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Lean Hospital: Creating a Lean Culture of Continuous Improvement "Part 1 of 3"
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Lean Hospital: Creating a Lean Culture of Continuous Improvement "Part 1 of 3"


The PowerHealth OnDemand Webinar Series brings you Leonardo Group Americas LLC (authors of the books Lean in the OR, Supplies Management in the OR, Value Stream Mapping in the OR, Lean Training Games …

The PowerHealth OnDemand Webinar Series brings you Leonardo Group Americas LLC (authors of the books Lean in the OR, Supplies Management in the OR, Value Stream Mapping in the OR, Lean Training Games in the OR and Quick Changeover in the OR), who share their experiences and learnings from working with hospitals across the country to develop a Lean mindset/environment that achieves continuous improvement and sustained profitability.

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  • Welcome to “A Roadmap to the Lean OR” This course is an introduction to Lean principles and tools as they apply to the Perioperative Services department. The material discussed during this course does apply to other areas of the hospital, but our focus and examples will be primarily for the OR. The content of this course is associated with the book Lean in the OR by Gerard Leone and Richard Rahn.
  • Lean Hospital Roadmap 101
  • We are at a pivotal point in time for hospitals in the US and in the world. Competition is beginning to be a meaningful market force, when it was not a short year ago. Pressure on cost is being brought to the forefront and many times not in the way we would like. Often staff appears to be the target for cost reduction, rather than the many forms of waste that plague the OR. We find ourselves right now where there are only two kinds of hospitals: those who have embraced Lean and those that will. Continuous Improvement is coming to a hospital near you and for your sake and that of your patients, we hope it is your hospital.  
  • In this introductory lesson, we will be discussing some of the very basic aspects of Lean. We will start with a series of definitions. We will then discuss the signs by which you can tell if you are working in a Lean Hospital and in a Lean OR. Our next topic will focus on why is Lean is so important for the OR and for the whole hospital. Next we need to start working on some specifics, by defining the concept of a value stream. Once we have defined a value stream, what do we do with this concept? We will apply it to a model to track the progress and maturity of a value stream. We will then briefly introduce some of the tools that will be used throughout this course. Finally, in this lesson we will make sure that we have a clear picture of what the “Lean stuff” is all about so there are no misunderstandings or misconceptions. Let's get going!
  • If you do some reading on Lean, this is the definition you are likely to find. It comes from the Lean Enterprise Institute.   This is a very good definition that starts by stating that Lean is a methodic approach. To do what? To identifying and eliminating waste. What is waste? Waste is activity that does not add value in the eyes of the customer. How do you eliminate waste? Through continuous improvement.   And right after that the definition breaks down for the hospital and for the OR, with the line “by flowing the product…”   Who are you calling product? My mother, My child? My husband? This is the OR, we deal with patients!   In all fairness, in the OR we do deal with some items that are not patients: instrument sets, medications, equipment. But the main reason why you are all in the OR is the patient.   Let’s see if we can come up with a better definition for the OR and the hospital as a whole.
  • In this definition of a Lean hospital, notice that all the elements are there, but we start by emphasizing the focus of our improvement efforts: patient safety, patient satisfaction, and treatment outcomes. Staff development is also a critical aspect of the Lean OR and the Lean Hospital, as only engaged staff can propel an OR towards perfection. Without an engaged staff, improvements will not be sustained. How do you do all that? Through the elimination of waste, the elimination of errors and a relentless focus on patient flow. So, how you know you are in a Lean hospital, one that has embraced the culture of continuous improvement and respect for staff?
  • Lean matters because at the center of it is the elimination of wasteful activities that prevent clinicians from doing what they were trained to do: to take care of patients. The reality is that a large percentage of what you do every day does not add value to patients. Every time you go into a supply room looking for an endomechanical staple that is not there, forcing you to make a call to the basement and wait; every time you need a debakey and have to open another instrument set to get it; every time you go to get your patient and the H&P is not ready. In all these cases, time goes down the drain. That is time you do not get back and that should have been devoted to patient care. That needs to be your main goal: To enable clinicians to deliver more patient care by eliminating the obstacles (the wasteful activities) that prevent them from doing so. The harsh reality is that a staggering amount of work is wasted in broken processes and all that time can never be recovered. It is gone. 70% or 80% waste is possible. All the work you do every day, waste and all, takes place in what we call a process and a collection of processes that delivers value is what we call a value stream. These are very important concepts for the Lean Hospital and we will revisit them many times. So, let’s define what a value stream is.
