Walking the Wards

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EXCELLENCE SYSTEMS GROUP
Consultants
Applying Lean to the wards
Michael Ballé

Lean is a system
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Consultants
Many have heard about the lean « tools »: 5S,
Value Stream mapping, Kaizen events, etc.
Lean veterans insist on applying the tools
rigorously
But mostly on the fact that lean is a « system »,
or a way of « thinking »
What do they mean by that?

Lean as a learning system
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Consultants
thinkingthinking
toolstools
systemsystem

What is lean thinking?
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Consultants
Visualize performance problems in the ward
Solve problems without « going around » them
In a « lean » way: using ideas rather than
investment
By involving all employees
And developing a kaizen mentality in everyone

Lean thinking is guided by a lean system
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Consultants
React
at
first
defect
React
at
first
defect
Flow
at
takt
time
Flow
at
takt
time
CUSTOMER SATISFACTIONCUSTOMER SATISFACTION
StandardizationStandardization
Continuous
Improvement
Continuous
Improvement
Employee
Involvement

Lean success needs working at all three levels
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Consultants
tool 5S Staff never have to look for
parts or equipment
system Standard
work
So they can keep to the
work standard without being
interrupted
thinking Visualize
problems
Interruptions can then be
recognized right away as
problems, and lead to quick
response and problem
solving

To begin with: walk the wards
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Consultants
Go and seeGo and see
Gemba walkGemba walk
Customer
satisfaction
Customer
satisfaction

Gemba walk
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Consultants

Gemba walk
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Consultants

Gemba walk
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Consultants

Customer satisfaction: metrics
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Consultants
performance
mindset
performance
mindset
metricsmetrics
customer
satisfaction
customer
satisfaction

What is a customer incident?
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Consultants
TC4 MS3 RF2 Total
Chutes 12 5 5 22
Fugues 5 3 0 8
Infection Urinaire 9 0 0 9
Escarres 0 1 0 1
Réactions médicamenteuses 1 0 0 1
Réclamations 2 2 0 4
Infection pulmonaire 1 0 0 1
Pertes ou vols d'objet 2 2 0 4
Erreurs de médicaments 0 0 0 0
Pansements 2 0 0 2
Accident avec Exposition au Sang 0 0 0 0
Infection s/ Sondes Urinaires 0 1 0 1
Kt périphériques 0 0 0 0
Allergie 0 0 0 0
SUIVI des INDICATEURS

Standardize work areas
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Consultants
Involve the teams in visual management
and quick response to problems
Involve the teams in visual management
and quick response to problems
5S5S

5S
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Consultants

Clear the workspaces, identify locations
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Consultants

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Consultants
Create supermarkets and hunt for out-of-date
or missing material
Visualize out of date or
missing material and eliminate
Visualize out of date or
missing material and eliminate
SupermarketsSupermarkets
FlowFlow

supermarkets
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Consultants

All the way to housekeeping material
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Consultants

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Consultants
Make sure material is desinfected after each
use
Visualize problem and solve it
by involving the team
Visualize problem and solve it
by involving the team
Team
problem-solving
Team
problem-solving
Standard/kaizenStandard/kaizen

Clear and clean after every use
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Consultants

Clear and clean after every use
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Consultants

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Consultants
Reduce inventory on hand so problems can be
seen at one glance
Visual management
And quick response
Visual management
And quick response
Daily ward walkDaily ward walk
React at
first defect
React at
first defect

Bacterial bombs!
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Consultants

Visual management for quick response
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Consultants

From the work environment to care itself
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Consultants
Involve team in creating
their work standards
Involve team in creating
their work standards
Work standardsWork standards

