1. Doing more with Less By: Melody States RN, CNOR, CASC“
By: Melody States RN, CNOR, CASC
Executive Director
Palo Alto Medical Foundation
Ambulatory Surgery Center Service Line

2. Lean strategies
An integrated set of activities focused on minimizing waste and non-value-added activities, i.e., things that take time and/or resources without direct benefit to the patient
Examples of how to use Lean concepts and tools in the Ambulatory Surgery Center setting
In the current day climate of health care reform, reduced reimbursements, transparency in pricing and staffing shortages, the need for surgery centers to be more nimble and productive than prior times has  increased substantially.  “Doing more with less” is the mantra that you hear everywhere these days. This session will provide a brief overview of Lean strategies--an integrated set of activities focused on minimizing waste and non-value-added activities, i.e., things that take time and/or resources without direct benefit to the patient.   

3. LEAN (versus Lean) RPIW Process Walks
5 S (Sort, Set in Order, Shine, Standardize, Sustain)

4. Lean Concepts and Practices
Value Stream Mapping
Process Flow Evaluations
4W boards
A3 Studies
PDCA
Standard Work
Reliable Methods
Visual Displays
Leader Standard Work

5. Value Stream Mapping
Looking at the process from patient arrival until the patient leaves the facility

7. Lean Concepts and Practices
Value Stream Mapping
Looking at the process from patient arrival until the patient leaves the facility

8. Lean Concepts and Practices

9. Process Flow Evaluation
4 w Boards
What, Work, Watch, Wait

11. Lean Concepts and Practices
Standard Work
Make sure it is followed by doing observations

16. Process Flow Evaluations
A3 study
A3 size of the paper 11 x 17, tells a story from left to right, lays out entire plan to solve a problem or make an improvement, no matter how big or small, on one sheet of paper

17. Develops thinking problem solvers – the 5 why's – what is the purpose, the problem, the cause, the plan, the proof. How do you know?
What is the Problem, what is the root cause of the problem, what are some possible countermeasures, how will you choose which to propose, what is implementation plan, how will you know if it worked

18. Do not act based on assumptions.
Fishbone – 5 categories – people, materials, equipment, method, environment

19. PDCA What is actually happening? What should be happening?
What must be happening?
What is the ideal condition?
Grasp the where, what and why of abnormalities by scanning a mile wide and an inch deep to spot the abnormality, then…
An inch wide and a mile deep to understand the root cause of the abnormality.

20. Standard Work
* Reliable Method

22. Visual Displays

25. Change Management Tools
(Tips and Techniques to direct change)
Leader Standard Work
Huddles
Rounding
White glove routine
Gemba Walks - Coaching opportunity with types of questions asked/Helpful Coaching
Observations/ Process walks
Tiered Checking Boards
Leader Standard Calendars
A3 Etiquette - Seek to Understand, Do not interrupt the presenter unless you totally don’t get it, ask factual questions, diagnostic questions to help presenter see cause and effect – do NOT suggest solutions, this takes ownership away from the problem solver/presenter.

26. Gemba Etiquette - Coaching Questions
A3 Etiquette - Seek to Understand, Do not interrupt the presenter unless you totally don’t get it, ask factual questions, diagnostic questions to help presenter see cause and effect – do NOT suggest solutions, this takes ownership away from the problem solver/presenter.
A task for leaders and managers is to create and maintain the organizational culture through consistent role modeling, teaching, and coaching, which is in many ways analogous to how kata are taught in the martial arts.
The basic goal of kata is to preserve and transmit proven techniques. Kata has come to be used in English in a more general or figurative sense, referring to any basic form, routine, or pattern of behavior that is practiced to various levels of mastery.

28. Leader Standard Calendars

29. Questions