creating a vision of lean healthcare at bolton

51

Click here to load reader

Upload: lean-enterprise-academy

Post on 13-Jan-2017

1.814 views

Category:

Education


2 download

TRANSCRIPT

Page 1: Creating a vision of Lean Healthcare at Bolton

Global Lean Healthcare Conference25-26th June 2007

Creating a Vision of Lean Healthcare at Bolton

David Fillingham, CBEChief Executive

Page 2: Creating a vision of Lean Healthcare at Bolton
Page 3: Creating a vision of Lean Healthcare at Bolton
Page 4: Creating a vision of Lean Healthcare at Bolton

• The state our hospitals are in today

• What would lean healthcare be like?

• Making it happen– Building the vision– Redesigning patient journeys– Changing the physical layout– Creating new behaviours

• Reflections and lessons

Page 5: Creating a vision of Lean Healthcare at Bolton

Today’s hospitals…….

• Wards and clinics are untidy and chaotic• Queues are everywhere• Processes are unplanned and of byzantine

complexity• Professional tribes and departmental silos

abound• Physical layouts and “monoliths” prevent a

smooth flow of work

Page 6: Creating a vision of Lean Healthcare at Bolton

The Fantasy Patient Journey

Information

Clinical assessment

Investi-gations

Clinical decision

Admi-ssion

Treat-ment

Dis-charge

Patients

Information

Page 7: Creating a vision of Lean Healthcare at Bolton

The Real Patient Journey

Page 8: Creating a vision of Lean Healthcare at Bolton
Page 9: Creating a vision of Lean Healthcare at Bolton

WaitingTransportation/Motion

Waiting Waiting

Waiting

Waiting

Waiting

Waiting Waiting

Waiting

Waiting

Mistakes

Mistakes

Mistakes

UncoordinatedActivity

UncoordinatedActivity

UncoordinatedActivity

UncoordinatedActivity

UncoordinatedActivity

UncoordinatedActivity

UncoordinatedActivity

Stock

Stock

TransportationTransportation

Transportation

Transportation/Motion

Transportation/Motion

Transportation/Motion

InappropriateProcessing

InappropriateProcessing

Page 10: Creating a vision of Lean Healthcare at Bolton
Page 11: Creating a vision of Lean Healthcare at Bolton

Patients suffer:- • Confusion and anxiety• Delays and cancellations• Harm• A sense of helplessness

Staff suffer:-

Taxpayers / Funders suffer:-

Today’s Healthcare

• Frustration and stress• Low morale• High sickness absence

• Waste and inefficiency• A “bottomless pit”

Page 12: Creating a vision of Lean Healthcare at Bolton

What would Lean Healthcare be like?

• Processes purposely designed and managed• A smooth flow of patients, staff and information• A physical layout to support flow and make

problems visible• Evidence based practice for every single patient• Every staff member a problem solver every

single day

Page 13: Creating a vision of Lean Healthcare at Bolton

Imagine a hospital with…….

• No needless deaths• No needless harm• No delays• No waste• No feelings of helplessness

(Don Berwick)

Page 14: Creating a vision of Lean Healthcare at Bolton

Making it Happen in Bolton Hospital

• Building the vision of a lean hospital• Patient journey redesign• Changing the physical layout• Creating new behaviours• Making it a daily activity

Page 15: Creating a vision of Lean Healthcare at Bolton
Page 16: Creating a vision of Lean Healthcare at Bolton

The beginnings of a lean journey……

• Began in August 2005• 856 (525 individuals) staff actively engaged in 85 Rapid Improvements Events • Early results promising

- Pathology: 40% floor space savingBlood Sciences processing time cut from hours to minutes

- Laundry: Capacity increase of 25%- Cataract Surgery: throughput increased by 30%- Trauma: 36% mortality reduction; 33% reduction in length of stay

• We now know just how much we don’t know!

Page 17: Creating a vision of Lean Healthcare at Bolton

Bolton Hospital – Pen Picture

• Based in NW England close to Manchester• 3,200 staff• Busy emergency hospital:-

– 100,000 ER attendances– 59,524 IP/DC admissions p.a.

• 692 beds• General medicine, general surgery, paediatrics,

obstetrics, orthopaedics• £150million turnover

Page 18: Creating a vision of Lean Healthcare at Bolton

A Vision of aLean Hospital

Page 19: Creating a vision of Lean Healthcare at Bolton

Our “EVSA”(Enterprise Wide Valuestream Analysis Event)

• Full week event for 50 senior Directors and Clinical Leaders

• Carried out after one year of ‘trying stuff out’• Current state: strategic context and hands on

mapping• Future state• How to get there

Page 20: Creating a vision of Lean Healthcare at Bolton
Page 21: Creating a vision of Lean Healthcare at Bolton
Page 22: Creating a vision of Lean Healthcare at Bolton

Hierarchy of Value Streams at Bolton Hospitals

Medical Conditions

Simple Complex

Condition Groups

Page 23: Creating a vision of Lean Healthcare at Bolton

8 Step High Level Flow:-

ImplementCare Plan

Follow UpAnd Review

History &Examination

DifferentialDiagnosis

Investigations AnalyseResults

DefinitiveDiagnosis

DevelopCare Plan

Page 24: Creating a vision of Lean Healthcare at Bolton

• Simple: one condition; likely to require only one medical discipline; little need for interagency working: likely to be day case or relatively short stay.

