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Implementing Lean in Healthcare Organizations Methods and Results John Beakes, Jr. President and CEO Operational Performance Solutions, Inc.
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Denver Health Results from Lean, 2006-2011
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Dr. Berwick on Lean “If you doubt that we know what to do, visit Denver Health or ThedaCare or Virginia Mason, and see the Toyota principles of lean production learned, mastered, adapted, and deployed through entire systems and into the skills and psyches of entire workforces. The result, over $100 million in savings at Denver Health while vastly improving the experience and outcomes of patients.” Observation from Donald M. Berwick, MD at the Keynote Presentation at IHI’s 23rd Annual National Forum on Quality Improvement in Health Care December 7, Orlando, Florida 3
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Kaizen Lean Gkanban Six Sigma JIT Ggemba MBB FMEA Poka-yoke 5S A3 RIE GSMED
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Transformation Has Two Elements Technical and Social
The Path to Lean Technical Tools and Techniques Pursuit of Perfection Value Stream Thinking Disconnected Process Improvement Tools Deployment Social Tools and Techniques Learning Organization Advanced Teambuilding Employee Empowerment Employee Engagement 5 5
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Quality “True North”
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Quality Patient Satisfaction Employee Morale “True North” Safety Cost
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Lean Deployment Guide 10
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Healthcare People “Get” Lean
Healthcare is the diagnosis and treatment of illness Lean is the diagnosis and treatment of processes The goal is to give healthcare professionals a new way to look at their processes using a small Lean toolset
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Lean System Models
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Denver Health Results from Lean, 2006-2011
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Ref: Going Lean In Healthcare. Institute for Healthcare Improvement
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A Medical Center Management System Model
The Erie VAMC Lean Model has been developed to provide the vision for all employees of the System that will be used to guide the implementation and sustainment of Lean in our organization. This is our Lean model, developed by the team here at Erie VAMC and adapted to our unique situation. While we have reviewed all the best Lean literature and consulted with highly experienced Lean practitioners in developing the Model, it is 100% our local adaptation of all this information. We will be introducing the Model to all current employees in the coming months, and it will be taught to all new employees in the future. In this manner, the Model will become a simple visual memory aid that helps the entire organization internalize the principles of Lean and the manner in which we will implement it at Erie VAMC. While the widespread acknowledgment of the Model is important, it is even more important that all employees understand and can describe each element. Once we have all embraced and understand this approach, we will introduce new tools to help with the implementation of each Model element. Always keep in mind we are going to develop OUR lean system, not that of any other group. It will most likely take several years to accomplish and we will need a visual to keep us always on True North for our system. Medical Center 17
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Benefits of a System Model
Provides an integrating framework Clarifies system interactions Facilitates communications Embodies “the story” Promotes consistency of purpose Enhances new employee training
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Benefits of a System Model
Provides an integrating framework Clarifies system interactions Facilitates communications Embodies “the story” Promotes consistency of purpose Enhances new employee training KEY TO SUSTAINMENT
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Quality Patient Employee Morale Satisfaction Safety Cost
© Copyright Operational Performance Solutions, Inc. Patient Satisfaction Employee Morale “True North” PDCA Safety A3 Problem Solving Value Stream Analysis Process (VSAP) Cost Mistake Proofing Pull Systems Continuous Flow 5S/Visual Management Standard Work The Lean System of Patient Care Principles Patient Centered Quality at the Source Standard Processes Engaged Employees Pursuit of Perfection Supplier Partnerships Objectives Defect Free Without Waste Just-in-Time Continuous Flow Continuous Improvement Leadership Commitment and Support Go See Ask Why Show Respect - Culture Centered on Patient Care Servant Leadership (EPIC) - Employee Engagement Cascading Annual Planning Process
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Quality “True North”
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Quality Patient Satisfaction Employee Morale “True North” Safety Cost
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Quality Patient Employee Morale Satisfaction Safety Cost
© Copyright Operational Performance Solutions, Inc. Patient Satisfaction Employee Morale “True North” PDCA Safety A3 Problem Solving Value Stream Analysis Process (VSAP) Cost Mistake Proofing Pull Systems Continuous Flow 5S/Visual Management Standard Work The Lean System of Patient Care Principles Patient Centered Quality at the Source Standard Processes Engaged Employees Pursuit of Perfection Supplier Partnerships Objectives Defect Free Without Waste Just-in-Time Continuous Flow Continuous Improvement Leadership Commitment and Support Go See Ask Why Show Respect - Culture Centered on Patient Care Servant Leadership (EPIC) - Employee Engagement Cascading Annual Planning Process
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Quality Patient Employee Morale Satisfaction Safety Cost
© Copyright Operational Performance Solutions, Inc. Patient Satisfaction Employee Morale “True North” PDCA Safety A3 Problem Solving Value Stream Analysis Process (VSAP) Cost Mistake Proofing Pull Systems Continuous Flow 5S/Visual Management Standard Work The Lean System of Patient Care Principles Patient Centered Quality at the Source Standard Processes Engaged Employees Pursuit of Perfection Supplier Partnerships Objectives Defect Free Without Waste Just-in-Time Continuous Flow Continuous Improvement Leadership Commitment and Support Go See Ask Why Show Respect - Culture Centered on Patient Care Servant Leadership (EPIC) - Employee Engagement Cascading Annual Planning Process
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Leadership Commitment and Support