  • And here are some more tools. As you can see, it’s quite a big toolbox.   Mistake proofing is a technique to design out the errors and defects from the processes. Standard Work is a tool for the development and documentation of the best way to do the work in a process. Before you get nervous about this, Standardization done properly will help you make work predictable so there are no surprises. This predictability will free up time for you to do other things. 7S is the technique for housekeeping and organization to ensure that you have what you need when you need it in a predictable location. Visual management is a tool in the lean toolbox that seeks to communicate the status of a process without calls, screams, or angry emails. Think about the lights or flags in the MDs offices that tell the doc where to go. Now think about a similar technique applied to most of the OR’s communications needs. The kanban system is the replacement for the broken PAR system for supplies managment. PAR does not work well; do not try to fix it as it is unfixable. Kanban has been around for over 100 years. I guess it has proven itself. Equipment management is a series of techniques to ensure that the equipment you need for a procedure is available when you need it and in proper operating condition.   But having presented you with this list, it is not ALL about tools…
  • Here are some of the tools we will touch on during this introductory course. We will delve into much more detail on some of the more critical tools for the OR in upcoming courses.   Value Stream mapping is an assessment technique to visualize the flow of value through a value stream and to identify forms of waste and opportunities for improvement in that value stream. Cell design is a technique we borrowed from our manufacturing friends that is used to design multiple paths for the unit of value where different amounts of work are needed. For the instrument sets, just think of a separate path for small sets versus large sets. Or for stat versus regular speed. Changeover reduction is a technique to minimize the time an OR suite is down in between cases. This technique also seeks to improve the quality of the OR Suite turnover. Kaizen is a Japanese word (one of VERY few we use) that means continuous improvement. Kaizen is “How we do Lean” It is the methodology of many rapid improvements to the processes in the value stream. Participative management refers to the fact that only with every staff member’s participation can a culture of continuous improvement take hold. Check-do-check is quality improvement technique that relies on staff to identify and root out errors.   We’re not done yet.
  • Lean is a culture, a culture of continuous improvement with everybody contributing to the improvement of the processes and value streams.   We cannot emphasize this enough: EVERYBODY, not just the green belts, black belts, and super-duper-my-belt-is-nicer-than-yours belts. EVERYBODY. That is where the power is.   Imagine a future where all staff members (1000? 2000? Over 10,000 for some of you?) make one suggestion per month and it is implemented. Can you imagine the power of that? No performance excellence department alone could ever do that. Not event with a staff of 100 consultants.   Is this vision possible in a month? Nah… how about three months? Nope… Six months? Niet… A year? Unlikely… We are looking at the long term here. There will be many successes along the way but those are just a tiny bit of what awaits the OR on the other end of the journey.   Like Aristotle says here “We are what we repeatedly do” The more we do continuous improvement, the more it becomes the culture of the OR.
  • This is the Lean Hospital Strategy roadmap, with the processes for this lesson circled. You can see that we’re just getting started! Remember too that the drill icon means that there is a detailed sub-roadmap for each of these two processes, with additional detail. So this is not as simple as it may look.   We’ll start by describing one of the deliverables of this part of the roadmap, an actionable Master Plan.
  • Let’s define first what we mean by a Master Plan. The Master Plan, that we will be using to guide our future improvement efforts, is a document that identifies the improvements that have been identified, the resources (time, people, equipment and money) that will be required to make these improvements a reality, an estimate of the time that will be needed to implement each improvement, and the estimated Return on Investment and dollar benefits of doing so. Not everything can be converted to dollars, of course, but we always try to do so in order to have a common denominator that we use to compare various options. Perhaps you’re now asking, what identified improvements? Hold that thought, because we’ll be talking about how to come up with improvement ideas in this very lesson, as a part of the Value Stream Mapping method. Next, here‘s a list of objectives for this lesson.
  • Now that we have an introductory understanding of what a Value Stream is, and what a Process is, let’s move on to a definition of a Value Stream Map. I’ll let you read these definitions yourself, but just understand that the “Map” part of a Value Stream Mapping exercise is a flow-chart that uses a specific layout and specific symbols to describe the work and the relationship of processes. It’s more than a simple flow-chart with boxes and arrows, as you will be seeing shortly. One of the biggest differences between a VSM and a regular flow-chart is that we want to document not only the processes in a Value Stream, but also the delays that happen between processes. In the world of Lean Thinking, time is very important, and delays where work is not being done are a source of waste, patient frustration, and cost that we need to be aware of. I’ll show you some examples of how we document delay on a VSM in just a moment.
