Lean Six Sigma applications in healthcare require an understanding of how the tools and methodologies translate to the people-intensive processes of patient care. Once applied, the possibilities are endless. Using real-world examples of the most common types of errors in clinical services, participants will learn how the DMAIC structure within Lean Six Sigma will lead them to solutions that will prevent future errors.
Lean Six Sigma applications in healthcare require an understanding of how the tools and methodologies translate to the people-intensive processes of patient care. Once applied, the possibilities are endless. Using real-world examples of the most common types of errors in clinical services, participants will learn how the DMAIC structure within Lean Six Sigma will lead them to solutions that will prevent future errors.
MarketLab's vision for 5S Lean for Healthcare is to create a better experience for both staff and patients. Our team of experts is equipped with the knowledge, expertise and product solutions necessary to help you and your healthcare organization's lean initiative.
A sample of slides used in our FMEA Training for Healthcare. This 3-day class is ideal for quality facilitators with hospitals and health systems. The key deliverable is a preliminary FMEA on a high-risk process of the client's choosing, complete with an improvement plan.
Presenting this set of slides with name - Continuous Improvement Powerpoint Presentation Slides. This PPT deck displays twenty slides with in-depth research. Our topic oriented Continuous Improvement Powerpoint Presentation Slides presentation deck is a helpful tool to plan, prepare, document and analyze the topic with a clear approach. We provide a ready to use deck with all sorts of relevant topics subtopics editable templates, charts and graphs, overviews, analysis templates. PPT slides are accessible in both widescreen and standard format. PowerPoint templates are compatible with Google Slides. Quick and risk-free downloading process. It can be easily converted into JPG or PDF format
LEAN Management:
It is a customer focused waste elimination method that makes the process and there by organization lean (eliminating Fat)
In a Lean company, employees always look to improve their skills and improve the processes. Products and Services are driven in right amounts, to right location, at the right time and in the right condition.
Lean Thinking
The Goal of Lean Thinking is the creation of a continuous stream which delivers customer value with the least waste of resources within the shortest possible time.
The Building blocks of Lean Management are 5s, 8 Wastes, Visual Management and Standardized work
In this 1-hour webinar you’ll learn what Lean is, why Lean is good for business and how some of the basic Lean concepts like 8 Wastes and Visual Management can improve and transform your operation.
Download the slides and more at https://goleansixsigma.com/webinar-introduction-to-lean/
Start your free Yellow Belt Training at http://www.goleansixsigma.com/free-lean-six-sigma-training/
Get The 8 Wastes Poster at https://goleansixsigma.com/product/the-8-wastes-poster/
Value, Value Stream, Flow, Pull, Perfection, Waste Types in Services, Waste Types in Manufacturing, Value Add, Non Value Add, 3 MU's, Gemba, Cycle Time, Lead Time, Takt, ECRS, Eliminate, Combine, Rearrange, Simplify, Sources of Waste, Excellence, Sustained,
standard operating procedure -SOP ( a detail discussion )martinshaji
Standard Operating Procedures (SOPs) are an integral part of Good Manufacturing Practices. Without SOPs its really tough to run such big infrastructures of Pharma Manufacturing Units. SOPs are also required as regulatory requirements & every worker must be aware of the SOPs related to his/her job function.
please comment
thank uu
Check out this introduction to Lean processes in a health care setting—touching on 5 keys to Lean success. This presentation is from a recent AORN webinar, which is available for replay at http://bit.ly/188O2uQ. Get complete Lean instruction and tools for implementation during a workshop in Denver, CO; more information on these August and September events available at http://bit.ly/14B9gLu.
MarketLab's vision for 5S Lean for Healthcare is to create a better experience for both staff and patients. Our team of experts is equipped with the knowledge, expertise and product solutions necessary to help you and your healthcare organization's lean initiative.
A sample of slides used in our FMEA Training for Healthcare. This 3-day class is ideal for quality facilitators with hospitals and health systems. The key deliverable is a preliminary FMEA on a high-risk process of the client's choosing, complete with an improvement plan.
