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Gemba walk: the start of your lean journey
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A primer for healthcare leaders about Lean / process improvement.
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Gemba walk: the start of your lean journey
1.
Gemba Walk: Starting your
Lean Journey Brian Ramos, MBA Director of Practice Operations Plexus Management Group, Inc. © 2013
2.
Abstract & Learning
Objectives Abstract: Made famous by the Toyota Motor Corporation, Lean has been effectively used in the healthcare industry for over a decade. However, most healthcare professionals have not been exposed to the management philosophy. This introductory presentation will help participants understand Lean’s applicability and use in our field and learn how to identify and eliminate waste in each process in their clinical or business unit. Learning Objectives: 1. Understand the core principles of Lean thinking. 2. Understand the process of value stream mapping and its use in Lean. 3. Learn how to identify and eliminate waste (“muda”) in your practice’s current processes. © 2013
3.
Let’s start at
the end . . . • What have you heard about Lean? • Is Lean mean? • Is it all about the bottom line? Reduce staffing? © 2013
4.
Lean in Healthcare
© 2013 N.B. List is not exhaustive
5.
Reasons for Action
• Economic environment cannot sustain current health care cost structure. Source: USA Inc.: Red, White, and Very Blue, Forbes Magazine, February 24, 2011 © 2013
6.
Reasons for Action
Continued • Patients as Consumers – Choice • Quality & Safety – Wide variation in quality measures and outcomes across institutions and patient populations. – Despite spending more than any other country (17.6% GDP), the US ranked: • 39th for infant mortality • 43rd for adult female mortality • 42nd for adult male mortality • 36th for life expectancy © 2013
7.
Core Principles 1. Respect
for People Employees know work best NOT top-down approach 2. Continuous Improvement Strive for zero defects 3. Customers (i.e. patients) define value 4. Based on the scientific method (e.g. experimentation) © 2013
8.
Value Stream Mapping
© 2013
9.
Value Stream Mapping
Identifies Waste Value Added Non-Value Added Any activity that directly Any activity that consumes time or contributes to satisfying the needs resources but does not add value. of a customer. © 2013
10.
8 Wastes in
Healthcare TRANSPORTING WAITING Moving anything on wheels (e.g. patients, Patients in a waiting room; waiting for lab specimens, equipment or supplies) results INVENTORY OVERPROCESSING Stock of medical or operational supplies, Asking patients for their information more patients in beds, specimens waiting for analysis than once; ordering more labs than needed MOTION OVERPRODUCTION People reaching, bending, or searching for Creating forms “just in case” you need them; supplies, patients, other staff producing more labs than needed HUMAN TALENT DEFECTS Unused or untapped potential of staff Wrong patient, wrong procedure, redraws What are some examples of waste in your practice? © 2013
11.
Examples of Waste •
Underutilized ORs • Wrong-site surgery accounts for 13% of medical errors. Waste (excess capacity) Source: injuryboard.com • Waiting for: – Provider – Patient – Results © 2013
12.
Everyday Lean Tools you
can use right now to do “Lean Lite” © 2013
13.
Daily Huddle •
Ensure team communications • Opportunity to prevent issues from developing • Focuses on small, incremental, change/improvements • Same time, every day, for NO MORE than 5 minutes • Everyone attends! That means doctors, mid-levels, nurses too! • Initiated by manager, eventually led by all team members. • Stand-up! (preferably at a visual management board) © 2013
14.
Visual Management Balanced
scorecard approach. People Quality/Safety Delivery Cost Growth Set goals by “doubling the good and halving the bad” © 2013
15.
Visual Management Continued
© 2013
16.
Standard Work •
current best known way to perform a task • Standard work secures improvement • Encourages root cause problem solving vs. firefighting • Do you use checklists? They’re a type of Standard Work Lean Principles Performance STD WORK Time © 2013
17.
Pareto Analysis A
means of focusing “80/20 Rule” on areas that matter the most Bar chart showing the affect of different categories of a given problem Benefits: Avoid working on the wrong or insignificant problem. Speaking with data © 2013
18.
PICK Chart •
Identify actions then group into benefit and difficulty High • P Plan to Do 6 4 1 • High benefit, Make a plan how to 2 I P9 do it. BENEFIT 7 • I Implement • High Benefit, Easy to Do. C Implement Now K5 Low 3 8 • C Choose (which if any) To Do Low High • Low benefit, but easy to do. DIFFICULTY • K Kick Out • Low benefit and difficult to do. Don’t bother with these! Do the high benefit/low difficulty actions. © 2013
19.
5 Whys •
The easiest of all Lean “tools” • Ask “why?” five times to arrive at the root cause . • A patient broke his leg in our clinic today. Why? • Because he fell Why? • Because the floor was wet Why? • Because there was a leak from the water fountain Why? • Because the valve seal was broken Why? • Because the fountain had not been maintained. © 2013
20.
Success Story Ambulatory Endoscopy
Suite • Staggered Patient Arrival Times Wait Time RN Overtime Pay • Gastroenterologist dictated note in Wait Time EMR in procedure room Motion • Increased through-put by 20% in each procedure room. Revenue • Maintained 99% patient satisfaction scores on Press Ganey survey. © 2013
21.
Recommended Reading
Websites: PBS Healthcare Cost Comparison http://www.pbs.org/newshour/rundown/2012/10/health-costs-how-the-us- compares-with-other-countries.html Lean Enterprise Institute http://www.lean.org/ Virginia Mason Institute http://www.virginiamasoninstitute.org © 2013
22.
Questions & Answers ©
2013
23.
About the presenter
Brian Ramos is an accomplished healthcare executive who is passionate about eliminating waste and lowering the cost of healthcare delivery systems. He has successfully created profitable clinical units in academic medical institutions, large private physician practices, and ambulatory surgical centers. Brian was formally trained in the Toyota Production System (Lean) and uses these tools to create cultures of continuous improvement. He serves as the Director of Practice Operations for Plexus Management Group, a healthcare management services organization and consulting firm in the greater Boston area. In his role, Brian provides chief operating officer functional responsibility to client ambulatory practices including Brian Ramos, MBA Director of Practice Operations P&L oversight, leadership of office-based practice administrators, and development of client strategic plans and partnerships. Plexus Management Group, Inc. 690 Canon Street | Suite 325 Brian earned a master's degree in Business Administration from Westwood, MA 02090 Fitchburg State University and a bachelor’s degree in Mathematics & Computer Science from Boston College. He is a Certified Medical bramos@plexusmg.com ph. 781.407.7771 Practice Executive (CMPE) nominee of the American College of Medical Practice Executives. Additionally, Brian holds Lean Silver Certification from Simpler® Healthcare. Follow me: Disclosure & Attestation @brianmramos The speaker attests that he does not have any real or apparent financial relationships or commercial interests to disclose. © 2013