  • You should know that the Lean approach, and this includes Value Stream Mapping, has a tendency to do things manually rather than try to bring in technology or computers right away. Creating a VSM by hand, using sticky notes, has several advantages: it’s much more visual, everyone can participate in the VSM creation, and it’s cheap and easy. What you see here is an actual VSM documenting the Current State for the Preference Card value stream. Sticky notes and brown butcher paper were used, along with markers and tape. As processes were identified, the process name was written on a sticky note and positioned on the paper. The VSM flows from left to right, like you read a book. There is a logic behind the different colors as well. The blue sticky notes are the processes, groupings of like work. The yellow sticky notes are the delays that happen between processes. We understand that delays are highly variable, but we just looking for an average wait time here. Below each process is the orange data box, with some of the key metrics for each process, with the most important one being the process time. Finally the green sticky notes represent reminders of the process improvements that we have identified, and we call these Kaizen Bursts. It’s not that pretty, but it’s a very effective way to work as a team through creating the VSM by hand. We are not the enemy of computers, however.
  • The next question is: how can we get to the Future State in a logical and manageable way? Well, we'll need to create a plan for each improvement project, lay this out in an achievable time-frame, and get to work. The Master Plan describes the who, what, when, where, why and how for each Kaizen Burst or improvement opportunity, and create a 6 to 12 month schedule for working on these improvements. The Master Plan can go beyond one year, but things start getting fuzzy beyond 12 months, so you should focus on more near-term projects that will yield you the biggest benefit. This Gannt Chart is only one page of a Master Plan document, but please don't feel like you need to write a book. It's a book that probably no one will actually read, so keep you Master Plan short and sweet, but with enough detail to be useful.  
  • To help the leadership team gain that understanding, they have to walk in the shoes of the staff members that will carry out the continuous improvement projects while they are learning about Lean culture, its principals, and some of its tools.   To that end the management training needs to include some level of hands-on project activity where the leader gets a first-hand sense of how it is to retrieve a trapeze on your own from a cluttered utility room and to assemble it without instructions. The expectation is that such experiences will trigger thoughts of “How can I help to fix this?”   Let’s now review this short lesson’s objectives.
  • Let’s start with the first question, why training is necessary for the leadership team?   The answer: because the goal is to change the culture to one of continuous improvement and respect for people. How can you even start to think about such a pivotal change if you do not know where you are going? A cultural shift can only start from the leadership team and it requires steadfast support from that same leadership team to become ingrained in the OR’s (and the whole hospital’s) culture.   Part of that cultural shift will be in the way leaders manage the processes entrusted to them. Leaders will need to start looking at managing continuous improvement as a part of what they do every day, not as something somebody else is doing. In a Lean Hospital and in the Lean OR managers manage continuous improvement.   We don’t get tired of making this point: to support Lean, you must understand it. Thinking that a good leader is one that gets out of the way and let others do continuous improvement is not good enough. It may work in the short term but the short term is not what the lean OR is going for. We are looking at constantly improved performance from now to forever.   People, including managers, embrace change in different ways. Some people are early adapters, and just love the idea of trying something new. Others are more cautious, but willing to get on board once it’s clear that continuous improvement is not going away. And finally some people just don’t want to change at all, ever, no way Jose. There is the potential for these people to undermine your hospital’s efforts to build a Lean culture, either actively or passive aggressively. By putting all managers through a Lean boot-camp, i.e. intensive training, you will not only win over converts but you will also identify those people that need a little special encouragement. And I’m not saying “special encouragement” with a sinister tone in my voice.   Let’s start by defining who should get trained in this phase.
  • Who should get trained? The general statement we make when asked is this: every single leader from managers on up through all the VPs and C-level leaders. The reason is to develop the understanding that a Lean culture demands that leaders manage the continuous improvement activities that will take place in the processes and values streams in their departments. Picture a future where every staff members makes two small suggestions for improvement per month. That amounts to many thousands of ideas of all types. Some are minutes long and some are days long to accomplish. These ideas must be managed, prioritized, staffed, audited, and supported so they stick. Only leaders can do that. If your OR and/or your hospital plans to have these training session live on site, we also recommend to bring some staff members into the workshop. The reason why we recommend this is because a good training session should divide the group in mini-project teams and those teams should have a mix of executives and staff. This helps in building the bridges that are necessary in a Lean OR and a Lean hospital. We cannot expect to cover “all things Lean” in a training session for leadership. So, what should we cover and how should that content be delivered?
