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Lean In Healthcare 12 Apr 10 [Compatibility Mode]


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The presentation was intended to introduce the basic concepts of Lean, Six Sigma and Kaizen to Healthcare professionals. The main message: "There is nothing fear; you can learn and do this."

Lean In Healthcare 12 Apr 10 [Compatibility Mode]

  1. 1. Raising the Bar Lean Thinking and Continuous Improvement in Healthcare Norm Nopper, MA, BBA Director, Varanor International Delivered for the ABC Heath Centre* April 12, 2010 12-Apr-10 * The client name has been masked for confidentiality. 1
  2. 2. Objectives Obj ti • Describe the key concepts of Lean Thinking, Six Sigma and Kaizen. • Review areas where Lean Thinking and g Continuous Improvement can be applied in Healthcare. 12-Apr-10 2
  3. 3. DEMYSTIFYING LEAN 12-Apr-10 3
  4. 4. Lean Thinking: How are Healthcare, Manufacturing, and Supermarkets Related? 12-Apr-10 4
  5. 5. Lean Thinking L Thi ki • T ii h Oh was th f th of the Toyota Production Taiicho Ohno the father f th T t P d ti System, on which Lean Thinking is based. • The Supermarket was Taiicho Ohno’s inspiration for the p p Toyota Production System, and he learned from it. • TPS, Lean, the Supermarket and Manufacturing can be our i inspiration f th ABC H lth i ti for the Healthcare O Operating ti System. 12-Apr-10 5
  6. 6. You re You’re Already Familiar with Lean Production: The Kitchen • The V i Th Voice of the Customer: Family says “W ’ h f th C t F il “We’re hungry!” !” • Value Added: Delicious, nutritious food. • Pull System: Family of four is hungry not twenty – five hungry, five. • Standard Work: Recipe book. • Equipment Capability: Working stove, p q p p y g , pressure cooker,, toaster, electric skillet, etc. • Kanban: Cupboards, refrigerator, the supermarket. • Reduce Waste: Spoilage, burnt food, uneaten leftovers. • 5S: Everything in its place, within reach. • Gemba: Go and See See. 12-Apr-10 6
  7. 7. The Goal: World Class through Capability Process Capability Human Capability • Products/Services • Employee Capability • Machinery & Equipment y q p – Individual’s education, training, skills, experience • Methods – Values and behaviours – Industry Specific Processes • C ti Casting, St Stamping, M hi i i Machining, • Organizational Capability Extruding, Brewing, Refining . . . – Values, vision, mission • Inpatient care, Ambulatory – Collective “Know – How” care, Emergency, Surgery . . . , g y, g y – Collective Behaviour C ll ti B h i – Process Management – Reputation and History • Lean, Kaizen, Six Sigma • Materials 12-Apr-10 7
  8. 8. High L Hi h Level Definitions l D fi iti • L Lean: R d ti i W t Reduction in Waste • Kaizen: Continuous Incremental Improvement • Six Sigma: Process Control – 99.9996667% Good Outcomes – 3.4 per million Bad Outcomes – DMAIC • Define, Measure, Analyze, Improve, Control 12-Apr-10 8
  9. 9. Productivity and Sustainability: It’s About the People A sustainable company i not a collection of i bl is ll i f "human resources." It is a community* of human b i h beings. Henry Mintzberg McGill University Mintzberg, Globe and Mail, July 18, 2008 * Italics are my emphasis. 12-Apr-10 9
  10. 10. The Changing Nature of Work Th Ch i N t fW k "Everyone has two jobs - to do what they do and to improve what they do ” do, do. Sven-Olaf Karlsson, CEO Jonkoping County Council, Sweden Quoted by Tom Closson, President Ontario Hospital Association at HealthAchieve 2008 12-Apr-10 10
  11. 11. LEAN CONCEPTS 12-Apr-10 11
  12. 12. Voice f th C t V i of the Customer • Voice f th P ti t V i of the Patient • Voice of the Family • Voice of the Public • Voice of the Internal Customer – Doctors, Nurses, Front – line Staff – Various Departments 12-Apr-10 12
  13. 13. Value Add d V l Added • B i Business C t t Context: – What does the customer really want for his/her dollar? • Healthcare Context: – What does the patient really want? • Goal: – Determine value added vs. non – value added activity. – Increase the former; reduce or eliminate the latter. 12-Apr-10 13