Presenting this set of slides with name - Continuous Improvement Powerpoint Presentation Slides. This PPT deck displays twenty slides with in-depth research. Our topic oriented Continuous Improvement Powerpoint Presentation Slides presentation deck is a helpful tool to plan, prepare, document and analyze the topic with a clear approach. We provide a ready to use deck with all sorts of relevant topics subtopics editable templates, charts and graphs, overviews, analysis templates. PPT slides are accessible in both widescreen and standard format. PowerPoint templates are compatible with Google Slides. Quick and risk-free downloading process. It can be easily converted into JPG or PDF format
LEAN Management:
It is a customer focused waste elimination method that makes the process and there by organization lean (eliminating Fat)
In a Lean company, employees always look to improve their skills and improve the processes. Products and Services are driven in right amounts, to right location, at the right time and in the right condition.
Lean Thinking
The Goal of Lean Thinking is the creation of a continuous stream which delivers customer value with the least waste of resources within the shortest possible time.
The Building blocks of Lean Management are 5s, 8 Wastes, Visual Management and Standardized work
In this 1-hour webinar you’ll learn what Lean is, why Lean is good for business and how some of the basic Lean concepts like 8 Wastes and Visual Management can improve and transform your operation.
Download the slides and more at https://goleansixsigma.com/webinar-introduction-to-lean/
Start your free Yellow Belt Training at http://www.goleansixsigma.com/free-lean-six-sigma-training/
Get The 8 Wastes Poster at https://goleansixsigma.com/product/the-8-wastes-poster/
Value, Value Stream, Flow, Pull, Perfection, Waste Types in Services, Waste Types in Manufacturing, Value Add, Non Value Add, 3 MU's, Gemba, Cycle Time, Lead Time, Takt, ECRS, Eliminate, Combine, Rearrange, Simplify, Sources of Waste, Excellence, Sustained,
standard operating procedure -SOP ( a detail discussion )martinshaji
Standard Operating Procedures (SOPs) are an integral part of Good Manufacturing Practices. Without SOPs its really tough to run such big infrastructures of Pharma Manufacturing Units. SOPs are also required as regulatory requirements & every worker must be aware of the SOPs related to his/her job function.
please comment
thank uu
Check out this introduction to Lean processes in a health care setting—touching on 5 keys to Lean success. This presentation is from a recent AORN webinar, which is available for replay at http://bit.ly/188O2uQ. Get complete Lean instruction and tools for implementation during a workshop in Denver, CO; more information on these August and September events available at http://bit.ly/14B9gLu.
Quality Clinic - Lean Six Sigma Fundamentals Training - SampleMark H. Davis
A sample of slides from our Quality Clinic training, which teaches the foundational elements of Lean Six Sigma DMAIC, with a dash of A3 and Constraints Management.
My business processes are deviant! What should I do about it?Marlon Dumas
Talk about deviance mining and predictive monitoring of business processes. Delivered at the Second European BPM Roundtable, Liechtenstein, 15 May 2014.
Justifying your Occupational Health Clinic budgetMedgate Inc.
Facing increasing budgetary pressures means that more than ever occupational health clinics are under pressure to justify their existence. Here is a preview of our forthcoming webinar with Dr Mary Anne Alexander which addresses the concerns of nurses, doctors and managers and shows how better use of data can help to provide the answers.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
2. Agenda
• Lean healthcare – what is it?
• Where and how does it apply?
• Why is it so hard to succeed?
• How do you get started?
• Summary and conclusions
• Appendix
Roper & Associates Inc. 2
3. Lean Healthcare – what is it?
• Lean healthcare is:
– An integrated philosophy, set of principles and tools
– Based on principles of the Toyota Production System and
focused on understanding and eliminating process “waste” by:
• Stabilizing / leveling work load
• Standardizing how work is performed
• Identifying and solving problems daily
• Engaging everyone in process improvement
• Valuing a common way of performing work
• Focusing on system effectiveness, rather than functional efficiency
• Waste and value
– Value is judged only by the customer (patient)
– Value adding activities in a process change the form, fit or
function of the product or service
– Activities that do not add value are waste; all they add is cost
Roper & Associates Inc. 3
4. Lean Healthcare – what is it?
• As in manufacturing, lean healthcare goes by many
names (yet the underlying principles are all the same):
– Perfecting Patient Care – Pittsburgh Regional Health Initiative
– Continuous Performance Improvement – Children’s Hospital and
Regional Medical Center, Seattle
– ThedaCare Improvement System - ThedaCare, Appleton, WI
• As in manufacturing, lean healthcare is no longer “new”
– Many sites well down the learning curve (5+ years into their
transformation) and “learning” the same lessons manufacturers
have learned
– 335 lean healthcare references on Lean Enterprise Institute (LEI)
website, covering wide range of implementation sites
• Of all the improvement concepts embraced by
manufacturers in the last 35 years, lean has “stuck” the
longest and is still evolving – will healthcare be the same?
