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Lean Lessons from Three Healthcare Systems


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presented by Daniel T Jones at the AME Conference in Toronoto on 23rd October 2013

Published in: Education
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Lean Lessons from Three Healthcare Systems

  1. 1. Lean Lessons from Three Healthcare Systems Daniel T Jones
  2. 2. Santa Maria Nuova – Established in 1288
  3. 3. flow design Linee chirurgiche Compartooperatorio Recovery room DegenzaDegenza Preospedaliz- zazione Prenotazione Classe A < 30gg Classi B,C,D > 30 gg Preospeda lizzazione DEA Sala operatoria urgenza C Sala operatoria B Sala operatoria A Sala operatoria orto-trauma Chirurgia progr. Degenza ≤5 Chirurgia progr. degenza >5 Chirurgia urgenza Chirurgia progr. degenza >5Chirurgia progr. Degenza ≤5 Chirurgia urgenza High depende ncy Dimissione Dimissione Intensive care Vi accedono: pazienti con indicazione chirurgica certa e per i quali è stato definito il tipo di intervento o le eventuali alternative da valutare in base ai risultati della preospedalizzazione cell model Equipe multidisci plinare Attenzione costante fino alla soluzione Ogni cosa al suo posto Ciascun paziente è l’unico paziente 0 50 100 150 200 250 300 350 giu-06 lug-06 ago-06 set-06 ott-06 nov-06 dic-06 gen-07 feb-07 mar-07 apr-07 mag-07 giu-07 lug-07 ago-07 set-07 ott-07 nov-07 dic-07 gen-08 feb-08 mar-08 apr-08 mag-08 giu-08 lug-08 involving people                 r r    r r       r r    r r  r      r   r r      r     r r r  r r          r r    r r r  r   r  r r r r r          r r  r r  r r r  r r          VALUESTREAMPROCESSIPORTANTI STRATEGIE PROCESSI €0 €0 €0  = €0  = €0  r    r r   r = correlazioni correlazioni / contributi IMPLEMENTAZIONE CICLO LEAN MANAGEMENT 5SAPPLICATE10%ARTICOLAZIONISANITARIE VISUALMANAGEMENT70%DEGENZESGDESMA PPP100%CHIRURGIAPROGRAMMATA VSMMEDICINA AUMENTARECONOSCENZESULEANTHINKING IMPLEMENTAZIONEFORMAZIONECERTIFICATA correlazioni / contributi debole correlazione o rotating team member accountabilityresponsabilità importante correlazione o core team member forte correlazione o team leader Legenda A3-X - Strategico correlazioni Membri del team DirettoreDip.chir. DirettoreDEA DirettoreDip.Diagnostica FORMAZIONE CERTIFICATA DIMISSIONI PULL TATTICHE RISULTATI IMPLEMENTAZIONE MONITORAGGIO PERFORMANCES REPORTMONITORAGGIO10STRUTTURE VSMFUTURAURGENZADISEGNATA IMPLEMENTARELEANSHOPFLOOR Referenteformazionelean DirettoriPO IMPLEMENTAZIONE 5S IMPLEMENTAZIONE VISUAL MANAGEMENT VALUE STREAM CHIRURGIA CICLOATTIVATO VALUE STREAM MEDICINA KANBAN REPARTI ALLINEAREATTIVITA'ISSSACICLOLEANMANAGEMENT Referentepercorsi Referenteaccreditamento Referentekanban ProjectleaderOLA Osservatorioappropriatezza Osservatorioperformances KANBAN ATTIVAZIONEPULLTUTTELEZONE Hoshin Kanri for the Lean Enterprise © 2006 Thomas L. Jackson Revenue DirettoreDip.medico Costi di sviluppo Costi Materiali Costi di conversione Value stream profit Emergenza Chirurgico Medico Materno Infantile Terapie Intensive OncologicoDiagnostica Immagini Laboratori Dipartimenti ospedalieri Managerdilinea(shusa) Linea della Chirurgia programmata Linea della Chirurgia in urgenza Linea della High Care medica Linea Outpatients Percorso Nascita Linea Low Care patient flows 1° LIVELLO · Principi del lean thinking · PDCA · 5S · Visual management e Kanban Nel proprio ambiente di lavoro: · Saper leggere gli sprechi · Rispettare le regole delle 5S · Utilizzare il kanban · Utilizzare gli strumenti di visual management Prova scritta di apprendimento P R E R E Q U I S I T I C O N O S C E N Z E P O S T T R A I N I N G A B I L I T A’ 2° LIVELLO 3° LIVELLO 4° LIVELLO Certificazione primo livello Letture avanzate · Strumenti per l’analisi di processo · Elementi di base del lean management · Costruzione di un A3T · Progetto 5S · Lavorare in team · Identificare i problemi di un processo · Saper utilizzare un A3 · Impostare un progetto 5S Certificazione secondo livello Letture avanzate Certificazione terzo livello Letture avanzate · Gestione di un evento kaizen · FMEA e POKAYOKE · Sviluppo KANBAN · Value stream mapping · Value stream management · Ciclo del Lean management · Supply chain · SPC · Identificare le aree chiave per progetti spot di miglioramento · Facilitazione/coaching · Costruire una VSM di base · Saper analizzare i rischi del processo · Formazione