Get Lean to Stay in the Green
Transforming Healthcare using Lean
Andrew L. McCart
“There are four purposes of
improvement:
easier, better, faster and cheaper.
These four goals appear in the order of
priority.”
Shigeo Shingo
What is Lean?
What is Lean?
What is Lean?
A business culture characterized by the endless
pursuit of the elimination of waste.
An effective methodology for improving patient
safety, quality and cost while preventing delays,
bridging “silos” and improving employee
satisfaction.
“It would be a lot easier if we
could stop calling it lean and
understand that it’s all about
serving others, developing
people and solving problems.”
Jon Miller
CEO Gemba
Lean Success
Not found in the tools, it’s the culture!
Respect For People
Why Lean?
“It provides a way to do more with lessless human effort, less equipment, less
time and less space-while coming closer
and closer to providing customers with
exactly what they want.”
James Womack,
author “Lean Thinking” 1996
It’s just a manufacturing thing, right?
Healthcare is Different!
Healthcare’s
Manufacturing’s Ideal World
Goods & Services
Delivered Error Free
Delivered On-time as requested
Delivered Efficiently without waste
Delivered Safely
Goals
Patient Safety
Patient Satisfaction
Employee, Staff Satisfaction
Employee Engagement
Low Turnover
Productivity
Space Utilization
Goal
“I could try to think differently”
Virginia Mason Hospital
Seattle, WA
In two years, lowered the
number of ventilatorassociated pneumonia from
34 cases to only 4 cases using
lean driven standardized
process in “ventilator bundle”.
ThedaCare
Appleton, WI
Started lean in 2003
• Reduced by 50% time to complete clinical paperwork on
admission.
• Reduced time from ER with chest pains to catheterization
from 91 min to 37 min.
• Reduced patient waiting time for orthopedic surgery from 14
weeks to 31 hours (from first call to surgery).
Allegheny General Hospital
Pittsburgh, PA
Reduced patient deaths
related to central-lineassociated blood stream
infections by 95%.
Denver Health Medical Center
Denver, CO
Since started “lean” in 2005, increased revenue due to improvements by $54
million.
• Consolidated and rearrange lab workstations improving flow saving
$88,000 and decreased turnaround test result times by 25%.
• Piloted noncritical patient flow in ER which increased seeing 5-6 patients
per hour from 2 patients per hour (still working on the kinks).
Seattle, WA
• Improved flow from
pickup through
processing in eye
bank.
• Reduced data errors
improving first time
quality.
Improved Transplant Rate
Lean Thinking Principles for
Healthcare
Principle
Lean Hospitals Must:
Value
Specify value from the standpoint of the end customer (the
patient).
Value Stream
Identify all the value-added steps across department
boundaries (the value stream), eliminating steps that do
not create value.
Flow
Keep the process flowing smoothly by eliminating causes of
delay, such as batches and quality problems.
Pull
Avoid pushing work on the next process or department; let
work and supplies be pulled, as needed.
Perfection
Pursue perfection through continuous improvement
No quick fixes
No instant success
No magic pill
No secret steps
No magic wand
Patience
Cannot be done overnight
Perseverance
Fall down seven times,
get up eight.
- Japanese Proverb
Practice, Practice,
Practice
Meaning of Kaizen
Kaizen Focus
Waste
elimination
Anything that adds cost or time
without adding value as
defined by the primary
customer is waste.
Who is our Primary Customer?
Let our Customers
define Value
•
The 7 Deadly Wastes
Transportation
Inventory
Motion
Waiting
Overproduction
Over-Processing
Defects
That’s just the
way work is done
around here
Waste becomes accepted
Challenge
We don’t see it as waste!
Total Lead Time
Value Added
5%
NonValue
Added
95%
Why Kaizen?
Main Purpose
Develop people!
Practice observing, analyzing and improving
Means to an End….
Improve the process to improve the people
Where to Start?
What are we trying to improve and why?
Go to Gemba to Understand
Collect “Real”
Data
Map the Flow
Customer Focused and Strategic
7 Flows of Healthcare
•
•
•
•
•
•
•
Flow of Patients
Flow of Family
Flow of Providers
Flow of Medications
Flow of Supplies
Flow of Equipment
Flow of Information
Patient Centered
Design around the patient experience
Yuck
!
Follow the pathways
Communicate
Gap Analysis - Space
5S
Sort
Set in Order
Shine
Standardize
Sustain
45
What is the Purpose of 5S?
Immediately make problems visible
Western Approach
Hear no problem, See no problem, Speak no problem
String Model
Who Are Our Experts?
Total Employee Involvement
Completed String
Model
50
Key to Lean Approach
It’s not management telling the staff how to
improve, it’s the other way around.
Experiment
Kaizen-man
Develop our
Kaizen Eyes
Kaizen Mind
Be Curious
What does Lean look like at my
facility?
• A Lean Event
• A Lean Transformation
• A Self-Sustaining Lean Culture
A Lean Event
• Examine a process/function or area
• Identify areas of waste, non-value added
steps
• Develop new process,
• Design rapid experiments
• Implement the new processes, standard work
• Observe new process and any change in
metrics
• Adjust and fine tune new standard work
• Celebrate!
A Lean Transformation
• 12 Months, 13 Visits
• 1 Enterprise-wide Value Stream Map
• 12 Weeks of Kaizen Events, 20-30 Events
A Self-Sustaining Lean Culture
• Trained Lean Experts In-House
• No more Consultants!
• Year-over-year Results in all Key Areas
Tips for Success:
• A ‘No Layoff’ Policy
• Support from the Top Down
• Internal Lean Champion
• Ownership by Process Leaders
Next steps:
• Schedule an on-site assessment
• See if Lean is a good ‘fit’ for your
organization
• Begin with a Lean Event or Transformation
Our sincere thanks for your participation today!
Thank you!
Andrew L. McCart
andrew@healthcaretransformations.us