An introduction to Toyota Lean concepts and tools applied to process improvement. Examples step the audience through a workflow redesign of a medical practice. Covered topics include the 7 wastes, workflow diagrams, 5 whys and A3 problem solving.

1. Lean and Meaningful Workflow Redesign
Pat Scherer
CEO, The Detail Person LLC
© 2010 The Detail Person LLC

2. Why Bother with Workflow Redesign?
Catch Errors Before They Happen
Prepare for EHR Installation
Control/Reduce Costs
Do More with Less
Satisfy the (Im)patient
Improve Communication
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3. Workflow Redesign Basics
Process List
Recording Workflows
Workflow Diagrams
The 7 Wastes
Other Tools
Summarize Workflow Redesign Process
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4. List Processes
1. Patient scheduling
2. Patient check-in
3. Patient exams, procedures and clinical recording
4. Patient check-out
5. Referrals
6. Call handling
7. Prescription refills
8. Claims and billing
9. Lab orders
10.Patient follow-up communications
11.Wellness/outreach
4
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5. Recording the 15 Minute Office Visit
Action Who Start Stop Elapsed W Notes
T Check-in P1 7:28a 7:32a
(min)
4 ? Queued behind 2 check in.
h Fill out forms
Wait in waiting room
P1
P1
7:32a
7:44a
7:44a
8:00a
12
16
?
W
Could forms be stream-lined?
Why?
e Move to exam room
Wait in exam room
P1/MA
P1
8:00a
8:02a
8:02a
8:10a
2
8
?
W
Efficient layout?
Why?
Take vitals & info P1/MA 8:10a 8:16a 6 ? Has to retrieve “good gauge” from another
room
Wait in exam room P1 8:16a 8:28a 12 W Why?
1 Exam
Wait to check out
P1/MD
P1/R1
8:28a
8:44a
8:44a
8:50a
16
6
?
W
MD repeats questions asked by MA
R1 finishes a call, searches for patient folder,
finds it left in exam room
5 Check-out P1/R1 8:50a 9:00 8 ? R1 has difficulty locating copay info, takes
another call, printer is in another room
Total elapsed 90
m
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6. Workflow Diagrams
Start (1st process step)
Process step
Decision
?
Document Data
Predefined
process
End (last process step)
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7. Office Visit Workflow
Check in
Yes
1st Visit?
No Forms
Move to
room
Vitals
Exam
Check out
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8. Over-production
Too much or too early
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9. Unnecessary Stock
Stashes of inventory and
supplies; “stuff” waiting to
be worked
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10. Inefficient Transportation
Moving people,
information and “stuff”
from one place to
another.
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11. Unnecessary Motion
Unnecessary movement
or strain including
walking, bending,
reaching and twisting.
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12. Waiting
Delays caused by
shortages, approvals or
downtime.
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13. Rejects & Defects
The costs associated with
making and correcting
mistakes.
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14. Inappropriate Processing
Stuff we do that doesn’t
add value to the patient.
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15. Other Tools
Swim Lane Diagrams
Value Stream Maps
Layouts and Spaghetti Diagrams
A3 Implementation Plan
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16. Swim Lane Diagrams
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17. Value Stream Map
M
WT: 2 min WT: 16 min WT: 8 min WT: 12 min WT: 6 min
2
Move to Exam
Check in Forms Vitals Check out
room
R1 MA MA MD R1
PT: 0.1 PT: 8 PT: 2
T PT: 4 PT: 14 PT: 2
M
WT: 1.9 WT: 4 WT: 0 WT: 2
M WT: 2 WT: 6
Total PT: 30.1
Total WT: 59.9
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18. Spaghetti Diagrams
Lab Exam 1 Exam 2
Legend
MA
Waiting Check Billing MD Office MD
In
Patient
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19. A3 Problem Solving Format
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20. Workflow Redesign Process Summary
Identify
Processes
A3: Plan,
Record
Do,
Workflow
Measure
Continuous
Improvement
Identify Diagram
Waste Workflow
© 2010 The Detail Person LLC

21. References
Links
 “Lean Health Care: Lower Costs, Better Outcomes”, Wharton Health
Economics; 11/11/2009
http://knowledge.wharton.upenn.edu/article.cfm?articleid=2374&specialid=95
 NHS (UK) Tools & Techniques http://www.tin.nhs.uk/index.asp?pgid=1134
 DIY Lean (free A3 templates)
http://www.diylean.com/A3%20Materials/A3_Materials.htm
 Presentation slides and other resources
http://www.thedetailperson.com/resources
Books
 Hadfield and Holmes, The Lean Healthcare Pocket Guide; 2006
 Chalice, Improving Healthcare Using Toyota Lean Methods: 46 Steps for
Improvement; 2007
 Jimmerson, A3 Problem Solving for Healthcare: A Practical Method for
Eliminating Waste; 2007
 Jimmerson, Value Stream Mapping for Healthcare Made Easy; 2009
© 2010 The Detail Person LLC

22. Questions?
Contact:
Pat Scherer
The Detail Person LLC
www.thedetailperson.com
512-415-3473
pat@thedetailperson.com
Health IT Services…we do IT your way!
© 2010 The Detail Person LLC