  14. 14. The S Th Seven Wastes (Muda) W t (M d ) • Overproduction • Waiting • Transporting • Processing ( pp p g (Inappropriate or Over p processing) g) • Inventory • Motion • Defects 12-Apr-10 14
  15. 15. Gemba: G G b Go and See dS • Value Stream Mapping • Gemba walks • Observe and record • Video tape a process 12-Apr-10 15
  16. 16. 5S P Process Japanese English English (Manufacturing) (Healthcare: 6S) Seiri Sort Sort Seiton Straighten (Set in Order) Straighten Seiso Sweep, Shine Scrub Safety Seiketsu S ik Standardize S d di Standardize S d di Shitsuke Sustain Sustain 12-Apr-10 16
  17. 17. Standard W k St d d Work • E Every team member does th same t k t b d the tasks, in the same manner, using the same skills, every ti time. • Reason: – Create a standard outcome. – Eliminate process variation. – Eliminate human error. 12-Apr-10 17
  18. 18. Kanban Signal K b = Si l • A signal t replenish supply. i l to l i h l – Build product, parts, components. – Buy/order product parts components product, parts, components. – Deliver product, parts, components. • Kanban techniques: q – Painted square on the floor. – Line painted on the wall. – Bin, cupboard, shelf – Ticket or card – Sh ld b VISIBLE Should be 12-Apr-10 18
  19. 19. SIX SIGMA CONCEPTS 12-Apr-10 19
  20. 20. Six Si Si Sigma in a Nutshell i N t h ll • Sigma (σ) a Greek letter used In statistics to indicate the (σ), measure of difference (or variance) in a group of similar things. • Th G l The Goal: – Improve Stakeholder Satisfaction – Gain Process Knowledge/Improve Process Capability g p p y – Reduce Process Variation – Reduce Defects and Improve Outcomes • Focus on Data Driven Decisions Decisions. • DMAIC: Define, Measure, Analyze, Improve, Control 12-Apr-10 20
  21. 21. Six Si Si Sigma Performance P f In t I terms of Good Parts ( f G d P t (Long – Term Yield): ) 3σ Capability 93.32% Most Companies 4σ Capability 99.38% Not Good Enough 6σ C Capability 99.99966% World C Class In terms of Defects: 6σ capability means 3.4 ppm. 3σ capability means 66 807 ppm 66,807 ppm. 12-Apr-10 21
  22. 22. Key Features of Six Sigma K F t f Si Si • Data Driven • Structured and Disciplined • Team Approach 12-Apr-10 22
  24. 24. Kaizen Tools K i T l • Customer O i t ti C t Orientation • Kanban (Kamban) K b (K b ) • Total Quality Control • Quality Improvement • Robotics • Just – in – Time • Quality Control Circles • Zero Defects • Suggestion System gg y • Small – group Activities g p • Automation • Cooperative Team • Discipline in the Member/Leader Relations Workplace • Productivity Improvement • Total Productive • New Product/Service Maintenance Development 12-Apr-10 24
  25. 25. FURTHER READING 12-Apr-10 25
  26. 26. Further R di F th Reading: Lean L • Gemba Kaizen: A Commonsense, Low Cost Approach to Commonsense Low-Cost Management, Masaaki Imai, McGraw-Hill, March 1997 • Lean Production Simplified: A Plain-Language Guide to the World's Most Powerful Production System, Second Edition, Pascal Dennis, Productivity Press Inc, September 2007 • Lean Thinking: Banish Waste and Create Wealth in Your g Corporation, Second Edition, James P. Womack and Daniel T. Jones, Free Press, June 2003 • Learning to See: Value Stream Mapping to Create Value and Eliminate Muda, Mike Rother and John Shook, Lean Enterprise Institute, June 2003 12-Apr-10 26
  27. 27. Further Reading: Lean Sigma for Healthcare • Lean Six Sigma for the Healthcare Practice: A Pocket Guide Guide, Roderick A. Munro, American Society for Quality, 2009 12-Apr-10 27
  28. 28. Further Reading: Cultural Transformation • R i Reinventing th Factory with Lifelong L ti the F t ith Lif l Learning. i – TRAINING, May 1993 – Author: Norm Nopper • Learning for Life: Employee Literacy at Honeywell – Conference Board of Canada, December 2002 12-Apr-10 28
  29. 29. Thank Th k you f your ti for time. Norm Nopper MA BBA Nopper, MA, Director, Varanor International Productivity Through Capability 12-Apr-10 29