Lean Processing For Practice Transformation Ellen Batchelor - - PDF document

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Lean Processing

For Practice Transformation

Ellen Batchelor

Objectives

■ How & Why Lean, a.k.a., the Toyota Production System ■ Introduce concepts ■ Whet your appetite ■ Next steps

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What is Lean?

■ Lean manufacturing, lean enterprise, or lean production...is a production practice that considers the expenditure of resources for any goal other than the creation of value for the end customer to be wasteful, and thus a target for elimination. Working from the perspective of the customer who consumes a product or service, “value” is defined as any action or process that a customer would be willing to pay for.

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What is Lean? Roadmap

■ Lean provides a road map

□ Value stream maps □ Process maps □ Are both tools and the structure

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Tools

■ Lean gives you the right tools.

Value Stream Mapping Cycle Time Waste Walk Takt Time 5 Whys

Special Glasses

■ Learning to See

□ Wastes □ Processes □ Employees

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Simple Definition?

■ Maximize customer value. ■ Minimize waste.

Who is Your Customer?

■ Maximize customer value. Minimize waste.

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What is Value?

Maximize customer value. Minimize waste.

■ Something the customer wants and is willing to “pay” for.

What is Waste?

Maximize customer value. Minimize waste.

■ Anything that adds cost or time without adding value.

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What is Waste? Over-, or “Extra” Processing

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Over-, or “Extra” Processing

■ Question: What am I doing that is not required by the customer either directly or indirectly.

Defects or Errors

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Defects or Errors

■ Question: Does this process result in anything that the customer would deem unacceptable?

Motion

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Motion

■ Question: how much do you move materials, people, equipment or goods within a processing step?

Transportation

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Transportation

■ Question: Is there unnecessary (non value added) movement of parts, materials

• r information between processes?

Overproduction

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Overproduction

■ Question: Are you producing sooner, faster or in greater quantities than the customer is demanding?

Inventory

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Inventory

■ Question: Do you have any raw materials, works in progress or finished goods laying around that you rarely or never use?

Wasted Human Talent

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Wasted Human Talent

■ Question: Do I know and use all the capabilities, wherever possible, of everyone on my staff?

Waiting

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Waiting

■ Question: What is waiting for a work cycle to be completed? Why must it wait?

Confusion

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Why do you Care?

■ “Waste is everywhere in healthcare...if we can harness it, there will be enough [resources] left over for every man, woman, and child who does not now have access to basic healthcare... and...we will retain a workforce who finds joy in their work.”

‒ --Richard A. Wright, M.D., MPH

Why Lean?

■ Minimal training and implementation time. Improvements implemented the same day. ■ Broad application within an organization. ■ Lean-based improvements affect all areas: □ Safety □ Satisfaction □ Outcomes □ Bottom line

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Why Not?

From the Lean Healthcare Exchange: ■ An ICU set about decreasing the 25 minute lead time to begin a dialysis procedure (because they perform a lot). The majority

• f this time was motion waste spent searching for equipment

and supplies. After implementing some solid lean techniques, the lead time decreased to slightly more than five minutes. However, there were an additional two minutes and 15 seconds

• f work required to return the unit upon completion and to

update a visual control. Thirty-days post implementation the new process was in disuse. When queried as to why, the team articulated; “It took too long to return the units and update the control.”

□ Net Lean savings = 18 minutes, 45 seconds per procedure - or 18 minutes/day * 5 days * 52 weeks = 81 hours

Why Not?

From the Lean Healthcare Exchange: ■ A team reduced excess processing and motion waste for nursing by 8,500 hours, annually. It required an additional 2,500 hours annually, to implement. At the interim report- out, the leadership were adamant: “There is no way we can support this, we simply do not have the budget.”

□ Net Lean savings 6,000 hours/year (or 115/week)

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Why Not?

From the Lean Healthcare Exchange: ■ A nurse delivered more than $86,000 in cost reductions to her unit on an annualized basis through “A3" work. Excited, she embarked on five others to deliver equal or greater value, only to be told by her manager, “Spend more time on patient care and less time on this A3 stuff.”

□ Lean savings $86,000/year on one project at cost of nurse time.

Where do I start?

■ Define your team ■ Engage your leader(s) ■ Remember: Leaders are key ■ Evaluate your process - map

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Lean Leaders

■ Know how the process (& business) serves the customer ■ Build ability in their team ■ Show a continuous improvement mind set ■ Focus on process and results ■ Demonstrate an understanding of the value stream ■ Create a culture to sustain improvement

Remember the Customer

■ Keep your customer top of mind.

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Assess

Value Stream Mapping Cycle Time Good Teams Takt Time BSC

Diagnose

Financial Analysis Waste Walk Cause & Effect 5 Whys Data Collection

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Problem Solving

■ Problems look the same on the surface, but may not have the same underlying cause. □ Blanket solutions and best practices don’t always work □ Boss/subordinate interactions - directive solutions aren’t the best □ “A Team” driven solutions not good □ Expert problem solvers

Treat

Work Load Balancing Just in Time Standard Work Leveling 5 S

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Prevent

■ Maintain a healthy process once it has been improved. ■ An apple a day keeps the doctor away.

Visual Control Storyboard Paynter Chart Run Chart Lean Chronicle

What are the Results?

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Do it Now

■ Form a lean team and start meeting regularly ■ Evaluate your processes - value stream mapping ■ Identify & focus on your customers ■ Go to the Gemba - the place where the work is being done ■ Look for Muda - waste ■ Eliminate waste ■ Repeat

Resources

■ Lean Enterprise Institute ▪ www.lean.org ▪ Perfecting Patient Journeys by Worth, Shuker, Keyte, et al. ▪ Value Stream Management for Lean Healthcare ▪ 2013 Lean Healthcare Transformation Summit, June 5-6, 2013, in Orlando, Florida ■ Lean Healthcare Exchange http:// www.leanhealthcareexchange.com/ ■ http://www.dummies.com/how- to/content/ lean-for-dummies-cheat- sheet.html

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Resources

■ CFMC

□ Free support through various QI initiatives

▪ In-office consultations and assistance with cardiology data collection and PQRS data collection, and other and reporting and resources ▪ Contact Devin Detwiler, ddetwiler@cfmc.org

■ Ellen Batchelor, Zeroth Blue

□ Healthcare Quality Improvement Coach □ Independent consultant

▪ ZerothBlue@yahoo.com, 720-552-1505, zb.dbeb.us

■ Health TeamWorks

□ Free support through various QI initiatives

▪ www.HealthTeamWorks.org