Moving to the Lean Enterprise in Healthcare
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Moving to the Lean Enterprise in Healthcare

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by Robin Santucci of Global Solutions Consulting shown at the 1st Global Healthcare Summit on 25th June 2007

by Robin Santucci of Global Solutions Consulting shown at the 1st Global Healthcare Summit on 25th June 2007

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Moving to the Lean Enterprise in Healthcare Presentation Transcript

  • 1. For internal use only / Copyright © Siemens AG 2006. All rights reserved.Copyright © Siemens AG 2006. All rights reserved. Moving to the LEAN Enterprise in Healthcare Global Solutions Consulting First LEAN Global Healthcare Summit 2007
  • 2. Page 2 June-07 Copyright © Siemens AG 2006. All rights reserved. What is the Global Solutions Division Establish Siemens Medical Solutions as the leader in integrated clinical solutions by combining trendsetting technology, clinical workflow know-how and consulting experience based on outstanding partnerships with our customers.
  • 3. Page 3 June-07 Copyright © Siemens AG 2006. All rights reserved. Healthcare Consulting Together we rethink The team is comprised of healthcare professionals, medical technology engineers, medical IT specialists, business management experts, and healthcare economists. Our strength lies in connecting strategy, process and technology. Understanding these interactions allows us to work with our customers to develop and implement solutions that have a proven outcome on cost and quality Strategy and Management Clinical and Business Process Optimization Technology and Infrastructure Planning, and Integration
  • 4. Page 4 June-07 Copyright © Siemens AG 2006. All rights reserved. Our LEAN Journey began at the Factory 550 Employees 2320 Customer specific system deliveries per year 2490 Components / Subsystems 21 System types 92 % Of all systems are exported Forchheim FactoryForchheim Factory Factory AX =>Factory AX => Factory CT =>Factory CT =>
  • 5. Page 5 June-07 Copyright © Siemens AG 2006. All rights reserved. Information – Planned and Stuctured AXAX--CustomisingCustomising AX SCM InfosystemAX SCM InfosystemInfo through Management 1 x month Info through group leader 1 x week 11 o‘clock round 1 x day ONLINE continuous
  • 6. Page 6 June-07 Copyright © Siemens AG 2006. All rights reserved. Striving toward perfection Every system is shippable within 4 weeks (60% reduction from 2000) Technical and deadline related changes are allowed until 3 days prior to start of fabrication On-Time-Delivery > 98 % Percentage of complete delivered systems > 99 %
  • 7. Page 7 June-07 Copyright © Siemens AG 2006. All rights reserved. Why bring LEAN to Healthcare MUDA (Waste) wherever one looks: Overproduction (producing something before it is needed) When do I admit patients for planned procedures (i.e. occupy a bed)? Waiting Transporting Orthopaedic patients moving to the radiology department Inpatient receives an x-ray; 3 hours later receives a CT Scan Inappropriate processing Why is door to balloon time an issue only in the US? Unnecessary inventory Why is this patient staying over the weekend? Unnecessary excess motion (ergonomics) Are you using plain film? Defects Incomplete Medical Records, Medication Errors
  • 8. Page 8 June-07 Copyright © Siemens AG 2006. All rights reserved. Why bring LEAN to Healthcare MUDA (Waste) can cost lives; Quality of Life Every patient handover exposes patients to risk Information needs to be exchanged Medication needs to be carried over Patients need to be lifted Intubation needs to be exchanged The longer a patient stays in a hospital the longer their exposure to nosocomial infection If the Institute of Medicine is correct in their assumptions Medical Errors are the 8th leading cause of death in the USA.
  • 9. Page 9 June-07 Copyright © Siemens AG 2006. All rights reserved. 90,000 deaths 2,000,000 adverse drug events …in the US every year** Canada in 2000, 9,250 – 23,750 deaths from adverse events* ‘Adverse Events’ Actual (without ‘Adverse Events‘) Ideal Actual (without ‘Adverse Events‘) ‘Adverse Events’ Why Bring LEAN to Healthcare CostsfortheInsured **Source: Institute of Medicine, To Err is Human, 1999, p.26. American Hospital Association. Hospital Statistics. Chicago. 1999; RAND study, Journal of Health affairs, September 2005 Prevention / Early Detection Diagnosis Therapy Care *Source: The Canadian Institute for Health Information, CMAJ, The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada • May 25, 2004; 170 (11). doi:10.1503/cmaj.1040498.
  • 10. Page 10 June-07 Copyright © Siemens AG 2006. All rights reserved. Why is healthcare LEAN resistant Who is the end customer? Patient Referrer Payer (private insurer, NHS, taxpayer) Answering this question is important because the value to the end customer drives the shape of the value chain What is the product? Health Information Patient The buildings are full of “monuments” (which are changing at a breakneck pace) Caregivers don’t like to be LEAN and MEAN
