SIMUL8 Workshop - Process Improvement Innovation: Lean and Simulation

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In this workshop, we broadcast live from the 25th Annual IHI Conference in Florida.

Dr. John Boulton, IHI Fellow and Rheumatologist, joins the panel to give his insight on using Lean and Simulation methodologies to improve healthcare processes and delivery.

The team will discuss recent research on the topic, the benefits of using Simulation in Lean projects, and will also present feedback from delegates at IHI and your chance to put your questions to the panel.

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SIMUL8 Workshop - Process Improvement Innovation: Lean and Simulation

  1. 1. Process Improvement Innovation: Lean and Simulation Dr. John Boulton: IHI Fellow and Rheumatologist Claire Cordeaux & Brittany Hagedorn: SIMUL8
  2. 2. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
  3. 3. • • • SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
  4. 4. Process Improvement Innovation: Lean and Simulation Dr. John Boulton: IHI Fellow and Rheumatologist Claire Cordeaux & Brittany Hagedorn: SIMUL8
  5. 5. Messages from Research “Simulation and lean are approaches that are rarely discussed together, particularly in the healthcare context. This is surprising given that they have a similar motivation: improvement of processes and service delivery” Warwick University – Simlean/SLIM simlean.org SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
  6. 6. What does Simulation add to Lean? Reflections from SimLean research participants: • Dynamic process maps • What if? scenario tool • Accelerates understanding SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
  7. 7. Testing, testing…Live from IHI Agenda • • • • Simulations of Lean concepts IHI participants’ feedback Implications for Simulation Reflections from Dr. John Boulton SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
  8. 8. Lean and Simulation Communities Why don’t they work together more? Both improvement methodologies are powerful change agents – surely we need all the help we can get to improve healthcare? SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
  9. 9. Our Hypothesis • Experts in both domains are passionate about their own methodology and don’t look to combine approaches • We believe that if Simulation is used to explain Lean concepts, we can bridge this gap. • The LeanSIM Toolkit: – Demonstrates Lean principles – Allows users to experiment with parameters and quickly see results SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
  10. 10. LeanSim – Using Simulation SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
  11. 11. LeanSim – Demand Smoothing SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
  12. 12. LeanSim – Batching vs. Single Piece Flow SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
  13. 13. What does the IHI community think? • “As a teacher of Lean, I often find it difficult to get buy-in on Lean concepts since they are counter-intuitive until Pictures actually live them.stand and quotations of people at This brings them to life.” you “I’ve often struggled to use simulations to explain Lean concepts as they are all manufacturing examples. Having healthcare SIMUL8.com | info@SIMUL8.com SIMUL8 Corporation | scenarios is so powerful!”
  14. 14. Click to edit Master title style “Why isn’t every hospital using this?” - Sara Dalo SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
  15. 15. What we heard at IHI... • Lean simulations are a really powerful communication tool. • Passion of clinicians to continually improve is alive and well. • People are busy with day-to-day tasks and struggle to find time to use the techniques. • Evidence-based solutions are still needed to complement cultural change management. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
  16. 16. Implications for Lean and Simulation 1. Simulation is a powerful means of engaging stakeholders and enabling collaboration in change programs. 2. Educational models are needed to bring Lean concepts to life. 3. Simulation will help with the IHI challenge for new patient-centered service models by demonstrating the impact on resources, outcomes and costs. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
  17. 17. Simulation and Lean – Improving Process Improvement Simulation is a powerful tool, which is even most effective when integrated with the Lean Six Sigma approach. By doing so, we can maximize the impact of our improvement efforts. Understand dependencies. Value Stream Mapping • Conduct observations. • Collect data. • Document value stream statistics. Identify Improvement Opportunities • Document all barriers, rework, and wait times. Incorporate variability into VSM. Validate your current state. Prioritize Projects Develop Charters • Estimate the impact and effort for each improvement. • Combine for prioritization. • Define process and outcome metrics. • Establish target (%) for improvement. Reduce risk. Map Current State Design Future State Pilot Future State • Create a detailed process map. • Identify potential interventions. • Develop and document a future state process map. • Implement the proposed future state on a small scale. • Identify issues & unexpected effects. Set evidencebased targets. Visualize improvement results. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com Implement Sustain • Modify the future state as needed. • Conduct training. • Go live. • Document standard work and policies & procedures. • Monitor and sustain improvements . Gain buy-in.
  18. 18. About me • Rheumatologist • Clinical lead for Quality Improvement • 2012-13 IHI QI Fellow – High reliability principles – System wide flow • An interest in simulation and modelling • Twitter: @the_Rheum_doc SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
  19. 19. What does the IHI community think? • “As a teacher of Lean, I often find it difficult to get buy-in on Lean concepts since they are counter-intuitive until Pictures actually live them.stand and quotations of people at This brings them to life.” you “I’ve often struggled to use simulations to explain Lean concepts as they are all manufacturing examples. Having healthcare SIMUL8.com | info@SIMUL8.com SIMUL8 Corporation | scenarios is so powerful!”
  20. 20. Click to edit Master title style “Why isn’t every hospital using this?” - Sara Dalo SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
  21. 21. Hospital Physiology First Edition SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
  22. 22. The challenge Processing (T) Variability (V) Utilization (U) 2000 1800 What is acceptable waiting? Waiting time in minutes 1600 1400 1200 acceptable wait 1000 High variability Medium Variability 800 Low variability 600 400 200 0 0.50 0.55 0.60 0.65 0.70 0.75 Utilization 0.80 0.85 0.90 SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com 0.95
  23. 23. Simple models SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
  24. 24. Deming’s System of Profound knowledge • System • Variation Simulation • Knowledge • Psychology SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
  25. 25. System SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
  26. 26. “If I had to reduce my message for management to just a few words, I’d say it all had to do with reducing variation.” W. Edwards Deming SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
  27. 27. Variation SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
  28. 28. Knowledge • Early Arthritis Clinic SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
  29. 29. knowledge • 10 medical follow-up slots • 12 nurse follow-up slots • Simple model – Insufficient capacity within 6 months • Clinic abandoned after 9 months SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
  30. 30. Psychology SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
  31. 31. Psychology SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
  32. 32. SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com Associates in Process Improvement
  33. 33. Simulation and Quality Improvement • A useful tool – Enables deeper understanding of systems – Translates difficult and counterintuitive concepts – Virtual PDSA cycles • Models do not need to be complex – Simple are often more effective SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
  34. 34. LeanSim Toolkit We’d love you to try these models yourselves and give us your feedback. To download your own copy link to: SIMUL8healthcare.com/LeanSIMToolkit SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
  35. 35. • • SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

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