This document discusses lessons learned from applying lean principles in three healthcare systems. It emphasizes using a scientific approach to diagnose and solve organizational problems, developing capabilities through hands-on problem solving rather than just training, making work visible through value stream mapping and management, focusing efforts on key priorities and experiments, and continually learning from experiments and customer feedback.

1. Lean Lessons from
Three Healthcare
Systems
Daniel T Jones

2. Santa Maria Nuova – Established in 1288

3. flow design
Linee chirurgiche
Compartooperatorio
Recovery
room
DegenzaDegenza
Preospedaliz-
zazione
Prenotazione
Classe
A
< 30gg
Classi
B,C,D
> 30 gg
Preospeda
lizzazione
DEA
Sala
operatoria
urgenza C
Sala
operatoria B
Sala
operatoria A
Sala
operatoria
orto-trauma
Chirurgia progr. Degenza ≤5 Chirurgia progr. degenza >5
Chirurgia urgenza
Chirurgia progr. degenza >5Chirurgia progr. Degenza ≤5 Chirurgia urgenza
High
depende
ncy
Dimissione Dimissione
Intensive
care
Vi accedono: pazienti con
indicazione chirurgica certa e
per i quali è stato definito il
tipo di intervento o le
eventuali alternative da
valutare in base ai risultati
della preospedalizzazione
cell model
Equipe
multidisci
plinare
Attenzione
costante
fino alla
soluzione
Ogni
cosa al
suo
posto Ciascun
paziente è
l’unico
paziente
0
50
100
150
200
250
300
350
giu-06
lug-06
ago-06
set-06
ott-06
nov-06
dic-06
gen-07
feb-07
mar-07
apr-07
mag-07
giu-07
lug-07
ago-07
set-07
ott-07
nov-07
dic-07
gen-08
feb-08
mar-08
apr-08
mag-08
giu-08
lug-08
involving
people
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     r r    r r
      r r    r r
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     r r    r r
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r  r r         
VALUESTREAMPROCESSIPORTANTI
STRATEGIE
PROCESSI
€0
€0
€0  =
€0  =
€0  r    r r   r =
correlazioni correlazioni / contributi
IMPLEMENTAZIONE CICLO LEAN MANAGEMENT
5SAPPLICATE10%ARTICOLAZIONISANITARIE
VISUALMANAGEMENT70%DEGENZESGDESMA
PPP100%CHIRURGIAPROGRAMMATA
VSMMEDICINA
AUMENTARECONOSCENZESULEANTHINKING
IMPLEMENTAZIONEFORMAZIONECERTIFICATA
correlazioni / contributi
debole correlazione o rotating team
member
accountabilityresponsabilità
importante correlazione o core team
member
forte correlazione o team leader
Legenda
A3-X - Strategico
correlazioni
Membri del team
DirettoreDip.chir.
DirettoreDEA
DirettoreDip.Diagnostica
FORMAZIONE CERTIFICATA
DIMISSIONI PULL
TATTICHE
RISULTATI
IMPLEMENTAZIONE MONITORAGGIO PERFORMANCES
REPORTMONITORAGGIO10STRUTTURE
VSMFUTURAURGENZADISEGNATA
IMPLEMENTARELEANSHOPFLOOR
Referenteformazionelean
DirettoriPO
IMPLEMENTAZIONE 5S
IMPLEMENTAZIONE VISUAL MANAGEMENT
VALUE STREAM CHIRURGIA
CICLOATTIVATO
VALUE STREAM MEDICINA
KANBAN REPARTI
ALLINEAREATTIVITA'ISSSACICLOLEANMANAGEMENT
Referentepercorsi
Referenteaccreditamento
Referentekanban
ProjectleaderOLA
Osservatorioappropriatezza
Osservatorioperformances
KANBAN
ATTIVAZIONEPULLTUTTELEZONE
Hoshin Kanri for the Lean Enterprise © 2006 Thomas L. Jackson
Revenue
DirettoreDip.medico
Costi di sviluppo
Costi Materiali
Costi di conversione
Value stream profit
Emergenza Chirurgico Medico Materno
Infantile
Terapie
Intensive
OncologicoDiagnostica
Immagini
Laboratori
Dipartimenti ospedalieri
Managerdilinea(shusa)
Linea della Chirurgia programmata
Linea della Chirurgia in urgenza
Linea della High Care medica
Linea Outpatients
Percorso Nascita
Linea Low Care
patient flows
1° LIVELLO
· Principi del lean thinking
· PDCA
· 5S
· Visual management e
Kanban
Nel proprio ambiente di lavoro:
· Saper leggere gli sprechi
· Rispettare le regole delle 5S
· Utilizzare il kanban
· Utilizzare gli strumenti
di visual management
Prova scritta di apprendimento
P
R
E
R
E
Q
U
I
S
I
T
I
C
O
N
O
S
C
E
N
Z
E
P
O
S
T
T
R
A
I
N
I
N
G
A
B
I
L
I
T
A’
2° LIVELLO 3° LIVELLO 4° LIVELLO
Certificazione primo livello
Letture avanzate
· Strumenti per l’analisi di
processo
· Elementi di base del lean
management
· Costruzione di un A3T
· Progetto 5S
· Lavorare in team
· Identificare i problemi di un
processo
· Saper utilizzare un A3
· Impostare un progetto 5S
Certificazione secondo livello
Letture avanzate
Certificazione terzo livello
Letture avanzate
· Gestione di un evento kaizen
· FMEA e POKAYOKE
· Sviluppo KANBAN
· Value stream mapping
· Value stream management
· Ciclo del Lean management
· Supply chain
· SPC
· Identificare le aree chiave per
progetti spot di miglioramento
· Facilitazione/coaching
· Costruire una VSM di base
· Saper analizzare i rischi del
processo
· Formazione livello 1 e 2**
· Funzione di mentore per
il kaizen a tutti i livelli
· Lean action plan
· Costruire VSM di processo
· Analisi variabilità
· Formazione livello 3**
Aver partecipato ad un progetto
A3T
Aver partecipato ad un evento
kaizen
Aver partecipato alla costruzione di
una Value stream map
Partecipazione a 3+ eventi kaizen
Aver condotto un evento kaizen con
tutoring
Aver partecipato alla costruzione di
una VSM di processo
Aver condotto 10+ eventi kaizen
Aver sviluppato un ciclo completo di
lean mangement
Formazione in aula 7 ore Formazione in aula 3 giorni Formazione in aula 4 giorni
Formazione in aula da istituzioni
riconosciute dal Lean Office o da un
livello aziendale certificato GOLD
** Deve dimostrare attitudine all’attività di formazione che verrà verificata tramite una scheda attitudinale e una prova pratica
Nessuno
Il livello viene certificato al termine del post training
strategy deployment staff training

