lean in healthcare - nhlc / cnls pdfs/june 11/pier 9/lea… · lean in healthcare rhonda schwartz...
TRANSCRIPT
LEANIn Healthcare
Rhonda Schwartz Michael EliasDirector, Quality & Corporate PerformanceRisk Management Improvement Specialist
2007 North York General Hospital
Embracing Health - www.nygh.on.ca
The NYGH Leadership Culture Transformation
IHI
Collaboratives
Canadian Collaborative
Process
TransformationProjects
Safer HealthcareNow!
LEAN
Story TellingCulture
Transformation
Shame/Blame→
Just Cultu
re
Silos→SystemsCommand & Control→Stewardship
ED-GIMToolkit
Bosses→
Coaches
Embracing Health - www.nygh.on.ca
What is Lean?
• A set of principles that define the way
we do things
• Defines the way we think about
improvement
• Shapes beliefs about what is possible
Lean is a management philosophy
© 2005 Simpler Consulting, Inc.
Embracing Health - www.nygh.on.ca
Pillars of Lean
Co
nti
nu
ou
s
Imp
rov
em
en
t
Res
pe
ct
for
Peo
ple
Embracing Health - www.nygh.on.ca
Continuous Improvement
Current State
Current State
Improved State
Improved State
Generate & Implement Solutions
Generate & Implement Solutions
Identify Waste
Identify Waste
© 2005 Simpler Consulting, Inc.
Embracing Health - www.nygh.on.ca
The Lean Approach…
Enables:
• True potential of a process to be realized
• Identification and elimination of waste
• Quantum leaps in performance
• Focused standardized approach to improvement
Is Not:
• A quick-fix; it takes time to change processes and cultures
• Easy to do; often it is quite painful for some
• Random process improvement
• Additional work, it is a new way of working
Embracing Health - www.nygh.on.ca
Cycle of Improvement
5 Day Kaizen
Day 1 – Current Condition
Day 2 – New Process
Day 3 – Implementation
Day 4 – Wash, Rinseand Tweak
Day 5 – Final Presentation
Preparation Kaizen
3 Weeks
Follow-up
1 Week 3 Weeks
Preparation
Week 1 – On your Marks
Week 2 – Get Ready
Week 3 – Get Set
Follow-up
Week 1 – All or Nothing
Week 2 – Don’t Relax
Week 3 – Hold the Gains
Embracing Health - www.nygh.on.ca
Kaizen (“For the Greater Good”)
• highly focused teams• right people involved
• accountability "by Friday"• identification of waste• application of proven principles• experienced coaching• rapid change
The “MAGIC” of Kaizen Events is simple…
Kaizen Week
FormingFormingTestingTesting
•• PolitePolite
•• ImpersonalImpersonal
•• WatchfulWatchful
•• GuardedGuarded
PerformingPerformingClosenessCloseness
•• ResourcefulResourceful
•• FlexibleFlexible
•• OpenOpen
•• EffectiveEffective
ThursdayFinalize and document standard work flow & control plan
MondayCurrent state map & identification of wastes
WednesdayImplement and test the new process
TuesdayElimination of wastes & creation of new process
NormingNormingGetting OrganizedGetting Organized
•• Developing SkillsDeveloping Skills
•• Giving FeedbackGiving Feedback
•• Establishing Establishing
ProceduresProcedures
StormingStormingInfightingInfighting
•• Controlling ConflictsControlling Conflicts
•• Confronting PeopleConfronting People
•• Opting OutOpting Out
•• Feeling StuckFeeling Stuck
FridayFinal Presentation
Embracing Health - www.nygh.on.ca
Embracing Health - www.nygh.on.ca
Emergency Services Program Results
74%74%0.7 hours2.8 hoursTransfer of Admitted Patients to Inpatient Beds
• Bed assigned to patient in bed
21%21%6.6 hours8.3 hoursSub Acute Care
• Triage to discharge
31%31%0.89 hours1.3 hoursAccess to CT Scan
• ED order written to results
received
16%16%2.6 hours3.1 hoursAmbulatory Care
• Card swipe to discharge
% ImprovementCurrentlyBaselineKaizen Event
Embracing Health - www.nygh.on.ca
In-patient Medical Unit Results
80%80%0.4 hours2.1 hoursBed Assignment
• Bed ‘dirty’ to bed assigned
45%45%0.9 hours1.6 hoursDischarge Bed Cleaning
• Response time to dirty room
82%82%
11%11%
0.4 hours
2.3 hours
2.4 hours
2.6 hours
Discharge Process• Discharge confirmed to order written
• Discharge order written to patient
leaves bed
43%43%69%39%
Hospitalist Standard Work• Identification of probable
discharges one day prior to discharge
49%49%
37%37%
17 patients
15 min/hr
11.4 patients
24 min/hr
Hospitalist Utilization• Average number of patients per
Hospitalist• Time spent traveling
% ImprovementCurrentlyBaselineKaizen Event
Embracing Health - www.nygh.on.ca
NYGH Before Kaizens
EVS
Admitting
Emerg
In Patient
Units
Port
ering
NYGH After Kaizens
Discharge process
Hospitalists
Bed cleaning
Bed assignment
Patient transfer
ED triage
CT test results
Embracing Health - www.nygh.on.ca
Embracing Health - www.nygh.on.ca
Results
Discharge Confirmed to Patient in Bed (in hours)
���� Discharged Confirmed to Order Written���� Order Written to Bed Empty���� Bed Empty to Cleaning in Progress���� Cleaning in Progress to ED Notification���� ED Notification to Patient in Bed
2.4 2.6 2.81.6BeforeKaizens
AfterKaizens 2.3 .9 .7
11.5 hours
4.7 hours59%
Reduction.4 .4
2.1
Embracing Health - www.nygh.on.ca
Lean Transformation
From:
• Staff Centred
• Role Focused
• They
• Followers
• Pessimism
• Powerless
• Problem Focused
• Reactive
• Silo Thinking
To:
• Patient Driven
• Team Focused
• We
• Leaders
• Optimism
• Empowered
• Solution Focused
• Proactive
• System Thinking
Embracing Health - www.nygh.on.ca
Our Common Goal
“The key is seeing everything through the eyes of the patient.”
Embracing Health - www.nygh.on.ca
Lean Learnings…
• Senior Leadership Support and Involvement• Physician Champion • Content Expert• Build Capacity• Identify Leaders• Strategic Event Selection• Time Commitment • Tenacity/Courage• Realistic Expectations• Rhythm for Improvement• Communicate, Communicate, Communicate• Celebrate the Successes!
Embracing Health - www.nygh.on.ca
Empowerment
“We are so used to having decisions
made for us and having to implement
them. It was nice to actually make
decisions ourselves and actually see
them implemented.”
Source: Staff RN