lean tenets and principles -...
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Lean Tenets and PrinciplesErika Sundrud, M.A.AVP, QHR Consulting ServicesQuality, Safety, & Performance ImprovementMaster Black Belt in Lean Six Sigma
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Objectives
Give examples of measureable
improvement goals
Evaluate the environment according to the key principles of Lean
Describe the key concepts of performance
improvement
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Institute of Medicine, Crossing the Chasm: A New Health System for the 21st Century, published in 2001
AIM 1 Care should be SAFE
Patients should not be harmed by the care that is intended to help them.
AIM 2 Care should be EFFECTIVE
Providing services based on scientific knowledge to all who could benefit and refraining from providing
services to those not likely to benefit.
AIM 3 Care should be PATIENT-CENTERED
Respectful of and responsive to individual patient preferences, needs, and values and ensuring that
patient values guide all clinical decisions.
AIM 4 Care should be TIMELY
Reducing waits and sometimes harmful delays for both those who receive care and those who give care.
AIM 5 Care should be EFFICIENT
Avoiding waste, including waste of equipment, supplies, ideas and energy
AIM 6 Care should be EQUITABLE
Care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic
location, and socio-economic status
Also known as the Six Dimensions of Quality
Six Measurable Improvement Aims
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Quality Assurance
Conform to standards
Relies on inspection
Focus on items
Quality is separate function
Departmental function
Quality Improvement
Improved performance
Monitor over time
System orientation
Quality integrated in organization
Interdisciplinary function
QA vs. QI
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A hospital is a system
Variation exists
Improvement is possible when decisions are based on analysis of data over time
Three Key Concepts of Performance Improvement
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The First Law of Improvement
Every system is perfectly designed to achieve exactly the
results it gets.
7Institute for Healthcare Improvement
“Changing the people, or pushing them to “try harder” or “do better” will not result in improved performance.
If we want a new level of performance, we must get a new system.”
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What is Lean?
“The endless transformation of waste into value from the customer’s perspective.”
It is a System Thinking Concept.
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Two Tenets of Lean
1. Continuous Improvement
2. Respect for People
10Adapted from James Womack, Juran Institute
Key Principles of Lean Thinking
Identify & eliminate anything that does not add customer value (eliminate waste)
Promote flow – eliminate batching and variation
Focus on processes that deliver customer value
All activities (within the Value Stream) are categorized as adding value or creating waste
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ValueSpecify Value in the Eyes of the Customer
Defining Value
Value Added vs. Non-Value Added Activities
Waste
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Voice of the Customer
Needs and Wants of customer?
What is considered VALUE in their eyes?
What are their expectations?
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Value Added or Non‐Value Added
The Value-Added test Does the task contribute to meeting customer
needs?
Is the customer willing to pay for the task?
Does the task transform the product/service?
Does the customer want or need the transformation?
Is the task done right the first time?
If you answer ‘No’ to any of the questions
is the task value-added?
Over-production
Waiting
Transportation
ProcessingInventory
Motion
Defects
Identifying Waste
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Value StreamIdentify the Value Stream
Value Streams
Value Stream Mapping
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Value Streams
The value stream is the entire set of activities that encompasses the transformation of a patient or product from beginning to end.
A value stream map is a visual tool to help see and understand the flow of a process, information, and material.
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Are ideally from the perspective of the customer.
Can focus on macro- or micro- functions of a process.
Maps all actions currently required to deliver a product or service.
Requires direct observation of the work unit.
Shows waste across departmental boundaries.
The point is to understand the flow of information and material and then use that knowledge to improve your business.
Value Streams Value Stream Mapping
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WHAT ARE YOUR
VALUE STREAMS?
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FlowMake Value Flow Continuously without Interruptions
Defining Flow
Creating Flow
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Flow
Flows of Medicine and Time
o Flow of patients
o Flow of providers
o Flow of family and relationships
o Flow of process engineering
o Flow of supplies
o Flow of equipment
o Flow of information
o Flow of medications
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Flow
In order to accurately capture the flows:
You must see the flows with your eyes today
You cannot rely on what you’ve heard or seen in the past
Penny Game
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PullLet Customers Pull the Value
Push Systems
Pull Systems
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Push Systems
Push System:
Each process step (work station) tries to maximize its production rate and passes output onto the next process step (work station) regardless if it’s needed or not
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Push Systems
http://www.youtube.com/watch?v=HnbNcQlzV-4
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Pull Systems
Pull System:
Pace of operation is set to customer demand. Each process step (work station) produces output only when the next station signals need.
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Continuous Flow
Quantity
T i m e
Develop Plan for this
Design Normal Process to meet this
Customer Demand
Average Demand
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PerfectionContinuously improve in the pursuit of perfection through elimination of waste
Kaizen Philosophy
Continuous Improvement
Sustainment
Lean Culture
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Kaizen Philosophy
Don’t let ideal state get in the way of better
0%
50%
100%
% Im
prov
emen
t
Time (or Cost)
50% improvement
today is good!
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Sustainment
Statistical Process Control
Standard Work – Documented Process
Process Control Plan
Audit Process
Mistake Proofing
Lean Boards Impr
ovem
ent
Time
Without Sustainment
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Traditional vs. Lean Culture
Traditional Lean
Functional Silos Interdisciplinary teams
Managers direct Managers teach/enable
Benchmark to justify not improving; “just as good”
Seek the ultimate performance, the absence of waste
Blame people Root cause analysis
Rewards: individual Rewards: group sharing
Supplier is enemy Supplier is ally
Guard information Share information
Volume lowers cost Removing waste lowers cost
Internal focus Customer focus
Expert drives Process driven
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Why Lean?
Staff engagement
“Nothing about me without me”
Identify waste
Learn to see
Innovation
Target state
32Source: Virginia Mason Medical Center, published by IHI
Impact of Lean in Healthcare
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Reduce waiting time to see a physician
Increase patient satisfaction
More timely medical interventions
Reduce number of walk-outs
Increase bed availability by reducing LOS
Increase staff time available to treat patients
Use Lean to create value for the patient
Achieving Results
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Lean Guiding Principles for Achieving Results
Put sacred cows out to pasture!
Don’t assume
Question habits
for a better way
Impossibilities often aren’t
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Guiding Principles for Achieving Results
Lean Thinking
Key Principles
• Focus on processes that deliver value
• Identify & eliminate anything that does not add value (waste)
What Lean Is Not About…
• Making people work harder
• Short-cutting value-added processes
• Cutting staff!
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Lean Thinking Key Principles
Categorize all activities as adding value or creating waste
Focus on processes that deliver value to the customer
Identify & eliminate anything that does not add customer value (eliminate waste)
Promote flow - eliminate batching and variation
Lean work environments are pleasing!
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What is the Secret to a Successful ‘Lean’ Hospital?
Make Lean thinking the way every single person in your current and future hospital behaves
Measure every single strategy, policy, business plan, job description and individual task accordingly
If it’s not Lean, than don’t do it
Meetings, meetings, meetings
o Daily bed management meetings are necessary only because of poor bed management
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Summary of Key Points
Lean is a systems thinking approach that incorporates and extends elements of performance improvement
Lean principles work effectively in hospital environments to create a more efficient and productive work flow