Lean & Meaningful Workflow Redesign

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An introduction to Toyota Lean concepts and tools applied to process improvement. Examples step the audience through a workflow redesign of a medical practice. Covered topics include the 7 wastes, workflow diagrams, 5 whys and A3 problem solving.

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Lean & Meaningful Workflow Redesign

  1. 1. Lean and Meaningful Workflow Redesign Pat Scherer CEO, The Detail Person LLC © 2010 The Detail Person LLC
  2. 2. Why Bother with Workflow Redesign? Catch Errors Before They Happen Prepare for EHR Installation Control/Reduce Costs Do More with Less Satisfy the (Im)patient Improve Communication © 2010 The Detail Person LLC
  3. 3. Workflow Redesign Basics Process List Recording Workflows Workflow Diagrams The 7 Wastes Other Tools Summarize Workflow Redesign Process © 2010 The Detail Person LLC
  4. 4. List Processes 1. Patient scheduling 2. Patient check-in 3. Patient exams, procedures and clinical recording 4. Patient check-out 5. Referrals 6. Call handling 7. Prescription refills 8. Claims and billing 9. Lab orders 10.Patient follow-up communications 11.Wellness/outreach 4 © 2010 The Detail Person LLC
  5. 5. Recording the 15 Minute Office Visit Action Who Start Stop Elapsed W Notes T Check-in P1 7:28a 7:32a (min) 4 ? Queued behind 2 check in. h Fill out forms Wait in waiting room P1 P1 7:32a 7:44a 7:44a 8:00a 12 16 ? W Could forms be stream-lined? Why? e Move to exam room Wait in exam room P1/MA P1 8:00a 8:02a 8:02a 8:10a 2 8 ? W Efficient layout? Why? Take vitals & info P1/MA 8:10a 8:16a 6 ? Has to retrieve “good gauge” from another room Wait in exam room P1 8:16a 8:28a 12 W Why? 1 Exam Wait to check out P1/MD P1/R1 8:28a 8:44a 8:44a 8:50a 16 6 ? W MD repeats questions asked by MA R1 finishes a call, searches for patient folder, finds it left in exam room 5 Check-out P1/R1 8:50a 9:00 8 ? R1 has difficulty locating copay info, takes another call, printer is in another room Total elapsed 90 m © 2010 The Detail Person LLC
  6. 6. Workflow Diagrams Start (1st process step) Process step Decision ? Document Data Predefined process End (last process step) © 2010 The Detail Person LLC
  7. 7. Office Visit Workflow Check in Yes 1st Visit? No Forms Move to room Vitals Exam Check out © 2010 The Detail Person LLC
  8. 8. Over-production Too much or too early © 2010 The Detail Person LLC
  9. 9. Unnecessary Stock Stashes of inventory and supplies; “stuff” waiting to be worked © 2010 The Detail Person LLC
  10. 10. Inefficient Transportation Moving people, information and “stuff” from one place to another. © 2010 The Detail Person LLC
  11. 11. Unnecessary Motion Unnecessary movement or strain including walking, bending, reaching and twisting. © 2010 The Detail Person LLC
  12. 12. Waiting Delays caused by shortages, approvals or downtime. © 2010 The Detail Person LLC
  13. 13. Rejects & Defects The costs associated with making and correcting mistakes. © 2010 The Detail Person LLC
  14. 14. Inappropriate Processing Stuff we do that doesn’t add value to the patient. © 2010 The Detail Person LLC
  15. 15. Other Tools Swim Lane Diagrams Value Stream Maps Layouts and Spaghetti Diagrams A3 Implementation Plan © 2010 The Detail Person LLC
  16. 16. Swim Lane Diagrams © 2010 The Detail Person LLC
  17. 17. Value Stream Map M WT: 2 min WT: 16 min WT: 8 min WT: 12 min WT: 6 min 2 Move to Exam Check in Forms Vitals Check out room R1 MA MA MD R1 PT: 0.1 PT: 8 PT: 2 T PT: 4 PT: 14 PT: 2 M WT: 1.9 WT: 4 WT: 0 WT: 2 M WT: 2 WT: 6 Total PT: 30.1 Total WT: 59.9 © 2010 The Detail Person LLC
  18. 18. Spaghetti Diagrams Lab Exam 1 Exam 2 Legend MA Waiting Check Billing MD Office MD In Patient © 2010 The Detail Person LLC
  19. 19. A3 Problem Solving Format © 2010 The Detail Person LLC
  20. 20. Workflow Redesign Process Summary Identify Processes A3: Plan, Record Do, Workflow Measure Continuous Improvement Identify Diagram Waste Workflow © 2010 The Detail Person LLC
  21. 21. References Links  “Lean Health Care: Lower Costs, Better Outcomes”, Wharton Health Economics; 11/11/2009 http://knowledge.wharton.upenn.edu/article.cfm?articleid=2374&specialid=95  NHS (UK) Tools & Techniques http://www.tin.nhs.uk/index.asp?pgid=1134  DIY Lean (free A3 templates) http://www.diylean.com/A3%20Materials/A3_Materials.htm  Presentation slides and other resources http://www.thedetailperson.com/resources Books  Hadfield and Holmes, The Lean Healthcare Pocket Guide; 2006  Chalice, Improving Healthcare Using Toyota Lean Methods: 46 Steps for Improvement; 2007  Jimmerson, A3 Problem Solving for Healthcare: A Practical Method for Eliminating Waste; 2007  Jimmerson, Value Stream Mapping for Healthcare Made Easy; 2009 © 2010 The Detail Person LLC
  22. 22. Questions? Contact: Pat Scherer The Detail Person LLC www.thedetailperson.com 512-415-3473 pat@thedetailperson.com Health IT Services…we do IT your way! © 2010 The Detail Person LLC

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