Lean thinking helps hospitals improve quality of care, patient safety, and employee satisfaction by reducing waste. Applying Lean principles like standardizing processes and reducing unnecessary walking can double the time nurses spend with patients from around 30% to over 50%. Case studies show Lean initiatives in hospitals have significantly reduced infection rates, medical errors, costs from complications, and turnover while improving productivity and staff morale.
The 8 waste in Lean Manufacturing - Lean Six Sigma TrainingAnkit Sharma
Waste is any step or action in a process that is not required to complete a process (called “Non Value-Adding”) successfully. When Waste is removed, only the steps that are required (called “Value-Adding”) to deliver a satisfactory product or service to the customer remain in the process.
In any business, the greatest enemy of profitability is waste-- typically of time or money. In lean manufacturing, waste is any expense or effort that is put forward which does not transform raw materials into an item the customer is willing to pay for. There are 8 types of waste in Lean Manufacturing. Seven of the eight wastes are production process oriented, while the eighth waste is directly related to management’s ability to utilize personnel.
The 8 waste in Lean Manufacturing - Lean Six Sigma TrainingAnkit Sharma
Waste is any step or action in a process that is not required to complete a process (called “Non Value-Adding”) successfully. When Waste is removed, only the steps that are required (called “Value-Adding”) to deliver a satisfactory product or service to the customer remain in the process.
In any business, the greatest enemy of profitability is waste-- typically of time or money. In lean manufacturing, waste is any expense or effort that is put forward which does not transform raw materials into an item the customer is willing to pay for. There are 8 types of waste in Lean Manufacturing. Seven of the eight wastes are production process oriented, while the eighth waste is directly related to management’s ability to utilize personnel.
Planned Maintenance is a proactive approach to maintenance that focuses on minimizing the downtime and costs associated with machine breakdowns. As one of the key pillars of the TPM Excellence framework, the goal of Planned Maintenance is to have trouble-free equipment that produce defect-free products.
Planned Maintenance achieves and sustains availability of machines at an optimum maintenance cost, reduces spares inventory, and improves reliability and maintainability of machines.
In this presentation developed by our JIPM-certified TPM Instructor, you will learn how to plan and organize the Plan Maintenance activities to strengthen the capabilities of your Maintenance department. It clarifies the roles of the Operations and Maintenance departments in supporting the TPM initiative and provides step-by-step guidance on the implementation of the Planned Maintenance pillar.
LEARNING OBJECTIVES
1. Understand what is Planned Maintenance and why it is important in TPM implementation
2. Acquire knowledge on how to plan and organize Planned Maintenance activities
3. Describe the seven implementation steps of Planned Maintenance
4. Gain knowledge on the JIPM TPM Excellence Criteria for Planned Maintenance
CONTENTS
1. Introduction to Planned Maintenance
2. What is Planned Maintenance?
3. Planning & Organizing for Planned Maintenance
4. The 7 Steps of Planned Maintenance
5. JIPM TPM Excellence Criteria for Planned Maintenance
To download this complete presentation, goto:
https://www.oeconsulting.com.sg/training-presentations
A presentation on TPM and its goals, pillars, and other aspects have been explored as well as its relation to 5s, OEE these tools also have been shown. In the end, step by step implementation of TPM is also discussed.
[Note: To download the complete presentation, visit:
https://www.oeconsulting.com.sg/training-presentations]
Autonomous Maintenance (Jishu Hozen) is one of the most important building blocks in any Total Productive Maintenance (TPM) program. Autonomous Maintenance refers to TPM activities that involve operators in maintaining their own equipment, independent of the maintenance department.
One of the basic principles of TPM is that operators are the first line of defense against unplanned equipment downtime. Operators and others in daily contact with equipment can use their knowledge and familiarity with operating conditions to predict and prevent breakdowns and other equipment-related losses. They do this through regular cleaning and inspection of equipment, and through team-based autonomous. maintenance activities that tackle equipment-related problems.
Activities in an Autonomous Maintenance program include: daily inspections, lubrication, parts replacement, simple repairs, abnormality detection and precision checks.
The goals of the Autonomous Maintenance program are to prevent equipment deterioration, restore equipment to its ideal state, and establish basic conditions needed to keep equipment well maintained.
