This document provides an introduction to Lean principles and their applications in healthcare. It discusses how Lean aims to identify and eliminate waste from processes to improve quality, reduce costs, and increase value for patients. Examples are given of healthcare organizations that have successfully applied Lean approaches to reduce wait times, infection rates, costs, and improve other outcomes. Both criticisms of Lean and its potential applications in radiology are mentioned.
The document discusses four new initiatives at The Scarborough Hospital in Toronto that aim to reduce wait times in the Emergency Department:
1. The Rapid Admissions Unit has reduced the average patient stay in the Emergency Department from 17 hours to under 24 hours for eligible patients. Over 1,000 patients have been treated here in its first year.
2. The Emergency Department Process Improvement Program is an 8-month, multi-pronged strategy involving frontline staff to streamline patient flow and improve wait times between the Emergency Department and inpatient units.
3. The Nurse Practitioner Outreach Team has diverted 32% of long-term care patients from the Emergency Department.
4. The Geriatric
This document outlines a proposal to implement a rapid response team (RRT) at an urban Magnet hospital to improve patient outcomes on medical and surgical units. The purpose is to determine if an RRT can reduce hospital stays, decrease transfers to higher levels of care, and increase patient functionality at discharge. The proposal describes the background on RRTs, significance to nursing practice, literature review on clinical outcomes, relevant nursing theories, and the Iowa Model framework. It provides details on the methodology, team development and training, communication systems, education, documentation, and implementation process including activation protocols and safety huddles. The goal is to activate the RRT for at-risk patients showing signs of respiratory distress, changes in mental status, abnormal
Here is a high-level layout of the PACU simulation model:
- Inputs:
- Historical daily OR schedule with planned start/end times of surgeries
- Distributions of surgery durations
- Distributions of PACU length of stay for different surgery types
- Process:
- Simulate surgeries based on schedule and duration distributions
- Patients enter PACU after surgery based on OR schedule
- Patients spend time in PACU based on PACU length of stay distributions
- Patients discharge from PACU over time
- Outputs:
- PACU census (number of patients) tracked over time
- Staffing requirements calculated to maintain target nurse-to-patient ratios
The model simulates patient flows
The Nebraska Medical Center implemented a 5-step plan to improve their culture of safety: 1) develop leadership skills and structure to support change, 2) provide teamwork and communication training, 3) create safety tools, 4) collect data to measure results, and 5) train internal "master trainers" to spread the changes. Survey results showed staff felt safer speaking up about safety concerns after training. Unexpected delays in procedures decreased. The culture change approach improved both safety and outcomes.
R2 Medscan Solutions provides teleradiology services with key benefits of lower costs, higher quality, and improved turnaround times. Their workflow involves hospitals sending imaging studies to R2's secure PACS system where US-trained radiologists can access studies 24/7 and provide fast preliminary reports. R2 aims to lower costs for hospitals by 2.5% for every 100 additional studies while maintaining high quality through peer reviews by board-certified radiologists.
Kate Hobson introduces how implementing some Lean principles in a small radiology department led to significant improvements. By process mapping and using the Glenday sieve to identify high-volume ("green") procedures, the department was able to streamline workflows to reduce wait times. Simple changes like standardizing dating scans to 5-minute slots and having sonographers see clinic appointments freed up capacity. Clearings the backlog and actively managing schedules further reduced waits. While change management was difficult, Lean principles can cure inefficiencies in radiology and beyond.
Mira 2011 Athens Business Class Vassilis Bardis Athens Medical CenterMIRA
This document outlines an investment business plan for establishing a robotic surgery program at Athens Medical Center. It discusses evaluating the costs of robotic surgery compared to alternative procedures. A key part of the plan is developing an activity-based costing model to accurately assess the true costs. The plan also covers initiating the program, including dedicating an OR room, assembling the robotic surgery team of a leading surgeon, nurses, and assistants. Training programs for staff and residents are also important. Monitoring outcomes and the economic feasibility is essential for the long-term success of the robotic surgery program.
This document summarizes the experience of Odette Cancer Centre in evaluating and implementing Elekta VMAT for prostate cancer patients. Key points:
1) Planning studies showed VMAT could significantly reduce treatment delivery times for prostate cases compared to IMRT and tomotherapy, without compromising dosimetry.
2) After extensive commissioning and quality assurance testing, Odette began treating their first prostate cancer patients with VMAT in 2011.
3) Initial results confirmed VMAT decreases treatment time from around 6 minutes for IMRT to around 90 seconds for a single-arc VMAT plan.
4) Faster treatment times with VMAT are expected to allow Odette to treat more patients per
The document discusses four new initiatives at The Scarborough Hospital in Toronto that aim to reduce wait times in the Emergency Department:
1. The Rapid Admissions Unit has reduced the average patient stay in the Emergency Department from 17 hours to under 24 hours for eligible patients. Over 1,000 patients have been treated here in its first year.
2. The Emergency Department Process Improvement Program is an 8-month, multi-pronged strategy involving frontline staff to streamline patient flow and improve wait times between the Emergency Department and inpatient units.
