Introduction to Lean Healthcare

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Clarence Jackson
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1 Introduction to Lean Healthcare Presented by: Steve Lockwood, CITEC Business Advisor / Lean June

2 What is Lean Lean Enterprise is a systematic approach to identifying and eliminating waste (non-value-added activities) through continuous improvement by flowing the **product at the pull of the customer in pursuit of perfection. **Product = Process, Information, Service, Patients 2

improvement by flowing the **product at the pull of the customer in

3 Definition of Value Added Value Added Any activity that increases the form or function of the service. These are the things for which our patients would be willing to pay. Non-Value Added Any activity that does not add form or function or is not necessary. These activities should be eliminated, simplified, reduced, or combined. 3

These are the things for which our patients would be willing to pay.

4 Lean is not a job reduction strategy 4

5 Lean in Healthcare The tools of Lean will allow you to: provide better service with less waste with improved quality 5

6 Lean = Eliminating (8) Wastes Value-Added Non-Value-Added Defects Overproduction Waiting Not Utilizing Employees Transportation Inventory Motion Excess Processing Typically 95% of all lead time is non-value-added. 6

Utilizing Employees Transportation Inventory Motion

7 Anything that adds cost or time without adding value as defined by the primary customer is WASTE. 7

8 Defects Medication error Wrong procedure Wrong patient Missing information Paperwork doesn t match Information entered incorrectly Incompatible software Lack of standard work 8

9 Overproduction Making more than is required by the next process Making it earlier than is required by the next process Making it faster than is required by the next process Pills given out early Multiple bosses & multiple jobs cause wrong order of jobs Duplication of tests 9

faster than is required by the next process Pills given out early

10 Waiting For bed assignments Discharge, Testing results Approvals Equipment Couriers People 10

11 Not Utilizing Employee s Knowledge, Skills, and Abilities The waste of not using people s abilities (mental, creative, physical, skill) Causes of People Waste Incompatible hiring practices Politics Corporate culture Improperly trained employee Old guard thinking Business culture Examples Bypassing procedures to hire a favorite candidate Start using system software without prior training Qualifications unclear Not providing opportunity for growth Temporary workforce Flawed suggestion system 11

Old guard thinking Business culture Examples Bypassing procedures to hire a favorite candidate Start using system software

12 Transportation Moving same patient, specimens, or supplies, Defects/rework Poor layout Poor scheduling 12

13 Excess Inventory Any supply in excess of a one-piece flow through your process Pharmacy stock Supplies (discount) Specimens waiting for analysis Files, manuals Patients 13

14 Motion Any movement of people or machines that does not add value to the product or service Searching for patients, needed meds right charts, supplies Common items stored on top or bottom shelves. 14

15 Excess Processing Effort that adds no value to the product or service from the customers viewpoint Retesting More paperwork. Printing, mailing, faxing ing same document Duplicate procedures, forms Use of different software in different departments 15

Printing, mailing, faxing emailing same document Duplicate

16 Waste becomes accepted That s just the way work is done around here It s the system 16

17 Lean Building Blocks Continuous Improvement Pull/Kanban Cellular/Flow Teams POUS Quality at Source Quick Changeover Standardized Work Batch Reduction TPM Visual 5S System Layout Value Stream Mapping 17

Source Quick Changeover Standardized Work Batch

18 VSM Improvement vs. Process Improvement Value Stream = All steps, both value added and non value added, Required to complete service/widget from beginning to end Process Process Process Process Establish Team Evaluation Solicitation Distribution Initial Customer Contact Value Stream Service Delivered 18

value added, Required to complete service/widget from beginning to end

19 Current Value Stream Map Dashboard Patient arrival with care needs Registration info entered into DB Lab info entered on DB Patient departure shown in DB Patient care received, Patient departs system DB tells RN patient has arrived DB notifies MD of patients arrival Labs collected are shown on DB DB shows when labs & other requisitions are complete Triage Vitals Patient History W 4 min Registration RN Exam Provider Exam Patient Patient W History W History W 28 min 15 min 10 min Provider Orders W 20 min RN Collects Lab W 40 min Completi ons of Labs and Req Lab sent Therapy Begins C/T=4 min C/T=3 min C/T=5 min C/T=8 min C/T=4 min C/T=10 min C/T=12 min U/T= U/T= U/T= U/T= U/T= U/T= U/T= C/O= C/O= C/O= C/O= C/O= C/O= C/O= FPY= FPY= FPY= FPY= FPY= FPY= FPY= 2 min 4 min 4 min 3 min 28 min 5 min 15 min 8min 10 min 4 min 20 min 10 min 40 min 12 min NVA=119 VAT=46 Lead Time = 165 minutes 19

Registration RN Exam Provider Exam Patient Patient W History W History W 28 min 15 min 10 min Provider Orders W 20 min RN Collects Lab W 40 min Completi ons of Labs and Req Lab sent Therapy Begins

20 Facility Layout: Figure 1. Traditional racetrack configurations distance staff from their patients and one another and increase time spent on non-patient activities. 20

21 Facility Layout: Figure 2. Adaptable spaces create efficient workplaces that can change as processes and requirements change. 21

22 5S Workplace Organization A safe, clean, neat, arrangement of the workplace provides a specific location for everything, and eliminates anything not required. Sort Set in Order Shine Standardize Sustain 22

23 5S Workplace Organization Store room before: 23

24 Visual Controls Simple signals that provide an immediate understanding of a situation or condition. They are efficient, self-regulating, and worker-managed. 24

25 Visual Controls Must be clear! 25

26 Standard Work DEFINITION: The process / method to be used every time by everyone to do a task safely based on the best known work practices. 26

27 Benefits of Standard Work I M P R O V E M E N T Standardized Work Sustains Improvements I Keystone of continuous improvement S I S I S I S Continuous Improvement Efforts I Keystone Time 27

28 Point of Use Storage (POUS) Material is stored at workstation where used. Vendor Managed Inventory (VMI) is best! 28

29 Lean Workforce Practices (Teams): Patient Care Teams with rotation of highly specified jobs. Cross-trained and multi-skilled employees. Continuous improvement mindset. Process quality, not inspection. Participatory decision-making. Leadership at all levels. 29

30 Quick Changeover Definition: The time between the last good output from the current task and the first good output from the next task at speed. Do changeovers occur in the office? One set of documents are put away and replaced by another set Office equipment has to be reset for the next job Computer files are closed down and others retrieved Associates go to the Boss for their next assignment Visits to the supply cabinet for needs Reconciliation of regulatory paperwork 30

31 A3 Problem Solving Reports 11 x 17 sheet of paper used to show the status of a problem or project. Use pictures and graphs versus text Follows the PDCA model. 31

32 Kaizen Rapid Change for the Better OR Rapid Continuous Improvement Kai = Take Apart Zen = Make Better 32

33 Questions??? Thank you Steven Lockwood (315) x28 33

Getting Started with Lean Process Management

Getting Started with Lean Process Management Hi-Tec Exchange Conference San Francisco July 25, 2011 Missions To team with Organizational Leaders, Managers, & Employees to focus on customers & improve competitiveness,