  • These are the topics that should be taught during the Lean Leadership workshop. Let’s quickly give you the gist of each one:   Hoshin Kanri or “Strategy Deployment” is one of the more important and least understood aspects of Lean. In a nutshell, it’s your Lean Management System, and how top-level organizational objectives are deployed throughout the organization, so that everyone is moving in the same direction. Standard Work is a tool for the development and documentation of the best way to do the work in a process. Before you get nervous about this, standardization done properly will help you make work predictable so there are no surprises. This predictability will free up time for you to do other things. Quick Changeover or Turnover Reduction is a technique to minimize the time an OR suite is down inbetween cases. This technique also seeks to improve the quality of the OR Suite turnover process. Visual management is a tool in the Lean toolbox that seeks to communicate the status of a process without calls, screams, or angry emails. Think about the lights or flags in the MDs offices that tell the doc where to go. Now think about a similar technique applied to most of the OR’s communications needs. 7S is the technique for housekeeping and organization to ensure that you have what you need when you need it where you need it every time. Kaizen is a Japanese word (one of VERY few we use) that means continuous improvement. Kaizen is “How we do Lean” It is the methodology of many rapid improvements to the processes in the value stream. The kanban system is the replacement for the broken PAR system for supplies management. PAR does not work well; do not try to fix it as it is unfixable. Kanban has been around for over 100 years. I guess it has proven itself.   Next, how should this training session take place?
  • Training can take place pretty much anywhere. Some prefer to go off-site for training, to avoid the distractions of calls, emails, and those lovely Blackberries and iPhones. And that is a fair point. But you must ask yourself: What do I have to show at the end of the workshop? For that reason you should hold the workshops on-site so the students can work on hospital processes, not some theoretical exercise that may not resemble your processes at all. That is why we also propose to learn a tool in the morning and apply it immediately in the afternoon. If at all possible each project should build on the prior day’s project. In a workshop with 16 people, you would finish 12 real projects and 1 Value Stream Map per class. Not bad for training, eh? Just one quick example: At one of our client hospitals, the team decided to map the value stream of just “patient transportation from the ED to the Cath Lab in a cardiac Alert”. These folks were already pretty good in their door-to-balloon time, which was well under the 90-min benchmark. In a 6-hrs VSM they identified and implemented several improvements for almost 5 minutes of improvement in door-to-balloon time. Not bad for an afternoon’s work, right?
  • The answer is simple: right now. Please notice how early in the roadmap this phase is. That is no accident. We firmly believe in starting soon with the Lean Leadership workshop so that leaders can start making plans. Some, I am afraid, may decide that this new culture of participation is not for them and they must make plans too. The way we like to conduct these sessions is as follows: 5 days of training. The classroom is divided in teams of 4 people each. Lecture every morning on a specific topic Lean principle or a specific tool. Every afternoon the teams work on hands-on projects of their own choosing. A typical class would go something like this: Monday AM: Lean principles and Kaizen. Monday PM: Teams work on a project based on something that bugs them. Call it free-styling, if you will. Teams prepare a short project report. Tuesday AM: Teams report on projects from prior day. Lecture on 7S. Tuesday PM: Teams complete a 7S project in an area of their choosing. Teams prepare a short project report. Wednesday AM: Teams report on projects from prior day. The topic for the day is Standard Work. Wednesday PM: Teams complete a Standard Work project in their 7S area. Teams prepare a short project report. Thursday AM: Teams report on projects from prior day. Lecture on Value Stream Mapping. Thursday PM: The entire class picks a value stream and map it with the instructor leading the activity. Friday AM: VSM is completed and a complete workshop progress report is prepared. Friday PM: The progress report is delivered and the workshop ends. We do understand that we seem to be asking a lot from leadership. But any less would do a disservice to the initiative. There are several aspects to consider when it comes to training and we have reviewed most of them. One key one remains, though; what about the location?
  • This is a succinct statement of what is involved with this step in the roadmap. The goal is to decide which measurements are going to be important to our Lean initiative, and that we will want to track on a regular basis. We then will need to determine how this data will be collected, how it will be reported and displayed, and what the process will be for review and follow-up. Going back to our car dashboard analogy: in our car we certainly need to know what the fuel level is, and how fast we’re going. Those are non-optional. A tachometer that shows engine speed, and an engine temperature gauge could also be useful, but we probably don’t need to look at them as often. We could also have gauges that show the level of wiper fluid, or the speed of our radiator fan, but it’s questionable whether that kind of data is needed or actionable. The lesson here is that we need to be careful and conservative in selecting items to measure, and just because we can measure something doesn’t mean that we should, or that its something we can do anything about. POWERHEALTH PLUG: “One of the main reasons we have a strong partnership with PowerHealth OnDemand is that in working with numerous hospital clients, it quickly became apparent that a majority of hospital staff do not have readily available access to the KPI data needed to measure and improve performance. PowerHealth OnDemand is a seamlessly integrated hosted service that enables access to the critical performance data.” Let’s now review the Learning Objectives for this lesson.
