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TRANSCRIPT
The Holistic Operational Strategy Series
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Lean Hospitals
Lean Hospitals
Lean Hospitals: Improving Quality, Patient Safety, and Employee Satisfaction Mark Graban . Copyright 2009 Productivity Press. All rights reserved. Authorized translation from English language edition published by Productivity Press, part of Taylor & Francis Group, an Informa business. : ..
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Thai translation rights 2012 by E. I. Square Publishing Company Limited. All rights reserved.
( Toyota ) Frank Gilbert Henry Ford JCI Lean Hospitals (.) . [email protected] MB: 081-613-6137
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5. Kanban () () Sid Siddiqi, Glen Elmore, Rich Rachner, Paul Scheel, P. L. Godwer, Blake Headey, Mike Santarelli, Mark Spearman, Stan Gershwin Steve Graves Dean Bliss Productivity Press Dean (www.leaanblog.org) ValuMetrix Services Rick Malik, Steve Friedland, Jo Ann Hegarty, Jamie Miles, Audrey Knable, Lewis Lefteroff, Ken LePage, Shana Padgett, Norka Saldana, Chetan Shukla, Susan South
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Jim Adams, Lee Fried, Dr. Ted Eytan, Andrew Castle, David Meier, Jamie Flinchbaugh Norman Bodek Jeff Maling Bryan Lund (Training Within Industry) Mike Wroblewski Henry Ford 1922 Dr. Sami Bahri Jim Adams, Dr. Beverly Rogers, Stephanie Mitchell, Dr. Mark Pool, Robin Aldredge Kim Morris ( ) Cheryl Fenske Kris Mednansky Maura May Lara Zoble
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Morsch, Laura, Five of the Most Unpopular Jobs, CNN 8 2006, http:// www.cnn.com/2006/US/Careers/02/08/cb.unpopular.jobs/index.html ( 7 2008).17
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Pittet, Didier, Improving Compliance with Hand Hygiene in Hospitals, Infection Control and Hospital Epidemiology 21 (2000): 381-86.5
HI NG
4
, 32.
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Toyota 2 5 Kanban
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(Visual Management) Gwendolyn Galsworth 1 2 :
Sonogram MRI 146 Lean Hospitals
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1 2 3
Hemmila, Donna, Banding Together for Patient Safety, NurseWeek, http://nsweb. nursingspectrum.com/CFForms/GuestLecture/bandingtogether.cfm ( 20 2007).4 5 6
Touissant, John, First Global Lean Healthcare Summit, 25 2007. Productivity Press Development Team, 5S for Operators (New York: Productivity Press, 1996), 12.
Productivity Press Development Team, Kanban for the Shopfloor (New York: Productivity Press, 2002), 1.
168 Lean Hospitals
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Galsworth, Gwendolyn, Visual Workplace, Visual Thinking (Portland, OR: Visual-Lean Enterprise Press, 2005), 13.
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Toyota 5 1 2 ( ) ? 169
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170 LeanHospitals
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188 LeanHospitals
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HI NGWoolcock, Nicola, Mark Henderson, Blundering hospitals Kill 40,000 a Year, The Times Online, 13 2004, http://www.timesonline.co.uk/tol/news/uk/health/article469178.ece ( 30 2007).1
6 7 8 9
Merry, Allan Alexander McCall Smith, Errors, Medicine, and the Law (Cambridge: Cambridge University Press, 2001), 32.10 11
, To Err Is Human, 54-55.
Mamberto, Carola, What Factory Managers Can Teach Hospital Wards, Wall Street Journal 25 2007, B3.12
Touissant, John, , First Global Lean Healthcare Summit, 25 2007.
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, 110.
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To Err Is Human, 19.
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Deming, W. Edwards, The New Economics, 2nd ed. (Cambridge, MA: MIT CAES, 1994), 33
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Quality of Healthcare in America and Institute of Medicine, To Err Is Human (Washington, DC: National Academies Press, 2000), 43.