Developed by our JIPM-certified TPM instructor, this Autonomous Maintenance (Jishu Hozen) PPT presentation is packed with diagrams, examples and practical tips and can be used to train shopfloor staff participating in autonomous maintenance activities.
LEARNING OBJECTIVES
1. Understand the key concepts of TPM and AM activities
2. Learn how to implement the AM activities, step by step
3. Learn how to use activity boards, meetings and one-point lessons to promote TPM goals
4. Learn how to measure and audit AM activities and performance
5. Familiarize with the JIPM TPM excellence criteria for AM
6. Understand the critical success factors in sustaining AM activities on the shopfloor
[Note: To download this poster, visit:
https://www.oeconsulting.com.sg/training-presentations]
The poster depicts the 8 steps of Focused Improvement (Kobetsu Kaizen).
[Note: This is a partial preview. To download this presentation, visit:
https://www.oeconsulting.com.sg/training-presentations]
In business, 'Gemba' refers to the place where value is created and improved. The 'Gemba Walk' is an activity that takes management to the front lines to look for waste (non-value added activities) and opportunities.
The objective of Gemba Walk is to grasp the situation by involving everyone touching the process to understand the Purpose, Process, and People. It is only when the situation is understood that improvement is possible and more likely to succeed.
By teaching this presentation to management teams, they will have a better understanding of the correct approach to implementing Gemba Walk and sustaining a Lean culture.
Process Change: Communication & Training TipsTKMG, Inc.
Subscribe: ksmartin.com/subscribe
Recorded Webinar: http://bit.ly/1Gl23Hm
Rolling out process improvements is a common point of failure in organizations.
Planned Maintenance is a proactive approach to maintenance that focuses on minimizing the downtime and costs associated with machine breakdowns. As one of the key pillars of the TPM Excellence framework, the goal of Planned Maintenance is to have trouble-free equipment that produce defect-free products.
Planned Maintenance achieves and sustains availability of machines at an optimum maintenance cost, reduces spares inventory, and improves reliability and maintainability of machines.
In this presentation developed by our JIPM-certified TPM Instructor, you will learn how to plan and organize the Plan Maintenance activities to strengthen the capabilities of your Maintenance department. It clarifies the roles of the Operations and Maintenance departments in supporting the TPM initiative and provides step-by-step guidance on the implementation of the Planned Maintenance pillar.
LEARNING OBJECTIVES
1. Understand what is Planned Maintenance and why it is important in TPM implementation
2. Acquire knowledge on how to plan and organize Planned Maintenance activities
3. Describe the seven implementation steps of Planned Maintenance
4. Gain knowledge on the JIPM TPM Excellence Criteria for Planned Maintenance
CONTENTS
1. Introduction to Planned Maintenance
2. What is Planned Maintenance?
3. Planning & Organizing for Planned Maintenance
4. The 7 Steps of Planned Maintenance
5. JIPM TPM Excellence Criteria for Planned Maintenance
To download this complete presentation, goto:
https://www.oeconsulting.com.sg/training-presentations
A presentation on TPM and its goals, pillars, and other aspects have been explored as well as its relation to 5s, OEE these tools also have been shown. In the end, step by step implementation of TPM is also discussed.
[Note: To download the complete presentation, visit:
https://www.oeconsulting.com.sg/training-presentations]
Autonomous Maintenance (Jishu Hozen) is one of the most important building blocks in any Total Productive Maintenance (TPM) program. Autonomous Maintenance refers to TPM activities that involve operators in maintaining their own equipment, independent of the maintenance department.
One of the basic principles of TPM is that operators are the first line of defense against unplanned equipment downtime. Operators and others in daily contact with equipment can use their knowledge and familiarity with operating conditions to predict and prevent breakdowns and other equipment-related losses. They do this through regular cleaning and inspection of equipment, and through team-based autonomous. maintenance activities that tackle equipment-related problems.
Activities in an Autonomous Maintenance program include: daily inspections, lubrication, parts replacement, simple repairs, abnormality detection and precision checks.
