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Lean – is it generically applicable? Lean in different industries Lean in Healthcare in the U.S.

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Title: Lean – is it generically applicable? Lean in different industries Lean in Healthcare in the U.S.


1
Lean is it generically applicable?Lean in
different industriesLean in Healthcare in the
U.S.
Members TalkMay 10, 2011
2
Create a picture of your perfect factory
3
Excerpt from US New and World Report
What Medicine Can Learn From Business (U.S. News
World Report, June 17, 2008)
  • During the visit, a team led by Virginia
    Mason's chief of medicine met with a Toyota guru,
    a sensei who had absorbed the Toyota approach
    into his very marrow. Examining a layout of the
    hospital, the sensei learned that there were
    waiting rooms scattered across the campus.
  • "Who waits there?" the sensei asked.
  • "Patients," said the chief of medicine.
  • "What are they waiting for?"
  • "The doctor."
  • The sensei was told there might be a hundred or
    so such waiting rooms and that patients wait
    about 45 minutes on average.
  • "You have a hundred waiting areas where patients
    wait an average of 45 minutes for a doctor?" He
    paused and let the question hang in the air.
    "Aren't you ashamed?

4
Create a picture of your perfect factory
Why?
How do patients make Lean in Healthcare different?
5
Lean in HealthcareTypes of Customer Waste
6
Lean in other industries
7
Financial Services
Research from the Corporate Executive Board finds
that financial firms leveraging Lean techniques
achieve 20 percent to 40 percent cost reduction
in 12 to 18 months. Equally remarkable are
specific anecdotal results One of the worlds
largest financial institutions headquartered in
the U.S., increased credit card activation by 10
percent in one year, achieving 2 million in
additional revenue through increased card
utilization. A prominent national bank reduced
its wholesale lockbox (payment processing) unit
cost by 58 percent while reducing associate
handling time by 48 percent and errors by more
than 75 percent in only eight months.
By implementing the right Lean tools and
practices at each level of the organization, they
create a continuous improvement mindset
throughout the culture. For example, senior
leadership may leverage a value-stream vision
session event as a methodology to support the
continuous improvement goal of communicating,
translating and deploying a new retail mortgage
strategy. Middle managers may rely on Kaizen,
Business Reviews, and War Rooms to drive weekly
and monthly execution to operating commitments.
And first level managers and employees may use
MDI (Managing for Daily Improvement) tools,
Performance Boards, and Point Kaizens for daily
continuous improvement of existing
processes. Ultimately, most executives who have
experienced the transformative power of Lean note
how it provides a disciplined, repeatable way to
engage every employee to see their business from
a customers perspective, identify areas for
improvement and make changes rapidly. They say
the true power of Lean isnt just in the quick,
dramatic results, but in its ability to create a
sustaining, continuous improvement mindset
throughout an organization.
8
Examples
  • Cell manufacturing of CT scanners
  • Kanbans, Visual Instruction in factories
  • Factory lines synchronized to demand
  • Lean processing of payroll and benefits
  • Lean complaints processes
  • Early warning of equipment prior to break-down
  • Call centres using control charts to drive
    proactive action rather than wasted time later

9
  • BUT
  • How do patients make Lean in Healthcare different?