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5
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: Supporting a Culture of Continuous Quality Improvement Hospitals and Other Health Care Organizations, Carolyn M. Clancy, MD Senate Permanent Subcommittee on Investigations Committee on Governmental Affairs, 11 2003 Agency for Healthcare Research and Quality, Rockville, MD, http://www.ahrq.gov/ news/tst61103.htm ( 7 2007).4
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189
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Bodison, Glenn W., Change Healthcare Organizations from Good to Great, Quality Progress 2005 22-29.3
PU
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Black, Nick Management Mistakes in Healthcare: Identification, Correction and Prevention, Journal of the Royal Society of Medicine 98 (2005): 432-33.2
Hollenbeak, Christopher S., Dispelling the Myths: The True Cost of Healthcare-Associated Infections, Healthcare Financial Management, 2007, http://www.hfma.org/library/ accounting/costcontrol/400546.htm ( 29 2007).13
Szabo, Liz, Global Goal: Reduce Medical Errors, USA Today, 23 2005, http://www. usatoday.com/news/health/2005-08-23-medical-errors_x.htm ( 21 2008).14
Rode, Jenny, Breaking the Rice Ceiling, Battle Creek Enquirer, 12 2006, http://www. leansigmainstitute.com/news/lean/2006/02/breaking-rice-ceiling.html ( 2 2008).15 17 18
, 24.
190 LeanHospitals
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Bates, D. W., D. L. Boyle, M. B. Vander Vilet, J. Schneider, I. Leape Relationship between Medication Errors and Adverse Drug Events, Journal of General Internal Medicine 10 (1995): 199205.21
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Woletz, Todd, Behavioral Safety Observation Program Presentation, 15 2007, http:// www.conney.com/expo2007/expo07_presentations/ToddWoletz_BSOP_Safety%20Day.ppt ( 22 2007).20
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, http://www.ahrq.gov/news/tst61103.htm ( 20 2007)19
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Taxis, K., N. Barber, Ethnographic Study of Incidence and Severity of Intravenous Drug Errors, BMJ 326 (2003): 684.
HI NG
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Gawande, Atul, Better (New York: Metropolitan Books, 2007, 21.
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Insulin Heparin () ( ) ( 191
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(Errors) Gemba 1 ? ? Microbore 192 LeanHospitals
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206 LeanHospitals
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207
Toyota Motor Corporation, Toyota Production System, http://www.toyota.co.jp/en/vision/ production_system/jidoka.html ( 2 2008).1
Kowalczyk, Liz, R.I. Raps Hospital for Errors in Surgery, Boston Globe, 27 2007, http://www.boston.com/news/local/articles/2007/11/27/ri_raps_hospital_for_errors_in_surgery/ ( 2 2008).2
Joint Commission, National Patient Safety Goal Compliance, http://www.jointcommissionreport. org/performanceresults/patientsafetygoal.aspx ( 20 2007).10 11 12
Meier, David, 2 2008
Schifferes, Steve, The Triumph of Lean Production, BBC News Online, 27 2007, http://news.bbc.co.uk/2/hi/business/6346315.stm ( 20 2007).13
Schifferes, The Triumph.
208 LeanHospitals
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Kwann, Mary, David Studdert, Michael J. Zinner, Atul A. Gawande Incidence, Patterns, and Prevention of Wrong-Site Surgery, Archives of Surgery, 141 (2006): 353-58.
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Convis, Gary, Role of Management in a Lean Manufacturing Environment, Society of Automotive Engineers, http://www.sae.org/manufacturing/lean/column/leanjul01.htm ( 20 2007).8
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Pedersen, Craig A., Philip J. Schneider, Douglas J. Scheckelhoff, ASHP National Survey of Pharmacy Practice in Hospital Settings: Prescribing and Transcribing 2004, American Journal of Health-System Pharmacy 62 (2005): 378-90.
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Shingo, Shigeo, Zero Quality Control: Source Inspection and the Poka-Yoke System, (New York: Productivity Press, 1986), 45.6
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WordNet Search 3.0, http://wordnet.princeton.edu/perl/webwn?s=mistake ( 20 2007).5
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Double Key Bounce and Double Keying Errors, Institute for Safe Medication Practices, 12 2006, http://www.ismp.org/Newsletters/acutecare/articles/20060112.asp?ptr=y ( 20 2007).4
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Grout, John, Mistake-Proofing the Design of Healthcare Care Processes, AHRQ Publication 07-0020 (Rockville, MD: Agency for Healthcare Research and Quality, 2007), 41, 76.3
HI NG fE .I. Sq ua re PU BL IS
9
Lean ( ) (One-piece Flow) (Single-piece Flow) () 1 209
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Toyota ( ) :
(Turnaround Time) 210 LeanHospitals
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90 60 45
5 Heijunka 1 3 Toyota Mura ()
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211
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Heijunka Gemba
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McConnell, K. J., , Ambulance Diversion and Lost Hospital Revenues, Annals of EmergencyMedicine 48(2006): 702-10.
