Effective Strategies for Maximizing Your Profit When Selling Gold Jewelry
Lean in Hospitals
1. “Introducing Lean to the Hospital”
Peter D. Schellinck
Partner
SHConseil
+32 496 386 437
www.shconseil.fr
www.schellter.eu
2. Agenda
The Crisis of Waste in Healthcare
Lean Thinking Principles in Healthcare
Benefits for:
Patients
Employees
Hospitals
3. Hospitals Are Dangerous…
CDC 1998:
90,000 killed
and 2,000,000
injured from
hospital-caused
drug errors &
infections
4. Preventable Errors Abound…
“… 3 to 5% of
specimens taken
each year are
defective… blood
that isn’t drawn
correctly… mix-up
with another
patient’s sample”
7. Mass Production or Healthcare?
Large batches Automation is the answer
Sub-optimizing one Lack of standard processes
resource
Lack of employee input Not communicating
metrics
One-person/One-machine Lack of leadership
Quality through inspection Constant fire fighting
8. Non-Lean, Current Thinking
1. Specify value in the eyes of the
provider (or the payer)
1. Identify your department and
sub-optimize it
1. Make patients wait for the
convenience of the system
1. Ignore some employees and
devalue others
1. Continuously fight the same fires
in the pursuit of surviving the day
9. Applications of Lean in Healthcare
Laboratories
Reducing Turn Around Times and Errors
Emergency Departments
Reducing diversions, improving flow
Outpatient Cancer Treatment
Reducing patient delays, increasing capacity
Operating Rooms
Reducing changeover times, increasing utilization
Pharmacies
Reducing errors, improving response
Food Service
Reducing wasted food, improving quality
10. Why LEAN Works in Healthcare
LEAN is not a list of tools that applies only
to factories
LEAN is a philosophy of management that
applies to any system
LEAN rallies people around goals we can all
agree on:
Patients and Employees
for
Quality
11. Not About Cutting Heads
Shortages of skilled employees
51% of hospital med techs greater than 45
years of age, vacancy rate at 11%
Shortfall of 65,000 nurses expected by 2012
Do more…
With the same
Eventually, with less
12. Not Only About Cutting Costs
Hospitals are using lean as a
Business Strategy
Improving quality
Improving service
Improving employee satisfaction
Growth strategies
“Un-outsourcing” testing work
13. Principles of LEAN Thinking
1. Specify value in the
eyes of the customer.
– The customer must be willing
to pay for the activity
– The activity must change the
form, fit or function of the
product or service
– The activity must be done right
the first time
Who are the “customers?”
Source: LEAN Thinking, Womack and Jones 1996
14. Principles of LEAN Thinking
1. Specify value in the
eyes of the
customer.
2. Identify the value
stream and
eliminate waste.
13% of hospital costs are due to controllable
waste.
Source: Zuckerman, Hadley, and Iezzoni, 1994
16. Value Stream – Anatomic Pathology
Patient & MD I
Transcriptionist I
Pathologist
Specimen I
Collection
Send to
Grossing
I
Embed Slide
I Grossing Processing
& Cut
Staining
Making
I I I I
17. Types of Waste – Lab Examples
Defects Label on the wrong tube
Overproduction Drawing all blood at 4 AM
Transportation Long walks, multiple handoffs
Waiting Time Tube waiting on centrifuge to fill
Inventory 50 weeks of supply
Motion Tech walking 80 ft to the printer
Processing Time/Date stamps added, not used
Human Potential Administration not listening to Med
Techs or ideas for improvement
18. Are We Tolerating Waste?
Healthcare = Workarounds
Professor Steven Spear
“Decoding the DNA of the Toyota Production
System” (HBR)
“Fixing Healthcare Today From the Inside” (HBR)
Case Example:
10-20% of MD orders are missing EVERY DAY
Call and get the order – done?
Tomorrow, we’ll do the same
Problems need to be seen as opportunities
19. Laboratory Layouts Drive Waste
Layout is driven by
departments
Benches interfere with
straight-line walking,
encourage batches
22. Layouts Drive Waste of Motion
Med Tech Walk Pattern Pharmacist Walk Pattern
Kms per Day!