10
Lean in the US Healthcare System
11
Miami Childrens
http//www.youtube.com/watch?vbe1HsYhr82cfeature
youtube_gdata_player
12
Virginia Mason Production System
Virginia Mason's vision is to be the Quality
Leader in health care. This vision requires
adopting a paradigm shift from expecting errors
and defects, to believing that the perfect
patient experience is possible. Key to
accomplishing this is understanding that staff
who do the work know what the problems are and
have the best solutions. VMPS strategies range
from small-scale ideas tested and implemented
immediately to long-range planning that redesigns
new spaces and processes. VM uses several
continuous improvement activities, such as Rapid
Process Improvement Workshops (RPIWs) and kaizen
events focused on incremental changes, as well as
3P workshops intended to completely redesign a
process. VM has held 850 continuous improvement
activities involving staff, patients and guests.
  • Patients spend more value-added time with
    providers, and VMPS helps providers deliver the
    best possible care. 
  • Patients benefit from greater safety, less delay
    in seeing physicians for care and more timely
    results and treatments. 
  • VM staff benefit by having less rework and
    greater opportunities to care for patients - one
    of the primary reasons many choose health care as
    a profession. 
  • The reduction of waste in administrative
    processes that support patient care but take
    valuable resources ultimately benefits customers.
    As a nonprofit organziation, savings are
    reinvested to support VM's mission to improve
    patient health and well-being.

13
Virginia Mason Continued
We have had many successes with VMPS. Below are a
few examples of how VMPS has improved the quality
of patient care. PSA System Improves Patient
SafetyVirginia Mason used VMPS to develop a
Patient Safety Alert (PSA) system requiring all
staff who encounter a situation likely to harm a
patient to make an immediate report and cease any
activity that could cause further harm. If the
safety of a patient is indeed at risk, an
investigation is immediately launched to correct
the problem. From the program's inception in 2002
through 2009, 14,604 PSAs were reported. Most
reports are processed within 24 hours a
significant improvement from when reports took
three to 18 months to resolve. Patient safety at
VM has increased and professional liability
claims have dropped. One-Stop Care for Patients
with CancerUsing VMPS, the Floyd Delores Jones
Cancer Institute at Virginia Mason was redesigned
with a laboratory and pharmacy inside,
elimininating the need for patients to travel
throughout the hospital for chemotherapy. Now,
all cancer services are brought directly to the
patient in his or her private treatment room. For
one patient, this reduced the length of a
chemotherapy visit from 10 hours to two and saved
about 500 feet of walking at each visit. Getting
Back to NursingIn most hospitals, nurses spend
about 35 percent of their time in direct patient
care. With VMPS, VM nursing teams increased it to
90 percent. They used RPIWs to evaluate their
work and make improvements. Instead of caring for
patients throughout a unit, nurses work as a team
with a patient-care technician in "cells" (groups
of rooms located near each other). The cell model
allows nurses to monitor patients and quickly
attend to needs. Also, the most commonly used
supplies for each unit were moved to patient
rooms so nurses reduced walking back and forth to
get supplies. Steps walked per day fell from
10,000 to roughly 1,200. Hyperbaric Center
Increases Patient CapacityWhen the VM Center for
Hyperbaric Medicine could no longer accommodate
all the patients needing treatment, many assumed
the solution was a new building to house larger
chambers. Instead, VM used VMPS tools to design
and build a new hyperbaric center in existing
hospital space, which saved 2 million in
construction costs and increased capacity from
two to three patients at a time to as many as
20. Express Treatment in the Emergency
DepartmentEmergency departments (ED) are a major
entry point for hospitals and can be a
bottleneck. ED patient care is typically more
expensive and involves longer wait times. Using
VMPS, the ED team at VM learned to predict
appropriate staffing levels for times of greatest
demand. A "team sort" process using standard
clinical assessment tools to quickly identify and
sort patients' care needs was implemented. Those
requiring minimal services receive express
treatment and are discharged without going to
patient-care beds. This creates capacity for
patients who require more extensive services.
This work helped VM decrease the number of hours
the ED was closed and unable to receive new
patients by more than 90 percent over the past
two years. In 2011, VM will move its ED into more
efficient space and the team sort process will
allow the team to care for more patients. Faster
Revenue CycleVMPS principles are used in all
areas of the organization, not just in clinical
settings. The Finance Department began using VMPS
to address outstanding revenue (revenue owed to
the organization that had not been paid in a
timely manner). The team improved Days Revenue
Outstanding (DRO) in the clinic from 52.3 in 2003
to 29.4 in 2009 and in the hospital from 66.5 in
2003 to 42.6 in 2009. Cash deposits improved from
471 million in 2003 to 794 million in
2009. Primary Care Achieves Positive Net
MarginsPrimary care has long been a money-losing
area of health care and often a good year means
breaking even. Primary care teams in VM's eight
locations used VMPS to realign their work and
improve the patient experience. Teams analyzed
how supplies and providers "flowed" through the
day. By making key changes, such as doing
non-direct patient care (reviewing lab results,
calling the pharmacy) in between patient visits
and setting up each exam room identically with
needed supplies, providers were able to see more
patients in shorter work days with better quality
care. Doctors, who previously stayed until 8 or 9
p.m. doing paperwork, now leave by 6 p.m. The
turnaround time for lab results also improved
from 25 days for normal results to two days or
fewer. Today, these clinics consistently achieve
positive net margins and see more patients
without sacrificing time spent with each patient.
14
Process capabilitySometimes 99 is just not good
enough
Patient Personal Items
Coding Processing
Sigma
Scheduling Time
DPMO
Yield
66,800
93.32000
3,660 Patients With Misplaced Personal Items
Every Day
770 Coding Errors Every Day Require Correction
257 Calls Each Day Exceed The Two Minute On-Hold
Time
3?
6,210
99.3490
340 Patients With Misplaced Personal Items Every
Day
72 Coding Errors Every Day Require Correction
24 Calls Each Day Exceed The Two Minute On-Hold
Time
4?
230
99.97700
12 Patients With Misplaced Personal Items Every
Day
13 Coding Errors Every Week Require Correction
5 Calls Each Week Exceed The Two Minute On-Hold
Time
5?
3.4
99.99966
6 Patients With Misplaced Personal Items Every
Month
During The Year, Only 10 Coding Errors Require
Correction
During The Year, 3 Calls Exceed The Two Minute
On-Hold Time
6?
15
Most Useful Tools for healthcare (in my opinion)
  • Value Stream MappingPatient at the Centre
  • 5 S culture
  • Spaghetti Diagram
  • Single Piece Flow versus Batching
  • Visual Management

