KAIZENTM / Lean - Expedient in Health Service?yalin.medikabil.com/2017/dokuman/2-ACarsten Otto 01.pdf · Kobetsu KAIZENTM Board 5N Analizi ... Assessment in tree Hospitals in Ankara,

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KAIZENTM / Lean

- Expedient in Health Service? -

Structure, needed Activities,

Resources and Benefit

Carsten Otto

March 24th 2017

© Kaizen Institute

Content

page 2Concept developed from Carsten Otto

© Kaizen Institute

Content


© Kaizen Institute 4Concept developed from Carsten Otto

1. Why Kaizen in the Hospitals?

a) Kaizen Institute has experience in hospitals in many countries (e.g. Germany,

Japan, Turkey, Kuwait, Portugal etc.).

b) The hospital-specific workflows are well known.

c) Kaizen Institute has a labour science based structure what we customize on

the specific needs from our client

Natural Science (Medicine) Social Science (Engineering)

a Anamnesis Assessment

b Diagnosis Deep Dive Analysis

c TherapyUsing of defined KAIZENTM Tools like

tablets, treatments, surgery etc.

d Convalescence/Rehabilitation Coaching, Monitoring, Support

e PreventionSustain of the new Standards and

Procedures

© Kaizen Institute

Content


© Kaizen InstituteConcept developed from Carsten Otto page 6

2. Guiding Principles – Success Factors

8-Step-Strategy for Improvement of the processes in the Hospitals

© Kaizen Institute

Together with the Management is to define:

1. The concrete Targets, Demands and Expectation from Management of the

hospital

2. All Do’s and Dont’s as Guideline

3. Confirmation of the Members of the “Core Team”

4. Standards and Procedures for optimal Project Organization (Responsibilities,

Sequence and Content of Project meetings, Escalation steps etc.)

Concept developed from Carsten Otto page 7


8-Step-Strategy for Improvement of the processes in the Hospitals – Step 1

© Kaizen Institute

Following structure to become a “World Class Hospital” with a KAIZEN Award is

recommendable:

a) Start with ED

b) Crossing interface to image procedures

c) Process improvement in the image procedures

d) Crossing interfaces to the different wards (sequence has to be defined)

e) Process improvement into the wards

f) Crossing interfaces to administration and support services

g) Process improvement in administration and support services




5N1K.ppt

© Kaizen Institute

Kobetsu KAIZENTM Board

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../../../../Documents and Settings/eturgut/Local Settings/Temp/2.1.12 Decision.ppt

../../../../DOCUME~1/eturgut/LOCALS~1/Temp/PDCA.ppt




© Kaizen Institute

Before Start with a Ward, ONE day as Kick-Off is needed.

Content of this “Kick-Off-Day” is:

a) Introduction and Creation of a “common Language”

b) Walk through all medical Department (Gemba)

c) Definition of Core Team from Ward-side

d) Development of the Agendas

e) Clarifying of Organization (Rooms, needed Resources etc.)




© Kaizen Institute

Following the described Procedure (Assessment-Diagnosis-Using of KAIZEN etc.) we

will start in each Area with an Assessment.

This Assessment will analyze the whole Area (all Layout, Offices, Interfaces, Workplace

Organization, Support Services etc.) and will need two days per area.

Result are clear defined Potentials (in time, resources) and a concrete schedule how

save this Savings (“Sub-Masterplan”) on Ward-Level.




Assessment 3 Hosp V06.pptx

kaizen.com

Assessment / Health Check in- Ankara Egitim Arastirma Hastanesi

- Dr. Sami Ulus Kadin Dogum ve Arastirma Hastanesi Ankara

- Numune Egitim Arastirma Hastanesi Ankara

Potentials and Proposal for Solutions

15.10.2015

Agenda

© Kaizen Institute

1. Introduction

Who is the Team?

