HFPS LEAN Principles PART I

Transcription

1 HFPS LEAN Principles PART I FOR HEALTHCARE

2 Course Outline Course Outline 1. Fundamentals of LEAN Basic CORE Training

3 Learning Objectives Learning Objectives Be able to: 1) Describe & implement effective process improvements based on manufacturing based production fundamentals, 2) Adopt unique measurement tools based on the scientific method of data collection to identify and analyze defective processes, 3) Manage empowered teams of 'expert' workers to continuously focus on the work & make improvements

4 Fundamentals of Lean Fundamentals of Lean What is Waste? 14 Principles (Liker- The Toyota Way) 4 Rules of Work Design (Spear & Bowen- Decoding the DNA of the Toyota Production System)

5 Focus of Lean? Reduce & Eliminate Waste, Continually Overproduction Time waiting Transportation Processing Stock on hand Movement Defective products The seven wastes

6 14 Principles of TPS & HFPS 1. Long Term Philosophy- Base your management decisions on a long term philosophy, even at the expense of short-term financial goals LEAN PROCESSES 2. Create continuous process flow 3. Use the Pull System 4. Level out the workload 5. Build a culture of continuous improvement by stopping to fix problems to get quality right the first time. Every hand-off is correct EVERYTIME 6. Standardization of tasks are the foundation for continuous improvements & employee empowerment 7. Use visual controls so no problems are hidden Liker: The Toyota Way, 2006.

7 14 Principles of HFPS (cont) 8. Use only reliable thoroughly tested technology that serves your people and processes PEOPLE & PARTNER RELATIONSHIPS 9. Grow Leaders 10. Develop People 11. Respect your suppliers, challenge & help improve PROBLEM SOLVING & CONTINUOUS IMPROVEMENT 12. Go and See for yourself to thoroughly understand 13. Decide carefully by consensus, Implement Rapidly 14. Become a Learning Organization, through relentless reflection & continuous improvement Liker: The Toyota Way, 2004.

8 Deming 1.Create constancy of purpose for improvement-customer focus 2.Adopt the new philosophy 3.Cease dependence on mass production 4.End the practice of awarding business on price alone 5.Constantly & forever improve systems of production & services 6.Institute modern methods of training on the job 7.Institute modern methods of supervision & leadership 8.Drive out fear 9.Break down barriers between departments 10.Eliminate numerical goals for workforce 11.Eliminate work standards & numerical quotas 12.Remove barriers to pride of workmanship 13.Institute a vigorous program of education & training for everyone 14.Create a structure in top management that will push every day on the above 13 points

9 The IDEAL Condition The IDEAL Condition Delivery of products & services should pursue the Ideal Production that is Defect Free On demand Immediate One by-one (single piece flow) Minimal waste Safe Physical, emotional, professional

10 Some Definitions Some Definitions The 5S's: A structured approach to clean and organize the workplace. Bottlenecks: Step in a process line that limits the throughput of the entire process line. Push: Manufacturing dictated by a traditional production schedule where a new lot is pushed onto the first step of the process. Pull: Customer order triggers the start of production. Underlies Just-in-Time production and continuous flow. One-piece Flow: Product is moved from one workstation to next one piece at a time without inventory build up between steps. Kanban: A visual signal, typically a re-order card or container that triggers a Pull manufacturing system. Value Stream Mapping: A graphical representation of all tasks and activities needed to transform input materials and information into an output.

11 What is Lean all about? What is Lean all about? Identifying the NON -Value in our work Value added Non value-added Eliminate Waste Non value-added, but necessary

12 Non Value Added Work Non Value Added Work Missing patient information Poor quality Redundant paperwork Lost samples Forms Closet

13 Handling Waste Calculator Handling Waste Calculator Total waste per hour: 14 min 40 sec (11 bags/hour) Total waste per shift: 2 hrs 24 min Time wasted in a 40 hr week: 9 hrs 36 min Time wasted per year: 499 hrs 12 min Above data is for only 1 shift!!