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Costello, Tom, Hospitals Work to Improve ER Wait Times. MSNBC.com, 20 2006, http://www.msnbc.msn.com/id/15817906/ ( 21 2007).1
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1 Convis, Gary, Role of Management in a Lean Manufacturing Environment, Society of Automotive Engineers, http://www.sae.org/manufacturing/lean/column/leanjul01.htm ( 29 2007). Vasilash, Gary S., David Mann and Leading Lean, Field Guide for Automotive Management, http://www.autofieldguide.com/coluumns/0906profile.html ( 29 2007).2 3 4 5 6 7
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9 10
270 LeanHospitals
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Mann, David, Creating a Lean Culture (New York: Productivity Press, 2005), 149.
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Productivity Press Staff, Improving Flow: Collected Practices and Cases (New York: Productivity Press, 2006), 40.
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Jimmerson, Cindy, A3 Problem Solving for Healthcare: A Practical Method for Eliminating Waste (New York: Productivity Press, 2007), xi.
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Public Affairs Division, The Thinking Production System: TPS as a Winning Strategy for Developing People in the Global Manufacturing Environment, 8 2003, http://www. toyotageorgetown.com/tps.asp ( 15 2007).8
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Wheeler, Donald J., Understanding Variation: The Key to Managing Chaos (Knoxville, TN: SPC Press, 1993), 28.
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Shook, John, , First Global Lean Healthcare Summit, 25 2007.
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Flinchbaugh, Jamie, The Hitchhikers Guide to Lean (Dearborn, MI: Society of Manufacturing Engineers, 2006), 39.
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Lean Enterprise Institute, New Survey: Middle Managers Are Biggest Obstacle to Lean Enterprise, 18 2007, http://www.lean.org/WhoWeAre/NewsArticleDocuments/Web_Lean _survey.pdf ( 10 2007).
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Marchwinski, Chet John Shook, Lean Lexicon (Brookline, MA: Lean Enterprise Institute, 2003), 34.1
HI NG
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316 LeanHospitals
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Appleby, Julie, Care Providers Slam Health System, USA Today, 9 2001, A01.
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Graban, Mark, LeanBlog Podcast #23-Group Health Cooperative Lean Panel, LeanBlog Podcast, 29 2007, http://www.leanblog.org/2007/04/leanblog-podcast-23-group-health. html ( 21 2007).
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FMEA: (Failure Modes and Effects Analysis) Gemba: / Genchi Genbutsu: Heijunka: 317
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FIFO: (First-in First-out)
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Baka Yoke: Poka yoke
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Jidoka: Kaikaku: Kaizen (Point Kaizen): Kaizen (System Kaizen): ( 12-16 ) Kaizen (Point Kaizen) Kaizen (Kaizen Event)
RPIW: (Rapid Process Improvement Workshop) Kaizen Six Sigma: Green Belt Black Belt 6 Sigma 3.4 1 318 LeanHospitals
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Poka Yoke:
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PDCA (PDSA): --- (Plan-DoCheck-Act) --- (Plan-Do-Study-Act) Shewhart Deming W. Edwards Deming
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Kanban:
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Kaizen:
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(Phlebotomist): (Value-added): 3 : (1) (2) (3)
(Rework): (Workaround): 319
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(Diversion):
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(Non-value-added): 3
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(Value Stream Map: VSM):
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(Turnaround Time): ( )
(Waste of Talent): (Flow): (Onepiece Flow) (One-piece Flow): (Single-piece Flow) (Single-piece Flow): (Stockout): 0 (Total Quality Management: TQM): 1980 1990 (Batching): (Batch) 1 1 (Pull): (Push) (Inspection): 100%320 LeanHospitals
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(Level Loading): Heijunka
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5 (Five Whys): ( ) (Error Proofing):
(Waste of Motion): (Waste of Defect): () ( ) (Rework) 321
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(Violation):
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(Waste of Transportation): (Waste of Overprocessing): (Centrifuge) (Waste of Overproduction):
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322 LeanHospitals
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(Standardized Work):
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(Product): (Metrics):
(Future State): (Ideal State): (Root Cause): 5 323
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(Practical State):
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(Safety Stock):
324 LeanHospitals
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(Value Stream):
Mark Graban ValuMetrix Services Ortho Clinical Diagnostics Inc. Johnson & Johnson Mark Mark Mark Northwestern University Massachusetts Institute of Technology Leaders for Manufacturing Mark LeanBlog (www.leanblog.org) Laboratory Medicine Lean Yearbook 2007 Society of Manufacturing Engineers Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement 2009 Shingo Research and Professional Publication Award 2 2012 Healthcare Kaizen: Engaging Front-Line Staff in Sustainable Continuous Improvements Mark Livonia Keller Amy com Mark www leanhospitalsbook.
