Understanding the Gains from Lean
•
0 likes•636 views
by Kate Silvester, Osprey Coach for NHS shown at the 2nd Lean Healthcare Forum on 6th June 2006 ran by the Lean Enterprise Academy www.leanuk.org
Recommended
More Related Content
What's hot
What's hot (20)
Viewers also liked
Viewers also liked (20)
Similar to Understanding the Gains from Lean
Similar to Understanding the Gains from Lean (20)
More from Lean Enterprise Academy
More from Lean Enterprise Academy (20)
Recently uploaded
Recently uploaded (20)
Understanding the Gains from Lean
- 1. Understanding the Gains from Lean Kate Silvester BSc MBA FRCOpthth Osprey Coach NHS 2nd Lean Healthcare Forum 6th June 2006 Motorcycle Museum
- 2. What have we done so far? In 1997: Patients waiting – ‘We need more resources!’ Increased NHS resources • £48 Billion to £97 Billion In 2006: • Patients still waiting: – 18 weeks from referral to treatment • £7 Billion deficit by 2010 (Economist 22nd April 2006)
- 3. The gains we want • Timeliness – Why do we have to wait 18 weeks? • Choose and Book when we want it • Value for money – Productivity ‘’more’ patients treated for less or same money’(?) – Cost efficiency (?) • Quality – Clinical outcome – Service experience – Patient and Staff morale
- 4. You will never solve the problem with the mindset that created it Albert Einstein
- 5. Functional Mindset Unit Cost Clinic Radiology Laboratories Theatres Admin Wards Unit cost Clinic Unit cost Activity cost Activity cost Activity cost Activity cost Activity cost Activity cost Activity cost
- 6. Behaviour: • More activity – Waiting list to keep resources utilised • (batch production) – (‘create’ demand?) • Less cost – Reduce staff • Technology (IT) – Cheaper suppliers • ‘Quality costs money’ • Private sector? – Bulk purchasing
- 7. ‘Keep activity high & unit cost low’ Queue Clinic Batch production demand into next step is distorted Utilisation of capacity = 100% = unit cost is low = ‘clinic is efficient’ Variable demand BUT: patients wait cost of storing queue? cost of managing the queue? cost of deterioration in the queue? cost of downstream capacity? Not my department / organisation = not my problem
- 8. SPC Control Chart Wait- between CT Exam time and CT Report printed 0:00:00 120:00:00 240:00:00 360:00:00 480:00:00 600:00:00 1 10 19 28 37 46 55 64 73 82 91 100 109 118 127 136 145 154 163 172 181 190 199 208 217 226 Consecutive Exams Wait delay mean upl Same session reporting Private patients 5 days 15 days 10 days 20 days 25 days ‘I am better utilised’ (Batch Logic) Stops same session reporting: Flow Logic Impact on total process cost = 5 days @ £125/day x 10% of 195 admissions = £12,000 per week
- 9. Impact of behaviour on flow? • Process View Clinic Radiology Laboratories Theatres Admin Wards Clinic
- 10. Queues = 100s of extra steps Doctor requests ‘test’ Porter picks up request Porter delivers request to dpt Clerk logs request Clerks puts request for prioritisation Consultant for prioritises request Consultant returns request Clerk files request in priority order Clerk draws request from file Clerk makes appointment Clerk sends appointment by post (>6 steps) Patient receives appointment Patient travels to hospital Patient finds car parking slot Patient finds X-ray department Patient checks in at reception etc Value? Waste! (approx £175,000 p.a.?)
- 11. Impact on Quality Probability of Performing Perfectly No. process steps Probability of Success, Each Process Step 1 25 50 100 0.95 0.990 0.999 0.999999 0.95 0.990 0.999 0.9999 0.28 0.78 0.98 0.998 0.08 0.61 0.95 0.995 0.006 0.37 0.90 0.99 Improve the quality of each step Remove the steps…. Carol Haraden IHI
- 12. Referral to 1st Treatment - Lung Cancer patients 0 50 100 150 200 250 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76 79 82 85 Consecutive patients Days Waiting Time Mean UCL LCL Direct referral from radiologist New radiologist unaware Impact of taking steps (waste) out
- 13. Process view reveals the real waste Is governing the rate of flow for the whole system Real waste
- 14. To get the gains from Lean • Mindset change – function to process – batch logic to flow logic • Value: – only deliver what the patient & your customer expect • right first time, on time • reduce variation, release capacity – reduce waste • Quality saves time, money and lives
- 15. Healthcare organisation are in grave danger.
- 16. What do desperate managers do? Clinic Radiology Laboratories wards Admin Theatres Clinic Cut costs or else! Is governing the rate of flow for the whole system Reduce Throughput = reduced income
- 17. So let’s get Lean! • Lean = no fat • Fat = waiting lists (waste of over production) • Concentrate on eliminating waiting lists • ‘Do today’s work today!’