16
Examples
  • Increase capacity utilization of CT scanners
  • Pharmacy workflow
  • Lab workflow
  • ED results signaling
  • Pre-Op assessment
  • Lean theatres late start and time between cases
  • Asset tagging
  • New hospital design

17
Pharmacy Projectsource isixsigma website
18
Pharmacy Example 5S, VSM
Pharmacy Area
IV Area
19
Lean OR process improvement - OR Turn Around Time
Turn around Time flows
  • Eliminated Waste
  • Reduced total time to get patient ready in OR 21
  • Reduced clinician travel distance to get patient
    ready in OR by 54
  • Reduced EVS time to clean OR by 50
  • Team
  • 10 hospital team members

20
Lean OR process improvement Case cart pick
Before
  • Eliminated Waste
  • Reduced technologist travel distance by 70
  • Reduced cycle time by 46
  • Improved productivity by 119
  • Team
  • 9 hospital team members

After
21
Lean EDExample ED Value Stream Map
Fax written report/ED access via PACS
Triage EKG, Draw Blood, UA, Order X-Ray,
administer Pain med 2- RNs 1 Tech
Express Care
X-Ray In ED
Registration If rooms full may reg pt while
waiting.
Front Desk
Portable
CT Fax written report
CT
Team Area
ED Waiting Room
MR
ED MD calls before scheduling
Treatment
Lab
Call critical values
Patient Flow
MD
Order Entry, Call, wait, page
People Flow (RN, MD, etc.)
Tube/blood
Registration For collection- if have White Dot
Respiratory Therapy Blood Gases
RT
E-Information flow
Other Flow (blood, etc.)
Nursing Unit
Reg-Hospital
Discharged (home or elsewhere)
Call Report
Phone Call
Psych-Consult
Patient Wait Time
22
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