  • Every process on our Lean roadmap, every one of the boxes that we’ll be discussing throughout this course, needs to have an “owner”. Let’s define that. The owner of a process is a human being with three main responsibilities regarding the process:   Number one. The process owner is responsible for documenting how the process should work. Note I said documenting and not necessarily defining. The details of how the process should work may be determined by a team, or by an outside regulatory agency. We sometimes call this step the Standard Work Definition, and it’s an important Lean tool.   Number two. The process owner is responsible for ensuring that staff members are properly trained in standard work, and that they are actually doing standard work. So we have two needs here, a training requirement and an auditing requirement. Note that training doesn’t mean exposing staff members to a PowerPoint presentation, and expecting that they will go out and actually do that. Training requires practice, under the guidance of a mentor, and repeated application.   Number three. The process owner will oversee the effort to continually improve the process, by soliciting ideas from the people that work in the process, and by helping to implement the good ideas as quickly as possible. There is no implication that by defining the process and writing it down, that somehow it can’t be improved. Continuous improvement is central to the Lean philosophy, and the process owner plays an important role in making this happen.   Finally, so what if the process owner doesn’t do what he/she is supposed to do? This introduces the concept of a Lean Management System, whereby the Process Champion, someone up the management chain, will be expected to supervise the Process Owner. We’re not being mean about it, but it’s not acceptable for a Process Owner to not do the job he/she was hired to do.   Let’s now talk about what a dashboard system will be used for.
  • We’re not creating a dashboard to keep ourselves busy, with no practical outcome. We intend to create a feedback system, based on concrete data, that will trigger some action, just like the dashboard of a car. If the dashboard says we’re going too fast, we let off on the accelerator. If our OR dashboard tells us that OR suite changeover times are going up, we focus our attention on the root cause of why that might be happening and take corrective action.   We need to be prudent in the number of things that we decide to track. If we try to measure too many things, especially if the data has to be collected manually, the effort may quickly become burdensome, and we’ll simply stop doing it as soon as a good excuse comes up. Let’s not measure too many things.   In fact, many things that we may currently measure are not actually things we can do anything about directly. They are results, and not really drivers. Let’s measure the things that we can take action on.   Finally, a dashboard sounds high-tech but it doesn’t need to be. In point of fact, dashboards and metrics in many Lean organizations are intentionally maintained manually. People that work in a process will physically mark on a piece of paper, at some specified interval, the process results. In a factory, if you’ll pardon the example, a worker might update a production chart every hour. In a hospital the OR nurse may update the OR suite changeover time chart at the completion of every changeover. The frequency of reporting is what we call the “pitch”. We might start out with a pitch that is a longer interval, but over time we would like to make the reporting period shorter and shorter. Let’s talk about the pitch concept in more detail.
  • As we said, the pitch is the frequency of monitoring performance, and the goal over time is to make it shorter. But why should we want to do that? The reason is that the longer the pitch, the smaller the opportunity to do something about it in a timely fashion. If we have a process problem, and measure the process monthly, we could have a month’s worth of bad performance before we get around to doing something about it. Lean organizations strive to reduce this reporting cycle, and in fact mature Lean organizations measure much of what they do daily and even hourly. The picture on this slide shows a management tool called a Heijunka Box. Heijunka is a Japanese word that means “smoothing”. Each slot that you see here represents a time period, which could be minutes or hours each. This is therefore a visual representation of the concept of pitch. The cards shown here could represent scheduled patients, or work already completed, and the status of the day is highly visual and there for anyone to see. With a little creativity, this could be a great hospital visual tool, but that’s a topic for another course.