3. The Nurse Practitioner Outreach Team has diverted 32% of long-term care patients from the Emergency Department.
4. The Geriatric
This document outlines a proposal to implement a rapid response team (RRT) at an urban Magnet hospital to improve patient outcomes on medical and surgical units. The purpose is to determine if an RRT can reduce hospital stays, decrease transfers to higher levels of care, and increase patient functionality at discharge. The proposal describes the background on RRTs, significance to nursing practice, literature review on clinical outcomes, relevant nursing theories, and the Iowa Model framework. It provides details on the methodology, team development and training, communication systems, education, documentation, and implementation process including activation protocols and safety huddles. The goal is to activate the RRT for at-risk patients showing signs of respiratory distress, changes in mental status, abnormal
Here is a high-level layout of the PACU simulation model:
- Inputs:
- Historical daily OR schedule with planned start/end times of surgeries
- Distributions of surgery durations
- Distributions of PACU length of stay for different surgery types
- Process:
- Simulate surgeries based on schedule and duration distributions
- Patients enter PACU after surgery based on OR schedule
- Patients spend time in PACU based on PACU length of stay distributions
- Patients discharge from PACU over time
- Outputs:
- PACU census (number of patients) tracked over time
- Staffing requirements calculated to maintain target nurse-to-patient ratios
The model simulates patient flows
The Nebraska Medical Center implemented a 5-step plan to improve their culture of safety: 1) develop leadership skills and structure to support change, 2) provide teamwork and communication training, 3) create safety tools, 4) collect data to measure results, and 5) train internal "master trainers" to spread the changes. Survey results showed staff felt safer speaking up about safety concerns after training. Unexpected delays in procedures decreased. The culture change approach improved both safety and outcomes.
R2 Medscan Solutions provides teleradiology services with key benefits of lower costs, higher quality, and improved turnaround times. Their workflow involves hospitals sending imaging studies to R2's secure PACS system where US-trained radiologists can access studies 24/7 and provide fast preliminary reports. R2 aims to lower costs for hospitals by 2.5% for every 100 additional studies while maintaining high quality through peer reviews by board-certified radiologists.
Kate Hobson introduces how implementing some Lean principles in a small radiology department led to significant improvements. By process mapping and using the Glenday sieve to identify high-volume ("green") procedures, the department was able to streamline workflows to reduce wait times. Simple changes like standardizing dating scans to 5-minute slots and having sonographers see clinic appointments freed up capacity. Clearings the backlog and actively managing schedules further reduced waits. While change management was difficult, Lean principles can cure inefficiencies in radiology and beyond.
Mira 2011 Athens Business Class Vassilis Bardis Athens Medical CenterMIRA
This document outlines an investment business plan for establishing a robotic surgery program at Athens Medical Center. It discusses evaluating the costs of robotic surgery compared to alternative procedures. A key part of the plan is developing an activity-based costing model to accurately assess the true costs. The plan also covers initiating the program, including dedicating an OR room, assembling the robotic surgery team of a leading surgeon, nurses, and assistants. Training programs for staff and residents are also important. Monitoring outcomes and the economic feasibility is essential for the long-term success of the robotic surgery program.
This document summarizes the experience of Odette Cancer Centre in evaluating and implementing Elekta VMAT for prostate cancer patients. Key points:
1) Planning studies showed VMAT could significantly reduce treatment delivery times for prostate cases compared to IMRT and tomotherapy, without compromising dosimetry.
2) After extensive commissioning and quality assurance testing, Odette began treating their first prostate cancer patients with VMAT in 2011.
3) Initial results confirmed VMAT decreases treatment time from around 6 minutes for IMRT to around 90 seconds for a single-arc VMAT plan.
4) Faster treatment times with VMAT are expected to allow Odette to treat more patients per
This document discusses strategies to optimize transcatheter aortic valve replacement (TAVR) programs, including:
1. Implementing a minimalist approach to TAVR procedures using local anesthesia and conscious sedation in the catheterization lab, rather than general anesthesia in the hybrid operating room, which can reduce procedure time, intensive care unit stay, length of stay, and hospital costs.
2. Developing standardized clinical pathways and protocols for pre-procedure patient evaluation and selection, the TAVR procedure itself, and post-procedure recovery, in order to decrease length of stay and readmissions while improving outcomes.
3. Considering ways to decrease resource utilization such as reducing hospital staff duplication, streamlining procedure-
Aldo Rolfo, National Clinical Development Manager, Genesis Cancer Care, Austr...GenesisCareUK
A program that seeks to redefine best practice across the drivers of the GenesisCare business (Quality, Access and Efficiency) in order to deliver on their vision of “Innovating Healthcare. Transforming Lives.”
Using Enterprise Data To Drive ImprovementEdgewater
The document discusses how Sentara Healthcare used enterprise data and analytics to drive surgical performance improvement across their healthcare system. They integrated clinical, operational, and financial data to gain a complete view of their enterprise. This allowed them to address questions from different perspectives and embed analytics throughout their organization. By establishing a common foundation of data and evidence, they were able to align strategy, drive quality improvements, and increase operational performance across Sentara Healthcare.