Roper & Associates Inc. 4
5. Lean Healthcare – what is it?
• Lean healthcare isn’t:
– Just a set of tools like 5S, standard work, value
stream maps, kaizen events, A3 problem solving,
mistake proofing, etc.
– Something that succeeds “bottom up,” without
leadership understanding and support
– Something that can be precisely planned at the
outset, it must evolve in any organization
– Something that anyone can understand without hands
on experience
Roper & Associates Inc. 5
6. Lean Healthcare – what is it?
True lean is about principles, not tools:
1. Directly observe work as actions (steps taken), connections
(how customer/supplier pairs function) and flows (paths and
rates for material, information and people)
2. Engage in systematic waste elimination – understand waste
and value, and how to identify and reduce or eliminate waste
3. Establish high agreement on what (goals) and how (process)
– Value a common way or process, with low ambiguity, more
than you value your own way
4. Encourage systematic problem solving by using a standard
system to expose and solve problems
5. Create a learning organization – experiment, follow PDCA
cycle, reflect, manage comfort and fear zones and provide
the time to do it
* - Hitchhiker’s Guide to Lean
Roper & Associates Inc. 6
7. Where and how does it apply?
• Lean healthcare principles can provide:
– Point solutions to reduce or eliminate specific, often simple, problems
– Building blocks of a complex, system level (value stream) improvement
• Some typical examples
IMPROVEMENT EXAMPLES IMPACT LEAN TOOL APPLIED
REDUCING TIME WASTED WHEEL CHAIRS MORE NURSING TIME AVAILABLE 5S / WORK PLACE ORGANIZATION, STANDARD
LOOKING FOR THINGS INFORMATION MORE HOUSEKEEPING TIME AVAILABLE WORK
EQUIPMENT REDUCED TURNOVER
SUPPLIES AND KITS BETTER SCHEDULE ADHERENCE
REDUCED TURNAROUND TIME LABS FASTER TEST RESULTS 5S, VALUE STREAM MAPPING,
PHARMACIES FASTER MEDICATION DELIVERY SET UP REDUCTION
OPERATING ROOMS REDUCED OPERATING ROOM DOWNTIME
PATIENT ROOMS REDUCED BED / ROOM DOWNTIME
REDUCED DELAYS / TOTAL REGISTRATION LESS PATIENT WAITING VALUE STREAM MAPPING, STANDARD WORK,
PROCESS LEAD TIME OPERATING ROOMS BETTER SCHEDULE PERFORMANCE LOAD LEVELING
TRANSPORTATION LESS DOCTOR WAITING
REDUCED ERRORS INFECTIONS REDUCED INFECTION RATES STANDARD WORK, 5S, MISTAKE PROOFING
PHARMACY ISSUES REDUCED FALL RATES
MORE EFFECTIVE HAND OFFS PATIENTS MORE PATIENT TIME FOR NURSES & OTHERS STANDARD WORK, 5S, MISTAKE PROOFING
INFORMATION IMPROVED PATIENT SAFETY
Roper & Associates Inc. 7
8. Where and how does it apply?
Organize storage areas to reduce time spent searching for supplies or equipment
5S – a place for
everything and
everything in its
place, easy to
access and ready to
use
Organize lab samples to simplify processing and reduce errors
Before – samples arrive haphazardly in After – samples and paperwork
plastic bags and pink buckets arrive together in well organized tray
Roper & Associates Inc. 8
9. Where and how does it apply?
Organize lab to improve processing efficiency (response time and work time)
Before: After:
• Work area cluttered and • Work area organized; contains
potentially dangerous 100% of what is needed to do
• No standard process evident the work (and nothing that isn’t
• Not designed for flow needed)
• U-shaped work area (cell)
designed for continuous flow
Lean tools applied - 5S, standard work, cell design
Roper & Associates Inc. 9
10. Where and how does it apply?
• A more complex case - reducing Central Line Infections
– Allegheny General Hospital, 2004, supported by PRHI / PPC,
physician lead effort
– Goal – eliminate CLIs in 2 ICUs, in 90 days
• Approach:
1. Clearly define the current condition
• Chart review of 1700 patients for 2002 – 2003 to set the baseline
– Standard metric - 5.1 infections / 1000 line days (meant what?)