  • What are the Lean metrics that you may want to consider adding to your dashboard? You may be tracking these already, but let’s go over them. The OR Suite or Patient Room Changeover Time. Remember here that we’re primarily concerned with the time between when it is available for cleaning, and the time when it’s ready for use. The OR Suite may be available for use, but the next patient isn’t there. That’s a different kind of problem, not related to whether or not the room is ready. The same goes for patient rooms. The room could be ready, but we have other issues, of transport for example, that keep the next patient for getting there. We need to track the number of improvement suggestions that the hospital or OR is receiving. We’ll talk about this in more detail in a later lesson, but for now let’s agree that this is something we want to track. It obviously doesn’t help to receive improvement suggestions and then not actually do them. This is a part of our improvement tracking database. The Process Maturity Level of the processes on our value stream is something that we want to see continually improving. Remember that a process with a low level of maturity will not perform well, and improvements in a low-maturity process will be difficult to sustain. Inventory Turnover and Inventory Accuracy are measures of how well we are managing supplies, and how well the supplies are flowing through the OR efficiently. Normally a higher level of accuracy and a higher level of turnover are considered good things. Our value stream mapping work will give us an estimate of the time that a patient spends in the value stream, including waiting time. Without compromising patient outcomes, we would like to see this time be reduced, primarily by eliminating the waste in the value stream. You’re probably tracking this already, but we want to make sure that quality measurements are front and center in our awareness. This is not a complete list, of course, and feel free to add to it the additional measurements that are important to you. Let’s now talk about the dashboard itself.
  • There are software systems available for purchase that are focused entirely on dashboards, and of course that costs money. Fortunately there are a number of electronic options, including the use of good old Excel. An example of an Excel dashboard is shown here. Two main points need to be made about the actual dashboard presentation: As I mentioned before, most Lean companies like to have the people that are close to the data record updates manually, and forego the use of computers altogether, other than maybe archiving the data later on. In that way people close to the issue are the ones that update the information, and presumably are also paying attention. Also, you probably already have a dashboard of some kind, so why not use it? The main thing to think about is: who needs to know this information to trigger action, and what is the best and easiest way to manage that.
  • We know this for sure: if the data we’re asking for is hard to get, the chances of you getting it on a regular basis will be slim. You will be setting yourself up for failure. Another failure inducing fact is that if the data you’re collecting is not actually used to trigger corrective actions, the incentive to continue to provide it also goes down dramatically. Here are some additional thoughts about dashboard maintenance: Share the wealth and don’t make data collection a burden on one person. Normally the supervisors in an area will be the first line of responsibility for data collection. Ideally it will become a routine part of some people’s daily responsibilities. If you’re already collecting information that you want, and chances are high that you are, use existing systems and ask for help from your IT department to get easy access to it.
  • Let summarize this task on the Lean in the OR roadmap that we’re following. We will probably want to add to the items that we’re currently tracking, and we talked about a list of these in this lesson. It doesn’t help to track measurements and then not take action when required. Think about moving prudently, over time, to a shorter and shorter pitch, i.e. the frequency of reporting and taking action. Reporting once a month is not going to cut it. Let’s make sure you have an accountability system in place. In Lean terms this is called a Lean Management System. Do you want to learn more about this topic? As usual, there is not shortage of information, and here are two good choices for additional reading.


  • 1. Sponsored by:Creating a Lean Culture of Continuous Improvement
  • 2. Covered Topics in the 3-part Lean Hospital Series – Why 3 parts? PART 11. The definition of a “Lean Hospital”, and what is meant by that term.2. Introduction to the Lean Roadmap, the step-by-step guide to Lean deployment for hospitals.3. The need for a Lean Performance Dashboard, and what might be included. PART 2 (December 18 1pm EST)4. The meaning of “Kaizen” and the definition of the two types of Kaizen activities.5. Creating a Quick and Easy Kaizen initiative.6. Benchmarking of Kaizen efforts with other Lean organizations. Part 3 (January TBD)7. The Process Improvement database. Is Excel the best option?8. Building a Kaizen infrastructure: people, systems and improvement processes.9. Audit Checklist: 10 things to do to create a Lean Culture of Continuous Improvement.
  • 3. • Principal, Leonardo Group Americas LLC. • Co-Author of Fundamentals of Flow Manufacturing, Aerospace Flow, In the OR series of Lean HospitalGerard books. • Vice President of Technology, JCIT.Leone • Trained over 5000 manufacturing professionals seeking improved performance over his tenure at JCIT and CSU. • Adjunct Instructor of Manufacturing Management at Colorado State University. • Implementation Leader in over 150 businesses of various sizes. • Lean Hospital work since 2002. • In charge of the Lean Healthcare practice at LGA. • Bilingual Spanish-English. • 12 years of manufacturing management and teaching at university level prior to consulting career.
  • 4. Webinar OverviewThe principles and tools of Lean thinking are changing the lives of Healthcare professionals by allowing them to devote more of their time to caring for patients. This is possible through the elimination of wasteful activities and the participation of all staff in a culture of Continuous Process Improvement, following a Lean Roadmap.
