An Introduction to Lean Healthcare

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An Introduction to Lean Healthcare

• Irish Society of Audiology
• Annual Conference
• October 2nd 2009
• Presented by Jim Collins BSc, MBA
• jim_at_ahearnecollins.ie

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5 Lean Principles

• Define Value from the end customer - patients
  view!
• Identify all steps in Value Stream eliminate
  waste
• Ensure a continuous and even patient Flow
• Trigger this patient flow using Pull rather than
  push
• Start implementing change and always pursue
  Perfection

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Lean in Healthcare

• Lean thinking is not a manufacturing tactic
  or a cost-reduction programme, but a management
  strategy that is applicable to all organisations
  because it has to do with improving processes.
• All organisations including healthcare
  organisations are composed of a series of
  processes or sets of actions intended to create
  value for those who use or depend on them
  (customers/patients).
• (IHI Going Lean in Healthcare 2005)

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A Look At Irish Healthcare
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What Healthcare Professionals want to say

• Administrators
• Yes your appointment is running on time
• Nurses
• Yes we have a bed for you right now
• Surgeons
• Scalpel!

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Currently Staff Learn.
To work around the problems
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Currently Patients Learn.

• To be Patient!

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Lean in Healthcare

• Mid-1990s, the Big 3 auto companies starting
  bringing lean into healthcare.
• Healthcare costs were more than the seats,
  engine, or anything else in their vehicles.
• Into insurance companies and hospitals.
• Dozens of hospitals began running kaizen
  workshops on everything from waiting rooms to
  surgical units.

• Championed by US Institute for Healthcare
  Improvement (IHI)
• Large Scale collaborative programmes since late
  1990s in US, Europe and Australia
• Widespread deployment across UK healthcare sector
  since early 2000s

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Why use Lean ?

• Reduced turnaround time for clinical laboratory
  results by 60 without adding headcount or new
  instrumentation Alegent Health, Nebraska
• Reduced patient waiting time for orthopaedic
  surgery from 14 weeks to 31 hours from first call
  to surgery
• Thedacare, Wisconsin
• Reduced patient deaths related to
  central-line-associated blood stream infections
  by 95
• Allegheny Hospital, Pennsylvania
• Saved 7.5 million from Lean Rapid Improvement
  Events in 2004 and reinvested the savings in
  patient care
• Park Nicollet Health Services, Minnesota

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Why use Lean ?

• Lean is a helpful framework because
• It provides an overall philosophy and a way of
  setting priorities
• It has a body of evidence-based tools and
  techniques
• There is a vibrant lean community, including
  many outside of healthcare, who are willing to
  share their experience and expertise
• It focuses on safety and quality from the
  patients perspective but enables these to be
  delivered at a lower cost.

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What Does it Look Like on the Ground? The
Practical Steps

• Being clear about value when seen from the
  patients and carers perspective placing a
  premium on safety and a high quality experience.
• Embedding this in the work of front-line staff
  and developing a culture which places safety and
  quality at the forefront and develops a practice
  of continuous problem solving and improvement.
• Organisation-level identification of key value
  streams (types of activity with common
  characteristics).
• Mapping processes to identify waste non-value
  add steps from the customers viewpoint.

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What Does it Look Like on the Ground? Practical
Steps ctd.

• Setting out the desired future state which
  eliminates/reduces non-value added activity.
• Running a cycle of intensive rapid improvement
  events, involving teams of frontline staff and
  service users, generating more detailed design,
  testing and implementation and retesting of the
  future state, in situ. These create a culture of
  rapid implantation and achievement which is not
  the norm in most healthcare settings.
• Measurement of changes.
• Agreeing plans for next step improvements to
  achieve future state a continuous cycle - to
  embed simple methods of observation and
  improvement in day-to-day delivery of care.

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Identify and Eliminate Waste
TIM WOOD
Master Muda Maker
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• Some early results from Bolton BICS

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Lean Healthcare activity in Ireland

• UL
• Primary, Critical Community Care
• VHI

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There really is another way
HERE is Edward Bear, coming downstairs now, bump,
bump, bump, on the back of his head, behind
Christopher Robin. It is, as far as he knows,
the only way of coming downstairs, but sometimes
he feels that there really is another way, if
only he could stop bumping for a moment and think
of it.
From A.A. Milnes Winnie the Pooh Series
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Questions ???