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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
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