Lean – an Integrated Simulation and Introduction Dean Bliss Iowa Health System WCBF 9 th Annual Lean Six Sigma And Business Improvement in Healthcare Summit
Jun 19, 2015
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