The goals of the Autonomous Maintenance program are to prevent equipment deterioration, restore equipment to its ideal state, and establish basic conditions needed to keep equipment well maintained.
Developed by our JIPM-certified TPM instructor, this Autonomous Maintenance (Jishu Hozen) PPT presentation is packed with diagrams, examples and practical tips and can be used to train shopfloor staff participating in autonomous maintenance activities.
LEARNING OBJECTIVES
1. Understand the key concepts of TPM and AM activities
2. Learn how to implement the AM activities, step by step
3. Learn how to use activity boards, meetings and one-point lessons to promote TPM goals
4. Learn how to measure and audit AM activities and performance
5. Familiarize with the JIPM TPM excellence criteria for AM
6. Understand the critical success factors in sustaining AM activities on the shopfloor
[Note: To download this poster, visit:
https://www.oeconsulting.com.sg/training-presentations]
The poster depicts the 8 steps of Focused Improvement (Kobetsu Kaizen).
[Note: This is a partial preview. To download this presentation, visit:
https://www.oeconsulting.com.sg/training-presentations]
In business, 'Gemba' refers to the place where value is created and improved. The 'Gemba Walk' is an activity that takes management to the front lines to look for waste (non-value added activities) and opportunities.
The objective of Gemba Walk is to grasp the situation by involving everyone touching the process to understand the Purpose, Process, and People. It is only when the situation is understood that improvement is possible and more likely to succeed.
By teaching this presentation to management teams, they will have a better understanding of the correct approach to implementing Gemba Walk and sustaining a Lean culture.
Process Change: Communication & Training TipsTKMG, Inc.
Subscribe: ksmartin.com/subscribe
Recorded Webinar: http://bit.ly/1Gl23Hm
Rolling out process improvements is a common point of failure in organizations.
Suggestion boxes, while well intended, usually fail to engage workforces in meaningful improvement. The "kaizen" model (from Lean and Toyota Production System), however, is alive and thriving in many organizations.
This webinar will focus on key differences between suggestion box programs and the kaizen model, giving specific tips and ideas that your organization can adopt.
bout the Presenter
Mark Graban is a popular speaker at conferences and private healthcare meetings. He has guest lectured at schools including MIT and Wharton and has served as a faculty member for the Institute for Healthcare Improvement.
He has been quoted and interviewed in many publications, including Health Affairs and the New York Times.
Lean is about learning, John Shook told a crowd of 200 managers from manufacturing, healthcare, government, and service organizations who had gathered for a learning session sponsored by the Iowa Lean Collaborative on Oct 2, 2012.
To be successful, he said lean learning needs these characteristics:
• All learner partners actively participate
• Mutual Respect: Openness in sharing experience, knowledge, challenges, struggles;
• Teachers are learners; learners are teachers
• Problems to be addressed are important and challenging to all partners
Go and See: why go to the gemba and what to do when you are thereChet Marchwinski
The slide deck for out recent free webinar "Go and See" offers tips for what you should do when you go to the "gemba," Japanese for the "actual place" where value is created.
Lean Management Institute of India (LMII) is a nonprofit entity driven towards promoting ‘Lean Thinking’ in organizations in order to provide the best quality services to the customers, with fewer resources and zero wastage.
In a keynote session at the 2011 IndustryWeek Best Plants Conference, LEI Founder James Womack explains the purpose and practical details for taking a “gemba walk,” a walk across a value stream to grasp the current state. Watch a video of the presentation at: http://www.industryweek.com/videos/Womack-Best-Plants-2011.aspx
Read excerpts from Gemba Walks, a collection of Jim’s essays on visiting companies implementing lean management, or post a question to learn more.
Concept of energy transmission & distribution ZunAib Ali
Downlaod is NOW Allowed (08/06/2016)
for more help: email me at zunaib_91@yahoo.com
Purpose of Electrical Transmission System
Main Parts of Power System
One-Line Diagram of Generating Station
Main Parts of Generating Station
Components of a Transmission Line
An introduction to Lean within veterinary practice presented to Joint Venture Partners of the Vets4Pets group. Apologies for formatting errors during file conversion.
