAME TITLETITLE SKILL SKILL 11

SKILL SKILL 22

SKILL SKILL 33

SKILL SKILL 44

LarryLarry

MoeMoe

CurlyCurly


4.4. Initiate TeamInitiate TeamTraining:Training:

Read required literatureRead required literatureAttend team and leadership training, lean Attend team and leadership training, lean overviewoverview

Tools:Tools:Standardized analysis and simulation toolsStandardized analysis and simulation toolsVideo cameras, TVs, and VCR’sVideo cameras, TVs, and VCR’sComputers, Printer, and ProjectorComputers, Printer, and Projector

Facilities:Facilities:Lean War Room located in the operational Lean War Room located in the operational areaareaOffice area appropriately furnished and Office area appropriately furnished and suppliedsupplied

Resource and Innovation Resource and Innovation Center Center


5.5. Select Pilot AreaSelect Pilot AreaSelection Criteria:Selection Criteria:

Contributes to key competitive strengths Contributes to key competitive strengths of businessof businessInnovation has a good chance of successInnovation has a good chance of successSignificantly tests the innovationSignificantly tests the innovationSolutions are transferable to other areasSolutions are transferable to other areas

Baseline the current process Baseline the current process

Do an initial walkthroughDo an initial walkthrough

Baseline AnalysisBaseline Analysis

1.1. # patients transferred from ED # patients transferred from ED to inpatient bed within 1 hour of to inpatient bed within 1 hour of decision to admitdecision to admit

2.2. Time to third next available apptTime to third next available appt3.3. # tests/day or # tests/week# tests/day or # tests/week

Keep it simple - look at 25 Keep it simple - look at 25 patients/wk collected over some patients/wk collected over some time period including weekends time period including weekends and at nightand at night


6.6. Activity of ProductActivity of Product

Videotape: selected productsVideotape: selected products

Analyze videotape and segregate:Analyze videotape and segregate:

travel time and distancetravel time and distance

storage time and typestorage time and type

inspection timeinspection time

non-value added processing timenon-value added processing time

value added processing timevalue added processing time

Map the flow of the product:Map the flow of the product:

Process ChartsProcess ChartsProcess: Emergency room admissionSubject: Ankle injury patientBeginning: Enter emergency roomEnding: Leave hospital

Step no.

Time (min)

Distance (ft)

Summary

Number of stepsActivity

Time (min)

Distance (ft)

Step description

Insert Step

Append Step

Remove Step

1 X Enter emergency room, approach patient window 2 X Sit down and fill out patient history3 X Nurse escorts patient to ER triage room4 X Nurse inspects injury5 X Return to waiting room

6 X Wait for available bed 7 X Go to ER bed8 X Wait for doctor9 X Doctor inspects injury and questions patient

10 X Nurse takes patient to radiology

11 X Technician x-rays patient12 X Return to bed in ER13 X Wait for doctor to return14 X Doctor provides diagnosis and advice15 X Return to emergency entrance area

16 X Check out17 X Walk to pharmacy18 X Pick up prescription 19 X Leave the building

0.50 1510.0 -0.75 403.00 -0.75 40

1.00 -1.00 604.00 -5.00 -2.00 200

3.00 -2.00 2003.00 -2.00 -1.00 604.00 -2.00 1804.00 -1.00 20

Transport 9 11 815 Operation 5 23 —

Inspect 2 8 —

Store — — —Delay 3 8 —


7.7. Group Technology AnalysisGroup Technology Analysis Process sequenceProcess sequence Pre- Post data collectionPre- Post data collection Identify number of possibilities Identify number of possibilities

and combinationsand combinations Identify commonality within each Identify commonality within each

product familyproduct family Plan analysis phasePlan analysis phase

A3 reportingA3 reporting

LEAN Development ProcessLEAN Development Process

8.8. Line/Cell visionLine/Cell vision Product flowProduct flow Operator activityOperator activity FlexibilityFlexibility Zero defect productionZero defect production

Group TechnologyGroup Technology

Machine 1

Machine 2

Machine 3

Machine 4Machine

5

Materials in

Finished goods out

One Worker, Multiple MachinesOne Worker, Multiple Machines


9.9. Activity of OperatorActivity of Operator Map work patternMap work pattern

VideotapeVideotape

Analyze what is value added, required Analyze what is value added, required waste, and pure wastewaste, and pure waste

Point to Point diagram representing Point to Point diagram representing movement of operator in work areamovement of operator in work area

Time studies analysisTime studies analysis Document new processDocument new process

Point to PointPoint to Point


10.10. Develop Standard WorkDevelop Standard Work

Define job steps, standard times, Define job steps, standard times, and material location within and material location within each order of processeach order of process

Define takt time Define takt time

Establish Line BalanceEstablish Line Balance


11.11. Improve Line flexibilityImprove Line flexibility Videotape – selected setups and Videotape – selected setups and

operatorsoperators Document improvement Document improvement

suggestions related to – suggestions related to – preparation, organizationpreparation, organization

““Milk runs”Milk runs” Document new processDocument new process


12.12. Design and approve Line Design and approve Line LayoutLayout

Design ConsiderationsDesign Considerations

Steps to approve new LayoutSteps to approve new Layout


13.13. Performance MeasurementsPerformance Measurements ID standard work, source quality ID standard work, source quality

controlcontrol Monitor performance and Post Monitor performance and Post

resultsresults ID ‘hit list’ and resolve identified ID ‘hit list’ and resolve identified

problems on a 90 day cycleproblems on a 90 day cycle Monitor changes on 30/60/90 days Monitor changes on 30/60/90 days

cyclecycle


14.14. Develop a business caseDevelop a business case Compare base conditions with projected Compare base conditions with projected

lean conditions (benchmark or audit)lean conditions (benchmark or audit) Output ratesOutput rates Floor spaceFloor space InventoryInventory LaborLabor

Document cost of implementationDocument cost of implementation Present findings to senior managementPresent findings to senior management

Include all stakeholders and decision makersInclude all stakeholders and decision makers Let the facts speak loudlyLet the facts speak loudly

overview of lean principles and continuous improvement lean in healthcare

Documents

healthcare slide

analysis slide

spread slide

sort slide

lean development process

waste lowers

waste people

little history slide