Carsten Otto

Account Director

KAIZENTM Institute Global Operations

page 13Assessment in tree Hospitals in Ankara,

15.10.2015

Fevzi Cem Samli

Senior Consultant

KAIZENTM Institute Turkiye

Umit Guneslik

Senior Cnsultant


Meryem Findik Celik

Senior Consultant


Deniz Gursoy

Country Manager


Gülcan Cakir

Planning and Development Manager


Yuksel Bayrak

Senior Consultant


© Kaizen Institute

4. Results in Egitim Arastirma Hastanesi

page 14

Study of Investigation

38 Proposals for 33 Problems

© Kaizen Institute



15.10.2015

Heijunka Board for

Balancing fromPatient

Proposal for

new Layout

Proposal for

Solutions (1)

Proposal for

Solutions (2)

First Solutions after Investigation

© Kaizen Institute

4. Results in Egitim Arastirma HastanesiThe Hospital gave as all Support and Recourses what we need. “Thank You!” for that.


15.10.2015

© Kaizen Institute

Recommendation for the next steps


15.10.2015

For the next Steps in Egitim Arastirma Hastanesi Hospital we propose:

This Hospital should be part of the “Start up Hospitals” (see Page 60)

Start should be KAIZENTM Improvement in the Emergency Department

a) 1st Step: “5S”

b) 2nd Step: “Development of the Heijunka Board for Patient Balancing”

c) 3rd Step: “Improvement and Standardization of the Interface (from Incoming

Patient until final Report)”

d) 4th Step: “Improvement of the Flow from the Patient and of Documentation”

e) 5th Step: “Improvement of Layout and Workplace Design”

f) 6th Step: “Improvement of Logistics (all needed Materials and Information)”

g) 7th Step: “Improvement of the Availability of the Equipment

h) Continuous: Solving of the founded Problems during Assessment


© Kaizen Institute

Based on the Result of the Assessment and the “Sub-Masterplan” of each Area

an “individual Therapy” will be defined.

In that Step we take each Problem/Potential will be solved by Finding and

Elimination of the Root Causes with Kaizen Methods.

Result of this Step are concrete Solutions, clear Action Plan and a Plan of

Implementation.

That Step is related to the specific Problems and for the concrete Area

customized. People from the hospital will be involved.




© Kaizen Institute

After development of Solutions for Elimination of the Root Causes for Problems

focus’ that Step the concrete Realization and Implementation.

That Step is realized at the Gemba directly in close Cooperation with the involved

People of the Hospital.

That “Therapy” is also related to the specific Problems and for the concrete

Area/Ward customized.

Here are an overview about the Triage-Structure, what’s to do an the example of the

“Canadian Triage and Acuity Scale (CTAS) or “Manchester-Triage-System (MTS)” or

“Emergency Severity Index (ESI)” or “Australasian Triage System” (ATS)




CTAS.pptx

© Kaizen Institute page 20Presentation name, date

CTAS – Canadian Triage and Acuity Scale

Level II Emergency within 15 minutes

Level III Urgency within 30 minutes

Level IV Less Urgency within 60 minutes

Level I Resuscitiation See patient immediately

Level V Non Urgency within 120 minutes

© Kaizen Institute page 21Presentation name, date


Time to NURSE and PHYSICIAN Assessment

IMMEDIATE

TRIAGE LEVEL 1

RESUSCITATION

© Kaizen Institute


page 22Presentation name, date

Time to NURSE Assessment - IMMEDIATE

Time to PHYSICIAN - 15 MIN

TRIAGE LEVEL II

EMERGENT

© Kaizen Institute




30 MIN

TRIAGE LEVEL III

URGENT

© Kaizen Institute




60 MIN

TRIAGE LEVEL IV

LESS URGENT

© Kaizen Institute




120 MIN

TRIAGE LEVEL V

NON URGENT

© Kaizen Institute



Who is involved and „touched“?

Physicians

Nurses

Med. – techn. Staff

(Imaging procedures, Laboratories etc.)

Pharmacy

Service Staff (Maintenance etc.)

Logistics

Administration

© Kaizen Institute



…but what can we see very often?

Physicians

Med-tech

Staff

Admin

Nurses

Pharmacy

Service

Staff

Logistics

…different „black boxes“

…each box in an „other colour“

…not defined, not intelligent interfaces (BSI)

© Kaizen Institute



How to do?

