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Arab Medical Center

Lean Thinking by: Wafa AlAhmed BSc, PgD, MLS(ASCP)cm Senior Quality Assurance Officer

Arab Medical Center-Jordan walahmad@amc-hospital.com

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Definition Lean is the culture of creating value & eliminating ‘waste’

• Improve quality• Enhance safety• Improve productivity• Improve efficiency• Reduce cost

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Lean Thinking

• Lean thinking was derived from Toyota organization in 1950

• Healthcare sector adopted lean in 2000 to improve the quality of its services

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1st Lean Principles Specify value from the customer viewpoint

Value Customer

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2nd Lean Principles

• Identify the value stream and eliminate waste

• Value Stream: A set of activities necessary to bring a service to the customer

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Value Stream Mapping

Phlebotomy Work Flow for Out Patients

Enter Patie

nt Data in LIs

Payment

Phlebotomy

Enter Patient Data in

LIsPayment Phleboto

my

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Types of Work Activities

Activities that Contribute to Satisfy the customer

Activities that must be

performed for legal or

regulatory requirements

Activities that the customer

would be unwilling to

pay for

Optimize Minimize Eliminate

Value-Add Business non- Non-Value Add Value Add

Types of Waste

The elimination of waste is the main characteristic of Lean. Waste is everything that doesn’t add value to the patient or process.

NON-UTILIZED TALENT

AUTOMATING INEFFICIENT PROCESS

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DefectsInformation, products or services that are inaccurate or incomplete.

• Repeated errors • Customer dissatisfaction• data entry errors• Fixing paper work that is not completely filled

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OverproductionMaking more, earlier or faster.

• The most serious of all wastes• Large batch sizes If defects discovered in small batch production then the economic loss is minimized • Printing 20 copies of a report but only

need 3 people to look at

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WaitingInvolves waiting for man, machine, materials or information.

• Excessive cycle time• High amount of wait time vs. work time• Waiting for files or information• Delays due to needing a signature

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Not utilizing people’s experience, skills knowledge, or creativity.

• Lack of empowerment• Not utilizing employees’ brains• Lack of suggestions• “That’s not my job” attitude• Lack of cross training

Non-Utilized Talent

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TransportUn-necessary movement of material around an organization.

• Inefficient “Flow”• Carrying large quantities in & out of storage• Moving equipment or files• Sending emails between departments• Redundant movement of materials

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InventoryAny supply (materials or goods) in excess of appropriate quantity at the appropriate time.

• Purchasing excess inventory• Long cycle times for certain parts or supplies• Risk of obsolescence (oldness) “First come- First go”

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MotionAny movement that does not add value to the product or service.

• Inefficient workplace organization• Inefficient placement of frequently used supplies,

tools,….etc.• Opening up multiple software applications• How far does the paperwork travel?• Where are critical resources located?

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Extra-ProcessingAny effort that does not add value to the product or service

• Re-work loops or work-around• Redundant process steps• Multiple signature• Extra fields requiring unused information• Un-necessary completion of templates, forms, documents

Over-processing is often inserted into a process as a result of dealing with defects, overproduction or excess inventory.

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3rd Lean Principles• Make value flow at the pull of the customer

• Flow is the goal

Value Customer

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4th Lean PrinciplesSupply what is pulled by the customer

• Buffer Holding area between two processes.

• Kanban Visual signs

Kanban Visual managementhttps://www.youtube.com/watch?v=rkpadFfyCqo

Perfection

5th Lean Principles  Problem Solving

By Root Cause Analysis

People & Partners(Respect, Challenge, Teamwork & Grown them Process

(Eliminate Waste)Right process will deliver right product

Philosophy (Long-Term Thinking) (Continuous Improvement & Learning)

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Patient Wait Time• Definition Wait time from the patients’ arrival to the laboratory reception area and the time at which the blood collected.

• Problem Patient waiting time in the reception area seem to be higher

between 10:30 AM – 12:00 PM. • Consequences -Excessive time spent away from work or personal activities. -Patients might leave and seek care elsewhere.

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Value Stream Mapping

Phlebotomy Work Flow for Out Patients

Enter Patie

nt Data in LIs

Payment

Phlebotomy

Enter Patient Data in

LIsPayment Phleboto

myWaitTime

WaitTime

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How to minimize Patient Wait Time

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How to minimize Patient Wait Time

• Insurance approval in the lab reception area

• Two med tech for registering the patients’ data, answering phone calls, delivering patients’ results.

• Two phlebotomists dedicated only for blood collection.

• Educate the patient by signs, posts, or through their physicians to get the approval for lab tests before visiting the lab.

