The document outlines the application of lean thinking principles at the Arab Medical Center, emphasizing value creation and waste elimination to improve healthcare services. It details the types of waste identified in the phlebotomy workflow, methods for reducing patient wait times, and the implementation of standardized work practices for better efficiency and safety. Additionally, it discusses the PDCA cycle for continuous improvement and employee involvement in the process.

1. Arab Medical Center
Lean Thinking
by: Wafa AlAhmed
BSc, PgD, MLS(ASCP)cm
Senior Quality Assurance Officer
Arab Medical Center-Jordan
walahmad@amc-hospital.com
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2. Definition
Lean is the culture of creating value & eliminating ‘waste’
• Improve quality
• Enhance safety
• Improve productivity
• Improve efficiency
• Reduce cost
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3. Lean Thinking
• Lean thinking was derived from
Toyota organization in 1950
• Healthcare sector adopted lean in 2000
to improve the quality of its services
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5. 1st Lean Principles
Specify value from the customer viewpoint
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6. 2nd Lean Principles
• Identify the value stream
and eliminate waste
• Value Stream: A set of activities necessary to
bring a service to the customer
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7. Value Stream Mapping
Phlebotomy Work Flow for Out Patients
7
Enter
Patient Data
in LIs
Payment Phlebotomy
Patient
Info
Payment
Type
Get
Approval
from
Insurance
Dept
CASH
Insurance

8. Types of Work Activities
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9. Types of Waste
The elimination of waste is the main characteristic of Lean.
Waste is everything that doesn’t add value to the patient or process.

10. Defects
Information, products or services that are inaccurate
or incomplete.
• Repeated errors
• Customer dissatisfaction
• data entry errors
• Fixing paper work that is not
completely filled
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11. Overproduction
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Making more, earlier or faster.
• The most serious of all wastes
• Large batch sizes
If defects discovered in small batch production then the
economic loss is minimized
• Printing 20 copies of a report but only need 3
people to look at

12. Waiting
Involves waiting for man, machine,
materials or information.
• Excessive cycle time
• High amount of wait time vs.
work time
• Waiting for files or information
• Delays due to needing a signature
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13. Not utilizing people’s experience, skills
knowledge, or creativity.
• Lack of empowerment
• Not utilizing employees’ brains
• Lack of suggestions
• “That’s not my job” attitude
• Lack of cross training
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Non-Utilized Talent

14. Transport
Un-necessary movement of material around
an organization.
• Inefficient “Flow”
• Carrying large quantities in & out of storage
• Moving equipment or files
• Sending emails between departments
• Redundant movement
of materials
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15. Inventory
Any supply (materials or goods) in excess of
appropriate quantity at the appropriate time.
• Purchasing excess inventory
• Long cycle times for certain parts
or supplies
• Risk of obsolescence (oldness)
“First come- First go”
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16. Motion
Any movement that does not add value to the
product or service.
• Inefficient workplace organization
• Inefficient placement of frequently used supplies,
tools,….etc.
• Opening up multiple software applications
• How far does the paperwork travel?
• Where are critical resources located?
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17. Extra-Processing
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Any effort that does not add value to the
product or service
• Re-work loops or work-around
• Redundant process steps
• Multiple signature
• Extra fields requiring unused
information
• Un-necessary completion of templates,
forms, documents
Over-processing is often inserted into a process as a result of
dealing with defects, overproduction or excess inventory.

18. 3rd Lean Principles
• Make value flow at the pull of the customer
• Flow is the goal
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19. 4th Lean Principles
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Supply what is pulled by the
customer
• Buffer
Holding area between
two processes.
• Kanban
Visual signs

20. Kanban Visual management
https://www.youtube.com/watch?v=rkpadFfyCqo

21. Perfection
5th Lean Principles

22. Patient Wait Time
• Definition
Wait time from the patients’ arrival to the laboratory reception
area and the time at which the blood collected.
• Problem
Patient waiting time in the reception area seem to be higher
between 10:30 AM – 12:00 PM.
• Consequences
-Excessive time spent away from work or personal activities.
-Patients might leave and seek care elsewhere.
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23. Value Stream Mapping
Phlebotomy Work Flow for Out Patients
23
Enter
Patient Data
in LIs
Payment Phlebotomy
Patient
Info
Payment
Type
Get
Approval
from
Insurance
Dept
CASH
Insurance
Wait
Time
Wait
Time