» Translation – in prior year 37 patients got 49 infections, 19 died
– Also had 10.5 infections / 1000 line days for femoral lines
• Decided to focus on all infections, with a goal of zero
2. Observe the actual work in detail; 40+ hours of observation
revealed significant variation in use of standard protocol by
nurses and doctors
3. Define, train and communicate standard protocol (standard
work) for central line insertion and maintenance
Roper & Associates Inc. 10
11. Where and how does it apply?
4. Use real time data and act on it immediately to solve
problems one by one, as close to the time and place
of occurrence as possible
• Respond to any identified infection within 6 hours
• Identify “root cause” of the infection – most often one or
more steps of standard protocol breached
• Refine and communicate standard protocol based on
learning
• Institute necessary behavioral changes; nurses given right
and responsibility to stop a procedure if protocol is not
being followed
5. Provide continuous training for staff, especially new
staff
Roper & Associates Inc. 11
12. Where and how does it apply?
• Result - number of infections dramatically reduced and
no deaths, despite:
– More line insertions
– More severe cases on average
Roper & Associates Inc. 12
13. Where and how does it apply?
• A more complex case – improving ED
throughput
– St. Mary’s Health Care, Grand Rapids, MI
• 2005 process characteristics:
– ED largest department in hospital
– Average door to discharge - 4.9 hours
• 20% discharged in < 2 hours
– ED staff turnover high and patient satisfaction low
• Process improvement objective:
– Door to discharge < 2 hours for 80% of patients
discharged
Roper & Associates Inc. 13
14. Where and how does it apply?
• Approach – use kaizen event to analyze how to apply
lean principles to achieve improvement objectives
– 28 of 150 ED staff participated
– Mapped the ED process flow from registration to discharge
– Identified “wastes” in the process to reduce or eliminate
Roper & Associates Inc. 14
15. What they did
• Identified specific sub-process performance objectives necessary to
achieve the “big objective” – 2 hour process for 80% - and a plan to
achieve them:
– Triage in 10 minutes
– Patient prep in 10 minutes
– Evaluation / orders / diagnostics collected in 20 minutes
– All results in < 1 hour
– Discharge time of 20 minutes
• Assigned incoming patients to 1 of 3 groups for processing –
discharge, admit and ?
– Assigned best charge nurses to triage and standardized the triage
process
• Reorganized ED into service PODs to reduce travel and maintain a
focus on serving patients (to move them through the process):
– Initially for nurses only; eventually for doctors too
– All needed supplies and routine equipment located in the PODs
• Focused on point based improvements to:
– Reduce registration time and improve information quality
– Reduce discharge time
– Reduce lab TAT
Roper & Associates Inc. 15
16. What they got
• Financial benefit for the hospital from increased patient volume,
fewer diversions, due to higher productivity and capacity
Roper & Associates Inc. 16
17. Why is it so hard to succeed?
• To succeed with lean, the organizational culture must change
– Focus on defining robust processes, then sustaining and continuously
improving them
– Organization must “trust” process improvement to deliver results and
support it as a way of doing business
– Managers at all levels must become leaders and coaches (always an
issue); process discipline and follow up are critical
– Employees at all levels must engage in process improvement (not
usually an issue)
– It’s not glamorous work; head down in the trenches, improving
processes (it’s sometimes hard to step back and see the big picture)
– Setting, communicating and achieving performance improvement
objectives is a never ending process
– You understand why these issues are critical by doing it (lean); there is
no other way that has shown consistent success
• But, once you “get it” everything becomes a lean opportunity
Roper & Associates Inc. 17
18. Why is it so hard to succeed?
• What makes healthcare more difficult:
– Overcoming the “people aren’t widgets” mentality
(they aren’t, but they still “flow” through your
processes)
– Size and complexity of healthcare facilities
– “Work around” culture
– Getting the doctors on board is key, but also very
difficult in most situations; financial, stature and time
issues get in the way
Roper & Associates Inc. 18
19. Why is it so hard to succeed?
• Common problems:
– Underestimating the leadership commitment and time required to
succeed
– Impatience (project vs. journey); change is slow and can be
extremely frustrating
– Not dedicating resources and time to lean efforts, including some
experienced help for training and support
– Focusing only on tools, not culture change (behaviors)