Cancer RN Walk Pattern
23. Typical 5S Baseline
Unorganized Workbenches Poor Utilization of Space
Product Flow not Obvious General Clutter
Time wasted looking for things Supply Shortages and
Hoarding of supplies “Hidden” Inventories
25. Principles of LEAN Thinking
1. Specify value in the
eyes of the customer.
2. Identify the value
stream and eliminate
waste.
3. Make value flow at
the pull of the
customer.
26. Reducing Patient Wait Times
Mass Production Thinking Utilization
Keep expensive assets heavily utilized
Machines Doctors
The tradeoff is waiting time
Cars Patients
Lean Thinking Flow
Focus on reducing Patient Waiting time
27. Outpatient Oncology Patient “Flow”
Value Added
A
• Blood drawn
• MD consult
• Needle into Port
NVA But Required
B
• Check In / Check Out
• Moving from room to room
ARRIVAL TO LATENESS FOR NVA, “Pure Waste”
TREATMENT TREATMENT
PATIENT (HOURS) (HOURS) • Waiting for Check In
A 2,5 0,42 • Waiting for MD
B 3,5 1,08 • Waiting for Treatment
AVG 3,0 0,75
30. Batching Hurts Quality
Lack of “standard work” and opportunity
for “error proofing” – Anatomic Pathology
Batch of slides made, 3 2nd histotech labels one
patients, risk of mixup? slide at a time
31. Batching Hurts Quality
Lack of “standard work” and opportunity for
“error proofing” – Pharmacy
32. Flow
You can’t have flow without some
amount of “leveling” in the system
“Leveled Production:
You won’t be Happy without it”
From Toyota publication
33. Typical Hospital Lab Not Level
39% of Samples Arrive in Just 3 Hours of the Day
TAT expectations are constant
35. Principles of LEAN Thinking
1. Specify value in the eyes of
the customer.
2. Identify the value stream and
eliminate waste.
3. Make value flow at the pull of
the customer.
4. Involve and Empower
employees.
5. Continuously improve in the
pursuit of perfection.
36. Pre-Lean Med Tech Quote:
“With all of the
automation,
I feel like a robot.”
37. The “Thinking Production System”
“Perhaps the greatest strength of the
Toyota Production System is the way
it develops people.
This is why the T actually stands for
‘Thinking’ as well as for ‘Toyota.’”
Teruyuki Minoura, Toyota
38. What Mistake-Proofing Means to
Healthcare
The Global Goal: Reduce Medical Errors
“Human error is inevitable.
We can never eliminate it.” …..
We can eliminate problems in the
system that make it more likely to
happen.”
Source: USA Today Liam Donaldson
August 24, 2005 WHO World Health Alliance
for Patient safety
39. Lean Requires a Cultural Shift
Traditional Approach:
“Naming, Shaming, and Blaming”
Lean Approach:
Supports open reporting of mistakes
Root cause problem solving process
“Anyone can make mistakes”
40. Error Proofing Example
Micrograms or Milligrams?
A medical mistake waiting to
happen when written by hand
42. MD Resistance to Standard Work
Which is
More effective?
