Moving to the Lean Enterprise in Healthcare

For internal use only / Copyright © Siemens AG 2006. All rights reserved.Copyright © Siemens AG 2006. All rights reserved.
Moving to the LEAN Enterprise in
Healthcare
Global Solutions Consulting
First LEAN Global Healthcare Summit 2007

June-07 Copyright © Siemens AG 2006. All rights reserved.
What is the Global Solutions Division
Establish Siemens Medical Solutions as the leader in
integrated clinical solutions by combining trendsetting
technology, clinical workflow know-how and consulting
experience based on outstanding partnerships with our
customers.

Healthcare Consulting
Together we rethink
The team is comprised of
healthcare professionals, medical
technology engineers, medical IT
specialists, business management
experts, and healthcare
economists.
Our strength lies in connecting
strategy, process and technology.
Understanding these interactions
allows us to work with our
customers to develop and
implement solutions that have a
proven outcome on cost and quality
Strategy and
Management
Clinical and Business
Process Optimization
Technology and Infrastructure Planning,
and Integration

Our LEAN Journey began at the Factory
550 Employees
2320 Customer specific system deliveries per year
2490 Components / Subsystems
21 System types
92 % Of all systems are exported
Forchheim FactoryForchheim Factory
Factory AX =>Factory AX =>
Factory CT =>Factory CT =>

Information – Planned and Stuctured
AXAX--CustomisingCustomising
AX SCM InfosystemAX SCM InfosystemInfo through Management
1 x month
Info through group leader
1 x week
11 o‘clock round
1 x day
ONLINE
continuous

Striving toward perfection
Every system is shippable within 4 weeks (60% reduction from 2000)
Technical and deadline related changes are allowed until 3 days prior
to start of fabrication
On-Time-Delivery > 98 %
Percentage of complete delivered systems > 99 %

Why bring LEAN to Healthcare
MUDA (Waste) wherever one looks:
Overproduction (producing something before it is needed)
When do I admit patients for planned procedures (i.e. occupy a bed)?
Waiting
Transporting
Orthopaedic patients moving to the radiology department
Inpatient receives an x-ray; 3 hours later receives a CT Scan
Inappropriate processing
Why is door to balloon time an issue only in the US?
Unnecessary inventory
Why is this patient staying over the weekend?
Unnecessary excess motion (ergonomics)
Are you using plain film?
Defects
Incomplete Medical Records, Medication Errors

Why bring LEAN to Healthcare
MUDA (Waste) can cost lives; Quality of Life
Every patient handover exposes patients to risk
Information needs to be exchanged
Medication needs to be carried over
Patients need to be lifted
Intubation needs to be exchanged
The longer a patient stays in a hospital the longer their exposure to
nosocomial infection
If the Institute of Medicine is correct in their assumptions Medical
Errors are the 8th leading cause of death in the USA.

90,000 deaths
2,000,000 adverse drug
events
…in the US every year**
Canada in 2000,
9,250 – 23,750 deaths
from adverse events*
‘Adverse Events’
Actual
(without ‘Adverse Events‘)
Ideal
Actual
(without ‘Adverse Events‘)
‘Adverse Events’
Why Bring LEAN to Healthcare
CostsfortheInsured
**Source: Institute of Medicine, To Err is Human, 1999, p.26. American Hospital Association. Hospital Statistics. Chicago. 1999;
RAND study, Journal of Health affairs, September 2005
Prevention /
Early Detection
Diagnosis Therapy Care
*Source: The Canadian Institute for Health Information, CMAJ, The Canadian Adverse Events Study: the incidence of
adverse events among hospital patients in Canada • May 25, 2004; 170 (11). doi:10.1503/cmaj.1040498.

Why is healthcare LEAN resistant
Who is the end customer?
Patient
Referrer
Payer (private insurer, NHS, taxpayer)
Answering this question is important because the value to the end
customer drives the shape of the value chain
What is the product?
Health
Information
Patient
The buildings are full of “monuments” (which are changing at a
breakneck pace)
Caregivers don’t like to be LEAN and MEAN

The Evolution of Medicine
Efficiency
Horizon 1
Craft Medicine
Horizon 2
Disease Management
Requires IT that captures
and analyzes workflow
Every patient unique
Very expensive
Quality highly variable
Technology drives
progress
Patient, provider &
industry act independently
Disease standards
Workflows optimized &
measured
Stronger product
integration
Stronger collaboration of
providers in value chain
Prevention Diagnosis
Horizon 3
Patient-Centric
Healthcare
Requires IT that captures
and analyzes knowledge
Time
Patient predisposition-
tailored medicine
Patient-specific real-time
diagnosis & treatment
Cost & quality continually
optimized
Evidence-based
Therapy
Care

