Lean An Integrated Simulation and Introduction

Lean – an Integrated Simulation and Introduction

Dean Bliss

Iowa Health System

WCBF 9th Annual Lean Six Sigma

And Business Improvement in Healthcare Summit

A little about me…

Where did Lean come from?

1990 1996

What is Lean?

� “Lean provides a way to specify value, line up value-creating actions in the best sequence, conduct these activities without interruption whenever someone requests them, and perform them more and more effectively.”

� “Lean thinking also provides a way to make work more satisfying by providing immediate feedback on efforts to convert muda (waste) into value.”

- quotes from Lean Thinking, by James Womackand Daniel Jones (1996)

So How Does This Work?

� Have a vision and case for change

� Understand where you are

� Decide where you want to be

� Define the gaps

� Plan your improvements

Leadership determines the success or failureof any Lean initiative

Keys to Success

� Those who do the work should be those who develop the new process

� Involve all affected stakeholders

� Don’t settle for the “easy” stuff

� Have resources available

� Do what we say we are going to do

� Make changes now

But what kinds of things are we looking for?

7 Forms of Waste

7 Forms of Waste

Time spent waiting on items required to complete task(i.e., Information, Material, Supplies, etc.)

1. Waiting

7 Forms of Waste

Any motion that does not add value to the product or service

2. Excess Motion

7 Forms of Waste

Transporting information or Material by mail, cart,conveyor or foot travel

3. Moving Items

7 Forms of Waste

Time spent repairing or reworking material or information

4. Fixing Defects

7 Forms of Waste

Producing more information or product than theultimate customer requires

5. Over Production

7 Forms of Waste

Material or Information that is waiting for processing

6. Inventory

7 Forms of Waste

7. Over Processing

Effort and time spent processing information or material that is not adding value

APPROVED

APPROVEDAPPROVEDAPPROVEDAPPRO

VEDAPPROVEDAPPROVEDAPPROVED

Lean Tools

� Defines value from the customer’s perspective

� All of the actions and tasks, both value added and non-value added, required to bring an item (an idea, information, product or service) from its inception through delivery.

� Mapping the process brings common understanding and the ability to see weaknesses that can be corrected/improved

Value Stream Mapping

Value Stream Map - Emergency Room

Wait

Out Patient

RegistrationTaken to ER

Room

Nurse Examines

Patient

Doctor Examines

Patient

Nurse brings Medical Supplies

Doctor Treats Patient

Patient Goes Home

Patient Hospital Records

Attending Nurse

Attending Physician

Material Flow

Information Flow

Go to Waiting

Area

Wait Wait Wait Wait

Insurance Company

Departing Instructions

Wait

Available Room

Patient history Vital Statistics

Patient history Vital Statistics

Treatment Information

Diagnosis & Supply Needs

Treatment Information

Insurance InfoNature of Injury

Patient history

Patient Info

Patient ready for Treatment

Patient history Vital Statistics

Diagnosis & Departing Inst.

Departing Instructions

Lean Tools

Standard Work

Represents the current best, easiestand safest way to do a job.

Lean Tools

Standard Work

Removing Variation and Variability

Using Best Practices Consistently

Lean Tools

Error Proofing

Murphy’s Law

How do we prevent defects from getting to our customers ?Error Proofing

Count the number of times the letter F appears in the following:

FINISHED FILES ARE THE RESULT OFYEARS OF SCIENTIFIC STUDY COMBINEDWITH THE EXPERIENCE OF YEARS.

Lean Tools

How do we prevent defects from getting to our customers ?Error Proofing

Count the number of times the letter F appears in the following:

FINISHED FILES ARE THE RESULT OFYEARS OF SCIENTIFIC STUDY COMBINEDWITH THE EXPERIENCE OF YEARS.

