Lean Healthcare Overview UM HCS Orientation What is Lean

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Lean Healthcare Overview

• UM HCS Orientation

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What is Lean?

• Originated in the Toyota Production System (TPS)
• Strives to eliminate waste so that all work adds
  value and meets the customers requirements
• Identifies value-added and non-value-added steps
  in every process
• Creates good flow

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Lean Thinking

• The endless transformation of waste into value
  from the customers perspective.
• Womack and Jones, Lean Thinking

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Lean Thinking Means That Operators

• Own the process, and ensure its continuous
  improvement
• Breakdown functional silos
• Standardize work processes
• Demand first time quality
• Understand and use lean metrics
• Make waste / problems visible
• Identify and eliminate the root cause of problems

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Toyota Philosophy
Process Thinking at Toyota

• Brilliant process management is our strategy
• We get brilliant results from average people
  managing brilliant processes
• our competitors often get average (or worse)
  results from brilliant people managing broken
  processes.

Toyota Observes that
Toyota President Cho
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TPS Lean House
Best Quality ? Lowest Cost ? Shortest Lead time
Just-In-Time Right part Right time Right amount
Built-In-Quality Never accept, built, pass-on a
defect
Highly Motivated People
Leveled Production ? Standardized Work ? Visual
Management Continuous Improvement
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How To Apply Lean Thinking to Healthcare
Processes

• Although manufacturing principles apply, details
  differ
• In manufacturing, the process itself is visible,
  thus easier to see, study and improve. Healthcare
  processes are not as visible
• Difficult to identify customer, supplier, product
  or service, and value
• Difficult to understand the relationship of work
  and information flow

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Michigan Quality System Concept

• Create
• a health system-wide consistent approach to
  quality and process improvement adapting the
  principles of the Toyota Production System
  building on CQI PDCA base
• Incorporate 4 goals of Michigan Value
• Quality
• Safety
• Efficiency
• Appropriateness

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MQS
Michigan Quality SystemSafe - Effective -
Efficient - Patient-Centered - Timely - Equitable
Health Care

Just-in-Time
Built-in-Quality

• Right Care,
• Right Time,
• Right Setting
• Exactly
• what is needed,
• when it is needed,
• where it is needed

Pursuing Perfection Dont Make, Accept,
or Send on an Error
Customer Defines Value
LeveledWorkload
Continuous Improvement (PDCA) and Learning
Standardized Work
Make Value Flow by Eliminating Errors and Waste
Sources J. Shook, J. Billi, J. Liker, S. Hoeft,
Park-Nicollet /jmk 03.19.07
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Lean Tools
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5S Process Purpose

• 1. To learn how to identify and eliminate waste
• 2. To improve your work environment
• - Safety
• - People
• - Quality
• - Responsiveness
• - Cost

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Visual Workplace The 5 S's
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The 5 Ss Visual Workplace

• 1. Sort Sort through items, keep only what is
  needed while disposing of what is not.
• 2. Straighten (orderliness) A place for
  everything and everything in its place.
• 3. Shine (cleanliness) The cleaning process
  often acts as a form of inspection that exposes
  abnormal conditions.
• 4. Standardize Develop systems and procedures
  to maintain and monitor the first three Ss.
• 5. Sustain (self-discipline) Maintaining a
  stabilized workplace in an ongoing process of
  continuous improvement.

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The 5S Numbers Game
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Game - Current

• This sheet represents our current work place.
• Our job during a 20 second shift, is to strike
  out the numbers 1 to 49 in correct sequence.
• Example 1 2 3
• The team score will be represented by the lowest
  individual score achieved.

The Value of Workplace Organization
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Game Page 1
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VAS Cart/Drawers before 5S
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VAS Drawers before 5S
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Why do we Sort?

• Eliminate unnecessary items
• Free floor space to organize necessary items
• Reduce inventories
• Free resources

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Game - Sort

• For our first action, we are going to implement
  5S in this area.
• The first step of this is Sort and so we have
  removed from the area all the numbers from 50 to
  90 which are not needed.
• Same rules apply. Strike out numbers 1 to 49 in
  sequence during a 20 second shift.

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Game Page 2
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Why do we Straighten?

• Enables sharing tools, equipment, and supplies
• Identifies excess inventory
• Easy to see
• Easy to get
• Easy to return

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How Do We Straighten?