Work standards for care
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Consultants
TOILETTE AU LIT
LA TOILETTE IMPORTANT SÉCURITÉ
Repères :1 – Planification murale à vérifier.
2 – Prendre connaissance de l’ état
du patient.
3 – Préparation du matériel.
4 - Installation du patient.
5 – Déroulement de la toilette.
6 – S’assurer d e l’état des
téguments.
7 – Réinstallation du patient.
8 – Environnement du patient.
9 – Nettoyage et rangement.
- Doit être à jour,
- Plan de Soins actualisé.
- Transmissions du jour,
- Autonomie du patient
- S’enquérir de la douleur.
- Vérifier dans la ch ambre si tout le
matériel nécessaire est présent et
propre (cuvette, gants, serviettes…),
- Apporter le matériel adapté aux
besoins du patient (changes,
produits…),
- Vêtements propres
- Position ergonomique, respect de
la pudeur et de la sécurité,
- Commencer par la toilette du siège
si le patient est souillé,
- Favoriser l’autonomie du patient
- Relationnel.
- Prévention d’escarres.
- Installation au fauteuil,
- Réfection du lit,
- Nettoyer le dentier et s oins de
bouche
- Réaménager l’environnement avec
tout le nécessaire à proximité.
- Proposer de boire.
- Désinfecter la cuvette,
- Nettoyer et ranger le matériel
utilisé,
- Mettre de côté le l inge sale
personnel au patient.
- Sécurité :
- Gestes et postures respect des
capacités à faire du pati ent ;
utiliser les a ides techniques (lève
malade, drap de transfert) .
- Risque de chute : réinstaller la
contention du patient au fauteuil si
prescrite ; sonnette à p ortée de
main ; déambulateur ou canne à
proximité ; dégager le passage
dans la chambre ; attention au sol
mouillé !!!
- Organiser l’espace : pour l e
confort et la sécurité des gestes et
postures du patient et du
personnel.
- Hygiène : Lavage des mains
avant et après la toilette ; Utiliser la
solution Hydro alcoolique entre
chaque acte, et quand nécessaire ;
Mettre tablier et gants vinyle non
poudrés ; Respecter les circuits du
linge et des déchets :
-Matériel :
Linge nécessaire à la réfection du
lit ;
Tablier à usage unique ;
Gants vinyles non poudrés ;
Solution Hydro alcoolique ;
Change adapté à la taille du
patient ;
Gant de toilette usag e unique si
patient souillˇ ;
Nécessaire de toilette propre à la
personne ;
Utiliser un gant et une serviette
de toilette pour le haut ; un gant et
une serviette de toilette pour le bas.
-Auto-contrôle visuel :
Vérifier l’installation du patient ;
S’assurer de son confort ;
Réfection du lit faite ;
Vérifier qu’il ait à porté de mains
les affaires personnelles dont il a
besoin : (sonnette, téléphone, verre,
eau, revues…).
Vérifier le rang ement du mat ériel
et des affaires personnelles du patient
(linge sale).

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Consultants
And more complex problems: preparing
patients for physiotherapy
Develop teamwork between
Specialisms and solve
Patient problems
Develop teamwork between
Specialisms and solve
Patient problems
Value Stream
Mapping
Value Stream
Mapping
Patient flowPatient flow

And further challenges
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Consultants
Moving to kanban for all supplies (which
means convincing hospital logistics)
Tracking the path of BMR through the wards
Improving patient journey and getting
involvement from the doctors

What results?
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Consultants
Over two years, the rate of incidents per patient halved
(that is, the probability each patient admitted has of facing
an incident reduced by 45%)

Lean is a learning system
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Consultants
The lean environment (visual management, pull
system) helps people to see cause and effect
The lean tools are learning opportunities, for
people to learn to produce with better, quality,
delivery, productivity and flexibility
The tools only highlight problems, resolution
with PDCA is the point!

Lean is a management system
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Consultants
Using the tools will not transform the culture
The lean culture is about solving all problems
rigorously
To understand real priorities
And create another type of relationship with workers
Based on developing abilities
And creating better products, through better thinking

The team!
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Consultants

Thank you
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Consultants
To the team from Villeneuve, Nord 92
To visitors from Bolton Hospitals
To you, for your attention

Walking the Wards

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