This presentation made at EMCON, Jaipur, November 2017, demonstrates the practical feasibility of improving quality care in Emergency Departments by application of Lean thinking, both theoretically and research based findings along with our own experience at THE MISSION HOSPITAL, DURGAPUR.
How To Drive Clinical Improvement Programs That Get Results - HAS Session 20Health Catalyst
Getting accurate data does not improve care unless empowered teams are created with knowledge of how to apply the data. This was the highest-rated breakout session, and the second-highest rated session overall. This was a very hands-on session, using four different “ah ha” experiences to demonstrate key principles for getting clinical improvement results. These experiences included a deal or no deal re-enactment, a popsicle bomb exercise, a water stopping contest, and Paul Revere exercise. Key principles included how to prioritize your clinical improvement programs and cohorts, defining and selecting the most impactful AIM statements, fixing data quality, and defining and rolling out interventions throughout the system.
Hardwiring Hospital-Wide Flow To Drive Competitive PerformanceEmCare
Thom Mayer, MD, FACEP, FAAP and Kirk Jensen, MD, MBA, FACEP, authors of “Hardwiring Flow” and “The Patient Flow Advantage, " share their secrets for streamlining processes, changing behaviors, and achieving sustainable advances in hardwiring flow throughout your hospital system.
This presentation is an abridged version of the webinar that Drs. Jensen and Mayer delivered July 9, 2015, in partnership with Becker's Hospital Review.
Discover more about how the West of England AHSN is putting innovation at the heart of healthcare, improving patient outcomes and generating wealth for economic growth.
Your aging patient bed tower top ten considerations when renovatingArray Architects
While the benefits of caring for inpatients within a private room have now been time tested, there are thousands who still receive care outside of this clinically preferred environment on a daily basis. As is often the case, the benefits may be clear, but the perceived cost of providing more private patient rooms has prevented the wholesale adoption of this basic principle throughout the United States. Building new bed towers has been an option for systems that could afford to build new facilities. However, many systems do not have that luxury or are landlocked, at capacity and cannot expand or afford to give up beds from their license. This session will provide a roadmap for the successful renovation of patient units to accommodate all private rooms, or enhanced 2-Bed rooms that incorporate best clinical practices in a cost effective manner. By breaking down the success factors into ten key considerations, this session will allow designers, managers, and contractors to plan and execute such projects more effectively. Case studies will be presented to demonstrate how this straightforward approach can increase the success of renovations that convert (primarily) double bedded units into single patient room units.
Healthcare Kaizen Webinar Mark Graban Gemba Academy Dec 2011Mark Graban
"Putting the Continuous Back in Continuous Improvement"
In this webinar, Mark Graban, author of the Shingo Award-winning " Lean Hospitals " and the upcoming book "Healthcare Kaizen," talks about kaizen and daily continuous improvement in healthcare. Across many industries, many organizations have come to equate the word kaizen with "kaizen events," or focused weeklong improvement projects. Leading lean healthcare organizations, such as ThedaCare and Virginia Mason Medical Center , have learned that they need both projects and small improvements.
Kaizen, as a mode of continuous improvement, is characterized by a large number of small, low-cost, low-risk improvements that are driven by front-line staff, who work in collaboration with their co-workers and leaders. Kaizen follows the scientific method and the PDCA (or PDSA) cycle of iterative improvement, where a hypothesis for improvement is tested against actual results.
The webinar will show examples of kaizen improvements from numerous healthcare organizations, as well as the practical mechanics for facilitating and managing kaizen. Graban will also discuss the important role of leaders at all levels.
How to improve patient flow in emergency and ambulatory care, pop up uni, 10a...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Lean, Six Sigma and Emotional IntelligenceIan R. Lazarus
An introduction to Lean and Six Sigma process improvement techniques as well as Emotional Intelligence in leadership to a medical staff. Using Lean can help 1) Reduce cost 2) Improve Reliability and Safety and 3) Increase the Quality of Care. Using Six Sigma can improve processes by reducing variation. Leadership with high Emotional Intelligence create the optimal environment to implement Lean and Six Sigma strategies.
Ideation in Medical Device Development: Finding Clinical NeedsCIMIT
This presentation focuses on:
Decreasing failure by finding and developing a compelling need.
Understanding needs - finding and screening.