14 Principle 2: Create continuous process flow Using only items that are needed for the next step in production

15 Central Processing Department Central Processing Department Equipment Roadblocks to Continuous Flow

16 Principle Refrigerator Refrigerator 2: Trail of operating room nurses search for blankets No blankets in the patient care area Bring the work to the man and not the man to the work -Henry Ford

17 Principle 2: Refrigerator Refrigerator Trail of operating room nurses search for blankets DEMONSTRATION of WASTED TIME Thanks to Angie Williams

18 U- Shaped Cell U- Shaped Cell Reduce excess travel and motion Task 4 Task 3 Task 2 One operator works multiple tasks on the inside of the cell Task 1 DROP-OFF

19 ONE Tech to run: Chemistry, Hematology and Coagulation workcells

20 Principle 3: Use the Pull System Pull what s needed when it s needed Operator displays Kanban card for supply delivery Supplier delivers what s needed, when needed

21 Pull one unit of work at a time kanban Custom-ordered F150 show truck Respond to customer demand Provide customer what they want, when they want it Pull is continuous and managed

22 Steps to Create Pull Production Steps to Create Pull Production Step 1: Create a process map and identify your current process Step 2: Design work cells for efficient flow Step 3: Rearrange equipment according to your new process Step 4: Shift to one-piece flow, one unit at a time, determined by the need of the costumer Step 5: Use kanbans to serve as an order production system to identify next step in production Kanban?

23 Kanban Signaling device that gives instruction 1. Trigger orders to restock inventory 2. Next step in production Red Zone We re low on: Gloves Cassettes Stain

24 Inventory Kanban Inventory Kanban 1 st Generation 2nd Generation Surgical Pathology Item Kanban inventory can be applied anywhere Vendor: Name ( ) Part #: People Soft #: N/A Cart Count #: N/A Reorder At: #, Unit Quantity to Order: #, Unit Price $0.00 Histology

25 More Inventory Kanban More Inventory Kanban

26 What Belongs on a Kanban Card What Belongs on a Kanban Card 1. The material 2. A vivid description, drawing, photo 3. Physical location and code 4. The external or internal supplier 5. The order number 6. What, when and how much to make/order

27 Production Kanban Production Kanban Work Flow

28 Principle 4: Level the Workload Patients Waiting Elimination of Waiting: 1. Create fast track streams to separate cases 2. Redesign staff schedules to more closely follow the work 3. Redesign appointment to distribute patient load

29 Testing Load Leveling Previous Testing Schedule Monday Tuesday Wednesday Thursday Friday ana ebv mump ana ebv rubg vzv hsvg 1,2 meas cmvg hpv toxg/m cmvm rubg vzvg Assays/day New Testing Schedule Measles, Mumps, Rubella, Varicella Problem: Many assays were done only once a week resulting in poor TAT Monday Tuesday Wednesday Thursday Friday mmrv ebv mmrv ebv mmrv ana toxg/m hsvg 1,2 ana hpv hsvg 1,2 cmvg/m hpv toxg/m cmvg/m Assays/day

30 Testing Load Leveling Improvement: The Ordering pattern of MMRV often ordered together so we prepared to batch mmrv requests together MEASLES AB 6.5 DAYS DAYS MUMP AB 5.8 DAYS DAYS RUBELLA AB 3.4 DAYS DAYS VARICELLA AB 3.3 DAYS DAYS

31 Cassette Delivery Man Cassette Delivery Man TECH MOVES THROUGHOUT A U-SHAPED CELL EVENLY DISTRIBUTING BLOCKS TO 5 HISTOTECHS

32 Principle 5: Build a culture of continuous improvement Kaizen Stop to fix problems to get quality right the first time. Case Rework Box Case Rework Box Non-Priority defects go into the Case Rework box with the form and slides.