• Complex complicating co-morbidities; needs multidisciplinary team; demands close interagency co-operation; likely to require a longer hospital stay and after care

Page 25: Creating a vision of Lean Healthcare at Bolton

Condition GroupsSIMPLE• Heart and Chest• First Contact• Musculoskeletal• Gastro• Eyes, Head & Neck• Simple Surgery• Women’s Care• Children• Skin

COMPLEX• Adult• Women• Children

Page 26: Creating a vision of Lean Healthcare at Bolton

Conditions• We used Runners Repeaters and Strangers to

identify commonly occurring conditions and outcomes analysis to spot high risk groups

• Examples include: Cataracts, Joint Replacements, Stroke

• For each condition we are mapping the patient journey and developing a plan for improvement

Page 27: Creating a vision of Lean Healthcare at Bolton

Emerging Thinking about the Hospital’s Future State

• Put senior decision makers and diagnostics at front end of process

• Stream quickly into simple and complex• Monitor closely and have ability to switch between streams• Create condition based work teams to put ‘simple’ patients

into flow:-– Reduce batch sizes; identify flow stoppers; relocate diagnostics into

the flow; create standard work and enforce it; establish pull systems; set up visual management

• For complex patients – create “one decision flow”; strengthen multidisciplinary team working; intensify support; co-locate where feasible

• Re-think “clinical effectiveness” to be the basis for standard work

Page 28: Creating a vision of Lean Healthcare at Bolton

Lean Tools/PrinciplesMove awayfrom batching,Backlog andQueues.

ReduceVariation & Complexity

Clear to See:StraightenSweep & CleanSafetyStandardiseSustain

Create signalsTo pull patients.Obvious whenSomething empty

1 PIECE FLOW

STANDARDWORK

6 SPULL

SYSTEMS

“ability to see the process”

VISUAL MANAGEMENT:

Page 29: Creating a vision of Lean Healthcare at Bolton

Patient Journey Redesign

Our aim is to redesign all of the patient flows through the Hospital.This will take time!

Page 30: Creating a vision of Lean Healthcare at Bolton

We started with Trauma…• 9 month programme• 1 week Event (VSA) to create Vision and

Plan• 6 week long events (RIEs) and many

JDIs• Significant results

– 36% mortality reduction– 33% length of stay reduction– 42% paperwork reduction

Page 31: Creating a vision of Lean Healthcare at Bolton

Value Stream Analysis: Current State for Trauma

Page 32: Creating a vision of Lean Healthcare at Bolton

Value Stream Analysis: Current State for Trauma

• Spaghetti Diagram• We walk miles when we

shouldn’t have to• Things are not where they

are needed (if they are even there at all)

• We have to look for the sick patients and they can be anywhere

Page 33: Creating a vision of Lean Healthcare at Bolton

Value Stream Analysis: Current State for Trauma

• Hand Off Chart• 197 handoffs to

discharge a patient!

• Duplication• Frustration• Huge source of

potential error

Page 34: Creating a vision of Lean Healthcare at Bolton

Action! Creating the TSU

Page 35: Creating a vision of Lean Healthcare at Bolton

Standard work layout for each bed space and the admin area Greatly reduced documentation in standard format and sequence

Floor markings for location of key equipment to aid flow

Page 36: Creating a vision of Lean Healthcare at Bolton

Our next priorities are

• Cataracts• Joint Replacements

• Stroke • Acute abdomens

Mainly simple

Mainly complex

Page 37: Creating a vision of Lean Healthcare at Bolton

Changing the Physical Layout

Page 38: Creating a vision of Lean Healthcare at Bolton

PathologyBefore & During photos

Page 39: Creating a vision of Lean Healthcare at Bolton

Designed for Flow

Page 40: Creating a vision of Lean Healthcare at Bolton
Page 41: Creating a vision of Lean Healthcare at Bolton

Physical Layout

• Declutter and prepare for flow with 5S• Co-locate linked processes• Creation of “complex care” wards with

intensified multidisciplinary team support• Decentralisation and downsizing of

diagnostics• Development of Visual Management

approaches

Page 42: Creating a vision of Lean Healthcare at Bolton

Creating New Behaviours

“It’s easier to act yourself in to a new way of thinking than it is to think

yourself in to a new way of acting”

Page 43: Creating a vision of Lean Healthcare at Bolton

• Engaging clinical staff

• The power of the rapid improvement event

• Learning and development framework

• Making BICS a daily activity

• Developing a “brand”: the Bolton Improving Care system (BICS)

Page 44: Creating a vision of Lean Healthcare at Bolton
Page 45: Creating a vision of Lean Healthcare at Bolton

Pathology Lean Management System

• Standard work– For workstations– For leaders

• Visual controls– Production control boards– Metrics– Workstations

• Daily accountability processes– Daily meetings of work groups– Daily meetings of supervisors

• Training– Awareness– Tools

• Discipline– Persistence & determination

Page 46: Creating a vision of Lean Healthcare at Bolton

From this……

Page 47: Creating a vision of Lean Healthcare at Bolton

…..To this

Page 48: Creating a vision of Lean Healthcare at Bolton

Bolton PathologyBlood Sciences staff

Page 49: Creating a vision of Lean Healthcare at Bolton

Pathology – Bottom Line• 40% Floor space saving• Turnaround times cut• £300K (10%) more income with

4.5 (2%) fewer staff

Page 50: Creating a vision of Lean Healthcare at Bolton

Reflections and Lessons (1)

• Healthcare is an underperforming industry. We are failing our patients, staff and funders

• Our hospitals are full of committed and skilled staff who are struggling to deliver good care within a set of broken processes

• A lean mindset and methods offer the hope of transformational improvements

Page 51: Creating a vision of Lean Healthcare at Bolton

Reflections and Lessons (2)• We need to:-

– Develop our vision for a lean healthcare system– Radically redesign the physical environment and the

flows of patients, staff and information … “big leaps”– Embed continuous improvement in the daily work of

healthcare staff … “thousands of small steps”– Have courage, persistence and determination …

… it will be a long journey