Selecting meaningful projects for entrepreneurial effort.
Sharing examples of needs and need statements.
Beginning a paradigm shift from technology push to need pull.
Similar to Erie st. clair graban sept 27 2010 (20)
Our Favorite Mistakes: Creating a Culture of Learning from MistakesMark Graban
Presented by Mark Graban for the Lean Leadership Week event hosted by Lean Frontiers.
We all make mistakes, even the most successful people we know. Are people successful because they avoid mistakes or because they make sure to learn from them? Mark Graban thinks it’s the latter based on podcast conversations he’s had with corporate CEOs, athletes, entrepreneurs, and entertainers – and former Toyota employees.
Are we willing to admit mistakes to ourselves, yet alone our colleagues, employees, or leaders? Do our organizations create a culture where it’s safe to talk about mistakes, as a first step toward preventing future mistakes? Can we shift from blaming and shaming to building a culture of continuous improvement?
In this talk, you will learn and hear stories about:
• Why it’s important to admit mistakes
• How to reflect on mistakes without being too hard on ourselves (or others)
• How to prevent repeating mistakes
• What key leader behaviors create a culture where it’s safe for people to admit mistakes
Mark Graban is an independent consultant, professional speaker, and entrepreneur. He is also a senior advisor for the technology company KaiNexus and advises healthcare clients through the firm Value Capture.
He is the author of Measures of Success: React Less, Lead Better, Improve More. Mark’s previous books include the Shingo-Award winning Lean Hospitals and Healthcare Kaizen. He was creator and editor of the anthology Practicing Lean.
Mark hosts many podcasts including “Lean Blog Interviews,” “Habitual Excellence, Presented by Value Capture” and “My Favorite Mistake.”
Mark has a B.S. in Industrial Engineering from Northwestern University, along with an M.S. in Mechanical Engineering and an M.B.A. from the Massachusetts Institute of Technology.
Today’s Effective Leader: Shifting From Cop to Coach and CounselorMark Graban
A webinar presented by Mark Graban for the Iowa Lean Consortium
This webinar, facilitated by Mark Graban, will provide practical approaches for changing the way you lead.
How often do we hear phrases like "If only people would just do what they're told," or "They're being resistant to change"? High quality organizations realize that "resistance to change" actually should be the beginning of a conversation about change, not the end.
This webinar will feature Mark Graban, an internationally recognized consultant, explaining how organizations can shift from a culture of compliance to a culture of continuous improvement – and in the process, get on the path to better quality and higher levels of performance.
Using real-life examples, Mark will share practical approaches for changing the way you lead to engage everyone in ongoing and sustainable continuous improvement. Mark also will introduce innovation mindsets and tactics from a surprising place – clinical counseling and addiction therapy – and share proven methods that have helped Toyota and other companies realize that "resistance to change" is a normal part of the change process.
The Steps You Need to Take to Get Your Business Ready to Reopen (Proactive Ma...Mark Graban
As our businesses enter the new phases of a return to post-pandemic life, it will be critically important for leaders to be proactive with their employees and customers – for the sake of the health of our people and our organizations.
By the end of this webinar, you will:
- Recognize the difference between merely containing a COVID-19 related problems and preventing them from occurring again, especially if we see a fall resurgence.
- Learn why it’s important to see problems, solve problems, and share problems in your organization.
- Understand how to use methods like FMEA (“Failure Mode Effects Analysis”) and root-cause problem solving to be more proactive in your management and improvement efforts post crisis.
Hosted by Mark Graban, M.B.A., M.S., a top expert in Lean Management. Graban is the author of “Measures of Success: React Less, Lead Better, Improve More” a book about using simple, yet practical statistical methods that help leaders overreact less to their metrics, which frees up time for real, focused, sustainable improvement. While he works with startups, entrepreneurs and midsized businesses, Mark previously worked for General Motors, Dell, Honeywell, and divisions of Johnson & Johnson. Graban is a guest lecturer at MIT, Wharton, Ohio State University, and several international universities.
Getting from Data to Analysis and Insight in the Covid-19 Pandemic (Final)Mark Graban
Presented by Mark Graban and Christopher R. Chapman.