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. Engineering Management Sciences Industrial Engineering Wichita State University 10 . . (The Toyota Way), , . .. , Marketing Logistics , Essentials of Supply Chain Management : ,
326 LeanHospitals
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E.I. Square Publishing...http://publishing.eisquare.com
: The Toyota Way Fieldbook : Jeffrey K. Liker David Meier : . ISBN : 978-974-09-6740-8 : 550
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: Toyota Talent : Jeffrey K. Liker David Meier : . ISBN : 978-974-09-6745-3 : 450
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: : : ISBN : : ISBN : :
The Toyota Way Jeffrey K. Liker . 974-93096-1-8 390 () 978-611-7062-07-0 250 ()
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327
(Shopfloor Series) Cellular Manufaturing : One-piece Flow for Workteams : The Productivity Development Team : . ISBN : 974-94684-0-6 : 170 : Just-in-Time for Operators : The Productivity Development Team : . ISBN : 974-94684-1-4 : 170 : Pull Production for the Shopfloor : The Productivity Development Team : . ISBN : 974-94684-5-7 : 170 : Identifying Waste on the Shopfloor : The Productivity Development Team : . ISBN : 974-94684-6-5 : 170 : Standard Work for the Shopfloor : The Productivity Development Team : ISBN : 978-974-7628-41-8 : 170 : OEE for Operators : The Productivity Development Team : ISBN : 978-974-7628-42-5 : 170 : Quick Changeover for Operators : The Productivity Development Team : ISBN : 978-974-7628-43-2 : 170 : Mistake-Proofing for Operators : The Productivity Development Team : ISBN : 978-974-7628-44-9 : 170 : Kaizen for the Shopfloor : The Productivity Development Team : ISBN : 978-974-7628-40-1 : 170
: Kanban for the Shopfloor : The Productivity Development Team : ISBN : 974-94684-4-9 : 170
328 LeanHospitals
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E.I. Square Publishing...Andy & Me : : Pascal Dennis : . ISBN : 978-974-7628-64-7 : 260 Lean Logistics : : Michel Baudin : . ISBN : 978-974-7662-69-6 : 430 Andy & Me 2 : Pascal Dennis : . ISBN : 978-616-7062-10-5 : 390 : Creating a Lean Culture : David Mann : . . ISBN : 978-974-2588-83-0 : 350 : LEAN THINKING : James P. Womack Daniel T. Jones : . ISBN : 978-974-7231-31-1 : 450 : World-Class Warehousing and Material Handling : Edward H. Frazelle, Ph.D. : ISBN : 974-94684-3-0 : 330 : : Damon Schechter, Gordon Sander : ISBN : 974-94420-9-1 : 330 ... ( 3) : . ISBN : 974-94063-7-0 : 150
: Marketing Logistics : Martin Christopher Ph.D., Helen Peck Ph.D. : . ISBN : 974-94684-2-2 : 280 : . ISBN : 974-91387-5-9 : 150 2 : . ISBN : 974-92314-8-1 : 150
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: Improving Production with Lean Thinking : Javier Santos, Richard Wysk, Jose Manuel Torres : ISBN : 978-974-0462-48-4 : 340
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DNA : Inside The Mind of TOYOTA : Satoshi Hino : . ISBN : 978-974-0462-57-6 : 450
Sq
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BL IS
HI NG
329
http://publishing.eisquare.com S&OP : Thomas F. Wallace : . . ISBN : 978-611-7062-05-6 : 350 : STRATEGY MOVES : Jorge A. Vasconcellos E S : ISBN : 978-974-9468-48-7 : 290 Samsung Sony : Sea - Jin : . ISBN : 978-974-2368-21-0 : 295 : Essentials of Supply Chain Management : Michael Hugos : . ISBN : 974-93568-3-7 : 270
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: The Apple Way : Jeffrey L. Cruikshank : ISBN : 978-974-8388-60-1 : 320
Mindset... : Carol S. Dweck : ISBN : 978-974-7628-65-4 : 295
(Outsource) : The Managers Step-by-Step Guide to Outsourcing : Linda R. Dominguez : . ISBN : 978-974-7231-22-9 : 270
