LEAN on the OR VU University Medical center

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LEAN on the OR VU University Medical center

  1. 1. Lean culture to improveoperating room efficiency 21th september 2011
  2. 2. 2007 operating room fire
  3. 3. 2010
  4. 4. Safetymanagement Qualitymanagement Passport NIAZ
  5. 5. Under- and overuse of OR resources
  6. 6. Gap between planning and reality
  7. 7. OR cancellations of elective operations
  8. 8. Why also LEANin our operating rooms ?1. Focus on the patient, focus on value2. Decrease waste (waiting, transportation, overproduction, overstocking)3. Improve employee engagement and satisfaction4. Improved OR use: decrease in under- and overuse of OR resources5. Streamlining the pre-, intra- and postoperative process6. Reducing OR nonoperative time (turnover times, waiting times)7. Process standardization
  9. 9. LEAN introduction teamKjeld Aij, head operating roomsEllen Duijnhouwer, lean coachMarjolijn Jungman, lean coachStephan Loer, head anesthetic departmentArnoud Orelio, lean coachPeter Veerman, medical head operating rooms
  10. 10. LEAN Pilot operating roomSterilization departmentAcute operationsDaysurgeryENT-daysurgery…
  11. 11. Value stream map
  12. 12. Key performance metrics
  13. 13. Invoeringsteam lean op OK - KPI 2: aantal afgezegde electieve operaties per dag Kleurcodes reden afzegging: norm AOZ (blauw) wk 10-25: 4x SNIJDER (rood) wk 10-25: 98x PATIENT (groen) wk 10-25: 67x GEEN IC/MC (zwart) wk 10-25: 31xweek ma di wo do vr totaalweek 24: 13-6 X II IIII IIIII IIIII 16week 25: 20-6 III II I II IIIII 13week 26: 27-6week 27: 4-7week 28: 11-7week 29: 18-7
  14. 14. Teaching principles of LEAN 1: Metingen! !  WSA! !  KPI definitie! !  KPIʼs meten! KPI bord! !  Visueel! !  Door het team! 5: Standaarden! 2: Stand-up! !  Vastleggen, visuali- !  Team rapporteert! seren & verifiëren! Continu
 !  Interactie team/ !  Trainen! manager! verbeteren ! Verbeterd!! met betrokken !  Definieer/ Stand-up! rapporteer acties! mensen! top 3! 4: Oplossingen! 3: Problemen ! !  Gestructureerd! !  Detectie/identificatie! !  In autonome teams! !  Communicatie! !  Bronoorzaken !  Op basis van feiten! Verbeter(team)! bepalen en !  Onder controle bord! oplossen! brengen/ isoleren! 16
  15. 15. Bijlage 2
  16. 16. Canceled procedures! 15-16 OR’s! Time: 8 a.m. - 15.45 p.m.! Capacity off-hours 4 - 2 OR’s
  17. 17. Canceled procedures! Every day 4 p.m.! Coordinators and OR management! Planning staff general surgery! .....
  18. 18. Invoeringsteam lean op OK - KPI 2: aantal afgezegde electieve operaties per dag # afgezegde electieve operaties per week 19 18 17 Kleurcodes reden afzegging: 16 15 14 13 norm 12 11 AOZ (blauw) wk 10-25: 4x 10 9 8 7 6 5 SNIJDER (rood) wk 10-25: 98x 4 3 2 1 0 PATIENT (groen) wk 10-25: 67x 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 GEEN IC/ weeknr MC (zwart) wk 10-25: 31x # afgezegde electieve operaties norm (nog te bepalen)week ma di wo do vr totaalweek 24: X II IIII IIIII IIIII 1613-6week 25: III II I II IIIII 1320-6week 26:27-6week 27: 4-7
  19. 19. Canceled procedures! AOZ 10 %! Patient 25 %! Surgical/scheduling 65 %
  20. 20. Canceled procedures! Difficult to determine root cause " Even coordinators don’t know! Reasons very divers! Information dissapears rapidly! Not perceived as problem
  21. 21. Process ImprovementMethodologies
  22. 22. Why get LEAN?• Productivity improvements of 20-50%• Set-up time reductions of 60-80%• Inventory reductions of 40-75%• Floor space reductions of 30-50%• Reduced quality defects by 50-100%• Improved safety performance of 30-60%• More efficient procedures• Survival in the marketplace
  23. 23. Surgery is a complex process where manyresources act together
  24. 24. Operating Room Layout
  25. 25. Actual LEAN examples
  26. 26. Lean lessons learned...• “Getting lean” takes a long time• Lean is not a part-time effort• Lean is more than tools, it’s also behavior• The journey to lean never ends• There will be resistance to lean within the organization
  27. 27. Keys to LEAN leadership • Gothe “production”floor (gemba) time on See--senior leaders must spend • Ask day to uncover the root cause times every Why--use the question many • Show Respect--respect employees, suppliers, and customers
  28. 28. Lean lessons from others • The top leaders need to lead lean • Be prepared for the front-end investment • Lean is not just for manufacturing • There is a lean “roadmap”, but no lean “cookbook” • You cannot just copy another lean organizations journey
  29. 29. Next steps• Business Assessment• Call to Action and Commitment• Align with Policy Deployment• Training and/or Sensei• Resource Allocation• Process Selection• Begin the “Journey”• Implement New Metrics• Review Progress and Adjust as Needed
  30. 30. You mustTRANSFORM theorganization to avoid “snap-back”to the old ways or …don’t even bother to start.

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