The aim of this webinar is to expose attendees to the “Process Behavior Chart” methodology, using data and examples related to the current pandemic. Mark will provide a quick introduction to the method, using a few charts from healthcare organizations. Chris will share a deeper dive using data from the province of Ontario related to testing and cases over time.
Learning objectives:
* Learn how Process Behavior Charts are more helpful than rolling averages and two-data-point comparisons
* Understand how to determine if performance is getting better or getting worse? Or is it just fluctuating around a stable average?
* Know how to better understand cause-and-effect when a system is changed
* Forecast how the system will behave and under what conditions
Mark Graban is President of Constancy, Inc. and is author of the book "Measures of Success: React Less, Lead Better, Improve More."
Christopher R. Chapman is Owner and Chief Agile/Lean Coach, Derailleur Consulting, Inc., based in Toronto.
Busting Myths About Just in Time: The Implications for Healthcare Supply ChainsMark Graban
During the Covid-19 crisis, some have blamed “just in time” or “Lean” for the current (and tragic) shortages of life-saving items like masks and ventilators. JIT has been vilified after nearly every major natural disaster that has disrupted supply chains. Is this fair?
In this webinar, Mark Graban, a Shingo award-winning author, will dispel some common myths about just in time and Lean management. He will share a broader context of JIT and Lean, along with practical suggestions that can help organizations in various industries.
How Authors Can Stress Less Over Their MetricsMark Graban
This is a webinar presented by Mark Graban, author of the book "Measures of Success: React Less, Lead Better, Improve More."
The webinar was hosted by Cathy Fyock, "The Business Book Strategist." https://www.cathyfyock.com/
Cathy coached me through the book writing process and I am grateful to her and her community of authors.
She invited me to give this presentation for her group of authors... so I tried to tailor a talk that focuses on authors, their metrics, and how to best manage them in a way that reduces stress and overreaction.
YouTube recording:
https://www.youtube.com/watch?v=5kRaxGiKOAY
Improve Your Lean Management System With a Simple ChartMark Graban
Many organizations have discovered the benefits of Lean management system practices, ranging from Strategy Deployment in the boardroom (and on down the organization) and Lean Daily Management practices at the front lines (and on up).
In our zeal to reduce waste in the actual work, how often are we introducing additional waste through our management practices? Too often, in the varied experience of our webinar presenter, Mark Graban. Reacting to every up and down in a metric or demanding a root cause explanation for every below average data point (or any data point that doesn’t hit a target) might be consuming time that would be better spent actually improving the system that generates your results.
In this webinar, you’ll learn practical tips and methods for being more effective in your Lean improvement efforts, including:
• Why two data points are not a trend (except for the few cases when they are)
• Why Run Charts or, better yet, “Process Behavior Charts” are far more helpful than red/green color-coded tables of numbers, a.k.a. “Bowling Charts”
• How to create a Process Behavior Chart for a metric
• How to use a Process Behavior Chart over time to separate “signal” from “noise,” which shows you when to react and look for a root cause for that last data point – and when to step back and improve more systematically
Mark will share lessons from his new book, Measures of Success: React Less, Lead Better, Improve More. Less
Measures of Success: React Less, Lead Better, Improve MoreMark Graban
In this webinar, Mark Graban shares key insights from his new book that will help you be more effective with your Lean management system. He will share the practical methods and mindsets of “Process Behavior Charts” that apply at the boardroom strategy deployment level and for frontline unit huddle boards. Every metric shows variation over time, but if we react to every change in every metric, then nothing is a priority. This approach can help us waste less time, which means we can improve more effectively and sustainably.
In this webinar, participants will:
Know the three questions people should ask about their metrics and the system that leads to those results
Learn how to interpret their metrics with “Process Behavior Charts”
Determine when to react to a change in a metric, based on three simple rules for determining that we have found a “signal” in the noise
Understand how Process Behavior Charts are more effective than “Bowling Charts” or “red/green” analysis
Respect for People and Continuous Improvement for HealthcareMark Graban
Presented by Mark Graban to a healthcare conference gathering in Turkey in April 2018. Mark Graban is the author of the book "Lean Hospitals" and co-author of "Healthcare Kaizen," the books that are essentially source material for this talk.
