Mark Graban - HIMSS Graban • President, ... • Faculty, Lean Enterprise Institute Author, Lean Hospitals: Improving Quality, Patient Safety, ... Slide 1 Author: Dave LaHote ...
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“How Lean Thinking Helps Hospitals”
Mark Graban • President, Constancy, Inc.
• Chief Improvement Officer, KaiNexus
• Faculty, Lean Enterprise Institute
Author, Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement
(2nd edition, November 2011)
Healthcare Kaizen
(To be released April 2012)
© 2011, Constancy, Inc., All Rights Reserved
Henry Ford - 1922
“In the ordinary hospital the nurses must make useless
steps. More of their time is spent in walking than in
caring for the patient.”
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Fast Forward to 2005-2008
What % of time do “med/surg” unit RNs spend directly with patients?
A: 21%
B: 33%
C: 50%
D: 65%
New Zealand: 33% VMMC: 32% UK: 34% Illinois: 31% Cinci Children’s 29%
It is possible to double this time with patients More time to do the “right things”
3
© 2011, Mark Graban, author of "Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement (2nd Ed.)"
5
*Warning: requires effort and leadership (not a silver bullet)
© 2011, Mark Graban, author of "Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement (2nd Ed.)"
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Management System
Philosophy
Culture
Thinking
Mindsets
5S
Kaizen
Std Work Kanban
VSM
A3
?
?
Dr. Jacob Caron, Orthopedic Surgeon
Chairman of the medical staff
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Stop Jumping
Through Hoops
(Reduce Waste)
The 8 Types of Waste
Type of Waste Example
Defects Wrong medication given to patient
Overproduction Specimens delivered in huge batches
Transportation Patient walking football fields between oncology clinic and chemotherapy
Waiting Patients waiting in E.D.
Employees waiting on work to do
Inventory Expired medications, excess O.R. variation
Motion RN’s walking 5 miles per day
Processing Unnecessary MRI’s when P.T. might work
Human Potential Med Techs recapping specimens
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Learning to See Waste
Quick Countermeasures Restocking Checklist
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Silos. Are. Bad.
Typical Department Silos
Oncology Clinic A
Oncology Clinic B
Oncology Clinic C
Chemotherapy Treatment
Radiation Treatment
ThedaCare “Door to Balloon” Time
91
65
52 37 37 45
0
10
20
30
40
50
60
70
80
90
100
2005 2006 2007 2008 2009 2010
Improving Radiology /MRI Access Time
0
2
4
6
8
10
12
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We
ek
s W
ait
ing
Tim
e
Outpatient Radiology Backlog
Process for Value Stream Mapping
Discharge Process Value Stream Map – Current State
• Patient discharge process (2 day VSM activity)
– Nursing, Medical Social Worker, Case Management, Patient Care Coordinator, IS, Bed Management, Chief Medical Officer
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Avoid Blame
The Quaid Case – Heparin/Hep-Lock
Hospital CMO:
“This was a preventable error, involving a failure to follow our standard policies and procedures, and there is no excuse for that to occur at Cedars-Sinai.”
Was this the first time the policies and procedures were not followed?
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Darrie Eason Case
"[The CEO] said the technician responsible for the mix up also no longer works there."
A Different Hospital Lab…
“It’s OK, my people are very careful!”
3 Different Patients - Batched
23 Problems Are Treasure
Yes to Suggestions, No to Boxes!
Visual Idea Board
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Completed Idea Card
Kaizen “Wall of Fame”
Value of Kaizen in a Hospital
• $4,000 per employee (Toyota benchmark)
• $2,000 per employee (Franciscan St. Francis)
• What about benefits from:
– Better Quality
– Morale
– Patient Satisfaction
– Less Waiting Time
= $$ ?
Data From Children’s Medical Center Dallas
Before Lean 12 Months
After Starting
3. I have the opportunity to do what I do
best every day. 3.11 3.92
8. I feel free to make suggestions for
improvement. 2.84 3.48
10. I feel secure in my job. 2.32 3.42
13. Stress at work is manageable. 2.43 3.23
17. I am satisfied with the lab as a place to
work. 2.51 3.43
18. I would recommend my work area as a
good place to work to others. 2.38 3.46
Grand Average 2.96 3.69
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No Tradeoffs
Why Lean for Healthcare?
No waiting
No waste
Zero harm
Source: an NHS hospital, UK
• 90% reduction in CR-BSI in MICU and Oncology
• Saved $1.7M
• Saved 17 days L.O.S. per case 32
Source: Dr. Richard Shannon
ThedaCare Coronary Bypass Improvement
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1
Lean Benefits All Stakeholders
Patients
Caregivers • Employees • Medical Staff • Administrators
Hospital
• Safety & Quality • Caring Encounters • Less Waiting and Delay
• Mission • Stewardship • Stability / Growth
• Pride in work • Less frustration • Job security • Career growth
Philosophy
People
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Q&A / Contact Info
• Email: mark@LeanBlog.org
• Blog: www.LeanBlog.org
• Twitter: www.twitter.com/LeanBlog
• Books:
– www.LeanHospitalsBook.com
– www.HCkaizen.com (pre-launch)
• www.LeanBlog.org/KaizenPreview
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