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Leadership Commitment and Support Go See Ask Why Show Respect
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Leadership Commitment and Support Go See Ask Why Show Respect
Culture Centered on Patient Care Servant Leadership (EPIC) Employee Engagement Cascading Annual Planning Process
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Principles Patient Centered
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Value Stream Thinking and Organizational Structure
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ED Pharmacy LAB Radiology Imaging Hospital Floor
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ED Pharmacy LAB Radiology Imaging Hospital Floor
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Hospital Floor Pharmacy Radiology Imaging LAB ED
Performance Review; Professional Recognition; Promotions ED Pharmacy LAB Radiology Imaging Hospital Floor
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Patient Hospital Floor Pharmacy Radiology Imaging LAB ED
Performance Review; Professional Recognition; Promotions ED Pharmacy LAB Radiology Imaging Hospital Floor Patient
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Patient Hospital Floor Pharmacy Radiology Imaging LAB ED
Performance Review; Professional Recognition; Promotions ED Pharmacy LAB Radiology Imaging Hospital Floor Patient W W W W W W= WASTE
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Value Stream Analysis Process
Performance Review; Professional Recognition; Promotions ED Value Stream Analysis Process Pharmacy LAB Radiology Imaging Hospital Floor Patient W W W W W W= WASTE
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Principles Patient Centered Quality at the Source Standard Processes
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Standard Work Chart & SPD Lead Checklist
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Principles Patient Centered Quality at the Source Standard Processes Engaged Employees
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Medication Sorting After ----->
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Medication Sorting <----- Before After ----->
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Principles Patient Centered Quality at the Source Standard Processes Engaged Employees Pursuit of Perfection Supplier Partnerships
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Objectives Defect Free Without Waste
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Current Rounds made by a Floor RN
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Roaming Supply Cart Frequently needed supplies are stored in drawers.
Dietary items (i.e. spoons, applesauce, straws, thickener) are located in drawers separate from the linens.
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Objectives Defect Free Without Waste Just-in-Time Continuous Flow
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Decontamination 47
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Decontamination After Before 48
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Objectives Defect Free Without Waste Just-in-Time Continuous Flow Continuous Improvement
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Continuous Improvement
Lower the water level Find rocks Remove them Find new rocks Etc., etc… Seek perfection (a never-ending process) 50
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Denver Health Results from Lean, 2006-2011
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Quality Patient Employee Morale Satisfaction Safety Cost
© Copyright Operational Performance Solutions, Inc. Patient Satisfaction Employee Morale “True North” PDCA Safety A3 Problem Solving Value Stream Analysis Process (VSAP) Cost Mistake Proofing Pull Systems Continuous Flow 5S/Visual Management Standard Work The Lean System of Patient Care Principles Patient Centered Quality at the Source Standard Processes Engaged Employees Pursuit of Perfection Supplier Partnerships Objectives Defect Free Without Waste Just-in-Time Continuous Flow Continuous Improvement Leadership Commitment and Support Go See Ask Why Show Respect - Culture Centered on Patient Care Servant Leadership (EPIC) - Employee Engagement Cascading Annual Planning Process
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The Key Processes for Lean Healthcare
A3 Problem Solving Value Stream Analysis Process
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Quality Patient Employee Morale Satisfaction Safety Cost
© Copyright Operational Performance Solutions, Inc. Patient Satisfaction Employee Morale “True North” PDCA Safety A3 Problem Solving Value Stream Analysis Process (VSAP) Cost Mistake Proofing Pull Systems Continuous Flow 5S/Visual Management Standard Work The Lean System of Patient Care Principles Patient Centered Quality at the Source Standard Processes Engaged Employees Pursuit of Perfection Supplier Partnerships Objectives Defect Free Without Waste Just-in-Time Continuous Flow Continuous Improvement Leadership Commitment and Support Go See Ask Why Show Respect - Culture Centered on Patient Care Servant Leadership (EPIC) - Employee Engagement Cascading Annual Planning Process
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Building a True Lean Culture
Means winning “one heart and soul at a time” Each individual comes to a full commitment at their own individual pace Be patient - some who embrace it slowly become the strongest advocates You know you’re there when all employees engage in identifying and eliminating waste every day
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Quality “True North”
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Quality Patient Satisfaction Employee Morale “True North” Safety Cost
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Quality Patient Employee Morale Satisfaction Safety Cost
© Copyright Operational Performance Solutions, Inc. Patient Satisfaction Employee Morale “True North” PDCA Safety A3 Problem Solving Value Stream Analysis Process (VSAP) Cost Mistake Proofing Pull Systems Continuous Flow 5S/Visual Management Standard Work The Lean System of Patient Care Principles Patient Centered Quality at the Source Standard Processes Engaged Employees Pursuit of Perfection Supplier Partnerships Objectives Defect Free Without Waste Just-in-Time Continuous Flow Continuous Improvement Leadership Commitment and Support Go See Ask Why Show Respect - Culture Centered on Patient Care Servant Leadership (EPIC) - Employee Engagement Cascading Annual Planning Process
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Denver Health Results from Lean, 2006-2011
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Contact Information Operational Performance Solutions, Inc. 77 East Main Street, Suite 402K Westminster, MD (410) 63
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