A New Paradigm
Workflow Technology in Healthcare
Traditional HIS Healthcare Process Management System
Linear, passive
Collect data
Report results
Manage orders
Capture documentation
Manage processes
Track, monitor, drive next steps
Automatic notification & escalation
Manage & monitor clinical
best practice

Coronary Artery Disease
CAD Management
Germany has created new legislation to
encourage contact between the inpatient
and the outpatient sectors
Despite the legislation, the change has not
occurred
Actors are still not looking at the entire
value stream
Tools and processes that support
changing the value stream are not yet
widespread
Clinical Challenge: patient receives
suboptimal care due to lost information,
duplicate procedures, longer wait times
Health Services #1

Current state: Coronary Artery Disease Care Path
Prevent Outpatient Inpatient
Rehab
PCP
Internist
Cardiologist
Follow-up/
Rehabilitation
Intern/Cardiol.
Medication
Admit Detect Treat Discharge Admit Detect Treat Discharge
Interface
Primary Care Provider
Internist
Cardiologist
Conservative
Interventional
Hospital
Cardiologist
Interface Interface
CAD Management

Current state: Coronary Artery Disease Care Path
Prevent
Admit Data &
History
Admit Data &
History
68 – 163 Minuten
Rehab
PCP
Internist
Cardiologist
Intern/Cardiol.
Medication
Interface
Internist
Cardiologist
Conservative
Interventional
Hospital
Cardiologist
Interface Interface
Outpatient Inpatient
Follow-up/
Rehabilitation
Admit Detect Treat Discharge Admit Detect Treat Discharge
CAD Management

Future state: Coronary Artery Disease Care Path
Prevent
Admit Data &
History
Electr. Report
S-IC
Rehab
PCP
Internist
Cardiologist
Intern/Cardiol.
Medication
Interface
Internist
Cardiologist
Conservative
Interventional
Hospital
Cardiologist
Interface Interface
Outpatient Inpatient
Follow-up/
Rehabilitation
Admit Detect Treat Discharge Treat Discharge
CAD Management

Future state: Coronary Artery Disease Care Path
Prevent Outpatient Inpatient
Follow-up/
Rehabilitation
Admit Detect Treat Discharge Treat Discharge
Admit Data &
History
Electr. Report
S-IC
Rehab
PCP
Internist
Cardiologist
Intern/Cardiol.
Medication
Interface
Internist
Cardiologist
Conservative
Interventional
Hospital
Cardiologist
Interface Interface
CAD Management

Technology can change the reference point
completely
Parameter Unit Current Potential
Missing Documentation at Central
Admissions
Share 10% 0%
Daily Time collecting
documentation for central Admit
Minutes 10-15 min/Patient 3 mouse clicks
Waiting time until patient files found Minutes 10-15 min/Patient 3 mouse clicks
# of repeated procedures due to
missing documentation
Share Ca 75% in ED
20% in scheduled
patients
Reduction to 20 % in ED
Reduction to 0 in scheduled
patients
# of repeated procedures due to
quality failure
Share Ca. 20% in ED
7% in Scheduled
Patients
Reduction to 10 % in ED
Reduction to 0% in
scheduled
Average waiting time by admit Minutes 35 min/Patient Reduction to 10 min
Time required to find patient
records in inpatient areas, to prep
eg for Bypass OP
Minutes 120
Minuten/Patient
5 mouse clicks

How else can the LEAN Enterprise develop
Customers can demand that suppliers stop building monuments.
Substituting contrast enhanced ultrasound for MR in peri-operative
confirmation of uterine fibroid embolisation
Using Biomarkers and ultrasound to monitor liver disease, detect
breast cancer (reduce or eliminate biopsies)
Customers can demand that more information or options come from one
monument
Hybrid equipment – PET CT
Hybrid Rooms – Cath Lab / Heart OR
Total Body Imaging
“Theranostics” - Using iron coated nano-particles to provide diagnostic
information and then thermal therapy of hard to reach tumors with MR
Customers can demand that partners move beyond transactional
relationships

Take Away Ideas
LEAN can be a powerful way of transforming healthcare’s organisational
cultures
The iterative approach and RIEs are keys to moving forward but you do
have to have “the vision thing” if you want to drive a LEAN enterprise
One can alter value streams drastically with simple common sense
changes. In healthcare, technology allows one to eliminate entire value
streams or change completely their perspective

Thank You

Moving to the Lean Enterprise in Healthcare

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (8)

Similar to Moving to the Lean Enterprise in Healthcare

Similar to Moving to the Lean Enterprise in Healthcare (20)

More from Lean Enterprise Academy

More from Lean Enterprise Academy (20)

Recently uploaded

Recently uploaded (20)

Moving to the Lean Enterprise in Healthcare