This document discusses performance management at Agha Khan Hospital in Pakistan. It begins with definitions of performance management and why organizations need to measure performance. It then provides an overview of the hospital, including its mission, vision, and philosophy. Several key performance indicators are examined, such as warehouse fill rates, patient satisfaction, and medical record documentation. The document concludes that while the hospital provides an outstanding work environment, it needs to improve staff awareness, develop a new performance management model, and ensure quality standards are known and practiced by all to increase efficiency and patient satisfaction.
This document summarizes a project to improve patient flow at a busy Emergency Department. The objective was to investigate delays in treatment and evaluate a newly adopted "split-flow" model. Data analysis revealed staffing issues and key factors. Simulation models of the current and split-flow EDs were created to identify bottlenecks and potential solutions. Adding specific resources allowed the goal to be achieved with reasonable resource utilization.
Sharing a New Ideal: How Tomorrow’s Understaffed, Multi-Site Lab Organization...mhartman1309
This presentation was presented by Chris Christopher at the Lab Quality Confab Conference on Nov 2, 2010. It shows how medical laboratories are using automation, technology and lean sigma improvement methodologies to meet organizational needs.
revelationMD developed a data bridge that reduces
healthcare costs & improves quality by connecting the
payer, the user & the authorizer for the first time ever
The document discusses the healthcare industry in India. It notes that India's healthcare system is undergoing a transformation and growth over the next decade will be closely tied to reforms. The industry is expected to substantially evolve to help India achieve its long-term healthcare vision. It then provides an overview of the healthcare scenario in India including statistics on expenditure and infrastructure. It also discusses St. John's Medical College Hospital including its services, processes, pricing strategies, and quality initiatives to improve service delivery.
With the transition to the value-based care model, improving TAT has become an important goal for radiology departments. Here are some top strategies for faster reporting of imaging results.
Radiology workflow recognizing clinical financial benefits of implementing a ...Trimed Media Group
The document discusses the benefits of implementing a full RIS-PACS-reporting solution at Rutland Regional Medical Center. It allows for a tightly connected workflow from patient arrival to report delivery. Physicians have efficient access to images and information. The single vendor system provides radiologists with a quick turnaround and unified vision. Key metrics like report turnaround time and coding callbacks have improved. The solution enhances patient care by making the physician workflow more efficient.
A LEAN SIX SIGMA APPROACH TO REDUCE WAITING AND REPORTING TIME IN THE RADIOLO...Joe Andelija
This document summarizes a research paper that used Lean Six Sigma to reduce waiting and reporting times in the radiology department of a tertiary care hospital in Kolkata, India. The researchers mapped the process from patient entry to report generation and identified areas of delay. Root causes of delay were found to be lack of patient preparation and disorganized operations. Recommendations included improving patient orientation to decrease pre-test wait times and streamlining operations to reduce post-test reporting delays. Implementing these changes statistically significantly reduced both pre-test and post-test waiting times.
This document discusses setting up IUI and IVF services. It covers the key components needed, including good lab design, infrastructure, equipment, and personnel. For infrastructure, it recommends building from scratch in a pollution-free area for an embryo-friendly environment. It provides details on room classification, air handling units, electricity, and gas supply. Essential and desirable equipment are outlined for IUI and IVF labs. It emphasizes the importance of a cohesive team approach. Startup costs are estimated at 1-1.5 lakhs for IUI and 40 lakhs for IVF, with an ideal setup costing around 100 lakhs plus 40-50 lakhs for infrastructure. Effective service provision focuses
First steps in improving phlebotomy: the challenge to improve quality, produc...NHS Improvement
This document summarizes the learning from pilot projects aimed at improving phlebotomy services using Lean methodology. Key findings include: understanding patient data is important to improve performance; observing processes from the patient perspective reveals opportunities; establishing clear standards helps focus improvement efforts; and fixing phlebotomy in isolation may not impact broader patient pathways. Common themes across sites included managing services with data, training staff in Lean tools, improving communication, and reducing waste.
Radiology Workflow: Recognizing Clinical & Financial Benefits of Implementing...TriMed Media Group
This document summarizes a presentation about implementing an integrated radiology information system (RIS), picture archiving and communication system (PACS), and reporting solution at Rutland Regional Medical Center. The system provides streamlined workflow from patient check-in through report delivery. It has led to improved efficiency through a unified system, faster report turnaround times, reduced transcription needs, better monitoring of metrics, and enhanced collaboration between radiologists and other physicians. The integrated system also allows for improved coding and billing processes as well as cost savings through staffing reductions.
This month's community call is part two in a series on Clinical Transformation. The presentations will highlight how Clinical Transformation affects outcomes AND the bottom-line of health care organizations. The presentation will provide a proof point on how Clinical Transformation has a direct Return on Investment (ROI) for both the patient and the provider organization.
This topic is both clinical and administrative in nature and will likely be useful to physicians, nurses and others interested in outcomes, as well as health care CIOs, CFOs and administrators.
Please feel free to forward this invitation to any colleagues or associates who you believe would find this topic of interest or would like to participate in the discussion.