33 Defect-Driven Continuous Improvement Defect-Driven Continuous Improvement QC person of the Day designated in each area Identified by name & photo Resolves defects using standard protocol

34 Reworking F150 Trucks Reworking F150 Trucks 1100 Trucks a day are manufactured 1% are defective = 11 trucks per day are reworked

35 Stopping the Line Stopping the Line Every employee is an inspector Inspect, STOP, and FIX at the source It is important to stop the line: To prevent defective products To make improvements To develop a line that is strong & rarely needs to be stopped Develop a culture of not passing defects

36 Principle 6: Standardization of tasks is the foundation for continuous improvements & employee empowerment Reducing the Variation in Our Work Method 1 Method 3 Method 2

37 Standardization

38 Principle 7: Use Visual Controls so no problems are hidden Work segregation When problems remain hidden they are neither shared nor resolved

39 Color Coded Tools by Work Station Color Coded Tools by Work Station

40 Color the Work Load Color coded rack to expedite the specimens that are shared

41 Principle 12: Go and See Go where the defect occurs, and ask why? Assume nothing, verify everything. Don t rely on other reports.

42 Observe the Process Observe the Process Is there a process in place How are defects handled? Who supplies whom? Who is the supplier? Is there waiting? Are there defects? Redundant paths?

43 Principle 13: Decide Carefully, Implement Rapidly Number of Specimens Extensive data collection to know source of problems :00 October, 2006 Specimen Collection Highest number of specimens Most Specimens arrived batched night between 4-8:00 PM W Bloomfield Fairlane NC1 Lakeside Troy Taylor 11:00 13:00 15:00 17:00 19:00 21:00 23:00 Time of Specimens Prepared for Picked Up

44 Current State Value Stream Map Map Pathway for for Processing 01/06 Redundancy Multiple Specimen Handling Acquisition & Transport Receive In Pathology Sort into Buckets Accession Gross 3 HRS CT= 75 min 75 min = 1 = 1 = 1 = 3 = 2 10 HRS 1 min CT= 1 min CT= 1 min CT= 3 min CT= 3 min 1 min Large Batches 3 min 1 HR 2 HRS 1 HR 3 min VA = 8.13 % NVA To Processor VA= 83 min NVA = 1020 min

45 Current State Value Stream Map Map Pathway for for Processing 01/06 Waiting 3 HRS 3 HRS Acquisition & Transport = 1 CT= 75 min 75 min UNCHANGED 75 min 1. Customer/Supplier meetings with clinics to = 1 = 3 expedite specimens to the lab CT= 1 min CT= 3 min 2. Standardize clinic specimen pick up to every Leveling hour with sign off the load 3. Installed lab pickup boxes in the clinic walls 4. Redesign courier pick up schedules to more closely follow the work 5. Added 2 more runs

46 Expediting Specimen Movement from Clinics to Lab Process Simplification Hourly specimen pick up NEW Process: Visual specimen drop-off boxes at each clinic entrance doorway, recessed into the wall. Easy to see & collect. OLD Process: Buckets throughout internally located clinics, nonstandard

47 Current State Value Stream Map Map Pathway to to Processing 01/06 Waiting Acquisition & Transport Receive In Pathology CT= 75 min = 1 = 1 CT= 1 min 1 min 10 HRS IMPROVED 10 sec 35 MIN Added 2 nd Accession Shift til 11PM 9.5 Hours REDUCED TIME

48 Current State State Value Value Stream Map Map Pathway to to Processing 01/06 01/06 Large Batches Leveling the load Multiple Specimen Handling Waiting Acquisition & Transport CT= 75 min Receive In Pathology = 1 = 1 = 1 CT= 1 min Sort into Buckets CT= 1 min 1 min 30 sec 2 HRS IMPROVED 5 min 1. Redesigned specimen handling 2. Removed multiple handoffs 3. Created Speciality Streams 1.9 Hours REDUCED TIME

