A basic introduction to Lean concepts in healthcare, presented by Premier Inc.

1. Introduction to Lean Concepts Material in this presentation can be used only with permission of Premier, Inc - Healthcare Informatics Contact: doug_miller@premierinc.com PE250

3. Describe Lean concepts

4. Understand how lean thinking can change an organization’s culture

5. Distinguish between Value-Added vs. Non-Value Added activities and processes

7. Precursors to Lean Thinking Eli Whitney: standardized interchangeable parts Henry Ford: workflow and standardized work What happened between processes How multiple processes were arranged within the factory How the chain of processes functioned as a system How each worker went about a task Toyota Production System Concepts of the Ford model, plus Employee centric Flexible manufacturing concepts Influenced by Deming and his 14 Points (attached) World Class Manufacturing, Just-in-Time Manufacturing, Continuous Flow Manufacturing Globalization of the Toyota Production System

10. Lean Culture The culture of “Lean Thinking”: There is always a better way Change becomes normal New ideas are understood, accepted, and lived at the highest levels within the organization Lean is not a program, it’s a way of life

11. The 4P Model Lean Thinking is based on the 4P Model: Philosophy People Process Problem Solving

12. Implementing Lean Cautionary points regarding Lean implementation: Its not just a set of tools, it’s a cultural change that requires strategy Changing the culture to Lean thinking is not easy Applied to the entire business enterprise, not just the “floor” It doesn’t happen overnight Continual CHANGE is a key element of the culture shift Education part of the everyday routine Will to learn and share knowledge Authority and accountability is based on the mutual respect

13. Implementing Lean: Change Management Tips Change Management Tips1 Prepare and motivate staff for the implementation Involve employees Identify and empower champions Create an atmosphere of experimentation Utilize realistic performance measures and reward systems Implement in pilot prior to organization rollout 1. Neo Tiong Wee, Kaizen Consulting Group

14. Principles of Lean Lean Thinking focuses these principles when evaluating process Principle Definition Specify value All processes serve the customer; know what they want and what they are willing to pay Identify the value stream View process from beginning to end, focusing on v versus work alue added non - value added Create flow Process one unit at a time with no stoppages or interruptions Develop pull system Consumption of resources triggers replenishment of resources Seek perfection Reducing waste in the entire value stream creates a highly competitive organization

15. The Three “M’s” Three critical concepts that are the target of elimination in a Lean organization: Muri – Overburdening people or equipment Mura – Unevenness of flow Muda – Non-value added “waste” in a process

16. Waste Elimination The 7 Common Wastes in Lean Thinking1 Defects Overproduction Transportation Waiting Inventory Motion Processing 1. Descriptions on the following slides taken from “The Toyota Gal” Blog (Tracey Richardson)

17. Waste Elimination The 8 Common Wastes for Premier Lean Thinking Defects Overproduction Confusion Waiting Inventory Motion Processing Underutilization of Staff 1. Descriptions on the following slides taken from “The Toyota Gal” Blog (Tracey Richardson)

18. Waste 1: Defects Work that contains errors, rework, mistakes or lacks something necessary Examples Medication errors Wrong patient ID Wrong procedure Missing admission information Poor clinical outcomes Retesting Records/reports misfiled Use Premier tools!

19. Waste 2: Overproduction Producing more than the Customer/Patient needs right now Examples Redundant medical record creation Prepping for procedures not yet scheduled Lab results printing at multiple locations (duplication)

20. Waste 3: Confusion Confusion occurs when staff aren’t comfortable with the best way to perform their jobs Examples Unclear MD orders Unclear role expectations between RN and Nurse Assistants Unclear billing procedures

21. Waste 4: Waiting Idle time created when material, information, people, or equipment is not ready Examples Waiting for… Bed assignments, supplies, records Admission to ED Testing, treatment, or discharge Patient lab test results Use Premier tools!

22. Waste 5: Inventory More materials, parts, or products on hand than the patient/customer needs right now Examples Excessive supplies, linens, etc. Paperwork in process Wrong quantities of required items on hand

23. Waste 6: Motion Movement of people, product, supplies that does not add value Examples Searching for required equipment, meds, charts Gathering supplies Transporting samples, specimens Moving patients room to room Transporting patients for testing, treatment

24. Waste 7: Processing Unnecessary processing or procedures Examples Excessive treatment/labs Unnecessary or inefficient scheduling steps Excessive or redundant paperwork for patient & hospital staff Use Premier tools!

25. Waste 8: Underutilization of Staff Underutilization of Staff is the misuse of skill sets Examples Registered Nurse picking up medications from Pharmacy CFO completing journal entries for end of month close Nursing Director stocking forms in unit Use Premier tools!

27. Visual Controls

28. 5S

29. Value Stream Mapping

30. Process Mapping

31. Spaghetti Diagrams

32. Turn Around Time Reduction

33. Maintenance and Reliability

34. Pull Systems

35. Standardized Work

36. Poke-Yoke (Mistake Proofing)

37. A3 Problem Solving

38. FMEA (Failure Mode Effect Analysis)