by Dr. Roel Schuring of University of Twente shown at the Lean Service Summit of 23rd June 2004 ran by the Lean Enterprise Academy

1. From cars to care
Dr. ir. Roel W. Schuring

2. WHO ranking (excl. Small countries)
9. Portugal (1.469)
10.Greece (1.390)
11.Netherlands (2.255)
12.U. Kingdom (1.774)
13.Ireland (1.944)
14.Switzerland (3.229)
15.Belgium (2.269)
31.USA (4.499)
9. Portugal (1.469)
10.Greece (1.390)
11.Netherlands (2.255)
12.U. Kingdom (1.774)
13.Ireland (1.944)
14.14.Switzerland (3.229)Switzerland (3.229)
15.Belgium (2.269)
31.31.USA (4.499)USA (4.499)
1. France (2.335)
2. Italy (2.040)
3. Singapore (913)
4. Spain (1539)
5. Oman (448)
6. Austria (2171)
7. Japan (2009)
8. Norway (2373)

3. US Growth of HC expenditures
0
2
4
6
8
10
12
14
1994 1995 1996 1997 1998 1999 2000 2001 2002
growthcost%

4. WHO ranking (excl. Small countries)
9. Portugal (1.469)
10.Greece (1.390)
11.Netherlands (2.255)
12.U. Kingdom (1.774)
13.Ireland (1.944)
14.Switzerland (3.229)
15.Belgium (2.269)
31.USA (4.499)
9. Portugal (1.469)
10.Greece (1.390)
11.Netherlands (2.255)
12.U. Kingdom (1.774)
13.Ireland (1.944)
14.14.Switzerland (3.229)Switzerland (3.229)
15.Belgium (2.269)
31.31.USA (4.499)USA (4.499)
1. France (2.335)
2. Italy (2.040)
3. Singapore (913)
4. Spain (1539)
5. Oman (448)
6. Austria (2171)
7. Japan (2009)
8. Norway (2373)

6. France Says Heat Wave Death Toll Is
11,435 / AP 31aug03
PARIS — France's first comprehensive
tally of the searing heat wave stirred fresh
outrage Friday when the government
revealed that an alarming 11,435 people
had died — far beyond its initial
estimates.

7. Healthcare is under pressure
• Reduced economic growth
• More old people
• New technologies available
• Increasing demands
• Complaining workers in the sector

8. Where do we stand?
• To err is human: 48.000 – 98.000 deaths
due to medical error in the US: yearly
• UK: NHS: 27 – 86 % prescription error
• Netherlands: 17 – 37 % distribution error
of medication in hospitals
• Variance in practice

9. Variance in practice (I)
Post Operative
Wound Infections
Best 25% Worst 25%
Breast Surgery < 3% > 9 %
Hip Replacement < 2% > 25%
Knee Replacement < 1% > 4%
Source: CBO/RIVM 1999

10. Variance in practice (II)
Variance knee
arthroscopics
least
(4 locations)
largest
(3 locations)
Minutes 10 min. ± 40 min.

13. We really do our best,
but everything is not under control!

14. What do we do about it?
• System changes, capacity planning,
budget-control
• Budgeting / pricing
• Cochrane standards
• System changes, capacity planning,
budget-control
• Budgeting / pricing
• Cochrane standards
• Management instruments
• High-Tech & IT solutions

15. Budgeting / pricing
• Administrative burden
• Selection of most attractive patients
(cream-skimming
• Tendency to upgrade patients
• Large control system is needed
• Basic properties of care unaffected.

17. Source: www.marklin.com

18. Chevy Monza Sports 1966

20. So what do they do?
• Clear process design
• Continuous measurement & feedback
• Continuous improvement
• Predictable & fun
• Scale is “just right”
• Part of value chain (specified pathway)

21. They say: yugo, but you don’t.

22. • Healthcare is under pressure
• Performance is disappointing
• Current approaches limited impact
• Examples of solutions in other sectors

23. Sad story
Happy end?

24. Creating Continuous Flow

25. Continuous Flow

26. Replenishment System

29. Outlook (I)
1. Healthcare performance will be more
transparent
2. Healthcare will be organized in
processes
3. Hospitals will no longer offer “all
services”

30. Outlook (II)
4. Each process will continuously
optimized
5. There will be bigger networks with a
role for each provider
6. Technology is an important enabler

31. Welcome to our workshop