49 Production Re-Design Workflow Leveling 20 min Buckets

50 Leveling the Load Leveling the Load Standardization of Work Trays contain variable number containers to produce 20 slides 8 min

51 Current State State Value Value Stream Map Map Pathway to to Histology 01/06 01/06 Smaller Batches Acquisition & Transport Receive In Pathology Sort into Buckets Accession = 1 = 1 = 1 = 3 CT= 75 min CT= 1 min CT= 1 min 1. Redesigned work into trays 2. Removed redundant steps 3. Redesigned & revised part types 4. Barcoded Specified & Standardized Work Processes CT= 3 min 3 min 2 min 56 Min REDUCED TIME 1 HR IMPROVED 5 min

52 Pull Smaller Batches Pull Smaller Batches Reduce Steps 60% time reduction = FASTER & Fewer Defects

53 Current State State Value Value Stream Map Map Pathway to to Processing 01/06 01/06 Implement PULL Acquisition & Transport Receive In Pathology Sort into Buckets Accession Gross CT= 75 min = 1 = 1 = 1 = 3 CT= 1 min CT= 1 min CT= 3 min 1. Created a macro to eliminate gross dictation 2. Standard protocols & cassettes via LIS 3. Prioritized specimens by specialty 4. Timer to PULL cassettes to processor = 2 CT= 3 min 3 min unchanged 3 min

54 Future Future State State Value Value Stream Map Map Pathway to to Processing 01/09 01/09 Acquisition & Transport Receive in Pathology Sort into Buckets Accession Gross = 1 = 1 = 1 = 2 = min CT= 60 min 75 min 35 min CT= 10 sec 10 sec CT= 30 sec CT= 2 min CT= 3 min 30 sec 2 min 5 min 5 min 28 min 3 min To Processor VA =80.6 min NVA =253 min VA/NVA = 32 %

55 Non Value Added Work Non Value Added Work Before WASTE 91.87% 8.13% Value Added After Lead Time WASTE 68% 32% Value Added Lead Time Cycle Time Cycle Time Focusing on eliminating waste is the best leverage for an improvement effort.

56 Getting Started Pick reasonable defects to eliminate SP Phone Calls For Various Reasons Per Week (Total Phone Calls Per Week=613, 1st Shift = 396, 2nd Shift = 217) First Shift Second Shift Number of Phone Calls 0 IN-HOUSE RESULTS? DID YOU RECEIVE? ADD-ONS ALREADY DONE ADD-ONS WHAT COLOR TUBE? FAX RESULTS TO OFFICE OTHER LANA Reason for Phone Call

57 Measuring Current State Measuring Current State Sensing the pulse of the machine If you can t measure it, you can t fix it Develop indicators critical to quality Adapting data collection & analysis Real-time, visual, publicly displayed Captured at point of worker detection Create measurement tools, Andon-like

58 Andon Boards Andon Boards Real-time production information

59 Data Collection Data Collection Keep it Simple

60 Case # Data Collection Defect Type Andon-like Board Scientific basis for change Detail Menu Data Collection Poster from Senior Staff Pathologists

61 Design Improvements Design Improvements Start Simple Define start and stop times Continue over all shifts Ensure blameless data capture Tabulate results

62 Visual Data Display Specifications: 1. Ease of use 2. Data capture in real-time 3. Equal accessibility by all employees 4. Standardized menu to identify root causes 5. Data capture closest to defect encounter by its discoverer 6. Visual presentation and public exposure of defects 7. Anonymous and blameless participation 8. Promoting of team spirit 9. Reusable

63 Four Rules of Work Design Four Rules of Work Design Rule 1: Activities Highly specified work- content, sequence, timing, location, & expected outcome Rule 2: Connections Every customer-supplier connection (roles not individuals)- highly specified, direct, unambiguous yes-or-no way to send requests & receive responses Rule 3: Pathways For every product/service- predefined, highly specified, simple & direct w/ no loops or forking Rule 4: Improvement Made in accordance w/ scientific method, under guidance of a teacher, at place work is done, toward the ideals, using data Bowen & Spear: Decoding the DNA of the Toyota Production System. Harvard Business Review, Sept-Oct, 1999.