What: Clinical Transformation (Part II)
- Clinical Transformation
- a Blueprint
- in Practice
- Transformation Working Group Update
- Review of status
- Framework for Planning
- Discussion
- Open Project Updates
- OpenVista/GT.M Integration
- CCD/CCR collaboration
- Medsphere.org: Tip of the month
When: March 26, 12:30 - 2pm Pacific
Where: Dial-in: (888) 346-3950 // Participant Code: 1302465
Web conference: http://www.medsphere.com/infinite/
===
The community calls are listed on the Medsphere.org event calendar (http://medsphere.org/community-events/) and we will update each month's call as the agenda is solidified.
Details and Recording available here: http://medsphere.org/blogs/events/2009/03/26/community-call-march-2009
The document discusses how lessons from Lean Thinking and Toyota's production system can be applied in healthcare to improve quality, efficiency and productivity. It outlines three levels of Lean transformation: improving individual processes (Point Kaizen), redesigning patient pathways (Value Stream Kaizen), and aligning support processes across organizations (System Kaizen). Early results in Bolton Hospitals NHS Trust show improvements like reduced mortality and length of stay through Rapid Improvement Events. The document advocates adopting a Lean approach to operations and strategy to manage processes and redesign services using Lean principles. Some challenges to Lean adoption in healthcare are also acknowledged.
City X Ray & Scan Clinic provides comprehensive clinical testing and diagnostic services under one roof. It aims to deliver world-class and affordable diagnostic facilities to all sections of society while maintaining high ethical standards. The clinic offers a wide range of pathology, radiology, and imaging services using state-of-the-art equipment. It has received several accreditations for its emphasis on quality, accurate reporting, and trained staff. The document outlines the clinic's vision, services, equipment, quality initiatives, and leadership team.
1) Waterbury Hospital integrated TigerText with their EMR system to improve communication between physicians and the hospital. Alerts from the EMR would be sent via TigerText to notify doctors about patient issues like lab results or new consult orders.
2) An analysis found that integrating TigerText reduced the average consult turnaround time from 1.56 to 0.68 days and reduced patient length of stay from 7.75 to 5.91 days. This saved the hospital over $200,000.
3) Challenges included getting physicians to use the secure messaging on personal devices and determining who messages should be routed to. Future plans include sending discharge notifications and image results to physicians' mobile devices.
Wake med north quality improvement initiativeKwilliams541
This quality improvement initiative at Wake Med North aimed to reduce operating room turnover time by redesigning processes based on a study done at Emory University Hospital. The summary is:
The initiative identified high variability, linear processing, and interaction lapses as contributing to long turnover times. A redesigned process using parallel processing, consistent definitions of room readiness, moving the call to order earlier, and establishing core staff roles reduced turnover time by 21 minutes on average. This allowed for increased surgical volume and cost savings while improving patient and staff experiences.
This document discusses strategies to optimize transcatheter aortic valve replacement (TAVR) programs, including:
1. Implementing a minimalist approach to TAVR procedures using local anesthesia and conscious sedation in the catheterization lab, rather than general anesthesia in the hybrid operating room, which can reduce procedure time, intensive care unit stay, length of stay, and hospital costs.
2. Developing standardized clinical pathways and protocols for pre-procedure patient evaluation and selection, the TAVR procedure itself, and post-procedure recovery, in order to decrease length of stay and readmissions while improving outcomes.
3. Considering ways to decrease resource utilization such as reducing hospital staff duplication, streamlining procedure-
Aldo Rolfo, National Clinical Development Manager, Genesis Cancer Care, Austr...GenesisCareUK
A program that seeks to redefine best practice across the drivers of the GenesisCare business (Quality, Access and Efficiency) in order to deliver on their vision of “Innovating Healthcare. Transforming Lives.”
Using Enterprise Data To Drive ImprovementEdgewater
The document discusses how Sentara Healthcare used enterprise data and analytics to drive surgical performance improvement across their healthcare system. They integrated clinical, operational, and financial data to gain a complete view of their enterprise. This allowed them to address questions from different perspectives and embed analytics throughout their organization. By establishing a common foundation of data and evidence, they were able to align strategy, drive quality improvements, and increase operational performance across Sentara Healthcare.
This document discusses performance management at Agha Khan Hospital in Pakistan. It begins with definitions of performance management and why organizations need to measure performance. It then provides an overview of the hospital, including its mission, vision, and philosophy. Several key performance indicators are examined, such as warehouse fill rates, patient satisfaction, and medical record documentation. The document concludes that while the hospital provides an outstanding work environment, it needs to improve staff awareness, develop a new performance management model, and ensure quality standards are known and practiced by all to increase efficiency and patient satisfaction.
This document summarizes a project to improve patient flow at a busy Emergency Department. The objective was to investigate delays in treatment and evaluate a newly adopted "split-flow" model. Data analysis revealed staffing issues and key factors. Simulation models of the current and split-flow EDs were created to identify bottlenecks and potential solutions. Adding specific resources allowed the goal to be achieved with reasonable resource utilization.
