Rutger I.F. van der Waal, dermatologist, MD PhD

Tergooi Medical Centre, Hilversum NL

Learning Lean for healthcare

Wheatfield under ThundercloudsVincent van Gogh, 1890

European Lean Educator Conference 2017

Programme in short

• Who am I – how did I become a doctor

• How I came across Lean

• Changing healthcare environment

• Lean in my hospital

• Lean in my department

• Future steps

Lean in healthcare

Lean in healthcare

• Who am I – how did I become a doctor

BSc Medicine: First 3 yearsTheory & knowledge

MSc Medicine: +3 years (T=6y)

Practical training

Next: PhD programme: +4 years (T=10y)

Research & thesis

Medical specialisation: +5 years (T=15y)Hands on practical training

The Anatomy Lesson of Dr Nicolaes TulpRembrandt van Rijn, 1632

• Who am I – how did I become a doctor

• How I came across Lean

• Changing healthcare environment

• Lean in my hospital

• Lean in my department

• Future steps

Lean in healthcare

Sailing aligned towards True North

• Who am I – how did I become a doctor

• How I came across Lean

• Changing healthcare environment

• Lean in my hospital

• Lean in my department

• Future steps

Lean in healthcare

Changing healthcare environment

• Increase in the need of healthcare (‘double aging’)

• Shortage of skilled nursing staff

• Decrease of compensation / price-reduction

Role of Lean

NOT:because Lean is about firing people or depriving them of acquired

benefits

BUT:to improve activities and processes WITHIN the healthcare system

How can Lean be helpful• Centralize activities that matter to the patient

• Hunt down and remove wasteful activities

Benefits of Lean in Healthcare

• Better performance

• Less mistakes and medical errors

• Better information provision for the patient

• Shorter waiting lists for the patient

• Lower hospital- and managementfees

• Greater work satisfaction for nurses and doctors

How Lean can be helpful

• Activities that matter to the patient:

• Skilled staff (i.e. nurses and doctors)

• No waiting list

• Safe and trustworthy environment

• Provision of good patient information

• Hunt down and remove wasteful activities

7 types of waste in healthcare

1. Transport moving patients, materials & equipment/machines

2. Waiting patients waiting for consultation or lab results

3. Overproduction excess diagnostics, and limit liability

4. Inventory medication, tools, referral notifications

5. Motion equipment, materials & medication

6. Mistakes & medical errors wrong patient booked, wrong procedure

planned, wrong diagnosis or medicine, an unsuccessful treatment, re-operate

7. Overprocessing perform diagnostic procedures more than once, filling in

too many lab forms, repeatedly explain procedures, test results or treatments

to the same patient.

• Who am I – how did I become a doctor

• How I came across Lean

• Changing healthcare environment

• Lean in my hospital

• Lean in my department

• Future steps

Lean in healthcare

Toyota Engineering Corporation, Nagoya

Kikuya Cleaning Services, Tokyo

Kanagawa Hospital

St Luke’s International Hospital, Tokyo

Nerima General Hospital, Tokyo

Lean applied in health care

Tergooi’s Lean House: ‘thoughtful & sustainable’

• Who am I – how did I become a doctor

• How I came across Lean

• Changing healthcare environment

• Lean in my hospital

• Lean in my department

• Future steps

Lean in healthcare

Lean for Dermatology: organisation & care

IdentifyValue

Map the Value

Stream

CreateFlow

EstablishPull

CreatePerfection

# 1

# 2

# 3# 4

# 5

The 5 principles of Lean

Lean in Health Care

Customer(a.k.a. patient)

How do we address the activitiesthat matter to the patient

• Activities that matter to the patient:

• Skilled staff

• No or hardly any waiting list, and in case of a

growing waiting list we plan more consultation

hours (in the evening)

• Safe and trustworthy environment (5S)

• Provision of good patient information

• Continuous patient surveys

• Hunt down and remove wasteful activities

We started with 5S

Learning experiences with Lean

Improvement ideas via Kaizen cards

1 2

Weekstarts & Improvement board

Patient satisfaction surveys for CI

improvement kata

coaching kata

Mentee

Mentor

Leading to better, quicker, safer & sustained processes & healthcare

Dermatologic patient care

Medicine: core business = patient care

Customer = patientbut: vulnerable and dependent customer, not (always) by choice

How to adjust patient care through Lean?

Burning platform

Burning platform in terms of dermatology

• Preventive care rather than treatment

• Provision of patient information

• Goal in the healthcare system: to eradicate skin cancer

Skin cancer treatmentthe Lean way

‘5S’ against skin cancer

Building new bridges in dermatologic care

• Who am I – how did I become a doctor

• How I came across Lean

• Changing healthcare environment

• Lean in my hospital

• Lean in my department

• Future steps

Lean in healthcare

Lean in healthcare

• Lean as part of medical education

• Continued Lean philosophy in healthcare

European Lean Educator Conference 2017

Learning Lean for Healthcare

Tulip Fields near The HagueClaude Monet, 1886

Rutger I.F. van der Waal, dermatologist MD PhD