3. St. Elisabeth Hospital: The Netherlands
Dr. Jacob Caron, Orthopedic Surgeon
Chairman of the medical staff
4. Henry Ford - 1922
“In the ordinary hospital the nurses must make useless
steps. More of their time is spent in walking than in
caring for the patient.”
4
5. Fast Forward to 2005-2008
What % of time do “med/surg” unit RNs spend
directly with patients?
A: 21%
B: 33%
C: 50%
D: 65%
New Zealand: 33%
VMMC: 32%
UK: 34%
Illinois: 31%
Cinci Children’s 29%
It is possible to double this time with patients
More time to do the “right things”
5
6. 6
• Deliveries of supplies delayed because of improper ordering
• Articles returned by other departmentsbecause they were not
made correctly
• Employees have difficultyin handlingnew-type equipment
• Limitedstorage space (linen and supplies) not properly used
• Safety equipmentnot being used
• Correct procedures not followed
• Employees leave to go to other hospitals
8. The Iceberg of Lean
8
Culture
Management System
Philosophy
5S
Kaizen
StdWork Heijunka
VSMs A3
8
9. Pitfall – Focus on Implementing
Tools
"We were offering suggestions and getting pushback on safe staffing,
yet being told to reduce the number of pens and pencils.”
– RN (Minnesota)
11. Identify Causes of Walking
(Primary Care)
• MDs, PA, RNS:
– Poor organization
– Supplies in inconvenient
locations
– Missing information
• The system causes this
670 ft for single procedure prep
(pre-Lean walking pattern)
Exam
Procedure
Lab
12. Reducing Podiatrist Walking
• Created standardized cart
• Along with standardized rooms,
eliminated the need to leave the room
during patient encounters
Restocking Checklist
13. Quality and Cost
• “Lean is a quality initiative, it isn’t a cost-cutting
initiative. But the end result is, if you improve your
quality, costs will go down.”
– Bill Douglas, CFO of Riverside Medical Center (IL)
• Allegheny Medical Center:
– Reduced central line infections by 95%
– Hospital lost $26,839 per case (~16 cases/yr) = ~$500k/year
• Beth Israel Deaconess Medical Center:
– Avoided 300 V.A.P. cases in one year
– $12M cost savings
14. • 90% reduction in CR-BSI in MICU and Oncology
• Saved $1.7M
• Saved 17 days L.O.S. per case 14
Source: Dr. Richard Shannon
20. ThedaCare Code STEMI
• Starting Point 2002
– “Did not have a clear,
standardized response to
heart attacks.”
• Studied each process step
in detail
• Posted standardized work
in each room
22. Need to Stop Blaming People
"[The CEO] said the
technician responsible for
the mix up also no longer
works there."
23. A Different Hospital Lab…
“It’s OK,
my people
are very
careful!”
3 Different Patients - Batched
24. Toyota’s Chairman
Mr. Cho
• Go See
– “Senior Management must
spend time on the front lines.”
• Ask Why
– “Use the “Why?” technique daily.”
• Show Respect
– “Respect your people.”
24
Three Keys to Lean Leadership
25. “Gemba”
“Toyota managers
should be sufficiently
engaged on the
factory floor that they
have to wash their
hands at least
three times a day.”
Taiichi Ohno
25
26. “…Kaplan tours the
hospital daily looking
for problems and
solutions. Everyone is
encouraged to look for
changes to make work
more efficient.”
- Virginia Mason CEO Gary Kaplan
26
“Gemba is for Everyone”
28. “Convis became the first
North American to head a
Toyota manufacturing plant
when he was put in charge
of the Georgetown facility.
He responded to the
promotion by moving his
office from the admin
building adjacent to the
Georgetown plant to the
center of the factory floor.”
28
29. Six
Sigma
Adapted from: “The Toyota” Way Fieldbook, Liker and Meier
Very few
Large problems
Few
Medium problems
Many
Small problems
Mgmt
Kaizen
Kaizen
Event
Daily Kaizen
Different Types of Kaizen
31. Metric Before After
Potassium IP TAT 74 min (June ’06 avg)
43 min (May 07 avg)
42% reduction
Labor Productivity 0.14 WHPUOS
0.12 WHPUOS
14% reduction
% of Results on
Chart < 7 AM
62% 92%
Square Footage
228 sq ft freed up
(behind manual area, to side of
special chemistry)
Initial Improvement
38. Documenting & Celebrating
Improvements
• What was the problem?