Sharing a New Ideal: How Tomorrow’s Understaffed, Multi-Site Lab Organization...mhartman1309
This presentation was presented by Chris Christopher at the Lab Quality Confab Conference on Nov 2, 2010. It shows how medical laboratories are using automation, technology and lean sigma improvement methodologies to meet organizational needs.
revelationMD developed a data bridge that reduces
healthcare costs & improves quality by connecting the
payer, the user & the authorizer for the first time ever
The document discusses the healthcare industry in India. It notes that India's healthcare system is undergoing a transformation and growth over the next decade will be closely tied to reforms. The industry is expected to substantially evolve to help India achieve its long-term healthcare vision. It then provides an overview of the healthcare scenario in India including statistics on expenditure and infrastructure. It also discusses St. John's Medical College Hospital including its services, processes, pricing strategies, and quality initiatives to improve service delivery.
With the transition to the value-based care model, improving TAT has become an important goal for radiology departments. Here are some top strategies for faster reporting of imaging results.
Radiology workflow recognizing clinical financial benefits of implementing a ...Trimed Media Group
The document discusses the benefits of implementing a full RIS-PACS-reporting solution at Rutland Regional Medical Center. It allows for a tightly connected workflow from patient arrival to report delivery. Physicians have efficient access to images and information. The single vendor system provides radiologists with a quick turnaround and unified vision. Key metrics like report turnaround time and coding callbacks have improved. The solution enhances patient care by making the physician workflow more efficient.
A LEAN SIX SIGMA APPROACH TO REDUCE WAITING AND REPORTING TIME IN THE RADIOLO...Joe Andelija
This document summarizes a research paper that used Lean Six Sigma to reduce waiting and reporting times in the radiology department of a tertiary care hospital in Kolkata, India. The researchers mapped the process from patient entry to report generation and identified areas of delay. Root causes of delay were found to be lack of patient preparation and disorganized operations. Recommendations included improving patient orientation to decrease pre-test wait times and streamlining operations to reduce post-test reporting delays. Implementing these changes statistically significantly reduced both pre-test and post-test waiting times.
This document discusses setting up IUI and IVF services. It covers the key components needed, including good lab design, infrastructure, equipment, and personnel. For infrastructure, it recommends building from scratch in a pollution-free area for an embryo-friendly environment. It provides details on room classification, air handling units, electricity, and gas supply. Essential and desirable equipment are outlined for IUI and IVF labs. It emphasizes the importance of a cohesive team approach. Startup costs are estimated at 1-1.5 lakhs for IUI and 40 lakhs for IVF, with an ideal setup costing around 100 lakhs plus 40-50 lakhs for infrastructure. Effective service provision focuses
First steps in improving phlebotomy: the challenge to improve quality, produc...NHS Improvement
This document summarizes the learning from pilot projects aimed at improving phlebotomy services using Lean methodology. Key findings include: understanding patient data is important to improve performance; observing processes from the patient perspective reveals opportunities; establishing clear standards helps focus improvement efforts; and fixing phlebotomy in isolation may not impact broader patient pathways. Common themes across sites included managing services with data, training staff in Lean tools, improving communication, and reducing waste.
Radiology Workflow: Recognizing Clinical & Financial Benefits of Implementing...TriMed Media Group
This document summarizes a presentation about implementing an integrated radiology information system (RIS), picture archiving and communication system (PACS), and reporting solution at Rutland Regional Medical Center. The system provides streamlined workflow from patient check-in through report delivery. It has led to improved efficiency through a unified system, faster report turnaround times, reduced transcription needs, better monitoring of metrics, and enhanced collaboration between radiologists and other physicians. The integrated system also allows for improved coding and billing processes as well as cost savings through staffing reductions.
This month's community call is part two in a series on Clinical Transformation. The presentations will highlight how Clinical Transformation affects outcomes AND the bottom-line of health care organizations. The presentation will provide a proof point on how Clinical Transformation has a direct Return on Investment (ROI) for both the patient and the provider organization.
This topic is both clinical and administrative in nature and will likely be useful to physicians, nurses and others interested in outcomes, as well as health care CIOs, CFOs and administrators.
Please feel free to forward this invitation to any colleagues or associates who you believe would find this topic of interest or would like to participate in the discussion.
What: Clinical Transformation (Part II)
- Clinical Transformation
- a Blueprint
- in Practice
- Transformation Working Group Update
- Review of status
- Framework for Planning
- Discussion
- Open Project Updates
- OpenVista/GT.M Integration
- CCD/CCR collaboration
- Medsphere.org: Tip of the month
When: March 26, 12:30 - 2pm Pacific
Where: Dial-in: (888) 346-3950 // Participant Code: 1302465
Web conference: http://www.medsphere.com/infinite/
===
The community calls are listed on the Medsphere.org event calendar (http://medsphere.org/community-events/) and we will update each month's call as the agenda is solidified.