livello 1 e 2** · Funzione di mentore per il kaizen a tutti i livelli · Lean action plan · Costruire VSM di processo · Analisi variabilità · Formazione livello 3** Aver partecipato ad un progetto A3T Aver partecipato ad un evento kaizen Aver partecipato alla costruzione di una Value stream map Partecipazione a 3+ eventi kaizen Aver condotto un evento kaizen con tutoring Aver partecipato alla costruzione di una VSM di processo Aver condotto 10+ eventi kaizen Aver sviluppato un ciclo completo di lean mangement Formazione in aula 7 ore Formazione in aula 3 giorni Formazione in aula 4 giorni Formazione in aula da istituzioni riconosciute dal Lean Office o da un livello aziendale certificato GOLD ** Deve dimostrare attitudine all’attività di formazione che verrà verificata tramite una scheda attitudinale e una prova pratica Nessuno Il livello viene certificato al termine del post training strategy deployment staff training
  4. 4. Rebuilding the hospital provided the opportunity to rebuild the organisation and mind-sets so everything supports the patient journeys while also deepening skills and capabilities What triggers your organisation to think back from its customers/users and learn to do new things? Question
  5. 5. Lean uses the same scientific approach to diagnose and treat organisational problems as doctors use to solve medical problems
  6. 6. Science is about asking the right questions not just about testing hypotheses We learn through doing experiments every day and reflecting on them Also through taking responsibility for solving real problems with others We develop capabilities by asking questions not by giving answers Everyone has to be involved in managing flow “Follow Me” Go See Ask Why & Show Respect To unblock the flow of value creation By develo ping capabil- itise Solve Business Problems using the Scientific Approach How are you taking responsibility for developing capabilities?
  7. 7. Dan Florizone Deputy Minister for Education Deputy Minister for Lean Across Government Previously Deputy Minister of Health Government of Saskatchewan
  8. 8. A Pioneering Experiment Began in healthcare – now spreading right across government Province-wide Hoshin focusing on the needs of groups of citizens in order to mobilize service delivery Led by doers – supported by politicians and civil servants How do you build common actions across big organisations?
  9. 9. The NHS is struggling with initiative fatigue We are carrying out experiments to build management systems to support lean operations and deliver results
  10. 10. Distinguish “real” from “created” demand Recognise common journeys – and complex tail How predictable is demand? What causes system driven variation? What is management doing to eliminate this noise? Attendances Admitted Patients
  11. 11. Experience the power of the Exec team walking and mapping patient journeys Learn to see the obstacles and delays Lean where to act to unblock the flow How to build stable and flexible flows across departments aligned with demand?
  12. 12. Common practice is created by making the work visible – not by hiding it in computers! Hands-on management of the end-to-end flow is critical for triggering actions unblocking obstacles and escalating issues and mentoring and coaching team capabilities Who is responsible for your end-to-end value streams? PFEP Visual Hospital
  13. 13. How many projects and targets? How much staff time spent reviewing them? Will they make a real difference and are they resourced? Hoshin is a framework for using CAPD to focus on the needs of broken value streams agree the vital few projects to close key performance gaps learn how time drives quality How good are you at focusing on the vital few?
  14. 14. Which experiments to deploy to close the gaps? Manage discharge with tertiary care Cellularize ED with near patient testing Synchronise support services to takt Frequent replenishment of supplies Which experiments will show where we need to go next?
  15. 15. We can all learn a lot from healthcare The dialogue with informed users and customers has only just begun Improving efficiency and quality buys time But we also need bold experiments with new ways of delivering services The scientific approach is key to acting our way to new ways of thinking What are you doing to prepare for this challenge?
  16. 16. Homework Further reading and video links at