Director of Lean Healthcare South Carolina Presented by: Melanie Sudduth Director of Lean Healthcare South Carolina msudduth@scmep.org 864-354-4773 Needed Materials: Class books Flip Charts for team exercises Masking Tape Computer Projector Flip Chart Markers Optional Materials: Name Tags Sign-In Sheets

Why Are We Here Today? Provide a brief introduction to SCMEP Provide an overview of Lean Healthcare Spotlighting - Lean – An Overview of the Tools - reVIEW Program - TWI

Who is SCMEP An independent, non-profit 501c3 organization with its own charter and board of directors made up of SC manufacturing company owners and senior executives, as well as representatives from the state technical college system, research universities and Department of Commerce. Mission - To Strengthen the Global Competitiveness of South Carolina Businesses Vision - To be a primary resource for the South Carolina business community in providing highly-valued technological, workforce, and business solutions that improve competitiveness

Services for Business Executive Leadership Services (Strategic Planning, M&A, Business Valuations, Succession Planning & Exit Strategies, etc.) Top Line Growth (Marketing, Sales, Eureka Winning Ways and Lean Product Development) Productivity/Process Improvements (Lean, TOC, Engineering Design, etc.) Quality System Implementation (6 Sigma, ISO, QS/ TS Automotive, AS Aerospace standards) ISO 14001, Energy Assessments Environmental, Health & Safety Assistance Human Resource Solutions

SCMEP – Impacts for 2008 Companies Served 1,823 Investment $36.3 MM New and Retained Sales $152 MM Cost Savings $49.9 MM Jobs Created/Retained 1,360 Overall Economic Impact $254.8 MM

Defining Lean Lean is: “A systematic approach to identifying and eliminating waste (non-value added activities) through continuous improvement by flowing the product or service at the pull of the customer in pursuit of perfection.” — The MEP Lean Network This is a definition of Lean. The important points are: Systematic approach – the approach is logical, not haphazard. Eliminating wastes – we are going to cut out the stuff that drives you crazy anyway! This isn’t about making people work harder, it is about getting rid of things that they have to do that is a waste of their time anyway! Continuous Improvement – We can’t do it all at once! We have to take a little at a time, but by breaking the transformation into small bite size pieces, we can be very successful. Pull of the Customer – It is really about the patients….we must be focused on the patient! Pursuit of Perfection – We can never be satisfied! We need to always drive to be better and better….if we don’t, someone else will!

Definition of Value-Added Any activity that increases the market form or function of the product or service. (These are things the customer is willing to pay for.) Non-Value-Added Any activity that does not add market form or function or is not necessary. (These activities should be eliminated, simplified, reduced, or integrated.) If you learn nothing else, please understand these 2 terms and begin to look at your own work in a different light. VA – These are tasks or activities that we do that our customer would be willing to pay for. Ask the class: Who are our customers? What activities or tasks would they be willing to pay this hospital for? Examples may include: - Administering Meds - Stitching wounds - Setting bones NVA – These are the tasks or activities that do not add any value to the service and we should eliminate, simplify, reduce or integrate these activities as much as possible. What activities might be NVA? - Moving patients to CT - Moving patients to the OR - Filling out redundant information - Waiting to see a Dr, Nurse, etc.

Typically >60% of the total lead time is non-value-added. Lean = Eliminating NVA Value-Added Non-Value-Added (Muda) Overproduction Waiting Confusion Processing Inventory Defects Motion/Travel As you can see from this chart, approximately 60% of the time that patient is in the hospital is non-value added time. This may also mean that 60% of the tasks that we spend our time on as staff are things that the customer would not be willing to pay us for. Typically these non-value added activities (or Wastes) can be categorized into 8 major categories, known as the 8 Forms of Waste. Overproduction – Defined as making more, earlier or faster than is required by the next activity. One example of this may be doing all your lab work at one time and sending it all down to the lab at the same time. Can the lab work on this much? Or would they rather receive lab work as you completed it? Waiting – Why do hospitals have such beautiful and spacious waiting rooms? Because we make people wait….a lot! Patients are definitely not paying us to sit in our waiting rooms, they want to be seen by the Dr’s and nurses! Confusion – This is experienced quite a bit in hospitals. Have you ever had to verify a written or verbal order? Did you ever have to ask someone for information? This is forms of confusion that we see, which causes delays for the patient and the staff. Non-Value Added Processing – This is any activity or task that we do that is not truly adding value. One example of this may be taking a hand written record and then typing it into the computer. Excess Inventory – We have a tendency to hoard supplies. Not because we are being bad but usually to ensure that we have what we need when we need it. We can all think of a time when we needed something to do our job and when we went to look for the item we couldn’t find it, so from then on we swore that we would always have that item! This excess amount stashed is excess inventory that the hospital has cash tied up in. The stashing that we do is a band aid….we need to fix the underlying problem. Defects – As we all know patients would never pay for errors. In fact we need to be more careful than other businesses, because people’s lives are at stake. Excess Motion – Wouldn’t it be great if you had everything you needed right at your fingertips? We spend a lot of time leaving the patient room because we need a warm blanket or linens, etc. This is excess motion. We want to minimize the travel distances that you have to travel in order to do your job. Underutilized People – KSA’s (Knowledge, Skills, and Abilities) – One of the greatest things about the lean methodology is that it is a team approach. We cannot successfully improve the processes as an outsider. It is the facilitator’s job to help the team follow the steps and understand the lean tools, but they do not solve the problem for the team. 5S is not something you will “do” to someone! Typically >60% of the total lead time is non-value-added.

