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1 Introduction to Lean Lean is a systematic approach to identifying and eliminating waste through continuous improvement. Key principles Value is in the eyes of the customer Make value flow without interruptions Improve work flow Standardize work processes Pursue perfection 7 wastes Overproduction Excess motion Waiting Inventory Defect correction Over processing Lost creativity/talent Common Lean Tools Process Map Title: Asthma Triage Process Map Triage Nurse Primary Nurse Resident/PA/NP/ Student Attending MD Phase: Initiation of Treatment Patient unassigned provider Assigned Assigned Assigned Based on patient load, zone staffing Primary Assessment (PASS) Low Acuity Data entry Primary Assessment Discussion of Patient Order for Tx Verbal request for Meds High Acuity Primary Assessment

Introductionto*Lean* · p ti lo , z n’staf g Primary’Assessment’ (PASS) Low’Acuity Data’entry P ri may’A s ent Discussion’of’Patient O rde ’fo Tx V e rbal ’qustfo

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Page 1: Introductionto*Lean* · p ti lo , z n’staf g Primary’Assessment’ (PASS) Low’Acuity Data’entry P ri may’A s ent Discussion’of’Patient O rde ’fo Tx V e rbal ’qustfo

1    

Introduction  to  Lean  

Lean  is  a  systematic  approach  to  identifying  and  eliminating  waste  through  continuous  improvement.    • Key  principles  

– Value  is  in  the  eyes  of  the  customer  – Make  value  flow  without  interruptions  

• Improve  work  flow  • Standardize  work  processes  

– Pursue  perfection    

• 7  wastes  – Overproduction  – Excess  motion  – Waiting  – Inventory  – Defect  correction  – Over  processing  – Lost  creativity/talent  

 • Common  Lean  Tools  

– Process  Map    

Title:    Asthma  Triage  Process  Map

Triage  Nurse

Prim

ary  Nurse

Reside

nt/PA/NP/

Stud

ent

Attend

ing  MD

Phase:  Initiation  of  Treatment

Patient  unassigned  provider

Assigned

Assigned

Assigned

Based  on  patient  load,  zone  staffing

Primary  Assessment  (PASS)Low  Acuity Data  entry

Primary  Assessment

Discussion  of  Patient

Order  for  Tx

Verbal  request  for  Meds

High  Acuity

Primary  Assessment

     

Page 2: Introductionto*Lean* · p ti lo , z n’staf g Primary’Assessment’ (PASS) Low’Acuity Data’entry P ri may’A s ent Discussion’of’Patient O rde ’fo Tx V e rbal ’qustfo

2    

 – Value  Stream  Map  

 

       

– Spaghetti  Diagram    

   

   

Page 3: Introductionto*Lean* · p ti lo , z n’staf g Primary’Assessment’ (PASS) Low’Acuity Data’entry P ri may’A s ent Discussion’of’Patient O rde ’fo Tx V e rbal ’qustfo

3    

– Pareto  Chart    

   

– Fishbone  Diagram    

   

– Poka-­‐Yoke  (error  proofing)  http://www.thetoyotasystem.com/lean_inventions/poka_yoke-­‐you-­‐can%E2%80%99t-­‐go-­‐wrong.php  

       

49  24  

17  

4   4   3   0   0   0  0%  10%  20%  30%  40%  50%  60%  70%  80%  90%  100%  

0  

20  

40  

60  

80  

100  

CumulaS

ve  Percentage  

Num

ber  o

f  Events  

Hospital  Acquired  CondiSons  

Hospital  Acquired  CondiSons      Jan  2011  -­‐  August  2012    

Page 4: Introductionto*Lean* · p ti lo , z n’staf g Primary’Assessment’ (PASS) Low’Acuity Data’entry P ri may’A s ent Discussion’of’Patient O rde ’fo Tx V e rbal ’qustfo

4    

– 5S  

   

The  content  included  in  this  document  is  provided  as  a  brief  overview  of  Lean  concepts.  Numerous  websites  and  texts  are  available  that  provide  additional  information  about  Lean.                            Christine  M.  Walsh-­‐Kelly  MD      5-­‐19-­‐2014