24. How to minimize Patient
Wait Time
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25. How to minimize Patient Wait Time
• Insurance approval in the lab reception area
• Two med tech for registering the patients’ data,
answering phone calls, delivering patients’ results.
• Two phlebotomists dedicated only for blood
collection.
• Educate the patient by signs, posts, or through their
physicians to get the approval for lab tests before
visiting the lab.
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26. Facts & Data Collection
Date 17/8/2015, Time 10:30 Am-1:00 Pm
Note: children were excluded
Patient No. Time In Time Out Wait Time (min)
1 10:30 10:50 20
2 11:00 11:20 20
3 11:00 11:15 15
4 11:05 11:20 15
5 11:10 11:32 22
6 11:15 11:53 38
7 11:30 11:55 25
8 11:30 12:00 30
9 11:40 12.05 25
10 12:10 12:25 15
11 12:12 12:30 18
12 12:40 12:50 20
13 12:45 12:53 8
14 12:50 1:00 10 26

27. Takt Time per 24 hours
on 16th august, 2015
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Takt Time Calculator
Working Shifts per Day 3 Shifts
Hours per Shift 8 Hours
Break Time per Shift 5 Minutes
Lunch Time per Shift 30 Minutes
Planned Downtime per
Shift 10 Minutes
Customer Demand per
Day 135 Units
Available Time per Shift 480 Minutes
Net Working Time per
Shift 435 Minutes
Net Working Time per
Shift 26,100 Seconds
Net Available Time per
Day 78,300 Seconds
Takt Time = 580 Seconds per Piece
Takt Time = 9.7 Minutes per Piece
Definition
Takt time is the time required to deliver quality services (to produce
customer requirements)

28. Takt Time
For Shift A on 16th August, 2015
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Takt Time Calculator
Working Shifts per Day 1 Shifts
Hours per Shift 8 Hours
Break Time per Shift 5 Minutes
Lunch Time per Shift 30 Minutes
Planned Downtime per
Shift 10 Minutes
Customer Demand per
Day 80 Units
Available Time per Shift 480 Minutes
Net Working Time per
Shift 435 Minutes
Net Working Time per
Shift 26,100 Seconds
Net Available Time per
Day 26,100 Seconds
Takt Time = 326 Seconds per Piece
Takt Time = 5.4 Minutes per Piece

29. Plan, Do, Check, Adjust (PDCA)
Sometimes known as PDSA (Plan, Do, Study, Act) cycle
• (PDCA) cycle provides a means of conducting safe
experimentation or a number of trials to see the effect of any
changes made in a bid to make improvement

30. Plan, Do, Check, Adjust (PDCA) Cycle
P - Plan: The trial is the most important part of the
process.
• What you are planning to trial?
• What are your objectives?
• Who is needed to be involved/informed?
• How are you going to do it?
• How long will the trial run?
• How are you going to measure improvement?
• What is your communication plan?
D - Do: Carry out the trial
• Test the change and collect the data.
C - Check: Study the results
• Analyze the data you collected in the ‘plan’ and ‘do’
phase
• Discuss outcomes with colleagues?
• What went well?
• What went wrong?
• Did anything unexpected happen?
• Could the process be improved?
• If the trial didn’t go to plan, what was the root cause?
A - Adjust: Act on the results
• If the trial did not improve the process, could you treat
the root cause in your next PDCA cycle?
• If the change was a measurable success, adopt and
spread the improvement in your PDCA cycle.

31. Using 5S to improve safety
5S is the basis for standardizing work to
make the processes and environment safe.
It is used to improve efficiency by
eliminating waste, promoting flow,
improving staff morale and most
importantly improving safety.

32. Why Standardized work is important?
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33. Why Standardized work is important?
• Employee involvement and empowerment,
• Consistency (reduction of variation) among staff
members performing the work,
• Improved productivity without added stress,
• Improved, consistent quality,
• Reduction or elimination of errors and mistakes (causes
of defects),
• Work process stability,
• Increased employee safety,
• Improved cost management as wastes are removed,
• Availability of a great tool for staff training,
• Visual management--managers and supervisors can
see when processes are not operating normally.
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34. Medical Technologist Task
• To implement lean in each department.
• Each medical technologist need to do a change in his/her
department that will improve AMC services.
• It is recommended to discuss the idea of change by
27/8/2015 with the laboratory Director Mrs Randa Al-Ahmad &
the senior QA officer Mrs Wafa Al-Ahmed & QA & Safety
officer & Aphaeresis specialist Mrs Tasneem Al-Nsour for
approval.
• You have two weeks time to perform a trial for your idea
starting from 29/8/2015 to 12/9/2015.
• Measure the effect of the change you made.
• Then demonstrate your work to your colleagues.
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36. References
• Improvement, N. H. S. Bringing lean to life. Leicester,
UK: NHS Improvement. 2010.
• https://leansixsigmahealthcare.wordpress.com/201
5/06/24/using-lean-six-sigma-analytics-to-improve-
patient-wait-times/
• http://www.6ixconsulting.co.uk/IGLC-Application-
of-Batch-size-reduction-in-construction.pdf
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