– Many people will resist it and the organization will try to kill it
– It’s often hard to tell how its going; it may appear to be failing
right up to the point where it really takes off
– Eventually, not connecting lean to the business case
Roper & Associates Inc. 19
20. How do you get started?
• Lean success depends on recognizing and
following seven key principles:
– Three integrated system elements must be in place
• A lean operating system
• Sustained by a lean management system
• Supported by appropriate organizational mindsets and
behaviors
– Four implementation strategies must be followed:
• Implement by value stream or “model line”
• Deploy in “generational waves”
• Implement to achieve specific, measurable objectives
• Support with a robust change management structure
Roper & Associates Inc. 20
21. How do you get started?
• Mark Graban – ThedaCare Center for Healthcare Value
– “To impact the big picture you have to start with small steps”
– Start in a department or patient pathway (value stream) that has
a significant improvement need
• Keep the scope small, but implement as much of a full
lean system as possible, then use the area as an
organizational learning lab
• Dramatic improvement will help get people’s attention
and provide the credibility to use the improved area as a
learning model for other areas
Roper & Associates Inc. 21
22. How do you get started?
• George Koenigsaecker, business general
manager, lean leader and author
– Find a change agent
– Get the knowledge
– Find a lever - seize a crisis or create one
– Forget grand strategy initially
– Map your value streams
– Begin as soon as possible with an important and
visible activity
– Demand immediate results
– As soon as you’ve got momentum, expand your
scope
Roper & Associates Inc. 22
23. How do you get started?
• Lean implementation is a multi-year learning process that takes time,
organizational discipline and consistent leadership
• Most organization lack the leadership continuity and organizational
focus to get “over the hump” to the integrate, sustain and continuous
improvement phases
Executive learning, alignment and
commitment at this stage is critical
YEAR
Roper & Associates Inc. 23
24. How do you get started?
• Decide whether to start (Why should your organization
be doing this?) :
– What critical internal and external improvement needs do you
have?
– Do you have a program or set of initiatives capable of satisfying
those needs?
– If not, could lean fill the gap?
• In manufacturing (and healthcare) lean improves quality,
cost, delivery and asset productivity; this impacts:
– Company financial performance – profitability and investment
requirement
– Market competitive position – service consistency and flexibility,
product quality and cost
Roper & Associates Inc. 24
25. Summary and Conclusions
• The application of lean principles to improve operational
and financial performance has been proven in
manufacturing, administrative and healthcare
environments
• Though healthcare application is the most recent, it is
maturing rapidly with implementation timelines and
benefits that mirror other environments
• Lean application increases process capacity; in
healthcare this is manifested as:
– Increased organizational capacity to serve patient needs –
nurses, doctors, etc.
– Reduced errors and service delays
– Increased process capacity – labs, pharmacies, operating
rooms, etc.
– Improved employee morale and patient satisfaction
Roper & Associates Inc. 25
26. Summary and Conclusions
• There are many organizations to learn from and
lots of people eager to provide help
• Like any important effort, there is never a “right”
time to start
• If you have no lean experience or understanding
you are not alone, most people don’t
• You only “get lean” by doing it; don’t be afraid to
start and expect to commit significant time and
organizational energy to it
• For those who succeed, the payoff is well worth
the effort
Roper & Associates Inc. 26
28. What resources exist to help?
• ThedaCare Center for Healthcare Value
– A new branch of the Lean Enterprise Institute (LEI)
– LEI is a non-profit training organization dedicated to global
expansion of lean thinking
• Healthcare Performance Partners, Nashville, TN
– HPP is a lean healthcare consulting firm
– Lean Healthcare West is an affiliate of HPP
• Pittsburgh Regional Health Initiative (PRHI)
– PRHI is a lean healthcare training organization within the Jewish
Healthcare Foundation of Pittsburgh
– PRHI provides training and consulting support for their
Perfecting Patient Care model of lean healthcare
– The Pittsburgh Way was written by Naida Grunden of PRHI
• Belmont University, Nashville, TN provides lean
healthcare training in cooperation with PRHI and HPP
Roper & Associates Inc. 28
29. What resources exist to help?
• Lean Enterprise Institute (www.lean.org ) –
Healthcare section of Knowledge Center
contains:
– 335 references to lean healthcare
– Includes a Google map showing 135 lean healthcare
sites in North America (page 2 of healthcare section)
Roper & Associates Inc. 29
30. References
• The following book and presentation were used
for examples and information in this
presentation:
– The Pittsburgh Way to Efficient Healthcare, Naida
Grunden, Productivity Press
– Utilizing Lean Principles to Improve Patient Flow in
the ED, AME presentation by St. Mary’s Health Care,
November 2006
Roper & Associates Inc. 30