Lean Tools

Distance Traveled Chart

Step

1-2

2-3

3-4

4-5

5-6

6-7

7-8

8-9

9-10

10-11

2

6

1

4

8

11

10 3

9

Dist.12’

46’

12’

15’

43’

45’

17’

16’

36’17’

5

7

(spaghetti chart)

Lean Tools

U-Shaped Layout

Step

1-2

2-3

3-4

4-5

5-6

6-7

7-8

8-9

9-10

10-11

Dist.2’

2’

2’

3’

2’

3’

2’

2’

2’2’

7

(visual flow)

8

6

5

4 3 2 1

9 10 11

Lean Tools

Lean Tools

Visual Controls

Everyone can see what is happening

Lean Tools

Visual Controls – in a Parking Lotwhat happens when they aren’t there?

The Five S’s

� Sorting – separating the needed from the not-needed

� Simplifying – a place for everything and everything in its place, clean and ready to use

� Systematic Cleaning – cleaning for inspection

� Standardizing – developing common methods for consistency

� Sustaining – holding the gains and improving

Now…

� We’re going to see a demonstration of how this stuff works

� After the break, the Oldskool Medical Center will be open for business

So, does this Lean stuff work in Health Care?

� Yes – and here are several examples

Cancer Treatment Centers of America

� Chemotherapy medication

� Improved turn-around time for preparation, dispensing, and delivering medication orders by 37%

� Reduced process steps by 50%

ThedaCare

� Improvements in several areas:

� Increased Accounts Receivable cash flow by $8.1 million

� Reduced clinical documentation cycle time by 50%

� Improved phone triage times by 75%

Lean Healthcare West

� By improving the accuracy of medical records received by Billing from ED, reduced Accounts Receivable days from 99 to 42 – 57% improvement

� Reduced IV drip rate errors in ICU from 7 to 0 (3 month total)

Alegent Health Labs

� Created a work cell for automated tests, which are 96% of total volume

� Improved turn-around time by 64%

� Reduced floor space by 26% in the lab and 43% in the warehouse

� Reduced needed FTE’s by 20%

Note: No layoffs as a result of Lean improvements

Iowa Health Des Moines Lab

� Reduced lab turn-around times as follows:

� Troponin – 55 min. to 36 min.

� Hgb – 28 min. to 18 min.

� BNP – 59 min. to 30 min.

� Reduced needed FTE’s by 15%

U of I Hospital & Clinics

� CT Scan Improvements

� Increase capacity from 64 to 84 patients per day – 31% improvement

� Patient Experience average time reduced from 1:54 to 1:16 – 33% improvement

St. Luke’s Hospital – Cedar Rapids

� Reduced nurse’s walking distance for admission & triage of expectant mothers by 37 miles per month

� Supplies in ED

� Reduced inventory by 20%

� Standardized supply locations in exam rooms

This isn’t magic

� The concepts and practice of process improvement aren’t

� Rocket science, or

� Brain surgery, or

� Quantum physics

� With a little training and practice, anyone can do them

Rawlings video

So keep in mind…

� The 7 forms of waste

� The Lean tools

� The Lean vision

� “Learning to see”

� Willingness to change

� Continuous improvement

StdWork

Visuals 5 Whys

5SKaizen

RootCause

FMEA

PDSA VSM

ProcessImprovement

ISO-9000Lean Transformation Six Sigma

American Focus – big projects - need tangible results to justify approach

DailyImprovements

StdWork

Visuals 5 Whys

5SKaizen

RootCause

FMEA

PDSA VSM

ProcessImprovement

ISO-9000Lean Transformation Six Sigma

Toyota’s Focus – Everyday improvement that adds up over time

DailyImprovements

“Do what you can, with what you have, where you are.”

Theodore Roosevelt

“The things that matter most must never be at the mercy of things which matter least.”

Johann Wolfgang von Goethe

Questions?

Dean Bliss

Iowa Health Systems

Cedar Rapids, Iowa

515-979-9413

blissd2@ihs.org