64 Rule 1: Activities Rule 1: Activities Work must be highly specified as to Content, Sequence, Timing, Location, and Expected Outcome Standard Work

65 Activities of Standard Work Activities of Standard Work How do you do the work? Who do you hand your work to? How do you know if you are doing the work correctly? How do you know if the outcome is free of defects? What do you do if you have a problem?

66 Standard Work Standard Work Requirements are Clearly Specified and Standardized Feb 1-March 1, 2007 Data Collect: 30 days Pre : 26 defects Post : 0

67 Get It Right the First Time Get It Right the First Time Ford F-150 Truck Factory Standard Work Critical to Quality Wiring harness assembly

68 Rule 2: Connections Rule 2: Connections Between customers & suppliers must be: Highly specified Direct With an unambiguous yes-or-no way to send requests & receive responses (NO assumptions)

69 In d ic a to rs Staff Surveys List the 10 top defects passed to you Recuts Tests Slides Blocks Tissue 3 Survery Results: Histology Histology Section Number of Responses Series1 Tissue 1. Tissue is not fixed well. 2. Tissue is not completely decalcified which makes the tissue hard to section well 3. Tissue too big to fit in the mold. 4. Tissue pops out of cassette. 4. Tissue in a block are not in the same level. 5. Grossed tissue too big to fit into blocks. 6. Tissue is too small or missing. 7. Unmarked or inappropriately marked. 8. Not enough tissue for recuts. 9. Tissue placed on wrong machine and improperly fixed. 10. Tissue is cut more then once for the same test. 11. Grossed too thick. 12. Tissue unfixed. 13. Tissue too thick. 14. Tissue not placed in the proper processor. 15 Little fixation time when cases are ordered too late. 16. Tissue too large. 17. Put on wrong procesor. Blocks 1. Not filed orderly to pull for recuts. 2. Blocks not labeled correctly or missing information. 3. Label, mislabeled or no label. 4. Incorrect labeling. 5. Tag missing from the cassette for tissue embedding. 6. Inproperly labeled. 7. Incorrect number of blocks dictated under gross description. 8. Not filed in a timely manner. 9. Parts A and B must travel together. 10. No indication if more then one go to together. A & B. 11. Mislabeled. 12. Not enough labels or too many labels. 13. Incorrect numbers or levels. 14. Not filed in a timely manner. Tests 1. Tests are not always ordered correctly. 2. Ordered tests do not always show up on the list. 3. Incorrect or not enough test initially ordered. 4. Special stains are ordered before the block in histology. 5. Pre order stains/recuts prior to prior to receiving in the department. 6. Improper forms are filled out. 7. Orders not clear.

70 How People Connect How People Connect Who are your customers? What is the form or quantity of goods or services to be provided? What is the expected time frame?

71 Direct Connection Direct Connection Customer-supplier relationship Customer Supplier Customer states requirements and supplier responds by meeting those requirements

72 Rule 3: Pathways Rule 3: Pathways The pathway for every product & service must be- Predefined Highly specified, Simple Direct with no loops or forks histology pathologist loop fork molecular pathologist pathologist histology molecular pathologist

73 The : LEAN Process Redesign Improves Service in the Molecular Diagnostic Laboratory Journal of Molecular Diagnostics, Vol. 11, No. 5, September2009

74 Goods and services do not flow to the next available person or machine but to a specific person or machine.

75 Rule 4: Improvement is Highly Specified Rule 4: Improvement is Highly Specified Any improvement must be made in accordance with- the scientific method (data driven) under guidance of a teacher Team or Group Leader, Quality Facilitator at place where work is done moving incrementally toward the ideal

76 Where the Work is Done Where the Work is Done Improvement discussions held for 20 minutes a few days a week

77 Q & A Q & A