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Making Hosiptals Work


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Making Hosiptals Work

  1. 1. Making Hospitals WorkHow to improve patient care while savingeveryone’s time and hospitals’ resources With Ian Taylor and Marc Baker I T l dM B k Senior Faculty Members of the UK’s Lean Enterprise Academy and authors of Making Hospitals Work
  2. 2. Lean in Healthcare WorkshopsPhiladelphia• Key Concepts of Lean in Healthcare September 29 30 29-30• Making Hospitals Work September 30-31 30 31• Value-Stream Mapping for Healthcare October 1• More information:, click Education g,
  3. 3. Introductory Comments Introductory Comments Author: Lean Hospitals: Mark Graban Improving Q lit Patient S f t I i Quality, P ti t Safety, Senior Fellow, LEI and Employee Satisfaction
  4. 4. Why Lean in Healthcare? (U.S.)
  5. 5. Universal Problems Waste ErrorsCostC SilosWork-Arounds Waiting Staff Frustration
  6. 6. Lean Works in Healthcare•Purpose Patients•Process•People Benefits  Staff & of Lean fL Healthcare Providers Organization g
  7. 7. Results from Lean•Safety • Zero central line infections for patients•Quality • Zero medication reconciliation errors•Time • “Door to Balloon” time in 37 minutes (national goal = 90) Door Balloon•Cost • 12% productivity improvement in 3 years•Morale • Better employee satisfaction scores, lower turnover
  8. 8. Healthcare Value Leaders www healthcarevalueleaders org
  9. 9. Our Initial NetworkGroup Health Cooperative - Seattle, WAGundersen Lutheran Health System - La Crosse, WIHarvard Vanguard Medical Associates - Boston, MAHotel Dieu-Grace Hospital - Windsor, Ontario,Iowa Health System - Des Moines, IA yJohns Hopkins Medicine - Baltimore, MDLawrence & Memorial Hospital - New London, CTLehigh Valley Health Network, Allentown, PAMcLeod Health - Florence SC Florence,Mercy Medical Center - Cedar Rapids, IAPark Nicollet Health Services - Minneapolis, MNSt. Boniface General Hospital - Winnipeg, Manitoba,St.St Joseph Health System - Orange CA Orange,ThedaCare - Appleton, WIUCLA Health System - Los Angeles, CAUniversity of Michigan Health System - Ann Arbor, MI
  10. 10. Making Hospitals Work •Marc Baker Marc •Ian Taylor Ian
  11. 11. Grasping the Situation:What iWh t is our Problem? P bl ?
  12. 12. The sort of changes we are predicting
  13. 13. Working out what the real problem is
  14. 14. How Big is g the BIG Problem? P bl ?What does this Medical Demand Look Like?• Who are they?• How many of them are there?• How similar or different are they?• Where do they come from?• What happens to them?• Where do they go?
  15. 15. Seeing where different types of patients & demand rates
  16. 16. Capturing where the patient comes from & where they are discharged to. The spine – Where the patient physicallyexperiences a step where th experience a wait or delay & if i t h they i it d l they are pushed or pulled.
  17. 17. Adding the data boxes & the time line capturing the time taken experiencing steps & the time p g p experiencing waits or delays (totalling both) A completed Data Box
  18. 18. Capturing the information flow – notes & electronic data or transactions & their connections with the spine
  19. 19. Capturing the scheduling and managementprocesses & their connections with the spine
  20. 20. Don’t worry if yours ends up looking like this !!!!
  21. 21. Deep Causes of the Current1. No plans for patients (therefore status checks impossible).2. Departmental working hours are not synchronised3. Capacity (staff) are not calculated to meet demand4. The frequency of interventions are not designed to meet demand d d
  22. 22. Staff/Departmental Availability
  23. 23. Nursing Availability to Discharge from Wards
  24. 24. 1. What is/are takt times?2. Where can we remove the t i th triangles ( iti )? l (waiting)?3. What can we do where we cannot remove the triangles?4. Which process should we make our single k i l point of schedule?
  25. 25. Demand: What are your takt times? “Takt” = rate of patient/customer demand for servicesDemand to Access Demand to Get Out
  26. 26. Where can we take out the triangles (waiting)?
  27. 27. ED Cell Layout
  28. 28. A fishbone icon identifying the key support service in treating a patient on a ward
  29. 29. Zooming into the Fishbone
  30. 30. What can we do where we can’t remove triangles? Need Bed Signal Supply Bed Signal Bed B d BedCustomer Buffer containing a Supplier Process constant number of Process empty bedsReversing the Polarity (You cannot ‘pull’ the customer) – In Healthcare (as pullin some other service industries) the Patient is actually present in Door toDoor system & is therefore both the Customer & the Product, moving fromleft to right. Unique to an Emergency Care environment is the fact that youcannot prevent the Customer should they need to, from entering the system Customer, to
  31. 31. Fact - Local Scheduling Creates Triangles Sc edu e Schedule Sc edu e Schedule Schedule
  32. 32. At which single point will you schedule?....The PacemakerThe schedule is sent to a single point in the entire process which works tothat schedule, with all other parts of the process subordinate to it.If the pacemaker is told to ‘speed up,’every other bit of the process speeds up, to keep pace.If the pacemaker is told to ‘slow down,’ every other part of theprocess slows down in response.
  33. 33. The Visual Hospital in Action – with the Master Patient Scheduler
  34. 34. 4: Where is the single point of schedule (pacemaker)?
  35. 35. What Happens at the Pacemaker pp
  36. 36. Flow, Pull & Pacemaker• Beat, Takt(s) ( ) • Balanced• Flow, Flow, Flow • Flexible• Synchronized • Standardized
  37. 37. Designing the Future State
  38. 38. The Future State: With the Questions Answered Pacemaker Flow Buffers
  39. 39. Achieving the Future State: Creating an Action Plan
  40. 40. Who’s going to make sure all this happens ???? The Value Stream Manager: g• Preparing the Business Case• Implementation of the Transition Plan• Cuts across all Departments & Divisions (silos) - who all have different targets andobjectives And when it’s in place:• Responsible for all Medical Patients - the ‘Patient Representative’• Ensures that Medical patient’s needs are met ‘On Time & In Full’• Responsible for resolving any issues that prevent this – At the very highest level ifrequired Who ‘currently’ has the time to do all this ???? y
  41. 41. Healthcare Resources Books & DVDsWorkshops Website• Key Concepts of Articles, case studies, videos, A ti l t di idLean in Healthcare forums, templates, and more at:• Value-Stream • lean.orgMapping for • leanuk.orgHealthcare •• Making Hospitals Connection C t C ti CenterWork Find and communicate with other lean thinkers in healthcare
  42. 42. Questions & Answers Ian Taylor Marc BakerSelected questions not answered in the webinarare posted on the webinar archive page
  43. 43. Next Steps:• Share the webinar link• Read Lean Hospitals and Making Hospitals Work• Lean-in-Healthcare Workshops, Philadelphia Sept. 29 to Oct.1: •Value-Stream Mapping for Healthcare. pp g •Key Concepts of Lean in Healthcare •Making Hospitals Work More info: