Lto2009 Jones
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1) Lean thinking and quality improvement methods can help healthcare organizations significantly improve patient care by eliminating waste and creating smooth flow through value streams. 2) Implementing lean requires redesigning patient journeys through departments and across the entire care continuum to reduce waits, handoffs, and unnecessary steps for both patients and staff. 3) Sustaining lean transformations requires establishing stability, responding quickly to problems, and designing experiments through visual management systems and a value stream leader responsible for coordination and conflict resolution across the organization.
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Lto2009 Jones
- 1. THE POTENTIAL OF LEAN THINKING IN HEALTHCARE Daniel T Jones Chairman Lean Enterprise Academy UK
- 2. Background LEA has helped many organisations get big benefits from following Toyota in using Lean thinking Consumer goods, construction and the public sector I brought the global lean healthcare pioneers together to encourage others to follow them We conducted our own action learning experiments to learn how lean works in healthcare We published our results so far in Making Hospitals Work so others can do it themselves Now we are learning how to build the right management systems to sustain lean
- 3. The Healthcare Challenge The healthcare industry was shocked to discover how far behind they had fallen on quality and safety Used evidence based medicine to define best practice interventions to eliminate variation and errors But these improvements are difficult to sustain in isolation Meanwhile containing healthcare costs is a growing issue Lean uses evidence based management to improve the flow of work to eliminate delays for patients, wasted effort for staff and unnecessary costs for hospitals If we can go beyond point improvements and lean pilots
- 4. Coming Together Quality and Lean are two sides of a coin together they: Use the scientific method for prioritizing, planning and problem solving Use lean principles and tools to turn activities into value streams (integrated patient journeys) Manage visually to establish stability, see variances and reveal problems Develop problem solving skills through learning by doing But the end-to-end perspective challenges traditional ways of managing
- 5. Understanding the Context PATHOLOGY THERAPIES EMERGENCY MAU HOME DEPARTMENT MEDICAL HOME SAU WARDS NURSING D HOME I NURSING S HOME IMAGING C H SURGUCAL A OPERATING WARDS R ROOM G GP E REHAB OTHER UNIT WARDS CLINIC CLINIC CLINIC CLINIC PHARMACY SUPPLIES What are the patient journeys through the District General Hospital?
- 6. Using the A3 Method Evidence based management
- 7. Defining the Problem What is the underlying problem?
- 8. Understanding Demand Which patients to follow? How many and where do they go? What is the rate of demand?
- 9. Mapping the Value Stream 6.5 days waiting for 3 hours of work!
- 10. Four Questions 1 1. What is the rate of demand? What is the planed work? Do we have the staff? 2. How to create flow within departments? Synchronise actions on the Wards Cells in ED
- 11. Four Questions 2 3. How to create flow between departments? Use buffers to signal the need for a bed 4. Where to schedule this flow? Can we level discharge?
- 12. Developing the Action Plan
- 13. Line Management Create Plan for Every Patient boards everywhere to see progress, variances and problems quickly Enable staff and line management to respond quickly to variances Show line management how to teach staff to analyse the root causes of persistent problems By the Hour in ED By the Day on Wards
- 14. Value Stream Management Create a coordination mechanism - a visual hub plus status boards - and an escalation management system Give someone responsibility for the whole Value Stream - to gain agreement to do the right things - with the backing to resolve conflicts - and deliver results A&E SYMPHONY WAST CWS MAU E-mail x3 E-mail x3 Ops Hub Dashboard Metrics Visual Hospital SAU x3 Staffing Ward Round Plan vs Actual OTIF Action Cards Wards x3 A&E MAU SAU Wards
- 15. Leadership from the Top Understand the scale of the lean opportunity and how to translate this into money Use Strategy Deployment to focus on the Vital Few Deselect activities to free up the capacity to act Appoint and support a Value Stream Manager and Clinical Value Stream leader Resolve conflicts between Departmental objectives and the needs of the Value Stream Go to Review Progress regularly
- 16. Lean Management Establish Respond to Design Stability Variances Experiments Top Voice of the Management Provider e Deselect Value Stream Manager Value Stream Voice of the Management Patient Hub Plan A P Line C D Voice of the Management Staff Patient Boards Responses Problem Solving
- 17. The Elective Surgical A3 Plan
- 18. The Potential Results From redesigning the emergency and elective journeys: For Patients seen quickly, no waits, no errors For Staff more care time, less frustration For the Hospital meet access targets, free up 30% of capacity, do more elective work, reduce Bank and Agency spending and meet budget targets But this is just the start spread to support functions HR Recruitment new staff in post quicker Finance and Admin streamline office processes Procurement 30% savings in stock and wastage Then spread lean across the whole healthcare system
- 19. The Healthcare System PRIMARY CARE UNIT SOCIAL SERVICES PATHOLOGY THERAPIES INJURY UNIT ASSESSMENT IMAGING UNIT CLINIC CLINIC CLINIC PHARMACY SUPPLIES HOME HOME GP REHAB NURSING UNIT NURSING HOME PATHOLOGY THERAPIES HOME EMERGENCY MAU DEPARTMENT SAU MEDICAL WARDS D I S IMAGING C H SURGUCAL A OPERATING WARDS R ROOM G E OTHER WARDS CLINIC CLINIC CLINIC CLINIC PHARMACY SUPPLIES SUPPLIES WAREHOUSE DISTRICT GENERAL HOSPITAL
- 20. In Conclusion Lean is the journey for this next decade It will have a profound impact on healthcare It will also change the way we manage organisations And become the New Common Sense
- 21. REALIZING THE POTENTIAL OF LEAN THINKING IN HEALTHCARE Daniel T Jones www.leanuk.org