• Visually inspect area ask
• Why are items located where they are?
• Are there items that arent needed?
• Are tools and equipment easy to see, easy to get
  and easy to replace?
• Is there closed storage where open would be
  appropriate?
• Frequently used items should be easy to get
• Arrange items for orderly appearance
• Arrange clean as you go

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Why Do We Sweep?

• Improves safety
• Boosts morale
• Cleaning is inspecting

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Game - Straighten Sweep

• Having achieved some improvement, we now need to
  move onto the next step Straighten Sweep.
• We have installed some racking, and we have
  organized the items so that the numbers are
  located from left to right and bottom to top
  examples 1 in the bottom left, 2 in the middle
  left, and 3 in the top left.
• Same rules apply 20 second shift, lowest
  individual score equals team score etc

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Game Page 3
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Why Standardize Make Visual
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Standardize and Make Visual

• Make placement of equipment and tools visual
• Labels
• Yellow tape on floor for items that move
• Green tape on walls, desks, tables
• Storage areas marked
• Supply shelves labeled
• Green signs for locations
• Pink signs for instructions
• Pull cards for supplies
• Reorder process
• Reorder point

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Workplace Organization
To put order to and maintain the workplace
by making out of standard conditions readily
visible.
Situation
Action

• You label the location of tools in your copy
  room. You know, at a glance, when something is
  missing. The only tools and supplies available
  are the ones you need, all excess is removed.

• Common areas where many employees use equipment
  can be problematic. Employees do not have time
  to waste looking for staplers, tape, etc.

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Office 5S WorkshopCopier Supply Room
Before
After
Closed versus Open Storage
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Game Standardize

• Since we are dealing with numbers 1 to 49 in
  sequence, it seems logical to re-organize them in
  a standard way that makes the completion of the
  work task as easy as possible.
• This should ensure that everyone is able to
  complete the task (and therefore produce a team
  score of 49.)

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Game Page 4
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Why Sustain?

• Promotes a safe work environment
• Maintains the area to the standard
• Promotes good habits and discipline

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Game - Sustain

• Returning to our original work area, we have for
  this assignment two numbers missing. We cannot
  complete the task without these numbers - so
  first we have to find them.
• Start a clock running and every 20 seconds, tell
  them how many shifts they have been down
  looking for the appropriate numbers.

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Game Page 5
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Game Sustain (2)

• Now how much easier is it to find the quality
  problems (i.e. missing numbers)?
• The value of Work Process Order is to allow us to
  quickly see abnormalities (out of standard
  conditions)

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Game Page 6
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Sustain (Maintenance Inspection)

• Develop post Standardized Work Sheet.
• Assign post Total Productive Maintenance (TPM).

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VAS Drawers after 5S
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Waste

• Any element of production, processing, or
  distribution that adds no value to the final
  product
• Waste only adds cost time

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Do More With Less?
Reducing headcount does NOT result in increased
productivity . . .
. . . reducing WASTE leads to increased productivi
ty!
Lean Mean
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Shift Mindset
CURRENT THINKING
NEW THINKING
Correction
Processing

C
P
Over Production
Inventory
TYPES OFWASTE
O
I
WASTE
M
W
M
Motion
Waiting
Material Movement
COMMWIP
WASTE NOT DEFINED REACT TO LARGE
EXAMPLES REACTIVE IMPROVEMENT
WASTE IS "TANGIBLE" IDENTIFY MANY SMALL
OPPORTUNITIES LEADS TO LARGE OVERALL CHANGE
Continuous Improvement
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Healthcare Waste

• Correction order entry errors
• Overproduction needless hardcopy
• Motion poor workplace layout
• Material movement moving storing paperwork
• Waiting computer downtime, transaction batching
• Inventory filled in-boxes
• Processing translating written orders

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Tips for Helping Identify Waste

• Simple items to look for to help identify waste
  in a value stream
• Low FTQ (First Time Quality)
• Long wait times as compared to process times
• Process steps requiring multiple
  iterations/reviews rework
• Excessive handoffs between people/organizations

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Lean Thinkingin Summary

• Specify value from customers perspective
• Identify the value stream for each product, and
  remove the waste
• Make value flow without interruptions from
  beginning to end
• Let the customer pull value from our process
• Pursue perfection - continuous improvement
• Do this every day in all our activities

Source Womack Jones Lean Thinking