1. Bill Nicklay Michele Balding Tiffany Brufladt THE IMPLEMENTATION OF LEAN WITHIN THE UNIVERSITY OF MICHIGAN HEALTH SYSTEM

2. THE TAUBMAN UROLOGY CLINIC WITHIN THE UNIVERSITY OF MICHIGAN HEALTH SYSTEMS The Department of Urology is comprised of a group of physicians and scientists with a single mission: curing urologic diseases. Provides comprehensive and compassionate care for adult and pediatric patients It is consistently ranked among the top fifteen in the nation by U.S. News and World Report.

3. Worked with Ford for eight years within their Lean manufacturing group He has worked with The University of Michigan Health System for 4 years Black belt in Six-Sigma His primary focus is on mentoring project managers and education in the clinic about lean He enjoys seeing positive change in the work environments he is involved with “It’s nice to combine my expertise (Lean) with healthcare to be able to help people.” He finds it most challenging to get everyone on board with the necessary changes and to get them to understand how it will make their daily work environment better. KEVIN DEHORITY - LEAN COACH

4. THE PROJECT The project began in October 2010 with a team of Lean Coaches, department administrators, director of operations, and a nurse manager It involved changing the way problems were dealt with and built problem solving into every day management As of March 2011, The University of Michigan Health System has implemented Lean in their department of Urology

5. LEAN IN DAILY WORK MODEL Daily team huddles were done at visual problem solving board Administration took part in daily leadership walks Monthly review and problem prioritization was done by team leads.

6. GEMBA WALKS Gemba is a Japanese term for going to where the work is done How They are Conducted: 1.Take Notes 2.Talk with at least one customer 3.Talk with individual members of the team 4.Review notes and make decisions

7. IMPLEMENTATION PROCESS Creating visual value metrics Teamwork Utilize the Everyday Lean Idea Process Gemba walks

8. Describe the Problem Impact on Organization Describe the Solution What was Learned? IMPLEMENTATION PROCESS Document Lean Solutions

9. Track the Frequency of Problems Visually Develop a Visual Problem Prioritization Process Build the Problem Solving into Every Aspect of Business IMPLEMENTATION PROCESS

10. CHALLENGES Lack of motivation from the staff to implement the changes To fix this, they showed the staff how their changes would make their work easier and more efficient Getting physicians engaged due to busy schedule Condensed meetings & responsibilities Complex data collection To fix this, they simplified value metrics.

11. QUALITATIVE RESULTS Graph provided by Kevin DeHority, Lean Coach

12. QUANTITATIVE RESULTS Value Metric Improvements: Pediatric surgery scheduling within 1 day, 112% improvement Adult patients into rooms within 15 minutes of arrival, 69% improvement # of Pediatric Patient visits completed in < 60 mins, 94% improvement.

13. FUTURE OPPORTUNITIES Implementing Lean in daily work model throughout the entire Value Stream of health system. Value stream- series of steps that a patient goes through that provides them with a good service from the health system. Follows the patient from the time they are admitted into the hospital until the time they are discharged Goal is to eliminate waste or steps that do not add value EX. Walk-In  Waiting Room  Nurse  I.C.U.  Dr. Assessment  X-ray  Follow-up/ Overview  Discharge

14. Any Questions?