Understanding Value & Waste

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Griselda Francis
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1 Understanding Value & Waste Objectives 1.! Define Value Stream 2.! Examine the value streams in healthcare 3.! Define Value Added (VA) and Non-Value Added (NVA) 4.! Learn the 7 wastes 5.! Identify the 7 wastes in healthcare 1

2 A Case: Value! 44 y/o female, 2 years s/p C6-C7 discectomy and fusion with no intervening trauma.! Patient reports neck pain radiating down her left arm into her hand, with left arm and hand numbness.! No improvement with PT.! Patient otherwise healthy and active. 20 X-RAY 30 options? JULY 28 AUGUST 27 SEPT 30??? options OUCH! SAME OCT 29 R X OUCH! DEC 03 DEC 01 Transfer to PACU! 2

3 ORDER 9/5/12?? OUCH!? Communication Error What? 7:00 Hm. This ll be a good story someday. X-RAY! The case I just recounted to you is real and I am this patient.! While I believe I received excellent care, there are a number of opportunities in our system to improve efficiencies for physicians, staff and improve the value to our patient.! How will we do that? Identify value and work to eliminate waste. 3

4 What is Value? Value is defined by our patient Defining value gives us a new way to look at the world!"# # $!" # 4

5 9/5/12 Every activity we perform is part of a Value Stream Optimizing one process may have unintended consequences up or down stream. 5

6 Ideal State Process Map: A world without waste. A 1 CURRENT STATE PROCESS MAP B C D A 1 IDEAL STATE PROCESS MAP 6 14 B C 22 D These Terms Work Against You Non-Value Added, But Necessary Business Value Added 6

7 Patients value being our priority! Easy communication with their provider! On time visits! Information and education Repetition Repetition Repetition 7

8 To increase value we must become more efficient or add features and benefits Old Adage You can have it!! Fast! Cheap! Good Lean Says! Pick two Eliminate waste Pick 3 You can have them all!! Standardize the work! Create Flow! Remove waste! Repeat! Heavy emphasis on principles Improve Quality* Create Flow 8

9 ! Lean s roots are in manufacturing: it s also known as the Toyota Production System.! 7 Wastes: A classification system developed by Taiichi Ohno to help identify waste in a value stream! Identifying waste is a key component in the Toyota Production System Let s take a look at how these principles apply to Healthcare 9

10 7 Wastes: Our Case Study Examples #1 Mistakes/Defects Communication regarding patient room Unsecured O2 Tank #2 Waiting 4 " Months between appointments 6 hours of waiting in clinic #3 Transportation Moving patient from clinic to radiology back to clinic #4 Over-production Patient boarding in PACU #5 Over-processing Filling out duplicate paperwork #6 Inventory None noted Visit to pre-surgery clinic 2 days prior to surgery #7 Motion Hunting and Gathering supplies for injection Surgical Fellow trying to locate patient 7 Wastes: Healthcare Examples The Seven Wastes 1. Defects/Mistakes 2. Waiting 3. Transportation 4. Over-production 5. Over-processing 6. Inventory 7. Motion 10

11 The Seven Wastes Common Healthcare Examples 1. Defects/Mistakes! Time and material spent doing something wrong! and later, fixing it rework! Includes costs of inspection 2. Waiting! Time when the product is idle 3. Transportation! Transport of product or materials between work centers 4. Over-production! Producing more than is needed by the customer! Producing too soon 1. Defects/Mistakes (Healthcare)! Duplicate MRNs! Correct labs not ordered! Misdiagnoses! Hospital acquired conditions 2. Waiting (Healthcare)! Patients or their information idle in queue 3. Transportation (Healthcare)! Moving patients from department to department! Moving lab specimens through pneumatic tube system! Moving information through or EMR! Moving meals from the cafeteria to the units 4. Over-production (Healthcare)! Delayed discharges! Urinary catheter staying in too long! A patient staying on a ventilator too long! Compounding infusions the patient doesn't S. Gulbransen, Module need 3: Value and! Waste Making a meal the patient can't/doesn't eat The Seven Wastes Common Healthcare Examples 5. Over-processing! Doing more work than is needed by the customer 6. Inventory! Inventory can expire, get damaged, become obsolete and always ties up cash 7. Motion! Unnecessary movement within a work center. 5. Over-processing (Healthcare)! Ordering and completing unnecessary tests, diagnostics and therapies! Performing surgery when a non-invasive intervention will suffice! Asking patients to come to the clinic unnecessarily! Asking patients to fill out additional paperwork! Putting patients on telemetry just in case. 6. Inventory (Healthcare)! Drawing and keeping blood samples (rainbow draws)! Overstocked consumables! Too much bedside equipment! Pre-printed forms 7. Motion (Healthcare)! Nurses walking - from HUC to med room to patient room! Providers walking - from floor to floor! Navigating through the EMR S. Gulbransen,! Hunting Module 3: for/gathering Value materials and equipment 11

12 Waste hides in complex systems, and healthcare is an immensely complex system. Terry Platchek, MD co author of Lean Healthcare for the Hospitalist Waste #1: Mistakes/Defects 12

13 Mistakes are a waste Time and material spent doing something wrong and later, fixing it. Includes costs of inspection.! Duplicate MRNs! Misdiagnoses! Hospital Acquired Conditions Waste #2: Waiting No Idling - It s the Law (or at least the goal)! Waiting Rooms! Idle Diagnostic Results! Backed up Emergency Department SEPT JULY AUGUST 27 13

14 Waste #3: Transportation Waste #4: Over-Production Producing more than is needed by the customer at this time. Producing too soon. Our patients want to go home! Delayed discharges! Urinary catheters staying in too long! Compounding infusions the patient doesn t need 14

15 Waste #5: Over-Processing As Quality Increases Cost Decreases Quality We must reduce our tendency to over-process for this trajectory Cost Note: We must also optimize non-clinical NVA. 15

16 Waste #6: Inventory! Drawing and keeping blood samples (rainbow draws)! Overstocked consumables! Too much bedside equipment Waste #7: Motion Unnecessary movement within a work center! Nurses walking from HUC to medication room to patient room! Navigating through the EMR! Hunting and Gathering 16

17 Conclusion!!!!! Our patients define value Any activity in the value stream that doesn t contribute to value is waste Every activity is either VA or NVA NVA does not equal Not Necessary There are 7 categories of waste Be Aware! Ask the 5 Why s Get to the Root Cause! Unintended consequences! Data Driven Decisions 17

18 Our Goal Highest quality, most efficient provider of care Expanded slide set and additional information on Understanding Value & Waste is provided as a separate attachment. 18

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