Gemba walk: the start of your lean journey


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A primer for healthcare leaders about Lean / process improvement.

Gemba walk: the start of your lean journey

  1. 1. Gemba Walk:Starting your Lean JourneyBrian Ramos, MBADirector of Practice OperationsPlexus Management Group, Inc. © 2013
  2. 2. Abstract & Learning ObjectivesAbstract:Made famous by the Toyota Motor Corporation, Lean has been effectively usedin the healthcare industry for over a decade. However, most healthcareprofessionals have not been exposed to the management philosophy. Thisintroductory presentation will help participants understand Lean’s applicabilityand use in our field and learn how to identify and eliminate waste in eachprocess in their clinical or business unit.Learning Objectives:1. Understand the core principles of Lean thinking.2. Understand the process of value stream mapping and its use in Lean.3. Learn how to identify and eliminate waste (“muda”) in your practice’s current processes. © 2013
  3. 3. Let’s start at the end . . .• What have you heard about Lean?• Is Lean mean?• Is it all about the bottom line? Reduce staffing? © 2013
  4. 4. Lean in Healthcare © 2013 N.B. List is not exhaustive
  5. 5. Reasons for Action • Economic environment cannot sustain current health care cost structure.Source: USA Inc.: Red, White, and Very Blue, Forbes Magazine, February 24, 2011 © 2013
  6. 6. Reasons for Action Continued• Patients as Consumers – Choice• Quality & Safety – Wide variation in quality measures and outcomes across institutions and patient populations. – Despite spending more than any other country (17.6% GDP), the US ranked: • 39th for infant mortality • 43rd for adult female mortality • 42nd for adult male mortality • 36th for life expectancy © 2013
  7. 7. Core Principles1. Respect for People  Employees know work best  NOT top-down approach2. Continuous Improvement  Strive for zero defects3. Customers (i.e. patients) define value4. Based on the scientific method (e.g. experimentation) © 2013
  8. 8. Value Stream Mapping © 2013
  9. 9. Value Stream Mapping Identifies WasteValue Added Non-Value AddedAny activity that directly Any activity that consumes time orcontributes to satisfying the needs resources but does not add value.of a customer. © 2013
  10. 10. 8 Wastes in HealthcareTRANSPORTING WAITINGMoving anything on wheels (e.g. patients, Patients in a waiting room; waiting for labspecimens, equipment or supplies) resultsINVENTORY OVERPROCESSINGStock of medical or operational supplies, Asking patients for their information morepatients in beds, specimens waiting for analysis than once; ordering more labs than neededMOTION OVERPRODUCTIONPeople reaching, bending, or searching for Creating forms “just in case” you need them;supplies, patients, other staff producing more labs than neededHUMAN TALENT DEFECTSUnused or untapped potential of staff Wrong patient, wrong procedure, redraws What are some examples of waste in your practice? © 2013
  11. 11. Examples of Waste• Underutilized ORs • Wrong-site surgery accounts for 13% of medical errors. Waste (excess capacity) Source: • Waiting for: – Provider – Patient – Results © 2013
  12. 12. Everyday LeanTools you can use right now to do “Lean Lite” © 2013
  13. 13. Daily Huddle• Ensure team communications• Opportunity to prevent issues from developing• Focuses on small, incremental, change/improvements• Same time, every day, for NO MORE than 5 minutes• Everyone attends! That means doctors, mid-levels, nurses too!• Initiated by manager, eventually led by all team members.• Stand-up! (preferably at a visual management board) © 2013
  14. 14. Visual Management Balanced scorecard approach.  People  Quality/Safety  Delivery  Cost  Growth Set goals by “doubling the good and halving the bad” © 2013
  15. 15. Visual Management Continued © 2013
  16. 16. Standard Work • current best known way to perform a task • Standard work secures improvement • Encourages root cause problem solving vs. firefighting • Do you use checklists? They’re a type of Standard Work Lean Principles Performance STD WORK Time © 2013
  17. 17. Pareto Analysis A means of focusing “80/20 Rule” on areas that matter the most Bar chart showing the affect of different categories of a given problemBenefits: Avoid working on the wrong or insignificant problem. Speaking with data © 2013
  18. 18. PICK Chart • Identify actions then group into benefit and difficulty High • P Plan to Do 6 4 1 • High benefit, Make a plan how to 2 I P9 do it. BENEFIT 7 • I Implement • High Benefit, Easy to Do. C Implement Now K5 Low 3 8 • C Choose (which if any) To Do Low High • Low benefit, but easy to do. DIFFICULTY • K Kick Out • Low benefit and difficult to do. Don’t bother with these! Do the high benefit/low difficulty actions. © 2013
  19. 19. 5 Whys• The easiest of all Lean “tools”• Ask “why?” five times to arrive at the root cause . • A patient broke his leg in our clinic today. Why? • Because he fell Why? • Because the floor was wet Why? • Because there was a leak from the water fountain Why? • Because the valve seal was broken Why? • Because the fountain had not been maintained. © 2013
  20. 20. Success StoryAmbulatory Endoscopy Suite• Staggered Patient Arrival Times Wait Time RN Overtime Pay• Gastroenterologist dictated note in Wait Time EMR in procedure room Motion• Increased through-put by 20% in each procedure room. Revenue• Maintained 99% patient satisfaction scores on Press Ganey survey. © 2013
  21. 21. Recommended Reading Websites:  PBS Healthcare Cost Comparison compares-with-other-countries.html  Lean Enterprise Institute  Virginia Mason Institute © 2013
  22. 22. Questions & Answers© 2013
  23. 23. About the presenter Brian Ramos is an accomplished healthcare executive who is passionate about eliminating waste and lowering the cost of healthcare delivery systems. He has successfully created profitable clinical units in academic medical institutions, large private physician practices, and ambulatory surgical centers. Brian was formally trained in the Toyota Production System (Lean) and uses these tools to create cultures of continuous improvement. He serves as the Director of Practice Operations for Plexus Management Group, a healthcare management services organization and consulting firm in the greater Boston area. In his role, Brian provides chief operating officer functional responsibility to client ambulatory practices includingBrian Ramos, MBADirector of Practice Operations P&L oversight, leadership of office-based practice administrators, and development of client strategic plans and partnerships.Plexus Management Group, Inc.690 Canon Street | Suite 325 Brian earned a masters degree in Business Administration fromWestwood, MA 02090 Fitchburg State University and a bachelor’s degree in Mathematics & Computer Science from Boston College. He is a Certified Medicalbramos@plexusmg.comph. 781.407.7771 Practice Executive (CMPE) nominee of the American College of Medical Practice Executives. Additionally, Brian holds Lean Silver Certification from Simpler® Healthcare. Follow me: Disclosure & Attestation @brianmramos The speaker attests that he does not have any real or apparent financial relationships or commercial interests to disclose. © 2013