1. Transforming Healthcare by Design
2nd Annual Global Nursing Management & Innovation Forum
Seán Paul Teeling
Assistant Professor Health Systems/Mater Lean Academy
UCD School of Nursing, Midwifery and Health Systems, Dublin
Affiliate, Centre for Person Centred Practice Research, Queen Margaret University, Edinburgh

3. Issue 1: The Complexity of Healthcare
Healthcare ‘the most complex of any industry’ Peter Drucker.

4. Issue 2: The Risk of Silo Mentality
Healthcare complexity can lead to a strong silo mentality.

5. Issue 3: ‘We’re not Japanese and we don’t make cars’

6. Issue 4: The Process not the Person
“94% of Problems are caused by the system and 6% by the individual” Deming’s 94/6 rule

7. Issue 5: Cutting waste not care

8. Describes the philosophy underlying the Toyota Production System (TPS) (Womack and Jones, 2003; Kollberg et al., 2007; Aherne and Whelton, 2010
Is a quality improvement approach that consists of the elimination of waste (steps that do not add value in the eyes of the customer) to improve the flow of people, information or goods (Zidel, 2006; Aherne and Whelton, 2010)
Provides a way to specify value, line up value creating actions in the best sequence, conduct these activities without interruption whenever someone requests them, and perform them more and more effectively. — (Jones and Womack,1996)
Achieves this value add by through the application of five principles (Womack and Jones (2003) and Proudlove et al (2008).

9. Has its origins in Motorola, where in 1987 it was introduced as a company-wide quality improvement methodology (Proudlove et al, 2008).
Is a quality improvement (QI) methodology and management system, focusing on data and costs (Bisgaard and Freiesleben, 2004).
Is a data driven process improvement methodology designed to improve process capability and enhance process throughput through the introduction of improvement projects (Pande et al., 2002; Rath and Strong, 2002; George, 2005).
Achieves this through use of the DMAIC process

10. Synergies exist between both Lean and Six Sigma as they each take a process view and converge in their focus on variation, flow and the customer (Laureani et al., 2013)
One of key strengths of LSS is that it seeks to find the ‘root cause’ of problems in process which means that it utilises real time observational data collection (Graban, 2012) .
Lean promotes a ‘doing the right thing’ approach ‘value add’ (Langabeer et al 2009).Six Sigma focuses on ‘doing things right’ ‘no errors’ (Langabeer et al 2009)
Lean and Six Sigma have complimentary strengths (De Konig et al, 2006)

11. A visual representation
BEFORE
AFTER

12. EMBEDDING LEAN provides membership for key governing body for Lean
LEAN STRATEGIC BOARD
HOSPITAL EXECUTIVE
LEADERSHIP TEAM
provides membership for
key governing body for Lean
one of its members appointed
actively engages with
HEAD OF TRANSFORMATION
EXECUTIVE CHAMPION
LEAN STEERING COMMITTEE
EXECUTIVE MEMBERS
owns success of the journey
LEAN MANAGER
MMUH BLACK BELT
guides all projects and trains / mentors Green Belts
TEAM LEADER
MMUH GREEN BELT
TEAM LEADER
MMUH GREEN BELT
TEAM LEADER
MMUH GREEN BELT

13. Mater Lean Academy – UCD Academic pathway
White Belt
Fundamentals of Lean
Green Belt
Black Belt
(Graduate Diploma)
Master Black Belt
(MSc)
2017/2018
The only complete healthcare pathway on the Island of Ireland

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A bottom up, top down approach

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Interdisciplinary, multidisciplinary teams

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Trained to be skilled LSS Green and Black Belts

17. ― H. James Harrington Business Improvement (1991)
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Examining their own processes to elicit change
“Measurement is the first step that leads to control and eventually to improvement. If you can’t measure something, you can’t understand it. If you can’t understand it, you can’t control it. If you can’t control it, you can’t improve it.”
― H. James Harrington Business Improvement (1991)
What are we doing?
Who is doing it?
Why are we doing it that way?
How will we improve it?
When will we improve it

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Using the Gemba philosophy of Go and See

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Listening and eliciting the voice of our customer

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By determining the Root Cause of problems – with data driven analysis
In God we trust, all others bring data – Demming

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By determining the Root Cause of problems – with data driven analysis
In God we trust, all others bring data – Demming

22. 8am drugs round time reduced by over 50%
Benefits realisation
ECHO Department
Cleaning
Drugs Round
8am drugs round time reduced by over 50%
Referrals to Community
Thrombolysis Pathway

23. 76% reduction in time to order in stores procurement
Benefits realisation
Hip Fracture Pathway
MDA Process
24% increase of patients reaching theatre for hip surgery within 48 hours
104 hours released p.a. for pharmacy and 434 for nursing in streamlined MDA order process
CT referral process
Ultrasound Waiting
20% improvement in CT order to report time and 61% improvement in accuracy of report
Wait time for patients in Ultrasound department reduced by 42% - wait time for Ultrasound appointment reduced from 115 to 84 days.
Stores Ordering
Outpatient Scheduling
76% reduction in time to order in stores procurement
83% reduction in waiting list inaccuracies and improved scheduling for outpatients

24. Annual Lean Symposium 280 attendees Standing room only
International Keynote speakers
Launched by Minister for Health
Widely publicised on twitter by the Minister and the Department of Health