Lean Management in Healthcare Medical Association of Georgia - - PowerPoint PPT Presentation

Lean Management in Healthcare

Medical Association of Georgia October 13, 2014 Kristina N. Hahn, MHA

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What is Lean?

• Philosophy derived from the Toyota Production System in the

1990s – the goal was to build ever-better automobiles at ever- lower costs.

• Lean simplifies processes by focusing on what adds value and

eliminating waste.

• Lean is much more than a set of tools – it is also a mindset and a

way of life.

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Lean can help you to…

• Improve safety
• Reduce errors
• Reduce cost
• Increase satisfaction
• Reduce wait times
• Grow volume
• Increase staff efficiency
• Increase revenue

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The 5 Principles of Lean

1. Value 2. Value Stream 3. Establish Flow by Eliminating Waste 4. Pull 5. Strive for Perfection

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• 1. Value
• Value is always defined by the customer.
• So many of the activities that consume our time and resources

are defined by what is valuable to the physician practice as a business – we fail to focus on what the patients value.

• A Lean practice identifies the activities the patient sees as

valuable and seeks to eliminate all other activities.

• Find out what your patient values: surveys, focus groups,
• bservations, etc.

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• 2. Value Stream
• Create visual representation of the value stream by mapping the

current process. This helps identify waste, issues with flow, or steps that do not add value.

• Example - ED Throughput:

Patient registered Patient arrives Presents at Reg Desk Reg asks patient presenting symptoms Patient sent to waiting room Triage nurse notified Patient brought to triage room Nurse completes triage Bed not clean – Patient sent to waiting room Patient brought to ED room Nurse completes ED assessment Provider sees Patient

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• 3. Establish Flow by Eliminating Waste
• Identifying and eliminating waste is key to process improvement
• 7 Types of Waste (WORMPIT):
• Waiting: delays or idle time involving the patient, physician or

staff

• Overproduction: producing too much or too soon
• Rework: any unnecessary work required due to an error
• Motion: any unnecessary movement of patients, staff or

physicians

• Processing: handling work in a way that is excessive
• Inventory: any information or materials waiting to be used
• Transportation: unnecessary transfers of materials,

information or people

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ED Throughput Example

Patient registered Patient arrives Presents at Reg Desk Reg asks patient presenting symptoms Patient sent to waiting room Triage nurse notified Patient brought to triage room Nurse does triage Bed not clean – Patient sent to waiting room Patient brought to ED room Nurse completes ED assessment Provider sees Patient

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Making Changes to Eliminate Waste

• Some design features to consider in rebuilding the process

include:

• Don’t move the patient. Instead, where it makes sense, make

the work come to the patient.

• Eliminate needless work. Perhaps your process includes too

many handoffs or outdated steps being completed out of routine.

• Because face-to-face time with the provider is often the most

valuable part of the visit, do everything you can to make the provider more efficient and effective.

• Make sure your process involves direct communication

between parties.

Source: Endsley S, Magill MK, Godfrey MM. Creating a Lean Practice. Family Practice Management. April 2006:34-38.

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• 4. Pull
• Taiichi Ohno (founder of Toyota

Production System) learned this principle from visiting American supermarkets

• Vendors do not replace fresh fruit until

consumers “pull” it from the shelves

• If we replenish only what the customer

requires or demands, we are not left with any waste

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• 4. Pull
• In healthcare, pull is used primarily to regulate the reordering of

supplies and their delivery to their point of use.

• It can also be used for scheduling and moving patients through a

process.

• The goal is to eliminate having more items or people in the

system than what the system can handle.

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Map the Redesigned Process

• Re-map your process, accounting for changes you believe will eliminate

waste, improve flow and maximize value.

Patient brought to bed (immediate bedding) Patient arrives Presents at Reg Desk Reg asks patient presenting symptoms Triage nurse notified Triage/Exam Bedside Provider sees Patient Nurse notifies provider Full Registration

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• 5. Strive for Perfection
• This final principle allows your practice to continuously strive for

excellence and not rest when progress is made

• Test your changes and make continuous improvements until the

process is close to perfection

• Never stop pursuing:
• Excellence
• Commitment to quality
• Total employee involvement

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Where do you go from here?

• It starts at the top
• Engage employees
• Designate a process improvement “expert”
• Begin identifying opportunities for improvement
• Work through each initiative, one at a time
• Celebrate wins, big and small
• Encourage continuous improvement

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Questions?

Contact Information: Kristina N. Hahn Consultant Stroudwater Associates khahn@stroudwater.com (404) 890-7255 www.stroudwater.com