  • 11. Page 11 June-07 Copyright © Siemens AG 2006. All rights reserved. The Evolution of Medicine Efficiency Horizon 1 Craft Medicine Horizon 2 Disease Management Requires IT that captures and analyzes workflow Every patient unique Very expensive Quality highly variable Technology drives progress Patient, provider & industry act independently Disease standards Workflows optimized & measured Stronger product integration Stronger collaboration of providers in value chain Prevention Diagnosis Horizon 3 Patient-Centric Healthcare Requires IT that captures and analyzes knowledge Time Patient predisposition- tailored medicine Patient-specific real-time diagnosis & treatment Cost & quality continually optimized Evidence-based Therapy Care
  • 12. Page 12 June-07 Copyright © Siemens AG 2006. All rights reserved. A New Paradigm Workflow Technology in Healthcare Traditional HIS Healthcare Process Management System Linear, passive Collect data Report results Manage orders Capture documentation Manage processes Track, monitor, drive next steps Automatic notification & escalation Manage & monitor clinical best practice
  • 13. Page 13 June-07 Copyright © Siemens AG 2006. All rights reserved. Coronary Artery Disease CAD Management Germany has created new legislation to encourage contact between the inpatient and the outpatient sectors Despite the legislation, the change has not occurred Actors are still not looking at the entire value stream Tools and processes that support changing the value stream are not yet widespread Clinical Challenge: patient receives suboptimal care due to lost information, duplicate procedures, longer wait times Health Services #1
  • 14. Page 14 June-07 Copyright © Siemens AG 2006. All rights reserved. Current state: Coronary Artery Disease Care Path Prevent Outpatient Inpatient Rehab PCP Internist Cardiologist Follow-up/ Rehabilitation Intern/Cardiol. Medication Admit Detect Treat Discharge Admit Detect Treat Discharge Interface Primary Care Provider Internist Cardiologist Conservative Interventional Hospital Cardiologist Interface Interface CAD Management
  • 15. Page 15 June-07 Copyright © Siemens AG 2006. All rights reserved. Current state: Coronary Artery Disease Care Path Prevent Admit Data & History Admit Data & History 68 – 163 Minuten Rehab PCP Internist Cardiologist Intern/Cardiol. Medication Interface Primary Care Provider Internist Cardiologist Conservative Interventional Hospital Cardiologist Interface Interface Outpatient Inpatient Follow-up/ Rehabilitation Admit Detect Treat Discharge Admit Detect Treat Discharge CAD Management
  • 16. Page 16 June-07 Copyright © Siemens AG 2006. All rights reserved. Future state: Coronary Artery Disease Care Path Prevent Admit Data & History Electr. Report S-IC Rehab PCP Internist Cardiologist Intern/Cardiol. Medication Interface Primary Care Provider Internist Cardiologist Conservative Interventional Hospital Cardiologist Interface Interface Outpatient Inpatient Follow-up/ Rehabilitation Admit Detect Treat Discharge Treat Discharge CAD Management
  • 17. Page 17 June-07 Copyright © Siemens AG 2006. All rights reserved. Future state: Coronary Artery Disease Care Path Prevent Outpatient Inpatient Follow-up/ Rehabilitation Admit Detect Treat Discharge Treat Discharge Admit Data & History Electr. Report S-IC Rehab PCP Internist Cardiologist Intern/Cardiol. Medication Interface Primary Care Provider Internist Cardiologist Conservative Interventional Hospital Cardiologist Interface Interface CAD Management
  • 18. Page 18 June-07 Copyright © Siemens AG 2006. All rights reserved. Technology can change the reference point completely Parameter Unit Current Potential Missing Documentation at Central Admissions Share 10% 0% Daily Time collecting documentation for central Admit Minutes 10-15 min/Patient 3 mouse clicks Waiting time until patient files found Minutes 10-15 min/Patient 3 mouse clicks # of repeated procedures due to missing documentation Share Ca 75% in ED 20% in scheduled patients Reduction to 20 % in ED Reduction to 0 in scheduled patients # of repeated procedures due to quality failure Share Ca. 20% in ED 7% in Scheduled Patients Reduction to 10 % in ED Reduction to 0% in scheduled Average waiting time by admit Minutes 35 min/Patient Reduction to 10 min Time required to find patient records in inpatient areas, to prep eg for Bypass OP Minutes 120 Minuten/Patient 5 mouse clicks
  • 19. Page 19 June-07 Copyright © Siemens AG 2006. All rights reserved. How else can the LEAN Enterprise develop Customers can demand that suppliers stop building monuments. Substituting contrast enhanced ultrasound for MR in peri-operative confirmation of uterine fibroid embolisation Using Biomarkers and ultrasound to monitor liver disease, detect breast cancer (reduce or eliminate biopsies) Customers can demand that more information or options come from one monument Hybrid equipment – PET CT Hybrid Rooms – Cath Lab / Heart OR Total Body Imaging “Theranostics” - Using iron coated nano-particles to provide diagnostic information and then thermal therapy of hard to reach tumors with MR Customers can demand that partners move beyond transactional relationships
  • 20. Page 20 June-07 Copyright © Siemens AG 2006. All rights reserved. Take Away Ideas LEAN can be a powerful way of transforming healthcare’s organisational cultures The iterative approach and RIEs are keys to moving forward but you do have to have “the vision thing” if you want to drive a LEAN enterprise One can alter value streams drastically with simple common sense changes. In healthcare, technology allows one to eliminate entire value streams or change completely their perspective
  • 21. Page 21 June-07 Copyright © Siemens AG 2006. All rights reserved. Thank You