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Lean in Hospitals


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Lean in Hospitals

  1. 1. “Introducing Lean to the Hospital” Peter D. Schellinck Partner SHConseil +32 496 386 437
  2. 2. Agenda The Crisis of Waste in Healthcare Lean Thinking Principles in Healthcare Benefits for:  Patients  Employees  Hospitals
  3. 3. Hospitals Are Dangerous… CDC 1998: 90,000 killed and 2,000,000 injured from hospital-caused drug errors & infections
  4. 4. Preventable Errors Abound… “… 3 to 5% of specimens taken each year are defective… blood that isn’t drawn correctly… mix-up with another patient’s sample”
  5. 5. Preventable Errors Abound…
  6. 6. Preventable Errors Abound…
  7. 7. Mass Production or Healthcare? Large batches  Automation is the answer Sub-optimizing one  Lack of standard processes resource Lack of employee input  Not communicating metrics One-person/One-machine  Lack of leadership Quality through inspection  Constant fire fighting
  8. 8. Non-Lean, Current Thinking1. Specify value in the eyes of the provider (or the payer)1. Identify your department and sub-optimize it1. Make patients wait for the convenience of the system1. Ignore some employees and devalue others1. Continuously fight the same fires in the pursuit of surviving the day
  9. 9. Applications of Lean in Healthcare Laboratories  Reducing Turn Around Times and Errors Emergency Departments  Reducing diversions, improving flow Outpatient Cancer Treatment  Reducing patient delays, increasing capacity Operating Rooms  Reducing changeover times, increasing utilization Pharmacies  Reducing errors, improving response Food Service  Reducing wasted food, improving quality
  10. 10. Why LEAN Works in Healthcare LEAN is not a list of tools that applies only to factories LEAN is a philosophy of management that applies to any system LEAN rallies people around goals we can all agree on:  Patients and Employees for Quality
  11. 11. Not About Cutting Heads Shortages of skilled employees  51% of hospital med techs greater than 45 years of age, vacancy rate at 11%  Shortfall of 65,000 nurses expected by 2012 Do more…  With the same  Eventually, with less
  12. 12. Not Only About Cutting Costs Hospitals are using lean as a Business Strategy  Improving quality  Improving service  Improving employee satisfaction  Growth strategies  “Un-outsourcing” testing work
  13. 13. Principles of LEAN Thinking1. Specify value in the eyes of the customer. – The customer must be willing to pay for the activity – The activity must change the form, fit or function of the product or service – The activity must be done right the first time Who are the “customers?” Source: LEAN Thinking, Womack and Jones 1996
  14. 14. Principles of LEAN Thinking 1. Specify value in the eyes of the customer. 2. Identify the value stream and eliminate waste.13% of hospital costs are due to controllablewaste. Source: Zuckerman, Hadley, and Iezzoni, 1994
  15. 15. Treatment CenterTypical Organization is Silo-ed Treatment Clinic Check-In Pharmacy Laboratory Testing Phlebotomy Physician Clinic
  16. 16. Value Stream – Anatomic Pathology Patient & MD I Transcriptionist I PathologistSpecimen ICollection Send to Grossing I Embed Slide I Grossing Processing & Cut Staining Making I I I I
  17. 17. Types of Waste – Lab Examples Defects  Label on the wrong tube Overproduction  Drawing all blood at 4 AM Transportation  Long walks, multiple handoffs Waiting Time  Tube waiting on centrifuge to fill Inventory  50 weeks of supply Motion  Tech walking 80 ft to the printer Processing  Time/Date stamps added, not used Human Potential  Administration not listening to Med Techs or ideas for improvement
  18. 18. Are We Tolerating Waste? Healthcare = Workarounds  Professor Steven Spear  “Decoding the DNA of the Toyota Production System” (HBR)  “Fixing Healthcare Today From the Inside” (HBR) Case Example:  10-20% of MD orders are missing EVERY DAY  Call and get the order – done?  Tomorrow, we’ll do the same Problems need to be seen as opportunities
  19. 19. Laboratory Layouts Drive Waste Layout is driven by departmentsBenches interfere withstraight-line walking, encourage batches
  20. 20. Clinical Laboratory Product Flow
  21. 21. Clinical Laboratory Timeline Total CT = 5.44 hours
  22. 22. Layouts Drive Waste of Motion Med Tech Walk Pattern Pharmacist Walk PatternKms per Day! Cancer RN Walk Pattern
  23. 23. Typical 5S Baseline Unorganized Workbenches  Poor Utilization of Space Product Flow not Obvious  General Clutter Time wasted looking for things  Supply Shortages and Hoarding of supplies “Hidden” Inventories
  24. 24. 5S Improvement Examples
  25. 25. Principles of LEAN Thinking1. Specify value in the eyes of the customer.2. Identify the value stream and eliminate waste.3. Make value flow at the pull of the customer.