• What was changed,
improved, or
implemented?
• What were the benefits?
• Who was involved?
Kaizen Wall
of Fame
What was the Problem?
For disposal of pipette tips, the only containers we had were “sharps” containers. This
Adds extra disposal cost, as the tips are not sharp. The container hole was also
Hard to get tips into.
What was changed, improved, implemented?
Create biohazard bag holders out of urine jugs, cut the tops off.
Photo/Diagram:
What were the benefits? Safety? Quality? Time? Waste? Cost?
Reduces cost since we aren’t doing unneeded sharps disposal and we aren’t throwing
the containers away each time. No safety risk.
Easier to get tips into container (less motion and less arm strain, since the
Container is lower and easier to get into). Tips can be dumped into a larger
Biohazard bin or we can replace the bag.
Who was Involved?
Gretchen, Beth, Janie, Franke
Date:
5/31/07
Area:
STL
Old Style
Container
New
Container
40. Value of Kaizen in a Hospital?
• $4,000 per employee (Toyota)
– Just the quantifiable benefit
• What about benefits from:
– Better Quality
– Morale
– Patient Satisfaction
– Less Waiting Time
= $$ ?
41. Employee Quote
“This is the best thing
we’ve done in my 20
years. We’re finally
fixing things.”
42. Data From Children’s Medical
Center Dallas
Before Lean 12 Months
After Starting
3. I have the opportunity to do what I do
best every day.
3.11 3.92
8. I feel free to make suggestions for
improvement.
2.84 3.48
10. I feel secure in my job. 2.32 3.42
13. Stress at work is manageable. 2.43 3.23
17. I am satisfied with the lab as a place to
work.
2.51 3.43
18. I would recommend my work area as a
good place to work to others.
2.38 3.46
Grand Average 2.96 3.69
43. Lean Benefits All Stakeholders
Patients
Caregivers
• Employees
• Medical Staff
• Administrators
Hospital
• Safety & Quality
• Caring Encounters
• Less Waiting and Delay
• Mission
• Stewardship
• Stability / Growth
• Pride in work
• Less frustration
• Job security
• Career growth Philosophy
People
43
So why are we talking about this today? Leadership presence at the front line – a very underappreciated topic and practice. When people become a manager often they think that they've graduated away from having to be at the front line… and their executive position means that they have people to do that for them that they are world now it's all about meetings and conference rooms that become disconnected from the work that's done if they were ever connected to it in the first place. The biggest complaint is – “we don’t have time” or that the executives have staff and other managers to do that for them!
Lean principles don’t change anything about our values or goals
This isn’t about tools – it’s about defining an ideal condition and working tirelessly to close the gap between current state (ACCURATE version) and the ideal state. Can we challenge assumptions? Test – first day on your job--- ask why something is done or why can’t we do it a better way? How does the organization respond? Start from need…
These problems are from 1944. Hospitals have tried virtually everything from other industries in their efforts to improve: Scientific ManagementTraining Within IndustryBenchmarkingCost CuttingTotal Quality ManagementDr. Deming / PDCA / PDSARe-EngineeringSix SigmaBest PracticesFunctional Expert ConsultantsJoint Commission & AccreditationsTargets and Goals
Waste reduction is not traditional cost cutting
1 in 350 cases in 2009 (full year)
We didn’t even do a formal VSM here, made a change almost immediately (Within a week) as opposed to doing nothing but mapping over 5 days… Laboratory – need to take an end-to-end view. Same is true at Radiology
Guideline = 120 min “door- to-balloon” – 70% success“Did not have a clear, standardized response to heart attacks.”Now 100% success against 90 minute targetFocus on the patient as customerRespect the patient’s timeIdentify systemic causes of patient waitingStandardized workVisual managementStaffing levelsScheduling practicesLook across the entire “value stream”Minimize delays from handoffs