Lean management in healthcare

1. Lean Management in
Healthcare
Presented By:
Siddharth Singh
PGDM (HEAD) Inlead

2. Introduction
• Lean management is an approach to running an organization that
supports the concept of continuous improvement. It is an ongoing
effort to improve products, services, or processes, which require
“incremental” improvement over time in order to increase efficiency
and quality.
• Lean management uses methods for eliminating factors that waste
time, effort or money. This is accomplished by analyzing a business
process and then revising it or cutting out any steps that do not
create value for customers.

3. Five Lean Management Principles
1. Identify customers and specify value added
2. Identify and map value streams
3. Create flow by eliminating waste
4. Organize according to customer pull
5. Improve continuously are the foundations of Lean hospital
management

4. Lean Management Tools
• 5S
• Kanban (pull systems)
• Value Stream Mapping
• SMED
• Poka-yoke (error-proofing)
• Elimination of Time Batching
• Total Productive Maintenance
• Mixed Model Processing
• Single Point Scheduling
• Rank Order Clustering
• Multi-process Handling
• Redesigning Working Cells
• Control Charts

5. 5 “S” Tool
• Seiri (Sort)
• Seiton (Set in order)
• Seiso (Shine/Sweeping/Cleanliness)
• Seiketsu (Standardize)
• Shitsuke (Sustain)

6. The 5 "S's" to Create an Efficient Hospital
Environment
• 1. Sort. In this step, hospitals sort through unnecessary items that are no longer being used and
identify expired or outdated items. For example, hospitals can eliminate physician preference items
for a surgeon who is no longer practicing at the hospital, which can clear space in the supply area.
2. Straighten. In this step, hospitals organize what they have using basic visual management such as
labeling, signs, pictures and designated areas for specific equipment. Organizing materials can help
hospitals "reduce inventory, establish par levels for future purchasing, designate areas for storage and
create standards related to how care and treatment are provided (i.e., the number and type of
instruments being utilized)," For example, a hospital may post pictures of specific instruments on
different bins in the supply area to help staff quickly retrieve needed items.
3. Shine. The "Shine" step exposes conditions that may jeopardize the hospital's overall quality.
Hospitals clean all areas and identify and address any gaps in cleaning standards. In addition to
sterilizing spaces, such as the operating room, hospitals should also ensure the work environment is
pleasant, by assessing the lighting, dust level and odors in the building. This step creates a safe
environment and can improve the patient experience.

7. Contd..
• 4. Standardize. In the "Standardize" step, hospitals develop standard protocols for maintaining and
monitoring the first three S's — sort, straighten and shine. These protocols should identify the actions
needed to accomplish these steps, the people responsible for these actions and when the actions
should be performed. For example, the hospital should establish standard practices for cleaning the
environment consistently.
The 5S approach is a great way to get everyone involved in creating an environment of success and
performance excellence. If not yet embraced, start today by involving all levels of staff to ensure that
true 5S deployment is occurring across the department."
5. Sustain. In the "Sustain" step, hospitals maintain an efficient work environment by continuing to
focus on the four previous "S's." Sustaining an efficient environment is one of the greatest challenges in
the 5S approach, Incorporating the 5S approach in hospitals' overall strategies to meet short and long
term goals can help hospitals maintain efficiency.

8. List of Practice Implemented in Hospital
Hospital Practices Lean Practice Implementation Procedures
Scheduled calibration and
checking of equipment’s
1) Zero defect principle
2) Safety improvement programs
3) Total preventive maintenance
The equipments were tracked by giving a
particular serial number or asset number.
Preventive maintenance of the equipment was
ensured through a separate checklist against
each asset number. Daily maintenance, weekly
maintenance, monthly maintenance
(calibration & functioning) and half yearly
maintenance (servicing equipment by service
engineer) were regularly performed
Scheduling for outdoor
patient department
1) Process simplification
2) Customer involvement
3) Cycle time and lead time
reduction
4) WIP reduction
Patient can fix their appointment either by
calling the hospital or using the hospital
website where they have the option of
selecting the timings and doctor of their
choice.

9. Scheduling staff
cyclically
1) Production smoothing or load
levelling
2) Work load balancing
3) Job rotation
Initially two separate set of employees used to work for
day shifts and night shifts but after implementing
cyclical scheduling for all the employees, number of
night shift a single employee as a whole has to attend
for a month significantly reduced.
Integrated
Pharmaceutical
Information
System (IHIS)
1) Electronic data interface
2) Information sharing
3) Supplier involvement
4) Sole sourcing and supplier
reduction
Pharmacy department through this information system
was able to leverage on bulk order special deals
provided by the drug suppliers on the medicine with
reduced shelf life as consumption pattern of each drug
could be tracked. System also enabled supplier inventory
monitoring by interfacing the information system with
suppliers.

10. Grievance management
system
1) Customer focus and
involvement
2) Defect prevention
3) Employee participation
4) Use of problem solving tools
Cause and effect analysis (Ishikawa diagram) was
used to reason the problems received through
grievance management system from the visitors to
the hospital. For example, high waiting time was
reported by visitors at pharmacy counters and
using the cause and effect analysis, some of the
reasons were identified to be lack of skill of
pharmacy counter employees, irregular supply of
drugs, space unavailability at counters and
multiple prescription medicine cross checks in the
pharmacy store.

11. Comparison of pre and post implementation of Lean
Process Performance measures Before After Percentage
Improvement
Out Patient
department
Average waiting time at different
nodes in the hospital
80 minutes 30 minutes 62.5% decrease
Average total lead time from
entering and leaving the hospital
115 minutes 35 minutes 70% decrease
Average redundant patient walking
distance
1770 meter 475 meter 73% decrease
Integrated
Pharmaceutical
Information
System
Average number of medicine stock
outs in a month
22 4 82% decrease
Average lead time between order
and delivery
3 days 1 day 67% decrease
Average number of emails
transacted for an order placement
6 Nil 100% reduction
Number of instances of wrong
billing in a month
13 3 77 % reduction

12. Effects of Lean Management in Healthcare
• Improving productivity (Output/Outcome).
• Reducing Errors.
• Increase Patient satisfaction.
• Reducing Waste.
• Continuous Improvement.

13. Conclusion
• Similar to the introduction of Lean management in production, service
organizations in health care have been facing opposition arising from various
stakeholders. In the meantime, more and more managers and employees
recognize that neither the product nor the output is at the core of Lean hospital.
In fact, it focuses on the processes underlying the service provision.
• As a consequence, Lean management is more frequently applied in health care
aiming at boosting productivity and reducing lead time as well as improving
customer and employee satisfaction.
• Hospitals and other players in health care have to evolve into modern companies
to survive the future of this fast-changing industry. Lean hospital management
offers leaders many possibilities for establishing professional, process-driven
health care organizations.

14. References
• http://www.ihi.org/resources/Pages/IHIWhitePapers/GoingLeaninHealthCare.asp
x
• https://www.kanbanchi.com/lean-management
• https://www.pomsmeetings.org/confpapers/051/051-070
• http://implementconsultinggroup.com/inspiration/articles/coping-with-current-
challenges-in-health-care/

15. Thank You