Details and Recording available here: http://medsphere.org/blogs/events/2009/03/26/community-call-march-2009
The document discusses how lessons from Lean Thinking and Toyota's production system can be applied in healthcare to improve quality, efficiency and productivity. It outlines three levels of Lean transformation: improving individual processes (Point Kaizen), redesigning patient pathways (Value Stream Kaizen), and aligning support processes across organizations (System Kaizen). Early results in Bolton Hospitals NHS Trust show improvements like reduced mortality and length of stay through Rapid Improvement Events. The document advocates adopting a Lean approach to operations and strategy to manage processes and redesign services using Lean principles. Some challenges to Lean adoption in healthcare are also acknowledged.
City X Ray & Scan Clinic provides comprehensive clinical testing and diagnostic services under one roof. It aims to deliver world-class and affordable diagnostic facilities to all sections of society while maintaining high ethical standards. The clinic offers a wide range of pathology, radiology, and imaging services using state-of-the-art equipment. It has received several accreditations for its emphasis on quality, accurate reporting, and trained staff. The document outlines the clinic's vision, services, equipment, quality initiatives, and leadership team.
1) Waterbury Hospital integrated TigerText with their EMR system to improve communication between physicians and the hospital. Alerts from the EMR would be sent via TigerText to notify doctors about patient issues like lab results or new consult orders.
2) An analysis found that integrating TigerText reduced the average consult turnaround time from 1.56 to 0.68 days and reduced patient length of stay from 7.75 to 5.91 days. This saved the hospital over $200,000.
3) Challenges included getting physicians to use the secure messaging on personal devices and determining who messages should be routed to. Future plans include sending discharge notifications and image results to physicians' mobile devices.
Wake med north quality improvement initiativeKwilliams541
This quality improvement initiative at Wake Med North aimed to reduce operating room turnover time by redesigning processes based on a study done at Emory University Hospital. The summary is:
The initiative identified high variability, linear processing, and interaction lapses as contributing to long turnover times. A redesigned process using parallel processing, consistent definitions of room readiness, moving the call to order earlier, and establishing core staff roles reduced turnover time by 21 minutes on average. This allowed for increased surgical volume and cost savings while improving patient and staff experiences.
Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Kosmoderma Academy, a leading institution in the field of dermatology and aesthetics, offers comprehensive courses in cosmetology and trichology. Our specialized courses on PRP (Hair), DR+Growth Factor, GFC, and Qr678 are designed to equip practitioners with advanced skills and knowledge to excel in hair restoration and growth treatments.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
1. Radiology and Lean
Leadership
Howard B. Fleishon, MD, FACR, MMM
Medical Director
Department of Radiology
John C. Lincoln North Mountain Hospital
Disclosure:
Council Vice Speaker
American College of Radiology
Learning Objectives:
1. Introduction to concepts of “Lean”
process engineering.
2. Applications of Lean principles in
Healthcare
3. Present pros and cons of “Lean”
2. “The future ain’t what
it used to be.”
Yogi Berra
“Make no mistake: The cost of our health
care is a threat to our economy. It’s an
escalating burden on our families and
businesses. It’s a ticking time bomb for
the federal budget. And it is unsustainable
for the United States of America.”
President Obama speech to the AMA, June 15, 2009
3. Bending the Cost Curve - Medicare Costs as % GDP
Redefining Health Care
“The patient's medical condition is the unit
of value creation in health care delivery”
Michael Porter
“Redefining Health Care”
4. Institute of Medicine
An epidemic of waste blights the US health
care delivery system. Despite a huge
dedication of resources to health care in
the United States, the medical system does
not deliver safe, effective, efficient,
patient-centered, timely, and equitable
care as recommended by the Institute of
Medicine.1
http://jama.ama-assn.org/cgi/content/extract/297/8/871
Institute of Healthcare Innovation
“All organizations, including health care
and Radiology organizations, are composed
of a series of processes, or sets of actions
intended to create value for those who use
or depend on them”
5. Institute of Healthcare Innovation
“Agreement is growing among health care leaders
that lean principles can reduce the waste that is
pervasive in the US health care system. The Institute
for Healthcare Innovation believes that adoption of
lean management strategies, while not a simple
task, can help health care organizations improve
processes and outcomes, reduce cost, and increase
satisfaction among patients, providers and staff.”
"We need health care that is sustainable and
excellent – both. That will require rethinking
our work and redesigning our systems of
care boldly and guided by proper theory.
Lean thinking and true patient-centeredness
are not just compatible; they are, at heart,
the very same thing.“
Donald Berwick, MD, MPP, FRCP, founder and former President
and CEO of the Institute for Healthcare Improvement
6. What is “Lean”
• Management strategy to improve processes.
• In any given process, distinguish value added steps
from non-value-added steps.
• Eliminate waste so that ultimately every step adds
value to the process.
• Evaluate processes by accurately specifying the
value desired by the end user.
• Making value flow from beginning to end of a
process based on the expressed needs of the
customer/patient.
What is “Lean”
“Lean” is the identification and steady
elimination of waste through:
The implementation of first time quality approaches to
work.
