Mark's slides from December 2, 2015

1. From Factories to Health Systems:
How Lean Principles
Can Drive Giant Leaps Forward
in Quality and Safety
Mark Graban
@MarkGraban
© 2015, Constancy, Inc., All Rights Reserved
http://www.markgraban.com/leapfrog2015

2. Not Just a Toolbox

3. Philosophy
People
Development
… An Integrated System

4. Why
Lean?

5. “Start from need.”
– Taiichi Ohno (1912-1990)

6. Allegheny General Hospital
76%
CLABSI
95%
Deaths

7. BJC Healthcare
58%
Pressure
Ulcers

8. ThedaCare “Door to Balloon” Time
0
10
20
30
40
50
60
70
80
90
100
2005 2006 2007 2008 2009 2010 2011 2012

9. Reducing MRI Wait Time
0
2
4
6
8
10
12
14
WeeksUntilAppointment

10. Why?

13. “Human error is inevitable.
We can never eliminate it.”
We can eliminate problems
in the system that make it
more likely to happen.”
– Liam Donaldson,
WHO World Health Alliance for Patient Safety

15. The
Five
Whos

16. The
Five
Whys

19. 5 Whys
Emergency
situation
Lack of training
They are using a mix
of soap & water and
gel instead of just gel
The alcohol makes
those cracks sting
Soap & water takes
oil out of hands, making
making skin crack
They think alcohol gel
cracks their hands
Too many
pressing issues
Lack of administration
attention
Lack of resources
Lack of training
Lack of awareness on
practices & requirements
Culture of "jump when
MD says jump"
RN is often running
in response to MD
request
They forget because
they are in a hurry
Gel dispensers
are not on the
computer carts
Gel dispensers
are not convenient
Lack of 5S
organization
Carts are not always
stored in the same place
Not enough storage
space nearby
Been told to
keep hallways clear
Not enough
carts in the unit
Too hard to find carts,
so nurse and techs
carry things in their arms
Their hands are full
when leaving a room
Why do clinicians not follow hand hygiene practices 100% of the time?
Things we can fix … today
Source: Lean Hospitals, Graban
“Many” Whys

20. Go See
Ask Why
Show Respect
Fujio Cho

21. 0
10
20
30
40
50
60
70
80
90
MinutesofWork

22. “In the ordinary hospital the nurses
must make useless steps. More of
their time is spent in walking
than in caring for the patient.”

23. How Many
Hospitals
Use Lean?

24. ¯_( )_/¯

26. Not Just Events

28. “We’ve been
implementing Lean
for 5 years…
now we’re focusing
on continuous
improvement.”

29. 25,000

32. www.leanblog.org/applesauce

35. Long-Term
Focus

37. We don’t have
time for
improvement

38. “Mikki Gremp, RN,
left one hospital
because… of
'flexing down.’”
AJN Report: The Other Side of Mandatory Overtime
Roxanne Nelson BSN, RN
Maureen Shawn Kennedy MA, RN, editorial director
AJN, American Journal of Nursing
April 2008, Volume 108 Number 4, Pages 23 - 24

39. Safety
First

40. “Safe work is “the door” to all work.
Let us always pass through this door first”
• Eiji Toyoda

41. Lost Workday Cases: Japan

42. “If we can’t do things safely,
why should we be doing them
in the first place?”

44. Survey: Top Issues
Confronting Hospitals in 2014
www.ache.org/pubs/research/ceoissues.cfm

45. Patient
Focus

46. “It is not at all certain whether
hospitals as they are now
managed exist for patients or
for doctors.”

47. Park Nicollet
Frauenshuh Cancer Center www.leanblog.org/parknic

48. Discipline

51. Lean Mindsets
“You get what you
inspect, not what
you expect.”

52. Speak Up
For Safety

53. 124 Deaths

57. Why Don’t
Staff
Speak Up?

59. Fear Futility
20% 26%

60. Andon

61. Q&A / Contact Info
• President, Constancy, Inc.
– www.MarkGraban.com
• Founder, LeanBlog.org
– mark@leanblog.org
• Twitter @MarkGraban

64. “No Problems
is Problem”

67. Leadership

68. Humility

70. “…in humility
there is great
freedom. We can
stop pretending to
know everything.”
- John Toussaint, MD

71. Community
Collaboration

74. Thank You!
• www.MarkGraban.com/leapfrog2015
• www.LeanBlog.org
• @MarkGraban
• mark@markgraban.com