SIMUL8 Workshop - Process Improvement Innovation: Lean and Simulation

Process Improvement
Innovation:
Lean and Simulation
Dr. John Boulton: IHI Fellow and Rheumatologist
Claire Cordeaux & Brittany Hagedorn: SIMUL8

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com

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Messages from Research
“Simulation and lean are approaches that
are rarely discussed together, particularly in
the healthcare context. This is surprising
given that they have a similar motivation:
improvement of processes and service
delivery”
Warwick University – Simlean/SLIM simlean.org


What does Simulation add to Lean?
Reflections from SimLean research
participants:
• Dynamic process maps
• What if? scenario tool
• Accelerates understanding


Testing, testing…Live from IHI
Agenda
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Simulations of Lean concepts
IHI participants’ feedback
Implications for Simulation
Reflections from Dr. John Boulton


Lean and Simulation Communities
Why don’t they work together more?

Both improvement methodologies are
powerful change agents – surely we need all
the help we can get to improve healthcare?

Our Hypothesis
• Experts in both domains are passionate
about their own methodology and don’t
look to combine approaches
• We believe that if Simulation is used to
explain Lean concepts, we can bridge this
gap.
• The LeanSIM Toolkit:
– Demonstrates Lean principles
– Allows users to experiment with parameters
and quickly see results

LeanSim – Using Simulation


LeanSim – Demand Smoothing


LeanSim – Batching vs.
Single Piece Flow


What does the IHI community think?
•

“As a teacher of Lean, I often find it difficult to get buy-in
on Lean concepts since they are counter-intuitive until
Pictures actually live them.stand and quotations
of people at This brings them to life.”
you

“I’ve often struggled to use simulations to explain Lean
concepts as they are all manufacturing examples.
Having healthcare SIMUL8.com | info@SIMUL8.com
SIMUL8 Corporation | scenarios is so powerful!”

Click to edit Master title style
“Why isn’t
every
hospital
using this?”
- Sara Dalo


What we heard at IHI...
• Lean simulations are a really powerful
communication tool.
• Passion of clinicians to continually improve
is alive and well.
• People are busy with day-to-day tasks and
struggle to find time to use the techniques.
• Evidence-based solutions are still needed to
complement cultural change management.


Implications for Lean and Simulation
1. Simulation is a powerful means of engaging
stakeholders and enabling collaboration in
change programs.
2. Educational models are needed to bring Lean
concepts to life.
3. Simulation will help with the IHI challenge for
new patient-centered service models by
demonstrating the impact on resources,
outcomes and costs.


Simulation and Lean –
Improving Process Improvement
Simulation is a powerful tool, which is even most effective when integrated with the Lean
Six Sigma approach. By doing so, we can maximize the impact of our improvement efforts.

Understand
dependencies.

Value Stream
Mapping
• Conduct
observations.
• Collect data.
• Document
value stream
statistics.

Identify
Improvement
Opportunities
• Document all
barriers,
rework, and
wait times.

Incorporate
variability
into VSM.

Validate your
current state.

Prioritize
Projects

Develop
Charters

• Estimate the
impact and
effort for each
improvement.
• Combine for
prioritization.

• Define
process and
outcome
metrics.
• Establish
target (%) for
improvement.

Reduce risk.

Map Current
State

Design Future
State

Pilot
Future State

• Create a
detailed
process map.

• Identify
potential
interventions.
• Develop and
document a
future state
process map.

• Implement
the proposed
future state
on a small
scale.
• Identify issues
& unexpected
effects.

Set evidencebased targets.

Visualize
improvement
results.


Implement

Sustain

• Modify the
future state as
needed.
• Conduct
training.
• Go live.

• Document
standard work
and policies &
procedures.
• Monitor and
sustain
improvements
.

Gain buy-in.

About me
• Rheumatologist
• Clinical lead for Quality Improvement
• 2012-13 IHI QI Fellow
– High reliability principles
– System wide flow

• An interest in simulation and modelling
• Twitter: @the_Rheum_doc


Click to edit Master title style

“Why isn’t
every
hospital
using this?”
- Sara Dalo


Hospital Physiology
First Edition


The challenge

Processing (T)

Variability (V)

Utilization (U)

2000
1800

What is acceptable waiting?

Waiting time in minutes

1600
1400
1200

acceptable wait

1000

High variability
Medium Variability

800

Low variability

600
400
200
0
0.50

0.55

0.60

0.65

0.70
0.75
Utilization

0.80

0.85

0.90


0.95

Simple models


Deming’s System of Profound knowledge
• System
• Variation
Simulation

• Knowledge
• Psychology

System


“If I had to reduce my
message for
management to just a
few words, I’d say it
all had to do with
reducing variation.”
W. Edwards Deming


Variation


Knowledge
• Early Arthritis Clinic


knowledge
• 10 medical follow-up
slots
• 12 nurse follow-up slots

• Simple model
– Insufficient capacity
within 6 months

• Clinic abandoned after
9 months

Psychology


Associates

in Process Improvement

Simulation and Quality Improvement
• A useful tool
– Enables deeper understanding of systems
– Translates difficult and counterintuitive
concepts
– Virtual PDSA cycles

• Models do not need to be complex
– Simple are often more effective


LeanSim Toolkit
We’d love you to try these models
yourselves and give us your feedback.
To download your own copy link to:
SIMUL8healthcare.com/LeanSIMToolkit


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