Standardization of processes
Smoothing of flow
Flexibility of work
Long term relationships with customers and vendors
Reduction in time leading to cost reduction and business
improvement
“Lean” Companies
Abbott Tool Works Industries Ravalg Sug F
Boeing Company Intel Corporation S&P 500 Index, RTH
Carlo Scodanibbio Johnson and Johns SSE Composite Index
Industrial Consultant NASDAQ Stanley Works
Danaher Newell Rubbermaid Steelcase Inc.
Danaher CP Nike Inc. CL B Tesco PLC
Deere Company Parker Textron Inc.
Djia Parker Hannifin C Toyota
Ford Pentair, Inc. Volkswagen
Glaxo Pfizer Wabtec Corporation
Hillenbrand Inc. Pinnacle West Capitol Wabtech
Hospira Rajvir Industries Wyeth
IBM
7. Lean Industries:
Validated Industry Averages
• Direct Labor/Productivity Improved 45–75%
• Cost Reduced 25–55%
• Throughput/Flow Increased 60–90%
• Quality (Defects/Scrap) Reduced 50–90%
• Inventory Reduced 60–90%
• Space Reduced 35–50%
• Lead Time Reduced 50–90%
*Summarized results, subsequent to a five-year evaluation, from numerous companies (more than
15 aerospace-related). Companies ranged from 1 to >7 years in lean principles application/
execution. Source: Virginia Mason Medical Center
Source: www.LeanMaps.com -- Mark Graban
Virginia Mason Production System
Reduced lab reporting times by more than 85%
Improved time nurses spend in direct patient care from 35
% to 90 %.
Reduced bedsores from 8% to less than 2%
Saved $1 million in supply expense in 2009.
Reduced professional liability insurance 48.9 percent from
2004 to 2009.
Pharmacy improved medication from 2.5 hours to 10
minutes, reduced incomplete inpatient medication orders
from 20 to 40 percent to less than 0.2 percent
Saved $8 million in planned expansion projects since 2002
8. Seattle Children’s Hospital
Continuous Performance Improvement
• Cut costs per patient by 3.7 percent for a total savings
of $23 million.
• Avoided spending $180 million on capital projects by
using its facilities more efficiently.
• Served 38,000 patients, up from 27,000, without
expansion or adding beds.
• Reduced the average waiting time for non-emergency
M.R.I.’s from 25 days to 1.5 days.
http://www.nytimes.com/2010/07/11/business/11seattle.html
University of Pittsburgh
Pittsburgh Regional Healthcare Initiative
• Reduced catheter related infection rates dramatically.
• Pathology decreased staff by 28% through attrition.
• Time needed to order inventory was cut from eight
hours weekly to minutes daily.
• Stock levels were reduced by 50%.
• Overstocking and rush orders due to stock outs were
virtually eliminated.
http://www.ihi.org/NR/rdonlyres/B6EA145C-BA93-429B-9BDF 46ACE63F1B1C/0/
ShadysideSuccessStory.pdf
ThedaCare Improvement System
Collaborative Care Units
• Patient Satisfaction- from 68% to 90%
• Quality of Care- Pneumonia: 38% to 95%
• 30% reduction in costs
• Projected improvement in NPV when disseminated
throughout the system: 63% or more than $23
million
9. University of Michigan
Michigan Quality System Projects
• 2 day reduction in LOS for uncomplicated cardiac patients
• Over 30 minute per patient decrease in time spent in ER
waiting room
• 4 hour decrease (from 7 hours to 3 hours) in time from ER
MRI requisition to scan started
• 34% improvement in payments posted within 3 days of receipt
• Interventional Radiology on-time starts improved from 13% at
baseline in July 2007 to 58% in January, 2010
Ontario Wait Time Information Program
• CT avg wait time: 42% improvement
• MRI avg wait time: 12% improvement
The Application of Lean Thinking to the Care of
Patients With Bone and Brain Metastasis With
Radiation Therapy
Results and Conclusion:
Reduced the number of individual steps to begin treatment
from 27 to 16
Percentage of new patients with brain or bone metastases
receiving consultation, simulation, and treatment within the
same day rose from 43% to nearly 95%.
“By implementing the ideas of lean thinking, we improved
the delivery of clinical care for our patients with bone or
brain metastases.”
http://jop.ascopubs.org/content/3/4/189.abstract
10. MRI Room Turnover
Process START: Previous patient off exam table. Process END: Current patient on table
Before: Observed Cycle Time = 17.5 minutes includes 14.5 minutes waiting for patient
Transporter
Transport Get w/c, Transport
prev Pt to cart if Pt to MRI
Unit needed
START
Tech
Clean, Patient Position,
resupply WAIT FOR PATIENT to Exam Instruct END
room Table Patient
After: Observed Cycle Time = 4.1 minutes, includes 0 minutes waiting for patient
Patient “on Transport
Transporter
Get w/c, Transport
cart if deck” before prev Pt to
Pt to MRI procedure Unit
needed
Clean, Patient
START resupply to Exam
room Table
Position,
Instruct
END
Tech
Patient
TPS - Basis for Lean
The Toyota Production System (TPS) is a
major part of the more generic "Lean
manufacturing". TPS is the philosophy which
organizes manufacturing and logistics at
Toyota, including the interaction with
suppliers and customers.