Overproduction Producing more than is required by the next process Producing earlier than is required by the next process Producing faster than is required by the next process Examples of overproduction: Duplicate charting Multiple forms with the same information Copies of reports sent automatically Greatly effects Process Lead Time! Little’s Law – PLT = Exit Rate (Slowest C/T) * WIP

Inventory Waste Any supply or purchase in excess of the current demand Examples of excess inventory: Overstocked medications on units Purchasing excess because the piece price is cheaper Stocking too much at point of use (large cabinet = fill it up!) Disorganization – can’t find it, so we buy more

Defects/Errors Inspection and correction of mistakes Examples of Defects/Errors: Wrong dosage/wrong medication administered Rework of any kind Inconclusive tests Incorrect charges/billing Surgical errors

Processing Waste Effort that adds no value from the patient/customer’s perspective Examples of processing waste: True requirements not clearly defined – Clarifying orders Extra copies or excessive information Missing medications Regulatory paperwork

Waiting Waste Idle time created when people, information, equipment or materials are not at hand. Examples of waiting waste: Waiting on test results Waiting on doctor/nurse, etc. Waiting on availability of equipment or treatment rooms Waiting on cleaning of rooms Waiting for “now” medications Waiting on supplies

Confusion People doing the work are confused or not sure about what should be done. Examples of confusion: Unclear MD orders Unclear route for medicine administration Unclear system for indicating charges for billing Same activities being performed different ways different people

Motion/Travel Waste Any movement of people, equipment, supplies, etc. that does not add value. Examples of motion waste: Looking for information, supplies, people, etc. Supplies not located at point of use Unfavorable layout Supplies not prepped prior to patient treatment

Lean Building Blocks Continuous Improvement Pull/Kanban Cellular/Flow TPM POUS Quality at Source Quick Changeover Standardized Work Batch Reduction Teams Value Stream Mapping 5S is just one of the many lean tools, but it is a very foundational tool. 5S is one of the simpler tools to apply and understand, but it is a great place to start. Lean is not a single method, but an applied set of methods that can be used to eliminate wastes (non value added activities) of these, 5S is one of the methods. You can think about these lean tools just as you would a tool box…there are many tools with many uses, so you must know the use of the tool in order to know when and how to use it. Not every tool is right for every situation, just like you wouldn’t want to use a screw driver when you really need a hammer! Visual 5S System Facility Layout

Standardized Work All work is safely conducted with all tasks organized in the best known sequence, and using the most effective combination of these resources: People Materials Methods Equipment

5S – Workplace Organization & Standardization Sort Set in Order Shine Standardize Sustain A safe, clean, neat arrangement of the workplace provides a specific location for everything, and eliminates anything not required. 5S is based on 5 different steps Unlike some organizational programs, 5S is meant to decrease the frustrations that workers feel by making the workplace more organized for the people who are doing the work. This is not a program that makes the workplace look pretty for someone else, but to make it more user friendly for the workers.

Visual Controls Simple signals that provide an immediate understanding of a situation or condition. They are efficient, self-regulating, and worker-managed. Examples: Kanban cards Color-coded forms, supplies, etc. Lines on the floor to direct visitors to correct departments Lines on the floor to instruct staff where to return carts, equipment, gurneys, etc. Andon lights outside patient rooms (signals)

Facility Layout

Teams Teams Cross-trained and multi-skilled personnel Teams for Continuous Improvement Process quality, not inspection Decision-making done by those doing the work Problem solving teams

Setup or Changeover Reduction Definition: The time required from the completion of the last procedure until the start of the next procedure. Set-up includes getting instruments, getting supplies, setting-up rooms, getting materials, and getting paperwork. Benefits include: Improvement of capacity and volume Increase in flexibility Increase in competitiveness Increase in Patient Satisfaction Increase in Physician Satisfaction

Impact of Batch Size Reduction Batch and Queue Processing Process A Process B Process C 10 min. 10 min. 10 min. 30+ min. for total order, 21+ min. for first piece Continuous Flow Processing Process A Process B Process C 12 min. for total order, 3 min. for first part

Point Of Use Storage (POUS) Materials, Supplies and Equipment is where used Benefits: Reduced Motion/Travel Decreases patient delays Increases patient throughput Reduces confusion and “searching’

Quality at the Source Personnel must be certain that work is being performed correctly Techniques used: Samples or visual standards Process documentation defining quality requirements Poka Yoke – Mistake Proofing Techniques Root Cause Analysis Tools (A3 Problem Solving)

Push versus Pull Systems In a pull system of service, the timely transition of work from one step in the process to another is the primary responsibility of the downstream (i.e., subsequent) process – for example, the intensive care unit (ICU) orchestrating the transfer of the patient from the emergency department (ED). This is in contrast to most traditional “push systems,” in which the transition of work is the responsibility of the upstream (i.e., prior) process – for example, the ED trying to “push” patients into the ICU. Pull systems can be created whenever a patient is being moved from one point of care to the next. This is particularly important when the patient is being transferred from one care setting to another. Smooth communication and cooperation are keys to pull systems for patient transfer.

Cellular Flow Linking of processes into the most efficient combination to maximize value-added content while minimizing waste.

Total Productive Maintenance (TPM) Systematic approach to the elimination of the six major equipment losses: Setup and adjustment Breakdowns Idling and minor stoppages Reduced speed Startup Defects and rework

Conclusion Lean Simple and visual Patient driven Supplies as needed Reduce non-value-added Minimal lead time Quality Controls Value stream managers Traditional Complex Internally driven Excessive supplies Speed up value-added work Long lead time Rework & Errors Functional departments

Thank You.