Lean Processing For Practice Transformation Ellen Batchelor - PDF document

5/13/13 Lean Processing For Practice Transformation Ellen Batchelor Objectives ■ How & Why Lean, a.k.a., the Toyota Production System ■ Introduce concepts ■ Whet your appetite ■ Next steps 1

5/13/13 What is Lean? ■ Lean manufacturing, lean enterprise, or lean production...is a production practice that considers the expenditure of resources for any goal other than the creation of value for the end customer to be wasteful, and thus a target for elimination. Working from the perspective of the customer who consumes a product or service, “value” is defined as any action or process that a customer would be willing to pay for. 2

5/13/13 What is Lean? Roadmap ■ Lean provides a road map □ Value stream maps □ Process maps □ Are both tools and the structure 3

5/13/13 Tools Cycle Time ■ Lean gives you the right tools. Value 5 Whys Stream Takt Time Mapping Waste Walk Special Glasses ■ Learning to See □ Wastes □ Processes □ Employees 4

5/13/13 Simple Definition? ■ Maximize customer value. ■ Minimize waste. Who is Your Customer? ■ Maximize customer value. Minimize waste. 5

5/13/13 What is Value? Maximize customer value . Minimize waste. ■ Something the customer wants and is willing to “pay” for. What is Waste? Maximize customer value. Minimize waste. ■ Anything that adds cost or time without adding value. 6

5/13/13 What is Waste? Over-, or “Extra” Processing 7

5/13/13 Over-, or “Extra” Processing ■ Question: What am I doing that is not required by the customer either directly or indirectly. Defects or Errors 8

5/13/13 Defects or Errors ■ Question: Does this process result in anything that the customer would deem unacceptable? Motion 9

5/13/13 Motion ■ Question: how much do you move materials, people, equipment or goods within a processing step? Transportation 10

5/13/13 Transportation ■ Question: Is there unnecessary (non value added) movement of parts, materials or information between processes? Overproduction 11

5/13/13 Overproduction ■ Question: Are you producing sooner, faster or in greater quantities than the customer is demanding? Inventory 12

5/13/13 Inventory ■ Question: Do you have any raw materials, works in progress or finished goods laying around that you rarely or never use? Wasted Human Talent 13

5/13/13 Wasted Human Talent ■ Question: Do I know and use all the capabilities, wherever possible, of everyone on my staff? Waiting 14

5/13/13 Waiting ■ Question: What is waiting for a work cycle to be completed? Why must it wait? Confusion 15

5/13/13 Why do you Care? ■ “Waste is everywhere in healthcare...if we can harness it, there will be enough [resources] left over for every man, woman, and child who does not now have access to basic healthcare... and...we will retain a workforce who finds joy in their work.” ‒ --Richard A. Wright, M.D., MPH Why Lean? ■ Minimal training and implementation time. Improvements implemented the same day. ■ Broad application within an organization. ■ Lean-based improvements affect all areas: □ Safety □ Satisfaction □ Outcomes □ Bottom line 16

5/13/13 Why Not? From the Lean Healthcare Exchange: ■ An ICU set about decreasing the 25 minute lead time to begin a dialysis procedure (because they perform a lot). The majority of this time was motion waste spent searching for equipment and supplies. After implementing some solid lean techniques, the lead time decreased to slightly more than five minutes. However, there were an additional two minutes and 15 seconds of work required to return the unit upon completion and to update a visual control. Thirty-days post implementation the new process was in disuse. When queried as to why, the team articulated; “It took too long to return the units and update the control.” □ Net Lean savings = 18 minutes, 45 seconds per procedure - or 18 minutes/day * 5 days * 52 weeks = 81 hours Why Not? From the Lean Healthcare Exchange: ■ A team reduced excess processing and motion waste for nursing by 8,500 hours, annually. It required an additional 2,500 hours annually, to implement. At the interim report- out, the leadership were adamant: “There is no way we can support this, we simply do not have the budget.” □ Net Lean savings 6,000 hours/year (or 115/week) 17

5/13/13 Why Not? From the Lean Healthcare Exchange: ■ A nurse delivered more than $86,000 in cost reductions to her unit on an annualized basis through “A3" work. Excited, she embarked on five others to deliver equal or greater value, only to be told by her manager, “Spend more time on patient care and less time on this A3 stuff.” □ Lean savings $86,000/year on one project at cost of nurse time. Where do I start? ■ Define your team ■ Engage your leader(s) ■ Remember: Leaders are key ■ Evaluate your process - map 18

5/13/13 Lean Leaders ■ Know how the process (& business) serves the customer ■ Build ability in their team ■ Show a continuous improvement mind set ■ Focus on process and results ■ Demonstrate an understanding of the value stream ■ Create a culture to sustain improvement Remember the Customer ■ Keep your customer top of mind. 19

5/13/13 Assess Cycle Time Value BSC Stream Takt Time Mapping Good Teams Diagnose Data Collection 5 Whys Financial Analysis Cause & Effect Waste Walk 20

5/13/13 Problem Solving ■ Problems look the same on the surface, but may not have the same underlying cause. □ Blanket solutions and best practices don’t always work □ Boss/subordinate interactions - directive solutions aren’t the best □ “A Team” driven solutions not good □ Expert problem solvers Treat Just in Time 5 S Work Load Balancing Leveling Standard Work 21

5/13/13 Prevent Storyboard ■ Maintain a healthy process once it has been improved. Run Chart Visual ■ An apple a day keeps the doctor Lean Control away. Chronicle Paynter Chart What are the Results? 22

5/13/13 Do it Now ■ Form a lean team and start meeting regularly ■ Evaluate your processes - value stream mapping ■ Identify & focus on your customers ■ Go to the Gemba - the place where the work is being done ■ Look for Muda - waste ■ Eliminate waste ■ Repeat Resources ■ Lean Enterprise Institute ▪ www.lean.org ▪ Perfecting Patient Journeys by Worth, Shuker, Keyte, et al. ▪ Value Stream Management for Lean Healthcare ▪ 2013 Lean Healthcare Transformation Summit, June 5-6, 2013, in Orlando, Florida ■ Lean Healthcare Exchange http:// www.leanhealthcareexchange.com/ ■ http://www.dummies.com/how- to/content/ lean-for-dummies-cheat- sheet.html 23

5/13/13 Resources ■ CFMC □ Free support through various QI initiatives ▪ In-office consultations and assistance with cardiology data collection and PQRS data collection, and other and reporting and resources ▪ Contact Devin Detwiler, ddetwiler@cfmc.org ■ Ellen Batchelor, Zeroth Blue □ Healthcare Quality Improvement Coach □ Independent consultant ▪ ZerothBlue@yahoo.com, 720-552-1505, zb.dbeb.us ■ Health TeamWorks □ Free support through various QI initiatives ▪ www.HealthTeamWorks.org 24