Bringing Sanity to Clinical Work Life Lean in Healthcare Michael Nelson, MD Blue Corn Professional Services, LLC

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Slide 2 Bringing Sanity to Clinical Work Life Lean in Healthcare Michael Nelson, MD Blue Corn Professional Services, LLC Slide 3 Slide 4 SO HOW DID THEY DO THAT? Slide 5 Slide 6 Lean About removing waste for clinical care processes Importance of tools and culture 5S, Kanban, Single piece flow, etc. Transformational change for leads, supervisors, managers and senior leaders (oh and by the way clinicians) Shingo method Process Operators Slide 7 Definitions Value Added Value Added Physically or Emotionally Changes the Patient Patient is Willing to Pay for it Done right the first time Required Work Non Value Added It must be done based on our current regulatory processes TODAY, but does not meet all three (3) criteria above Slide 8 Leading with Lean The Possibilities Slide 9 8 Shingo Lean Implementation Primary Care Clinic Eight primary care physicians 4 internal medicine 2 family practice 2 pediatrics Lean Implementation Jan 08 April 08 Slide 10 Standard Work Area??? Solution = 5S Sort (remove infrequently used items) Set (Everything has a place and everything in its place) Shine (clean) Standardize Sustain Slide 11 Slide 12 Standard Work Area!!!! Slide 13 Creating the Value Stream Map Direct observation People flow: patients, providers, staff Materials flow: medical records, equipment Information flow: messages, test results Cycle time measurement Minutes count but seconds rule Full work analysis Videotape providers / staff Analyze each step of work with the staff person Determine demand Determine resources Slide 14 13 Future State Value Stream Map (where we need to focus improvement efforts to reach desired state) Slide 15 Taiichi Ohno was the Toyota executive largely responsible for structuring and implementing the system known today as the Toyota Production System over four decades after World War II. Ohno was known for drawing a chalk circle around managers and making them stand in the circle until they had seen and documented all of the problems in a particular area. Ohno Circle Slide 16 15 Creating Well Child Check Packets LOCATION: Registration Desk Packets: Created by Registration Staff Given to Patients Seen For Well Child Checks Contains a Variety of Forms & Documents 47,424 packets created per year Slide 17 Eight Deadly Wastes Excess Inventory Excess raw material, WIP, or finished goods. This hides problems such as process imbalances, late deliveries from suppliers, defects, equipment downtime and long setup times. Motion Any wasted motion employees make to perform the course of their work. Actions such as looking for, reaching for, stacking, picking up or putting down and walking. Correction Producing products that need correction or are defective. Repair, rework, scrap, replacement and inspection are all defect costs. Employee Participation Losing time, ideas, skills, improvements and learning opportunities by not engaging or listening to employees. Slide 18 Eight Deadly Wastes Overproduction Products being produced in excess of whats required. Products being made too early. This generates other costs such as overstaffing, storage and transportation. Waiting (time on hand) Workers that are standing around waiting on a machine, someone to bring them materials, equipment downtime and no work available. Transportation Carrying work in process (WIP) long distances, moving materials more than once, moving parts in and out of storage. Over processing Taking unneeded steps to process the work. Inefficient processing due to poor tool or product design and. Producing a higher quality product than necessary. Slide 19 18 Initial Batch Process CYCLES: 5 TOTAL TIME: 3:36 min CYCLE TIME: 0:43 sec OBSERVATIONS? Slide 20 19 Improved Batch Process CYCLES: 5 TOTAL TIME: 1:40 min CYCLE TIME: 0:20 sec (53% Improvement) IMPROVEMENTS: Forms Organized by Packet Type Eliminated Wasted Movement Error Proofing Slide 21 20 Single Piece Flow Process IMPROVEMENT: Build Packets While Waiting For Printer Eliminated Non-Value Added Time No Added Time To The Process Slide 22 Primary Care Clinic (FP, IM, Peds) Slide 23 Slide 24 Primary Care Clinics (FP, IM, Peds) Slide 25 Lean Culture consider culture in a work organization to be the sum of peoples habits related to how they get their work done David Mann Creating a Lean Culture Slide 26 Lean Culture That is, our idea of culture of a place or organization is a result of what we experience there. In this way a companys culture is a result of its management systemculture is critical, and to change it, you have to change your management system. David Mann Creating a Lean Culture Slide 27 Slide 28 Slide 29 QUESTIONS