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330 LeanHospitals
PU
BL IS
Does IT Matter? : : Nicholas G. Carr : . ISBN : 974-9391-78-0 : 250
... : How Dell Does It : Steven Holzner : . ISBN : 978-974-9468-49-4 : 330 : Systems Thinking : Virginia Anderson Lauren Johnson : . ISBN : 978-974-8388-61-8 : 260 : : David A. Schmaltz : ISBN : 974-91903-9-4 : 225
HI NG
: The Origin of Brands : AI Ries, Laura Ries : ISBN : 974-94253-2-4 : 350
... : Performance Measurement Explained : Bjqrn Andersen, Tom Fagerhaug : . . ISBN : 974-94407-9-X : 290 TRIZ : ISBN : 978-974-0547-37-2 : 190 Best Practices : Dr.Tony Wild : ISBN : 978-974-2368-26-5 : 450 ERP : David Olson : . . ISBN : 978-616-7062-01-3 : 320
What is Lean Six Sigma? : Michael L. George, David Rowlands, Bill Kastle : . ISBN : 978-616-7062-08-2 : 220 : The Handbook of Logistics and Distribution Management 3rd ed. : Alan Rushton, Phil Croucher and Peter Baker : . . . ISBN : 978-974-09-6754-5 : 650 RFID (ROI) : Charles C.Poirier & Duncan McCollum : . . ISBN : 978-974-2588-88-5 : 350 ! Lean Accounting : Brian H. Maskell Bruce Baggaley : ISBN : 978-616-7062-00-6 : 490 TPM : Kenichi Sekine Keisuke Arai : ISBN : 978-616-7062-03-7 : 550 All I Need to Know about Manufacturing I Learned in Joes Garage : William B. Miller Vicki L. Schenk : . ISBN : 978-616-7062-09-9 : 150
Supply Chain Science : Wallace Hopp : . , . . ISBN : 978-616-7062-02-0 : 390 Hoshin Kanri : Thomas L. Jackson : . , ISBN : 978-616-7062-04-4 : 390
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What is Lean Six Sigma? : Michael L. George, David Rowlands, Bill Kastle : . ISBN : 978-616-7062-08-2 : 220 : Lean Distribution : Kirk D. Zylstra : . . ISBN : 978-616-7062-06-8 : 350 : Value Stream Management : Don Tapping, Tom Luyster, Tom Shuker : . , ISBN : 978-974-9468-47-0 : 295 101 (Creative Problem Solving Techniques) : James M. Higgins : . ISBN : 978-616-7062-13-6 : 360
Six Sigma : Warren Brussee : ISBN : 978-616-7062-05-1 : 400
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Mayo Clinic : Leonard L. Berry Kent D. Seltman : ISBN : 978-616-7062-12-9 : 390
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Extreme Toyota: : Emi Osono, Norihiko Shimizu No Picture Hirotaka Takeuchi : . ISBN 978-616-7062-17-4 332 : LeanHospitals
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PDCA Toyota A3 : Understanding A3 Thinking : Durward K. Sobek Art Smalley : . , ISBN : 978-616-7062-11-2 : 320
(Creating your Lean Future State) : Tom Luyster Don Tapping : . , , ISBN : 978-616-7062-14-3 : 250 Lean Six Sigma : Michael L. George, David T. Rowlands, Mark Price, John Maxey : . ISBN : 978-616-7062-15-0 : 450 Lean Hospitals : Mark Graban : . ISBN : 978-616-7062-16-7 : 390 Toyota Under Fire : Jeffrey K. Liker Timothy N. Ogden : . ISBN : 978-616-7062-18-1
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5 (Learning Organization)Peter Senge MIT The Fifth Discipline : The Art and Practice of The Learning Organization Learning Organization
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: David Hutchens : .
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The Tip of the Iceberg : ISBN : 978-611-7062-00-1 : 200
Systems Thinking
Personal Mastery
The Lemming Dilemma : ISBN : 978-611-7062-01-8 : 200
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Shadows of the Neanderthal : ISBN : 978-611-7062-02-5 : 200
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Outlearning the Wolves : ISBN : 978-611-7062-03-2 : 200
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Listening to the Volcano : ISBN : 978-611-7062-04-9 : 200
Dialogue
5 (Learning Organization) 5 ISBN : 978-611-7062-06-3 : 850 333
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