5. Latar Belakang
Toyota saat ini
merupakan perusahaan
manufaktur terbesar di
dunia dalam bidang
otomotif
1 Mobil tiap enam detik
5,5 juta mobil dalam
tahun 2009
6. Sekilas mengenai Toyota
Berdiri tahun 1933
Bermula dari industri tekstil
Tahun 2003 menjadi
perusahaan automotif no 3 di
dunia
Tahun 2009 menjadi produsen
terbesar di dunis
14. What is Lean?
Definition-”The endless
transformation of waste into value
from the customer’s perspective.”
IT is a System Thinking Concept.
A little History
16. Impact of Lean in the Industry
Direct Labor/productivity improved 45-75%
Cost Reduced 25-55%
Throughput/Flow Increased 60-90%
Quality (Defects/Scrap) Reduced 50-90%
Inventory Reduced 60-90%
Space Reduced 35-50%
Lead Time Reduced 50-90%
Source: Virginia Mason Medical Center
17. Examples of Lean in Healthcare
Adding greater “value-added”
services
Same day office visits
Next day outpatient surgery
Next day mammogram
Quick & errorless billing
No wait emergency room
18. TRADITIONAL CULTURE VS. LEAN CULTURE
TRADITIONAL LEAN
Functional Silos Interdisciplinary teams
Managers direct Managers teach/enable
Benchmark to justify not
improving; “just as good”
Seek the ultimate
performance, the absence
of waste
Blame people Root cause analysis
Rewards: individual Rewards: group sharing
Supplier is enemy Supplier is ally
Guard Information Share information
Volume lowers cost Removing waste lowers cost
Internal focus Customer focus
Expert driven Process driven
32. LEAN Development Process
1. Establish the vision for the future
Focus the organization on the PATIENTS
Align Performance Measurements
Set high expectations for success and low
tolerance for failure
Method:
Establish a core team of implementers
Focused training, reading, and benchmarking
Standardized, systematic, methodical
approach
Clearly define objectives and time table
Create success through pilots and spread
33. Mission Statement
Develop the ability:
To recognize and identify waste
To have the courage to call it waste
To have the desire to eliminate it
Eliminate the waste
Understand that waste simply
Raises costs
Produces no corresponding benefit
Threatens all of our jobs
You get what you expect and you
deserve what you tolerate.
34. LEAN Development Process
2. Develop your objectives
Look at your key processes or VALUE
STREAMS
Patient Journey (ERRadiologyClinicORBilling)
Charge capture (Clinical ServiceBilling Insurance)
Operating Room flow (Scheduling, consent, pre-op
visit, prep,….)
These support your “Products” which might be
Office visit
Inpatient stay
Visit to the ED
How do your Internal and External Customers
define Value
35. LEAN Development Process
3. Selection of Team Members
Characteristics:
Technology curiosity
Common sense
Inner confidence
(create structure, Win allegiance, instinctive
reactions)
Cross Functional Team:
Manager/Supervisor from the area
Operators from area
Functional departments
(HR, Lab, Pharmacy, Admitting, Surgery,
Materials Management,etc.)
37. LEAN Development Process
4. Initiate Team
Training:
Read required literature
Attend team and leadership training, lean
overview
Tools:
Standardized analysis and simulation tools
Video cameras, TVs, and VCR’s
Computers, Printer, and Projector
Facilities:
Lean War Room located in the operational area
Office area appropriately furnished and supplied
39. LEAN Development Process
5. Select Pilot Area
Selection Criteria:
Contributes to key competitive strengths of
business
Innovation has a good chance of success
Significantly tests the innovation
Solutions are transferable to other areas
Baseline the current process
Do an initial walkthrough
40. Baseline Analysis
1. # patients transferred from ED to
inpatient bed within 1 hour of
decision to admit
2. Time to third next available appt
3. # tests/day or # tests/week
Keep it simple - look at 25 patients/wk
collected over some time period
including weekends and at night
41. LEAN Development Process
6. Activity of Product
Videotape: selected products
Analyze videotape and segregate:
travel time and distance
storage time and type
inspection time
non-value added processing time
value added processing time
Map the flow of the product:
42. Process Charts
Process: Emergency room admission
Subject: Ankle injury patient
Beginning: Enter emergency room
Ending: Leave hospital
Step
no.
Time
(min)
Distance
(ft)
Summary
Number
of stepsActivity
Time
(min)
Distance
(ft)
Step description
Insert Step
Append Step
Remove Step
1 X Enter emergency room, approach patient window
2 X Sit down and fill out patient history
3 X Nurse escorts patient to ER triage room
4 X Nurse inspects injury
5 X Return to waiting room
6 X Wait for available bed
7 X Go to ER bed
8 X Wait for doctor
9 X Doctor inspects injury and questions patient
10 X Nurse takes patient to radiology
11 X Technician x-rays patient
12 X Return to bed in ER
13 X Wait for doctor to return
14 X Doctor provides diagnosis and advice
15 X Return to emergency entrance area
16 X Check out
17 X Walk to pharmacy
18 X Pick up prescription
19 X Leave the building
0.50 15
10.0 -
0.75 40
3.00 -
0.75 40
1.00 -
1.00 60
4.00 -
5.00 -
2.00 200
3.00 -
2.00 200
3.00 -
2.00 -
1.00 60
4.00 -
2.00 180
4.00 -
1.00 20
Transport 9 11 815
Operation 5 23 —
Inspect 2 8 —
Store — — —
Delay 3 8 —
43.
44. LEAN Development Process
7. Group Technology Analysis
Process sequence
Pre- Post data collection
Identify number of possibilities and
combinations
Identify commonality within each
product family
Plan analysis phase
48. LEAN Development Process
9. Activity of Operator
Map work pattern
Videotape
Analyze what is value added, required waste,
and pure waste
Point to Point diagram representing movement
of operator in work area
Time studies analysis
Document new process
50. LEAN Development Process
10. Develop Standard Work
Define job steps, standard times, and
material location within each order
of process
Define takt time
Establish Line Balance
51. LEAN Development Process
11. Improve Line flexibility
Videotape – selected setups and
operators
Document improvement suggestions
related to – preparation, organization
“Milk runs”
Document new process
52. LEAN Development Process
12. Design and approve Line Layout
Design Considerations
Steps to approve new Layout
53. LEAN Development Process
13. Performance Measurements
ID standard work, source quality
control
Monitor performance and Post results
ID ‘hit list’ and resolve identified
problems on a 90 day cycle
Monitor changes on 30/60/90 days
cycle
54. LEAN Development Process
14. Develop a business case
Compare base conditions with projected lean
conditions (benchmark or audit)
Output rates
Floor space
Inventory
Labor
Document cost of implementation
Present findings to senior management
Include all stakeholders and decision makers
Let the facts speak loudly
