Lean Hospitals: Improving Quality, Patient Safety, and Employee Satisfaction

The Case for Lean Hospitals Why Do Hospitals Need Lean? Lean Methods Are Not New to Healthcare Toyota's Role in Popularizing Lean Origins of the Term Lean Lean Is Proven to Work Outside of Automotive Factories Lean Is Helping Hospitals Improve Problems in Healthcare Price Pressures and Cost Challenges Coping with Employee Shortages Poor Quality of Care Good Quality Costs Less A Snapshot of Department Success A Snapshot of Hospital Success Conclusion Lean Lessons Ponder Notes Overview of Lean for Hospitals What Is Lean? Ohno's Definition of Lean Lean Thinking The Toyota Triangle: Tools, Culture, and Management System Human Development Philosophy Technical Tools Managerial Methods Lean Is about Reducing Waste and Respecting People Elimination of Waste Respect for People Fixing Healthcare from the Inside Capability 1: Work Is Designed as a Series of Ongoing Experiments That Immediately Reveal Problems Capability 2: Problems Are Addressed Immediately through Rapid Experimentation Capability 3: Solutions Are Disseminated Adaptively through Collaborative Experimentation Capability 4: People At All Levels of the Organization Are Taught to Become Experimentalists Conclusion Lean Lessons Points to Ponder Notes Value and Waste What Is Waste? What Is Value? Start with the Customer How Do We Define Value? Rule 1: The Customer Must Be Willing to Pay for the Activity Rule 2: The Activity Must Transform the Product or Service in Some Way Rule 3: The Activity Must Be Done Right the First Time Examples of Value-Added and Non-Value-Added Activities Learning to Identify and Describe Waste Waste of Defects Waste of Overproduction Waste of Transportation Waste of Waiting Patients and Products Waiting Employees Waiting Waste of Inventory Waste of Motion Waste of Nursing Motion Waste of Overprocessing Waste of Talent What Non-Value-Added Activities Are Required? Non-Value-Added, Pure Waste Conclusion Lean Lessons Points to Ponder Notes Observing the Process and Value Streams How Do We Find Waste? What Is a Value Stream? Value Stream Mapping Creating a Value Stream Map Observing the Process Activity of the Product Activity of the Product--Laboratory Activity of the Employee Activity of the Employee--Nursing Activity of the Employee--Perioperative Services Conclusion Lean Lessons Points to Ponder Notes Standardized Work as a Foundation of Lean The Need for Standardized Work The Toyota House Metaphor Overview of the Lean Foundations Lean Foundations: Standardized Work Definition of Standardized Work "Current" "Proper Outcome and the Highest Quality" "To Safely Complete" "One Best Way" Standardized, Not Identical Written by Those Who Do the Work Considering How Long Tasks Take Types of Standardized Work Documents Standardizing Daily Routines Defining Roles and Responsibilities Explaining Why through Standardized Work Standardized Work Documents and the Standardized Work System Measuring and Observing for Standardized Work Adherence Resistance to Standardized Work Asking Why When Standardized Work Is Not Being Followed Standardized Work Can Apply to Physicians Another Example of Having to Ask Why Training through Standardized Work Conclusion Lean Lessons Points to Ponder Notes Lean Methods: Visual Management, 5S, and Kanban Lean Is More Than Tools, but Tools Can Help Reducing Waste through Visual Management Examples of Visual Management 5S: Sort, Store, Shine, Standardize, and Sustain First S: Sort Second S: Store Third S: Shine Fourth S: Standardize Fifth S: Sustain Safety as a Sixth S? Kanban: A Lean Approach to Managing Materials Problems with Traditional Materials Systems Trade-offs with Inventory Using Kanban within a Department A Kanban Case Study Conclusion Lean Lessons Points to Ponder Notes Proactive Root Cause Problem Solving Improving Quality and Patient Safety Cultural Obstacles to Quality Improvement Why Do Errors Occur? Examples of Quality Improvement Finding Root Causes and Preventing Errors Workarounds and the Need for Fixing Root Causes Asking "Why?" Instead of "Who?" Start at the Gemba The Five Whys Method Example of the Five Whys: Hand Hygiene Be Proactive and Use FMEA Proactive Resolution of Near-Miss Problems The Safety Pyramid Conclusion Lean Lessons Points to Ponder Notes Preventing Errors Creating Quality at the Source through Error Proofing Being Careful Is Not Enough Why 100% Inspection Is Not 100% Effective Types of Error Proofing Make It Impossible to Create the Error Make It Harder to Create the Error Make It Obvious the Error Has Occurred Make the System Robust, So It Tolerates the Error Error Proofing, Not Dummy Proofing Examples of Error Proofing in Hospitals Banned Abbreviations as Error Proofing Computer Systems as Error Proofing Preventing Surgery Errors through Error Proofing Stopping the Line (Andon) Error Proofing the Error Proofing Conclusion Lean Lessons Points to Ponder Notes Improving Flow Processes Should Flow Like a River Uneven Workloads as a Barrier to Flow Naturally Occurring Unevenness Mura Caused by Morning Rounds Mura Caused by Suboptimizing Courier Routes Mura Created by Clinic Scheduling Mura in the Patient Discharge Process Addressing Mura by Matching Staffing to Workloads Improving Patient Flow Improving Patient Flow in the Emergency Department Improving Patient Flow in Outpatient Cancer Treatment Improving Flow for Patient Care and Support Improving Flow in Clinical Laboratories Reducing Delays in Specimen Collection Reducing Delays in the Lab's Receiving Areas Improving Flow Also Improves Quality and Teamwork Reducing Delays Inside the Lab's Testing Areas Improving Flow in Pharmacies Conclusion Lean Lessons Points to Ponder Notes Engaging and Leading Employees Changing How We Manage What Is a Manager's Role? Common Management Problems Lean as a Management System and Philosophy A Daily Lean Management System Process Audits or Rounding Standardized Audits of the Standardized Work A Hierarchy of Audits Performance Measures Timely Measures Drive Improvement A Balanced Scorecard Focuses on All Stakeholders Metrics Should Be Visible, Visual, and Statistically Meaningful Daily Stand-up Team Meetings Kaizen and Suggestion Management Problems with Suggestion Boxes The Role of Supervisors in Kaizen Finding a Better Method for Managing Kaizen Visual Tracking of Suggestions Communicating Kaizen Changes Conclusion Lean Lessons Points to Ponder Notes Getting Started with Lean Where Do We Start? Types of Kaizen Kaizen Events Pitfalls of Kaizen Events Lean Transformation Executive Sponsorship and Leadership Starting from the Middle Establishing a Model Line and a Roadmap Chartering a Project Dedicating Internal Resources: The Lean Team The Importance of Change Management The Beginnings of a Lean Enterprise Starting in the Lab Moving to Other Areas Designing a Hospital for Lean Designing a New ED Process for the New Space The Future Roadmap Conclusion Lean Lessons Points to Ponder Notes A Vision for a Lean Hospital When Is a Hospital Lean? What Would a Lean Hospital Look Like? What Would a Patient Experience in a Lean Hospital? What Would It Be Like to Work in a Lean Hospital? How Would We Describe a Lean Hospital? Strategy and Management System Patients Employees Waste and Kaizen Technology and Infrastructure Final Thought