  • 5. Learning Objectives: Part I of III• What is Lean?• What are the Characteristics of a Lean Hospital?• Introduction to the Lean Hospital Roadmap.• Phases I and II: Assessment and Master Plan.• Phase III: Train Leadership Team.• Phase IV: Create a Lean Dashboard.
  • 6. What is Lean?Basic Lean Definition Originally from Industry A systematic approach to identifying and eliminating waste (non-value-addedactivities) through continuous improvement by flowing the product at the pull of the customer in pursuit of perfection. The Lean Enterprise Institute
  • 7. Lean Hospital VisionLean is Patient-Focused Lean for Hospitals A hospital that is continually improving patient safety and satisfaction, treatment outcomes, and staff development through the elimination of waste and errors, and improvement in patient flow. The Lean Hospital Group
  • 8. 10% Value Adding Non Why Does Value Adding Lean Matter? 90%
  • 9. Characteristics of a Lean Hospital ILean Characteristic What To Look For
  • 10. Characteristics of a Lean Hospital IILean Characteristic What To Look For
  • 11. Some Lean Tools
  • 12. Some Lean Tools
  • 13. Not Just “Excellence is an art won byAbout the training and habituation. Tools We do not act rightly because we have virtue or excellence, but we rather have those because we have acted rightly. We are what we repeatedly do. Excellence, then, is not an act but a habit.” -Aristotle
  • 14. Lean Hospital Implementation Roadmap Train Leadership Team in the principles of To support the Hospital’s Lean A Lean Hospital embraces a An initial assessment of current hospital Hoshin Kanri (Goal Deployment) and formalize journey, Leaders must participative model of Continuous operations, including future vision and level internal process. Use A3-X chart and Team understand the tools and Improvement. All Lean Hospital of process improvement maturity. Includes Charter forms for all Master Plans. culture of Continuous Process employees must be trained to be a analysis of potential benefits. Improvement. part of this culture. Conduct Value Stream analysis for each unit and department to identify 1 3 TRAIN 6 opportunities for improvement. Create a START LEAN HOSPITAL ASSESS O.R. TRAIN TRAIN unit-level Master Plan. START LEAN HOSPITAL ASSESS O.R. LEADERSHIP TRAIN TRANSFORMATION OPERATIONS LEADERSHIP HOSPITAL STAFF TRANSFORMATION OPERATIONS TEAM HOSPITAL STAFF TEAM The Lean Hospital Master Plan includes a definition of identified 2 VALUE STREAM 4 7 8 Formalize the VALUE STREAM SET UP SET UP IMPLEMENT IMPLEMENT improvements, resources DEVELOP UNIT DEVELOP UNIT process of soliciting, ANALYSIS AND ANALYSIS AND PERFORMANCE PERFORMANCE GOAL DEPLOYMENT GOAL DEPLOYMENT required, implementation MASTER PLANS MASTER PLANS receiving, MASTER PLAN MASTER PLAN DASHBOARD DASHBOARD TOOLS TOOLS timeline, estimated benefits, and evaluating, andROI for the selected value streams. implementing process Establish lean performance metrics improvement and method for reporting, analysis, suggestions for the 5 and follow-up. CONDUCT CONDUCT entire hospital. PILOT PROJECTS PILOT PROJECTS Select highly visible areas for proof 9 10 SUSTAINED of concept and buy-in. Follow CONDUCT INITIAL IMPLEMENT KAIZEN SUSTAINED Roll-out unit and department CONDUCT INITIAL IMPLEMENT KAIZEN PERFORMANCE Kaizen methodology to achieve KAIZEN EVENTS SUGGESTION SYSTEM PERFORMANCE process improvement KAIZEN EVENTS SUGGESTION SYSTEM results in less than 5 days. activities per the Lean Certify all Internal Lean Hospital Master Plan. Mentors through completion of actual projects and 15 14 IMPLEMENT Knowledge Checks. ROADMAP IMPLEMENT ROADMAP SUSTAINABILITY COMPLIANCE AUDIT SUSTAINABILITY COMPLIANCE AUDIT ROADMAP ROADMAP 13 12 KAIZEN MENTOR 11 KAIZEN MENTOR KAIZEN MENTOR INSTITUTE KAIZEN MENTOR CERTIFICATION INSTITUTE CERTIFICATION CERTIFICATION UNIT CPI TEAM Conduct a comprehensive, lean- CERTIFICATION TRAINING UNIT CPI TEAM TRAINING focused audit, with the objective of advancing the Lean Culture at the Hospital. Each team leader presents the status of Organize a local Continuous completed Kaizen projects to ensure Train a team of Hospital Staff Process Improvement Team to results and sustained performance. to become internal Lean identify, evaluate, and Mentors. implement improvements.