11. Learning to Lead at Toyota-4 Principles
• There is no substitute for direct observation
• Proposed changes should always be structured as
experiments
• Workers and managers should experiment as
frequently as possible
• Managers should coach, not fix
http://hbr.org/2004/05/learning-to-lead-at-toyota/ar/1
Lean Manufacturing
is a manufacturing philosophy which shortens the time between the customer
order and the product build / shipment by eliminating sources of waste.
Business as Usual
CUSTOMER Waste PRODUCT
ORDER BUILT & SHIPPED
Lean Manufacturing Time
CUSTOMER PRODUCT
ORDER BUILT & SHIPPED
Waste
Time (Shorter)
“Waste” in TPS
The original seven wastes are:
1. Transportation
2. Waiting
3. Inventory
4. Motion
5. Over Processing
6. Defects
7. Rework
There has now been identified an 8th Waste
8. Unused Human talent
12. “Lean” and Quality
"It turns out--what we've learned," summarizes
Kaplan, "is that the best way to improve quality
is to eliminate non-value-added variation. This
is a way, a method for that. And it's working!“
Gary Kaplan, MD
Chairman and CEO
Virginia Mason
Lean Thinking as the Scientific Method
Applied to Daily Work
Scientific Method Lean Thinking
• Observation • Go see, ask why, respect
• Hypothesis • Plan P
• Intervention • Do D
• Results/reflection • Check/reflect C
• Revise hypothesis • Adjust A
• New intervention… • Repeat PDCA cycle…
• Structured abstract • A3 report, Value Stream Map
35
MANAGEMENT
SYSTEMS
MINDSET METHODS
13. Culture Change
Culture Shift
Traditional Culture Lean Culture
• Function Silos • Interdisciplinary teams
• Managers direct • Managers teach/enable
• Benchmark to justify not • Seek the ultimate performance,
improving: “just as good” the absence of waste
• Blame people • Root cause analysis
• Rewards: individual • Rewards: group sharing
• Supplier is enemy • Supplier is ally
• Guard information • Share information
• Volume lowers cost • Removing waste lowers cost
• Internal focus • Customer focus
• Expert driven • Process driven
Applications in Radiology
• Standard Work
Protocols
Policies
Structured reporting
Standard Lexicon
• Streamline workflow in Billing and Collections
14. Criticisms of Lean
• Standardization versus patient variability
http://online.wsj.com/article/SB10001424052748704913304575371210975895460.html
• Standard work flow and lack of inventory and
may not be able to readily adapt to rapid
changes in demand (i.e ER).
http://online.wsj.com/article/SB10001424052748703792704575367003265429096.html
?mod=googlenews_wsj#articleTabs%3Darticle
• Reiteration of past methods- Six Sigma, CQI,
etc.
Summary
• “Lean” is a method of process
engineering based on the Toyota
Production System.
• As Radiology group leaders we should
be aware of “Lean’s” increasing profile
in healthcare.
• Potential applications in Radiology
ASRT Code:
VAD0110025
15. Books: References
• Womack, Jones. Lean Thinking. (An overview)
• Liker. Toyota Way. Liker, Meier. Toyota Way Fieldbook. Liker, Hoseus. Toyota Culture.
• Shook. Managing to Learn. (Best book on leadership in a lean organization and A3 use)
• Sobek, Smalley. Understanding A3 Thinking. (Problem solving and A3 use)
• Dennis. Getting the Right Things Done. (Strategy deployment or hoshin kanri)
• Rother, Shook. Learning to See. (Value stream mapping)
• Baker, Taylor. Making Hospitals Work (From Lean Enterprise Academy, UK)
• Graban. Lean Hospitals. (Applies Lean principles to health examples)
Articles:
• Kim, Spahlinger, Kin, Billi. Lean health care: what can hospitals learn from a world-class automaker? J
Hosp Med. 2006;1:191.
• Kim, Hayman, Billi, Lash, Lawrence. The Application of Lean Thinking to the Care of Patients With
Bone and Brain Metastasis With Radiation Therapy. J Oncology Practice. 2007;3:189.
• Kim, Spahlinger, Kin, Coffey, Billi. Implementation of Lean Thinking: One Health System's Journey.
Joint Commission J Quality and Safety 2009;35:406.
• Bush. Reducing Waste in the US Healthcare System. JAMA 2007;297:871.
• Spear. (all Harvard Business Review) Fixing Health Care from the Inside, Today (9/05); Learning to
Lead at Toyota. (4/04); Decoding the DNA of Toyota Production System. (9/99)
• IHI. Going Lean in Health Care
www.ihi.org/IHI/Results/WhitePapers/GoingLeaninHealthCare
Web:
• Michigan Quality System at UMHS: med.umich.edu/mqs
• Lean Enterprise Institute: www.lean.org webinars, books, meetings…
• Lean Healthcare Value Leaders Network www.healthcarevalueleaders.org
• Lean Enterprise Academy (UK): www.leanuk.org
• Ideal Patient Care Experience at UMHS www.med.umich.edu/i/acs/ipe.htm