The Presentation describes about What is Lean and its Principles, various Lean Initiatives and Quality Tools like 5 WHYs, Kaizen, 5S, 8 Wastes.

1. LEAN INITIATIVES IN
HEALTHCARE

3.  Lean is defined as a set of management practices to improve efficiency and
effectiveness by eliminating waste. The core principle of lean is to reduce and
eliminate non-value adding activities and waste.
 Lean Healthcare is providing value to the patients/customers, in so doing
eliminate “delays”, “overcrowding” and “frustration” associated with the
present care delivering system by continuously improving the healthcare
processes. Lean Healthcare creates a better working environment, where what
is supposed to happen does happen, on time, every time.
Let’s have an example…….

5. Basic v/s Advanced Quality Tools
Basic Quality Tools
 PDCA
 Histogram
 Bar Graphs
 Benchmarking
 RCA & CAPA
 Flow charts
 FMEA
 Scatter Diagram
Advanced Quality Tools
 8 wastes
 5S Techniques
 Kaizen
 5 Why
 Six Sigma
 Just in Time (JIT)

8. 8 Wastes in Hospital

9. 1. DEFECTS
 Misdiagnosis
 Administration of incorrect/inefficient/excessive
medication
 Hospital acquired infectious/conditions
 Incorrect ID codes – Mistaken patient identifies
 Wrong site surgeries
 Surgical tools inside the body
 Improper labeling of specimens +++

10. 2. WAITING
 Patients in waiting rooms (or exam rooms)
 Staff members with uneven workloads awaiting for
their next task
 Emergency Departments patients and physicians
waiting for test results
 ED/Patients waiting to be admitted to the hospital
 Patients waiting to be discharged once medically
ready

11. 3. TRANSPORTATION
 Patients are moved from department to department
or room to room
 Medication is moved from the Pharmacy to where it
is needed.
 Supplies are moved from storage to the floor
 Transporting Lab specimens

12. 4. OVERPRODUCTION
 Unnecessary diagnostic tests
 Uneaten meals
 Ordering medications that the patient does not need
 Peak staffing during non-peak hours

13. 5. OVERPROCESSING
 Ordering complex diagnostic imagery (MRI) when a
simpler method would suffice (X-Ray)
 Unnecessary paper work
 Surgical interventions in lieu of an equally effective
medical alternative
 Follow up appointments that don’t improve patient
outcomes
 Treatment by specialists that could be done by
primary providers

14. 6. INVENTORY
 Medication that may expire
 Lab specimens waiting analysis
 Overstocked consumables
 Pre-printed forms
 Excess bedside equipment

15. 7. MOTION
 Office or hospital layout is not consistent with flow
Supplies are not stored where needed
 Equipment is not conveniently located

16. 8. UNUSED TALENT
 Incompetent Hiring
 Unspecified KRAs
 Wrong placements to Department
 Lack of Performance Evaluation

18. 1. SORT
 The focal point of the first “S”, Sort, is the elimination of unnecessary
items in the work place.

21. 2. STRAIGHTEN
 Once unneeded items have been removed from an area, the next
step is to organize those items that remain.
 The second S focuses on the use of effective storage methods.
 The labeling of bins, shelves, cabinets and drawers should always
be included during this phase of 5S.

23. Example:
1. Colored Tap Used to ensure
proper Sequencing of Manuals
2. Labeled Crash Cart
3. Labeled Medicines Drawers

24. 3. SHINE
 Shine in 5S is the component that emphasizes the removal of dirt, trash, medical wastes
and other contaminants from the work place.
 Shine activities can play an important part in aiding work efficiency and patient safety.
 Healthcare facilities that do not implement “Shine” suffer the following types of
problems:
• Defects are more difficult to discover and correct in many healthcare
facilities.
• Hospital acquired infection ratio raise when commonly touched surfaces
are not cleaned constantly and hand washing is not a common practice.
• Unclean work environment can lower morale.
• Poorly placed equipment can cause falls.
• Equipment do not receive sufficient check up maintenance and tend to
breakdown frequently.

26. 4. STANDARDIZE
 Standardization helps to maintain the gains achieved by implementation of the
first 3Ss.
 Everyone must be educated regarding Kaizen, Visual Controls and Sort, Set in
order and Shine activities.
 The three steps to making sort, set in order and shine activities a habit are:
Step 1: Decide who is responsible for which activities with regard to
maintaining 3S conditions.
Step 2: To prevent backsliding, integrate 3S maintenance duties into the regular
work activities of providers and support staff.
Steps 3: Check on how well 3S condition are being maintained by providers and
staff.

27. Medication Room Before and After 5S

28. 5. SUSTAIN
 The fifth and final phase of 5S deals with development a habit.
 Everyone should feel uncomfortable failing to keep things item
back in the drawer, neglecting to refill the paper towel dispenser,
ignoring thrash accumulating in the corner, hoarding supplies just
in case or doing anything else not consistent with the goal of
maintaining 5S environment.

30. “Being satisfied with the status quo means you are not making
progress”

33. 5 WHYs
 It is an iterative question – asking technique used to explore the
cause-and-effect relationships underlying a particular problem.
The primary goal of the technique is to determine the root cause
of a defect or problem.
 The five whys can be used independently or as part of a cause-
and-effect diagram. You may need to ask the question fewer or
more than five times before you get to the origin of a problem.

34. 5 WHY EXAMPLE
 The patient was late in theatre, it caused a delay.
Why?
 There was a long wait for a trolley. Why?
 A replacement trolley had to be found. Why?
 The original trolley’s safety rail was worn and had
eventually broken. Why?
 It had not been regularly checked for wear. Why?

35. The Root Cause……
• There is no equipment maintenance schedule. Setting up a
property maintenance schedule helps ensure that patients should
never again be late due to faulty equipment. This reduces delays
and improves flow and the problem may not happen again in the
future.