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Facts & Data CollectionDate 17/8/2015, Time 10:30 Am-1:00 Pm

Note: children were excluded

Patient No. Time In Time Out Wait Time (min)

1 10:30 10:50 202 11:00 11:20 203 11:00 11:15 154 11:05 11:20 155 11:10 11:32 226 11:15 11:53 387 11:30 11:55 258 11:30 12:00 309 11:40 12.05 2510 12:10 12:25 1511 12:12 12:30 1812 12:40 12:50 2013 12:45 12:53 814 12:50 1:00 10

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Takt Time per 24 hourson 16th august, 2015

Takt Time Calculator 

 

Working Shifts per Day

3 Shifts

  Hours per Shift 8 Hours

  Break Time per Shift 5 Minutes

  Lunch Time per Shift 30 Minutes

 

Planned Downtime per Shift

10 Minutes

 

Customer Demand per Day

135 Units

 

       

 

Available Time per Shift

480 Minutes

 

Net Working Time per Shift

435 Minutes

 

Net Working Time per Shift

26,100 Seconds

 

Net Available Time per Day

78,300 Seconds

  Takt Time = 580 Seconds per Piece

  Takt Time = 9.7 Minutes per Piece

       

Definition Takt time is the time required to deliver quality services (to produce customer requirements)

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Takt TimeFor Shift A on 16th August, 2015

Takt Time Calculator 

 

Working Shifts per Day

1 Shifts

  Hours per Shift 8 Hours

  Break Time per Shift 5 Minutes

  Lunch Time per Shift 30 Minutes

 

Planned Downtime per Shift

10 Minutes

 

Customer Demand per Day

80 Units

 

       

 

Available Time per Shift

480 Minutes

 

Net Working Time per Shift

435 Minutes

 

Net Working Time per Shift

26,100 Seconds

 

Net Available Time per Day

26,100 Seconds

  Takt Time = 326 Seconds per Piece

  Takt Time = 5.4 Minutes per Piece

       

Plan, Do, Check, Adjust (PDCA) Sometimes known as PDSA (Plan, Do, Study, Act) cycle

• (PDCA) cycle provides a means of conducting safe experimentation or a number of trials to see the effect of any changes made in a bid to make improvement

Plan, Do, Check, Adjust (PDCA) Cycle

P - Plan: The trial is the most important part of the process.

• What you are planning to trial?• What are your objectives?• Who is needed to be involved/informed?• How are you going to do it?• How long will the trial run?• How are you going to measure improvement?• What is your communication plan?

D - Do: Carry out the trial

• Test the change and collect the data.

C - Check: Study the results

• Analyze the data you collected in the ‘plan’ and ‘do’ phase• Discuss outcomes with colleagues?• What went well?• What went wrong?• Did anything unexpected happen?• Could the process be improved?• If the trial didn’t go to plan, what was the root cause?

A - Adjust: Act on the results

• If the trial did not improve the process, could you treat the root cause in your next PDCA cycle?

• If the change was a measurable success, adopt and spread the improvement in your PDCA cycle.

Using 5S to improve safety5S is the basis for standardizing work to make the processes and environment safe.It is used to improve efficiency byeliminating waste, promoting flow,improving staff morale and mostimportantly improving safety.

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Why Standardized work is important?

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Why Standardized work is important?

• Employee involvement and empowerment,• Consistency (reduction of variation) among staff

members performing the work,• Improved productivity without added stress,• Improved, consistent quality,• Reduction or elimination of errors and mistakes

(causes of defects),• Work process stability,• Increased employee safety,• Improved cost management as wastes are removed,• Availability of a great tool for staff training, • Visual management--managers and supervisors can

see when processes are not operating normally.

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Medical Technologist Task

• To implement lean in each department.• Each medical technologist need to do a change in his/her

department that will improve AMC services.• It is recommended to discuss the idea of change by

27/8/2015 with the laboratory Director Mrs Randa Al-Ahmad & the senior QA officer Mrs Wafa Al-Ahmed & QA & Safety officer & Aphaeresis specialist Mrs Tasneem Al-Nsour for approval.

• You have two weeks time to perform a trial for your idea starting from 29/8/2015 to 12/9/2015.

• Measure the effect of the change you made.• Then demonstrate your work to your colleagues.

The Key to Success Is Small, Incremental

Improvement

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References• Improvement, N. H. S. Bringing lean to life.

Leicester, UK: NHS Improvement. 2010.• https://leansixsigmahealthcare.wordpress.com/20

15/06/24/using-lean-six-sigma-analytics-to-improve-patient-wait-times/

• http://www.6ixconsulting.co.uk/IGLC-Application-of-Batch-size-reduction-in-construction.pdf