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Lean Thinking In Medical Practices
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Lean Thinking In Medical Practices.

Lean Thinking In Medical Practices.

Innovation, Action and Quality Improvement

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Lean Thinking In Medical Practices Presentation Transcript

  • 1. Lean Thinking InMedical PracticesInnovation, Action and Quality Improvement Michael Crosnick
  • 2. What Is Lean? • Elimination of waste – Toyota Production System (TPS) • Philosophy – Produce only what is needed, when it is needed, with no waste • Methodology – Determination of value added in the process • Tools – Five Ss, kaizen event, standardized work, etc.2
  • 3. Types of Waste (Muda) • Overproduction • Waiting • Transportation • Inventory • Motion • Over Processing • Defects3
  • 4. Kaizen Philosophy • Employee-led continuous improvement • Five steps – Specify value – Map and improve the value stream – Flow – Pull – Perfection • Even if it isn’t broken, it can be improved.4
  • 5. Value Stream Mapping • Process map of the value stream • Includes information processing and transformational processing • Value-added steps: ―Would the customer be willing to pay for this activity?‖ • Non-value-added steps – Necessary – Unnecessary5
  • 6. Value Stream Mapping Suppliers : Payer Customers: Accounting,Physicians, Appointment Physician Office Payer, Physician (chart) Scheduling Software 102 Patient visits/day Prep patient, Verify insurance Revisit authorization, Exam and Rx. SOAP note Discharge summary Transcripts Check in, Copy to Report to Prep patient, Registration letterhead, Physician & Review packet,Insurance forms Proof read Fax revised Proof read signature med records, Verify insurance, First draft draft to second draft Close chart, Submit claim Exam and Rx., transcription File report or invoice New Evaluation Soap note Evaluation summary & plan 3 2 3 1 3 3 3 2 5-15 m P/T 0-1 m P/T 1-3 m P/T 10-60 m P/T 1-10 m P/T P/T 0-15 m P/T P/T 5-15 m 0-1 m W/T W/T 0-15 m W/T 7-50 m 1-10 d W/T 1-20 d W/T 14-90 d W/T 1-10 d W/T 1-20 d 0 98% W/T 50% FTQ 90% FTQ FTQ 98% FTQ 98% FTQ 99% FTQ 20% FTQ 98% FTQ Current State Metrics P/T = 21-120 min. (average: 71 min) W/T =18-150 days (average: 84 days) 6 FTQ = 10%
  • 7. Value Stream Mapping Suppliers : Payer Customers: Accounting,Physicians, Appointment Physician Office Payer, Physician (chart) Scheduling Software 102 Patient visits/day Prep patient, Verify insurance Revisit authorization, Exam and Rx. SOAP note Discharge summary Transcripts Check in, Copy to Report to Prep patient, Registration letterhead, Physician & X Review packet, X X XInsurance forms Proof read Fax revised Proof read signature med records, Verify insurance, First draft draft to second draft Close chart, Submit claim Exam and Rx., transcription File report or invoice New Evaluation Soap note Evaluation summary & plan 3 2 3 1 3 3 3 2 5-15 m P/T 0-1 m P/T 1-3 m P/T 10-60 m P/T 1-10 m P/T P/T 0-15 m P/T P/T 5-15 m 0-1 m W/T W/T 0-15 m W/T 7-50 m 1-10 d W/T 1-20 d W/T 14-90 d W/T 1-10 d W/T 1-20 d 0 98% W/T 50% FTQ 90% FTQ FTQ 98% FTQ 98% FTQ 99% FTQ 20% FTQ 98% FTQ 7
  • 8. Tools• Takt time • Standardized work• Throughput time • Kanban• Five Ss • Single minute exchange of die• Spaghetti diagram (SMED)• Kaizen blitz or event • Flow• Jidoka • Pull• Andon8
  • 9. Takt Time• The speed with which customers must be served to satisfy demand for the service. Available work time /day Takt time Customer demand/day• Cycle time is the time to accomplish a task in the system.• System cycle time is equal to the longest task cycle time in the system—the rate at which customers or products exit the system, or ―drip time.‖ 9
  • 10. Throughput Time• Time for an item to complete the entire process, which includes: – Waiting time – Transport time – Actual processing time10
  • 11. Clinic ExampleCycle, Throughput, and Takt TimePatient check-in Move to examining room 3 minutes 2 minutes Wait 15 minutes Nurse does Physician exam preliminary exam and consultation Visit complete 5 minutes 20 minutes Wait 15 Wait 10 minutes minutes11
  • 12. Clinic Example Cycle, Throughput, and Takt Time• Patient check-in cycle time = 3 minutes.• System cycle time = cycle time for longest task = physician exam and consultation = 20 minutes.• Throughput time = 3 + 15 + 2 + 15 + 5 + 10 + 20 = 70 minutes.• 8 physicians 5 hours/day Takt time 100 patients/d ay 0.4 physician hours/pati ent 24 physician minutes/pa tient. 12
  • 13. Clinic Example: Value-Added Time• Valued-added tasks: – Nurse preliminary exam – Physician exam and consultation• Non-value-added steps, necessary: – Patient check-in• Value-added time = 5 minutes (nurse preliminary exam) + 20 minutes (physician exam and consultation) = 25 minutes.• Percentage value-added time = 25 minutes/70 minutes = 35 percent.13
  • 14. Kaizen Blitz or Event• Determine and define the objectives Act Plan• Determine the current state of the process• Determine the requirements of the process Check Do• Create a plan for implementation• Implement the improvements• Check the effectiveness of the improvements• Document and standardize the improved process• Continue the cycle 14
  • 15. Standardized Work • Written documentation of the way in which each step in a process should be performed • Not a rigid system of compliance, but a means of communicating and codifying current best practices15
  • 16. Jidoka and Andon • Jidoka is the ability to stop the process in the event of a problem. – Prevents defects from passing from one step in the system to the next – Enables swift detection and correction of errors • Andon is a visual or audible signaling device used to indicate there is a problem in the process.16
  • 17. Kanban Signal Signal patients echo patients CT17
  • 18. Single Minute Exchange of Die (SMED)• Used to reduce changeover or setup time, which is the time needed between the completion of one procedure and the start of the next procedure• Steps – Separate internal activities from external activities – Convert internal setup activities to external activities – Streamline all setup activities 18
  • 19. Advanced Access• Patients are unable to obtain timely primary care appointments.• Advanced access scheduling reduces the time between scheduling an appointment for care and the actual appointment.• The goal is swift, even patient flow through the system. 19
  • 20. Advanced Access: Advantages• Decreases no-show rates• Improves patient satisfaction• Improves staff satisfaction• Increases revenue – Higher patient volumes – Increased staff and clinician productivity• Promotes greater continuity of care – Increased quality of care – More positive outcomes for patients20
  • 21. Advanced Access: Implementation• Advanced access challenges established practices and beliefs.• Balance supply and demand: – Obtain accurate estimates of supply and demand. – Reduce or eliminate backlog. – Minimize the variety of appointment types. – May need to: • Adjust demand profiles. • Increase availability of bottleneck resources. 21
  • 22. Lean SigmaLean and Six Sigma are focusedon continuous improvement ofthe system. 6 Lean Six SigmaEliminate waste Eliminate defects• Achieve flow • Reduce and pull variation in processes22