Lean and Quality Improvement. Quality Improvement Unit Regina Qu Appelle Health Region

Transcription

1 Lean and Quality Improvement 101 Julie Johnson, Director Quality Improvement Unit Regina Qu Appelle Health Region

2 Lean and QI 101 Lean - part of a comprehensive approach to improvement in healthcare What is Lean? Lean Culture Our customers; Our valuable human resources; Our focus on process redesign Lean Concepts - waste Lean Tools standard work

3 RQHR Improvement Approach The People Side Of Change Model for Improvement Lean Measurement For Improvement Change Leadership SPC Analysis Project Management Increasing Improvement Team Success Six Sigma

4 You are here

5 Lean Lean Culture Lean Concepts Lean Tools

6 Lean Culture in Healthcare Compassion and respect for all patients, clients, residents families; Respect and collaboration amongst all staff and physicians; Value Streams: Understanding that care processes are horizontal: patients pass through many areas/ clinics/departments/facilities i t /f iliti during their care journey

7 Culture: Our Customers Patients/Clients/Residents/Families Service Industry we are side-by-side every day with our customers Compassion and Respect - see through our customers eyes Involve our customers as part of the team - redesigning the services they receive

8 Culture: Staff and Physicians Respect for everyone s intelligence, passion, innovation and effort We are one team collaboration is easy Separating processes from people Stewardship - designing efficient/effective horizontal care streams

9 Culture: Focus on Process Pharmacist going to jail over role in 2-year-old s death CLEVELAND, Ohio An area pharmacist who played a role in the death of a 2-year-old girl spent six months in jail. Eric Cropp, in February 2006, approved a pharmacy technician s fatal saline solution for 2-year-old Emily Jerry, who was on her final phase of cancer treatment. The organization that Eric worked for blamed Eric for the critical incident, rather than identifying the faulty process that allowed this scenario to unfold. VP Clinical operations stated the similarity between the insulin labels and the heparin label likely contributed to the error. The incident review has resulted in immediate changes to how TPN solutions are produced.

10 Lean Concepts Voice of customer One piece flow/ Create pull Measure. report, communicate Redesigning systems from the customer perspective Continuous Improvement Build quality in at every step Identify and reduce waste Level scheduling to meet takt Balance work to meet takt Knowledge of demand and capacity Remove/ reduce inventory

11 Lean Concept: Waste (Or things that drive you crazy!) Defects Talent Waiting Inventory Waste Motion Over Transportation processing Over production

12 1. Defects Processes that are difficult, confusing or cumbersome may cause you to make errors. Medication error Wrong patient Wrong procedure Missing information

13 Defects an example Air and Oxygen flow meter connections are identical

14 2. Waiting Idle time created when material, services, information, people, or equipment are not ready Waiting for a signed physician order Waiting for a bed to open up Waiting for lab test results

15 3. Motion Physical movement required to get a task done Searching for meds Searching for charts Gathering supplies Handling paperwork Patients driving to numerous locations to receive various aspects of treatment

16 4. Transportation Movement of products/ people that does not add value Moving samples, specimens, supplies Moving patients from bed to bed, room to room Moving equipment to multiple locations

17 Example: excessive motion or transport Before After

18 5. Overproduction Producing work or providing a service prior to it being requested/required q by the customer. Testing ahead to suit own schedule/demand Creating 100 packages of information when only require 10 per week Arriving 3 hours or more before a procedure/test/surgery

19 6. Over Processing Extra effort that adds no value from the customer s point of view. Multiple bed moves Unnecessary testing Excessive paperwork Duplicating patient s history Filling out the same information in several locations

20 7. Inventory A build up of supplies, requisitions, medications, people, etc. (e.g. people on a wait list) Inventory stuck between steps in the process Process A Process B waiting waiting

21 8. Talent Maximize skills and abilities fully Is valuable time lost searching, gathering, waiting, duplicating Tap into staff and physicians i to be part of the solution to problems Get them involved Identify talents Tap into their ideas Identify leaders, mentors, innovators

22 Lean Tools Buffer Standard Work 5S Balanced Work Takt Time Continuous Improvement Leveled Scheduling Supermarket Kanban Redesign of Work Cell

23 Standard Work Reduces patient safety risks Ensures consistent use of clinical best practice Ensures resources are available when needed Reduces wasted effort and time Focus on unique aspects of patient care versus generalized aspects

24 Standard Work: Reduces Risk Air and Oxygen flow meter connections were identical All Air and Oxygen flow meter connections are now very different and well labeled

25 Standard Work: Clinical Best Practice Patient s Head of Bed At Daily Patient Sedation Vacations Orotracheal Intubation Preventing Ventilator-Associated Pneumonia Continuous Suction ET Tube

26 Standard Work: Resources Available Code Blue Carts

27 Example: Standard Standard Work: Reduces Time &Work Effort

28 Standard Work: Ensures Generalized Aspects of Care

29 Lean Projects: Standard Work

30 Summary Lean is an important part of improvement science for healthcare Lean Philosophy - respect, collaboration and inclusion Lean Concepts new ways to see Lean Tools tools for redesign