  26. 26. Reducing Patient Wait Times Mass Production Thinking Utilization  Keep expensive assets heavily utilized  Machines Doctors  The tradeoff is waiting time  Cars Patients Lean Thinking Flow  Focus on reducing Patient Waiting time
  27. 27. Outpatient Oncology Patient “Flow” Value AddedA • Blood drawn • MD consult • Needle into Port NVA But RequiredB • Check In / Check Out • Moving from room to room ARRIVAL TO LATENESS FOR NVA, “Pure Waste” TREATMENT TREATMENT PATIENT (HOURS) (HOURS) • Waiting for Check In A 2,5 0,42 • Waiting for MD B 3,5 1,08 • Waiting for Treatment AVG 3,0 0,75
  28. 28. Re-Work Loops Cause Delays
  29. 29. Batching Prevents Flow
  30. 30. Batching Hurts Quality  Lack of “standard work” and opportunity for “error proofing” – Anatomic PathologyBatch of slides made, 3 2nd histotech labels onepatients, risk of mixup? slide at a time
  31. 31. Batching Hurts Quality Lack of “standard work” and opportunity for “error proofing” – Pharmacy
  32. 32. Flow You can’t have flow without some amount of “leveling” in the system “Leveled Production:  You won’t be Happy without it”  From Toyota publication
  33. 33. Typical Hospital Lab  Not Level39% of Samples Arrive in Just 3 Hours of the Day TAT expectations are constant
  34. 34. Leveling Reduces Peak Costs Shift Shift Shift
  35. 35. Principles of LEAN Thinking1. Specify value in the eyes of the customer.2. Identify the value stream and eliminate waste.3. Make value flow at the pull of the customer.4. Involve and Empower employees.5. Continuously improve in the pursuit of perfection.
  36. 36. Pre-Lean Med Tech Quote: “With all of the automation, I feel like a robot.”
  37. 37. The “Thinking Production System”“Perhaps the greatest strength of theToyota Production System is the wayit develops people.This is why the T actually stands for‘Thinking’ as well as for ‘Toyota.’”  Teruyuki Minoura, Toyota
  38. 38. What Mistake-Proofing Means toHealthcare The Global Goal: Reduce Medical Errors “Human error is inevitable. We can never eliminate it.” ….. We can eliminate problems in the system that make it more likely to happen.” Source: USA Today Liam Donaldson August 24, 2005 WHO World Health Alliance for Patient safety
  39. 39. Lean Requires a Cultural Shift Traditional Approach:  “Naming, Shaming, and Blaming” Lean Approach:  Supports open reporting of mistakes  Root cause problem solving process  “Anyone can make mistakes”
  40. 40. Error Proofing Example Micrograms or Milligrams? A medical mistake waiting to happen when written by hand
  41. 41. Error Proofing Example Confusing Unambiguous (Lean)
  42. 42. MD Resistance to Standard Work Which is More effective? “… some surgeons make a tiny, mole-sized mark on a patient instead of a big, bold "X”…. I call them passive- aggressive marks…”  USA Today, 4/18/06
  43. 43. Lab Benefits from Lean Productivity improvement >30% Space savings of >250 sq m Standardized work practices Reduction in Errors and Error Potential Test Turnaround Time (CT) reduced by 50%
  44. 44. Reflections on Year’s in Healthcare Lean is a powerful methodology People are people Healthcare people have incredible intrinsic motivation Humility and asking questions is better than being a know-it-all Coaching the team to “do lean & be lean” is the only sustainable route