Team

„ER Physicians/Nurses“

Med-tech

Staff

Admin

Pharmacy

Service

Staff Logistics

Order

Service

Order

Service

Ord

er

Se

rvic

e

Ord

er

Se

rvic

e

Ord

er

Se

rvic

e

1. One ER „Client“ with a clear defined

„colour“

2. Different „Supporter“ in the same common

colour

3. Clear defined Interfaces with clear defined

„Customer-Supplier-Relationship“ with

using of the 5W1H-methodology

- who?

- what?

- when?

- where?

- which?

- how

© Kaizen Institute



How to do?

1. All procedures were related on medical art and nursing

competence has to be defined from the team

„Physicians & Nurses“ and is part of natural science

2. All procedures were related on functional services has to be defined

from the teams „All functional services” and is part of natural science

3. All definitions how this special procedures must be connected comes

from the team „Engineering“ and is part of labour science

4. The guideline to define and connect all procedures defined in

pt. 1-3 is defined in CTAS

© Kaizen Institute



How to do?

…But…

ONLY as interdisciplinary team can all involved persons succeed

…the certification is a result of that, not more…




“Emergency Severity Index" defined a

Structure and a Procedure for a

failure-free Initial-Indication

© Kaizen Institute

How works Manchester-Triage-System (MTS)”? (1)

Manchester-Triage-System (MTS) is a standardized Procedure for initial

Investigation in an Emergency, developed in Manchester/GB 1995.

Target of MTS is to build a Consensus between Emergency Doctor and Nursing

Staff as additional Standard to the existing Standards of clinical Triage (e.g.

Emergency Severity Index).

Focus of MTS are Kinds of Discomfort and Main Indication.

Main Indications are „Danger to Life“, „Degree of Pain“, „Quantity of Blood

Loss“, „State of Consciousness“, „State of Temperature“ and „Length of

Sickness“.




© Kaizen Institute


MTS define maximum Waiting Times in five Categories.

Group Indication Color Max. Waiting Time

1 Immediately Red 0 min

2 Very urgent Orange 10 min

3 Urgent Yellow 30 min

4 Normal Green 90 min

5 Not urgent Blue 120 min




© Kaizen Institute


Mackway-Jones & Marsden & Windle (2011)

Red

Orange

Yellow

Green

Blue

yes• Andangered Airway?

• Inadequate Breathing?

• Shock?

yes• Acute neurological deficit?

• Striking Mechanism of Injury?

• Child with high Temperature?

• Adauld with very high Temperature?

• Abdominal Pain?

• Strongest Pain?

no

yes• Fresh neurological Deficit?

• Direct Back Trauma?

• Unable to walk?

• Adauld with high Temperature?

• Colicky Pains?

• Mismatching History?

• Moderate Pain?

yes• Younger Problem?

• Younger slight Pain

no

Immediately

Very urgent

Urgent

Normal

Not urgent




© Kaizen Institute


MTS is used in Australia, Brasil, Germany, Irland, Italy, Japan, Canada, Mexiko,

New Zealand, Nederland, Norway, Austria, Portugal, Sweden, Swiss, Spain,

Tansania.

I recommend a special, customized „KOC-Triage-System“ with best points from

a) ESI (Emergency Severity Index)

b) MTS (Manchester Triage System)

c) CTAS (Canadian Triage and Acuity Scale)

d) ATS (Australasian Triage Scale)




© Kaizen Institute

Once a Month should be a “Follow up Workshop”.

Content will be:

1. Status Check

2. Degree of Realization of defined Actions

3. Adjustment

4. Additional support

5. Audit after three Month




© Kaizen Institute

To guarantee a stable Sustainment is it necessary to educate OWN Employees in

the KAIZENTM Methodology. This Step create an own KAIZENTM Way and make

the Hospital independent from external Consultants.

KPI are:

1. for 250 Employees a Hospital need 1 full Time “KAIZENTM Manager”

2. For 25 Employees a Hospital need 1 “Process Facilitator”.

This Person spends 10%-20% from his/her Time for Continuous Improvement.




© Kaizen Institute

In that Step the Hospital is able to manage, to control and to monitor the own

KAIZENTM Process with own educated Employees.

If support of KAIZEN Institute is needed for further Steps, must be defined at

that time.





Possible Results

Done in World Class Companies


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