REALIZING THE POTENTIAL OF LEAN
THINKING IN HEALTHCARE
Daniel T Jones
ChairmanLean Enterprise
AcademyUK
Why am I here?
• Jim Womack and I have helped many industries get big benefits from following Toyota in using Lean thinking
• Consumer goods, construction and the public sector• I volunteered to try in healthcare - the time is right!• I took many walks – following the flow of work • I brought the pioneers together – to share experiences
and create awareness of the opportunities• We then conducted many experiments – to hone and
write down how lean methods work in healthcare• Now helping to build management systems to go
beyond point improvements and pilots to deliver results
Quality and Lean Thinking
• The Quality movement strives to define best practice interventions and to eliminate variation and errors
• Lean focuses on the context of the flow of work to eliminate delays for patients, wasted effort for staff and unnecessary costs for hospitals
• They complement each other – quality > stability < flow• They also share a common evidence based methodology• Lean begins with engaging staff in improving their work• But these point improvements are hard to sustain without
and end-to-end perspective and a management system to support them
The District General Hospital
HOMEHOME
REHABREHAB
HOMEHOME
GPGP
PHARMACYPHARMACY SUPPLIESSUPPLIES
PATHOLOGYPATHOLOGY THERAPIESTHERAPIES
EMERGENCY DEPARTMENTEMERGENCY DEPARTMENT
MAUMAU
SAUSAUEMERGENCY
CLINICCLINICCLINICCLINIC
CLINICCLINICCLINICCLINIC
ELECTIVE
SURGUCALWARDSSURGUCALWARDSOPERATING
ROOMOPERATINGROOM
MEDICALWARDSMEDICALWARDS
IMAGINGIMAGING
OTHERWARDSOTHERWARDS
DISCHARGE
DISCHARGE
The Challenge
• Now we see the hospital as a collection of processes
• And we know how to improve most of the pieces
• What would it take to connect all these pieces together?
• This has to have the support of the top team – who need to take the time to see:-– What are all the things that could be done?– What would be the results for hospital performance?
Defining the Problem
The A3 Method
What is Demand?
Demand to Get OutDemand to Get In
Mapping the Current State
Mapping the Current State
Mapping the Current State
The Emergency Medical Value Stream
What is the rate of demand?How to create flow within departments?How to flow between departments?Where to schedule this flow?
6.5 days waiting for 3 hours of work!
The A3 so far
Creating Flow in ED
Synchronizing activities on Wards
Nursing Availability to Discharge from Wards
How to Level Discharge?
The Future State
Buffers
Pacemaker
Flow
The Emergency Medical A3 Plan
The Elective Surgical A3 Plan
The ResultsFree up capacity
Cut the Agency and Overtime Budget
Big procurement savings
Khalid’s ‘End to End’ Trial: The Perfect Week (October 2008)
• ED Cell led by Senior Decision Maker – Safe Admission Avoidance• MAU Cell led by Senior Decision Maker – Safe Admission Avoidance• MAU Buffer• Discharge Lounge Buffer• Plan for Every patient (on medical wards)• Visual Hospital (Bed Management)
The Implementation
• If there is a will to act• Someone has to have the end-to-end responsibility
- a value stream manager• Who works to establish the foundations
- stability and visibility• Gaining agreement from the team on the right actions
- based on the facts• With the backing to resolve conflicts between
Departmental and value stream objectives• And to deliver results – in length of stay and $ saved
Plan for Every Patient Boards
By the Hour in ED
By the Day on Wards
Line Management
The Tasks
Establish Stability – Plan for Every Patient BoardsRespond to Variances – Delays and Escalation
Solve Problems – Root Cause Analysis
Management
Standard Management – Frequent Regular ReviewsOngoing Role – Develop Staff Problem Solving Capabilities
The Visual Hospital Board
Managing the Hub
Escalation Management
System
Value Stream Management
The Tasks
Establish Stability – Visual Hospital Hub and Status BoardRespond to Variances – Buffers and Escalation
Redesign Processes – Design Experiments and Review progress
Management
Standard Management – Regular Value Stream WalksOngoing Role – Develop the A3 Analytic skills of the team
Top Management
$
• Understand the scale of the Opportunity and how to translate this into Money
• Focus on the Vital Few – emergency medical length of stay• Deselect other activities to free up the Capacity to act• Appoint and support a Value Stream Manager and Team• Resolve Conflicts between Departmental Objectives
and the needs of the Value Stream• Go to Review Progress regularly
A Lean Management System
Establish Respond to DesignStability Variances Experiments
A PC D
TopManagement
Value StreamManagement
LineManagement
$ Deselect
Responses
Value Stream Manager
PlanHub
Problem SolvingPatient Boards
In Conclusion
• This takes an end-to-end perspective
• And a different management system
• We call this Lean Management
• You might call it – Evidence Based Management
• Or “a New Common Sense”
REALIZING THE POTENTIAL OF LEAN
THINKING IN HEALTHCARE
Daniel T Jones
www.leanuk.org