  • 15. Phases 1.1 and 1.2 1ASSESS HOSPITAL ASSESS HOSPITAL 2 VALUE STREAM VALUE STREAM ANALYSIS AND ANALYSIS AND OPERATIONS OPERATIONS MASTER PLAN MASTER PLAN The Lean Hospital Master Plan includes a definition of identified improvements,resources required, implementation timeline, estimated benefits, and ROI for the selected Value Streams.
  • 16. VSMDefinitions
  • 17. VSM for Preference CardsProcess Delay Time/Data Opportunity/Burst
  • 18. Master Plan
  • 19. Phase 1.3 3 TRAIN TRAIN LEADERSHIP LEADERSHIP TEAM TEAMTo support the hospital’s Lean journey, leaders must understand the tools and culture of Continuous Process Improvement.
  • 20. • Lean is not a bottoms-up initiative. It’s lead from the top. Why?• Making improvements and sustaining them is management’s job.• How can you support something you don’t understand?• Avoid the rotten apple effect by training entire leadership.
  • 21. Who?
  • 22. What?
  • 24. When Should Leadership Training Happen? • Leadership team training happens soon. • Sustainability depends on leadership team engagement. • Train in groups of 16-20. • This requires commitment.
  • 25. Phase 1.4 Performance Dashboard 4 SET UP SET UP PERFORMANCE PERFORMANCE DASHBOARD DASHBOARDEstablish Lean performance metrics and method for reporting, analysis, and follow-up.
  • 26. Assign Dashboard Process OwnerWHO IS A PROCESS OWNER? DON’T MESS WITH MY DATA• A person responsible for the process: documentation, training, continuous improvement.• Who to go to if there are questions, or the task is not completed.• Someone who is responsible for getting the job done.• The Process Owner also needs a Process Champion for accountability.
  • 27. Set Dashboard GoalsDashboard Purpose K.I.S.S. • Too many measurements It needs to be become burdensome.understood and decided • Some metrics are drivers, at the beginning what and other metrics are the dashboard will be outcomes. used for. The goal is to • Dashboard should be create a feedback automated, but doesn’t need to be 100% real-time. system that results in • Move towards decreasing concrete improvement the “pitch”. activities.
  • 28. What is the Pitch? Evolutionary Process Heijunka Box• Pitch = How often you measure performance.• The longer the pitch, the less opportunity to do something about it.• Lean organizations strive to reduce the pitch duration.• Monthly -> Weekly -> Daily
  • 29. • OR Suite and Patient Room Changeover TimeTypical Lean • Number of Improvement Suggestions Per Person Per KPIs Month • Number of Implemented Ideas • Process Maturity Level • Inventory Turnover and Inventory Accuracy • Patient Flow Metrics • Quality Related Metrics
  • 30. Create Electronic DatabaseMANUAL PROCESSES ARE RISKY EXCEL DASHBOARD EXAMPLE• Temptation is to develop dashboard manually.• Data consistency may be variable.• Completion depends on individual people.• Pitch is probably long.• Expensive.
  • 31. Dashboard MaintenanceMAKE DATA COLLECTION EASY NOT A DIRTY JOB• Data collection should not be a one-person job.• Rely on existing systems.• Get IT help for automated data processing.• Automate the process as much as possible.
  • 32. Dashboard PurposeMETRICS LEAD TO ACTION RUBBER MEETS THE ROAD• Lean metrics need to be added to current performance measurements.• Data needs to be looked at closely by management, and action taken.• Mature Lean organizations do this daily. Move in this direction.• Action items are assigned and people are held accountable for completion.
  • 33. Value Stream Mapping Is Scan Tool
  • 34. Kaizen Suggestion Database
  • 35. Convert Suggestion to A3 Team Charter
  • 36. Manage the Kaizen Projects
  • 37. Performance Dashboard
  • 38. Thank you for joining us today. Please be on the lookout for a follow-up email with the Leonardo “Lean Sweepstakes” link to enter. See you in December for part 2…. Leonardo Group Principals: Gerard Leone & Richard D Rahn 303-494-4404 Boulder, Co 80303 PowerHealthOnDemand Scott Calvert VP Business Development 303-683-8239 Greenwood Village, Co 80111