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Lean Healthcare Overview UM HCS Orientation What is Lean

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Title: Lean Healthcare Overview UM HCS Orientation What is Lean


1

Lean Healthcare Overview
  • UM HCS Orientation

2
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

3
Lean Thinking
  • The endless transformation of waste into value
    from the customers perspective.
  • Womack and Jones, Lean Thinking

4
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

5
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
6
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
7
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

8
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

9
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
10
Lean Tools
11
5S Process Purpose
  • 1. To learn how to identify and eliminate waste
  • 2. To improve your work environment
  • - Safety
  • - People
  • - Quality
  • - Responsiveness
  • - Cost

12
Visual Workplace The 5 S's
13
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.

14
The 5S Numbers Game
15
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
16
Game Page 1
17
VAS Cart/Drawers before 5S
18
VAS Drawers before 5S
19
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20
Why do we Sort?
  • Eliminate unnecessary items
  • Free floor space to organize necessary items
  • Reduce inventories
  • Free resources

21
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.

22
Game Page 2
23
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24
Why do we Straighten?
  • Enables sharing tools, equipment, and supplies
  • Identifies excess inventory
  • Easy to see
  • Easy to get
  • Easy to return

25
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

26
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27
Why Do We Sweep?
  • Improves safety
  • Boosts morale
  • Cleaning is inspecting

28
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

29
Game Page 3
30
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31
Why Standardize Make Visual
32
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

33
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.

34
Office 5S WorkshopCopier Supply Room
Before
After
Closed versus Open Storage
35
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.)

36
Game Page 4
37
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38
Why Sustain?
  • Promotes a safe work environment
  • Maintains the area to the standard
  • Promotes good habits and discipline

39
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.

40
Game Page 5
41
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)

42
Game Page 6
43
Sustain (Maintenance Inspection)
  • Develop post Standardized Work Sheet.
  • Assign post Total Productive Maintenance (TPM).

44
VAS Drawers after 5S
45
Waste
  • Any element of production, processing, or
    distribution that adds no value to the final
    product
  • Waste only adds cost time

46
Do More With Less?
Reducing headcount does NOT result in increased
productivity . . .
. . . reducing WASTE leads to increased productivi
ty!
Lean Mean
47
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
48
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

49
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

50
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
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