by Daniel T Jones of Lean Enterprise Academy 1st October 2009

1. REALIZING THE
POTENTIAL OF LEAN
THINKING IN HEALTHCARE
Daniel T Jones
Chairman
Lean Enterprise
Academy
UK

2. Why am I here?
• Jim Womack and I have helped many industries get big
benefits from following Toyota in using Lean thinking
• Consumer goods, construction and the public sector
• I volunteered to try in healthcare - the time is right!
• I took many walks – following the flow of work
• I brought the pioneers together – to share experiences
and create awareness of the opportunities
• We then conducted many experiments – to hone and
write down how lean methods work in healthcare
• Now helping to build management systems to go
beyond point improvements and pilots to deliver results

3. Quality and Lean Thinking
• The Quality movement strives to define best practice
interventions and to eliminate variation and errors
• Lean focuses on the context of the flow of work to
eliminate delays for patients, wasted effort for staff and
unnecessary costs for hospitals
• They complement each other – quality > stability < flow
• They also share a common evidence based methodology
• Lean begins with engaging staff in improving their work
• But these point improvements are hard to sustain without
and end-to-end perspective and a management system
to support them

4. The District General Hospital
HOMEHOME
REHA
B
REHA
B
HOM
E
HOM
E
GPGP
PHARMACYPHARMACY SUPPLIESSUPPLIES
PATHOLOGYPATHOLOGY THERAPIESTHERAPIES
EMERGENCY
DEPARTMENT
EMERGENCY
DEPARTMENT
MAUMAU
SAUSAU
EMERGENCY
CLINICCLINIC
CLINICCLINIC
CLINICCLINIC
CLINICCLINIC
ELECTIVE
SURGUCAL
WARDS
SURGUCAL
WARDSOPERATING
ROOM
OPERATING
ROOM
MEDICAL
WARDS
MEDICAL
WARDS
IMAGINGIMAGING
OTHER
WARDS
OTHER
WARDS
D
I
S
C
H
A
R
G
E
D
I
S
C
H
A
R
G
E

5. The Challenge
• Now we see the hospital as a collection of processes
• And we know how to improve most of the pieces
• What would it take to connect all these pieces together?
• This has to have the support of the top team – who need
to take the time to see:-
– What are all the things that could be done?
– What would be the results for hospital performance?

6. Defining the Problem

7. The A3 Method

9. What is Demand?
Demand to Get Out
Demand to Get In

10. Mapping the Current State

11. Mapping the Current State

12. Mapping the Current State

13. The Emergency Medical Value Stream
What is the rate of demand?
How to create flow within departments?
How to flow between departments?
Where to schedule this flow?
6.5 days waiting for
3 hours of work!

14. The A3 so far

15. Creating Flow in ED

16. Synchronizing activities on Wards

19. Nursing Availability to Discharge from
Wards

20. How to Level Discharge?

21. The Future State
Buffers
Pacemaker
Flow

22. The Emergency Medical A3 Plan

23. The Elective Surgical A3 Plan

24. The Results
Free up capacity
Cut the Agency and Overtime
Budget
Big procurement savings

25. Khalid’s ‘End to End’ Trial: The Perfect Week (October 2008)
• ED Cell led by Senior Decision Maker – Safe Admission Avoidance
• MAU Cell led by Senior Decision Maker – Safe Admission Avoidance
• MAU Buffer
• Discharge Lounge Buffer
• Plan for Every patient (on medical wards)
• Visual Hospital (Bed Management)

26. The Implementation
• If there is a will to act
• Someone has to have the end-to-end responsibility
- a value stream manager
• Who works to establish the foundations
- stability and visibility
• Gaining agreement from the team on the right actions
- based on the facts
• With the backing to resolve conflicts between
Departmental and value stream objectives
• And to deliver results – in length of stay and $ saved

27. Plan for Every Patient Boards
By the Hour in ED
By the Day
on Wards

28. Line Management
The Tasks
Establish Stability – Plan for Every Patient Boards
Respond to Variances – Delays and Escalation
Solve Problems – Root Cause Analysis
Management
Standard Management – Frequent Regular Reviews
Ongoing Role – Develop Staff Problem Solving Capabilities

29. The Visual Hospital Board

30. Managing the Hub
Escalation
Management
System

31. Value Stream Management
The Tasks
Establish Stability – Visual Hospital Hub and Status Board
Respond to Variances – Buffers and Escalation
Redesign Processes – Design Experiments and Review progress
Management
Standard Management – Regular Value Stream Walks
Ongoing Role – Develop the A3 Analytic skills of the team

32. Top Management
$
• Understand the scale of the Opportunity
and how to translate this into Money
• Focus on the Vital Few – emergency medical length of stay
• Deselect other activities to free up the Capacity to act
• Appoint and support a Value Stream Manager and Team
• Resolve Conflicts between Departmental Objectives
and the needs of the Value Stream
• Go to Review Progress regularly

33. A Lean Management System
Establish Respond to Design
Stability Variances Experiments
A P
C D
Top
Management
Value Stream
Management
Line
Management
$ Deselect
Responses
Value Stream Manager
PlanHub
Problem SolvingPatient Boards

34. In Conclusion
• This takes an end-to-end perspective
• And a different management system
• We call this Lean Management
• You might call it – Evidence Based Management
• Or “a New Common Sense”

35. REALIZING THE
POTENTIAL OF LEAN
THINKING IN HEALTHCARE
Daniel T Jones
www.leanuk.org