4. Rebuilding the hospital provided the opportunity
to rebuild the organisation and mind-sets
so everything supports the patient journeys
while also deepening skills and capabilities
What triggers your organisation to
think back from its customers/users
and learn to do new things?
Question

5. Lean uses the same scientific
approach to diagnose and
treat organisational problems
as doctors use to solve
medical problems

6. Science is about asking the right questions
not just about testing hypotheses
We learn through doing experiments every day
and reflecting on them
Also through taking responsibility for solving
real problems with others
We develop capabilities by asking questions
not by giving answers
Everyone has to be involved in
managing flow
“Follow
Me”
Go See
Ask Why &
Show
Respect
To
unblock
the flow
of value
creation
By
develo
ping
capabil-
itise
Solve Business
Problems
using the Scientific Approach
How are you taking responsibility
for developing capabilities?

7. Dan Florizone
Deputy Minister for Education
Deputy Minister for Lean Across
Government
Previously Deputy Minister of Health
Government of Saskatchewan

9. A Pioneering Experiment
Began in healthcare – now spreading
right across government
Province-wide Hoshin focusing on the
needs of groups of citizens in order to
mobilize service delivery
Led by doers – supported by politicians
and civil servants
How do you build common actions
across big organisations?

10. The NHS is struggling with initiative fatigue
We are carrying out experiments
to build management systems
to support lean operations
and deliver results

11. Distinguish “real” from “created” demand
Recognise common journeys – and complex tail
How predictable is demand?
What causes system driven variation?
What is management doing to
eliminate this noise?
Attendances
Admitted Patients

12. Experience the power of the Exec team
walking and mapping patient journeys
Learn to see the obstacles and delays
Lean where to act to unblock the flow
How to build stable and flexible flows across
departments aligned with demand?

13. Common practice is created by making the work visible
– not by hiding it in computers!
Hands-on management of the end-to-end flow
is critical for triggering actions
unblocking obstacles and escalating issues
and mentoring and coaching team capabilities
Who is responsible for your end-to-end
value streams?
PFEP Visual Hospital

14. How many projects and targets?
How much staff time spent
reviewing them?
Will they make a real difference
and are they resourced?
Hoshin is a framework for using CAPD to
focus on the needs of broken value streams
agree the vital few projects to close
key performance gaps
learn how time drives quality
How good are you at focusing
on the vital few?

15. Which experiments to deploy
to close the gaps?
Manage discharge with tertiary care
Cellularize ED with near patient testing
Synchronise support services to takt
Frequent replenishment of supplies
Which experiments will show
where we need to go next?

16. We can all learn a lot
from healthcare
The dialogue with informed users and
customers has only just begun
Improving efficiency and quality buys time
But we also need bold experiments with
new ways of delivering services
The scientific approach is key to
acting our way to new ways of thinking
What are you doing to prepare
for this challenge?

17. Homework
Further reading and video links
at www.leanuk.org