“… some surgeons make a tiny, mole-sized mark on a
patient instead of a big, bold "X”…. I call them passive-
aggressive marks…”
USA Today, 4/18/06
43. Lab Benefits from Lean
Productivity improvement >30%
Space savings of >250 sq m
Standardized work practices
Reduction in Errors and Error Potential
Test Turnaround Time (CT) reduced by 50%
44. Reflections on Year’s in Healthcare
Lean is a powerful methodology
People are people
Healthcare people have incredible intrinsic
motivation
Humility and asking questions is better
than being a know-it-all
Coaching the team to “do lean & be lean”
is the only sustainable route
Notas do Editor
Other important points we must consider: focus on what the customer wants, and the align all our processes to deliver collect best practices and develop standard processes use teams to execute use all of the brains in the company establish flow; eliminate the barriers to flow (causes of waste) rework is not value-added, need quality built into products/processes understand customer demand reward LEAN thinking and LEAN behavior reward problem solving rather than work-arounds make every process visual multi-skill everyone
Other important points we must consider: focus on what the customer wants, and the align all our processes to deliver collect best practices and develop standard processes use teams to execute use all of the brains in the company establish flow; eliminate the barriers to flow (causes of waste) rework is not value-added, need quality built into products/processes understand customer demand reward LEAN thinking and LEAN behavior reward problem solving rather than work-arounds make every process visual multi-skill everyone
Other important points we must consider: focus on what the customer wants, and the align all our processes to deliver collect best practices and develop standard processes use teams to execute use all of the brains in the company establish flow; eliminate the barriers to flow (causes of waste) rework is not value-added, need quality built into products/processes understand customer demand reward LEAN thinking and LEAN behavior reward problem solving rather than work-arounds make every process visual multi-skill everyone
Respect for humanity includes the following concepts (this terminology comes from noted lean author Norman Bodek), including 1) jidoka (separating people from machines and empowering employees to stop production) 2) People working in teams, and 3) people contributing improvement ideas (kaizen)
All of the eight types of waste can be found in a laboratory environment. A big challenge in a lean transformation is learning to SEE waste, then having the courage to call it waste, then having the drive to actually reduce the waste.
All of the eight types of waste can be found in a laboratory environment. A big challenge in a lean transformation is learning to SEE waste, then having the courage to call it waste, then having the drive to actually reduce the waste.
Let ’ s look at a typical non-LEAN lab. If you trace the flow of a product (such as a tube of blood) or the path an operator walks during a shift, the resulting picture is what we call a “ spaghetti diagram. ” This usually results when we organize the lab without thinking about product or operator “ flow ” . “ Flow ” is another key lean word that we ’ ll hear a lot today. When a lab (or a factory) is organized with similar machines grouped together, the resulting workflow ends up looking like this. All the wasted steps and wasted time involved in moving product (and people) such a long distance. Before lean concepts are introduced, is this even seen as a problem? Do we just put up with this as “ the way we ’ ve always done it? ”
Other important points we must consider: focus on what the customer wants, and the align all our processes to deliver collect best practices and develop standard processes use teams to execute use all of the brains in the company establish flow; eliminate the barriers to flow (causes of waste) rework is not value-added, need quality built into products/processes understand customer demand reward LEAN thinking and LEAN behavior reward problem solving rather than work-arounds make every process visual multi-skill everyone
Ford examples – announcing 30,000 layoffs but CEO Bill Ford says he wants a “ risk taking ” and “ innovative ” culture…. How will people do that if they ’ re afraid? Merck announced “ lean ” is about cutting heads at their factories, including 25% of the staff at their first “ lean ” factory…. I ’ m sure the other factories are sure excited about lean coming to them. It ’ s basic human nature…. Fear does not lead to creativity and risk taking. People will look to protect their own job and keep their heads down. It ’ s takes very rare and outstanding leadership to keep people on board when layoffs are going on.
Respect for humanity includes the following concepts (this terminology comes from noted lean author Norman Bodek), including 1) jidoka (separating people from machines and empowering employees to stop production) 2) People working in teams, and 3) people contributing improvement ideas (kaizen) Add in example about Gary Convis and “ servant leadership ” Coach Carter: the best way care for someone is to have high expectations The “ if the operators would learn to read english ” story
Other important points we must consider: focus on what the customer wants, and the align all our processes to deliver collect best practices and develop standard processes use teams to execute use all of the brains in the company establish flow; eliminate the barriers to flow (causes of waste) rework is not value-added, need quality built into products/processes understand customer demand reward LEAN thinking and LEAN behavior reward problem solving rather than work-arounds make every process visual multi-skill everyone
Toyota continues to allow TPS to evolve and grow LEAN often involves balance – there is a balance between being so flummoxed as to be overwhelmed, versus being flummoxed enough to get create and solve problems “ Fat dumb and happy ” is not a term Toyota would ever want. They want a “ healthy stress ” or “ healthy pressure ” that drives improvement.
This is a very Toyota-like philosophy. People WILL make mistakes because they are human. Certain circumstances make it MORE likely to make errors. Management has a responsibility to help improve the system so it ’ s harder to make mistakes. Deming, who deeply influenced Toyota, liked to say 94% of errors were management ’ s responsibility (meaning the system).