The Karolinska University Hospital in Sweden has been on a Lean journey since 1993. [1] It is one of the largest hospitals in Europe with over 1.5 million patient visits per year across multiple sites. [2] The hospital aims to improve patient care, work environments, resource use, and long-term sustainability through Lean methods like reducing waste and standardizing processes. [3] Some results so far include increased bed availability, lower infection rates, shorter wait times, and improved staff satisfaction. [4] Moving forward, the hospital plans to strengthen Lean implementation across the organization and develop performance management to better support continuous improvement.

1. The Lean journey
at
Karolinska University Hospital Sweden
MIHealth Forum May 24 2012
1 Anna Rasmuson

2. BACKGROUND
Strategic Business Development, Anna Rasmuson

3. One Hospital
Several Sites
Full Range of Care
Solna Huddinge
3
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4. Patient Care
1.5 million patient visits per year
7 operations per hour, 365 days per year
1,736 beds
54,800 laboratory analyses per day
15 000 employees
4
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5. Organization
Chief Executive Officer
Executive Staff
Executive Vice President Research, Development, & Education
Quality and Patient Safety
Strategic Business Development
Marketing and Contracts
Human Resources
Finance
Administration/Communication/Services
Oncology
Cardiovascular & Medicine & Surgery 1 Medicine & Surgery 2
Respiratory Diseases
Karolinska
Emergency Care Pediatrics Clinical Neurosciences
University Laboratory
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6. LEAN AGENDA
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7. The Karolinska Lean journey
Referral to first assessment Labour pains Maternity ward A
D A
a
y
A
s Delivery ward Maternity ward B
End-to-End approach End-to-End approach
Outpatient Clinic Maternity care ED/Ward
Dpt of Cardiology Top down & bottom up Top down & bottom up
Lean journey
2010
1993 2007 2012
120 improvement projects
TQM, Six Sigma, SPC, LEAN +
85 % success rate short term.
The merger
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8. What are we aiming for with the Lean agenda?
Excellent Health Care:
• Improve patient security and quality
• Improve the work environment
• Improve availability and utilisation of resources
• Create long-term sustainable results
Strategic Business Development, Anna Rasmuson

9. Why Lean?
• Proven successful method
• Patient first
• Create ownership and commitment
• Way of working and philosophy
• Long-term competitiveness
Strategic Business Development, Anna Rasmuson

10. Hospital vs industry
What can we learn from industry?
- with a more competitive environment
Strategic Business Development, Anna Rasmuson May 2012

11. Why Lean?
• Proven successful method
• Patient first
• Create ownership and commitment
• Way of working and philosophy
• Long-term competitiveness
Strategic Business Development, Anna Rasmuson

12. Focus on the patient
Quality and Patient Safety Department
Laboratory
Communications
Human Resourses
Planning Department
IS/IT
Strategic Business
Development
X-ray Finance
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13. Why Lean?
• Proven successful method
• Patient first
• Create ownership and commitment
• Way of working and philosophy
• Long-term competitiveness
Strategic Business Development, Anna Rasmuson

14. The two-fold role and task for all employees
1. Execute and deliver result
2. Continuous improvement work
Sorry, I don´t have the
time- have to work
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15. Why Lean?
• Proven successful method
• Patient first
• Create ownership and commitment
• Way of working and philosophy
• Long-term competitiveness
Strategic Business Development, Anna Rasmuson

16. Management by Principles
Values Core Values
Principles Guidance on how to think
(to find solutions within the framework)
The way to do things
Methods
(practical ways to apply the thinking)
The outcome of how well we
Results follow the principles and use
the chosen methods and tools
Strategic Business Development, Anna Rasmuson

17. Why Lean?
• Proven successful method
• Patient first
• Create ownership and commitment
• Way of working and philosophy
• Long-term competitiveness
Strategic Business Development, Anna Rasmuson

18. Long-term thinking
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19. Business plan 2012
Our mission
Our
Vision
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20. Long-term Goals 2015
• Safe care
• Right care at the right time
• Ready for new Karolinska
More than 80% of our organisation work with continuous
improvement work according to Lean principles.
Strategic Business Development, Anna Rasmuson

21. METHODS
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22. Methodology
Excellent Health Care
Phase 3
Continuous Improvement Work
Phase 1
Prototype
Phase 2
Implementation
Phase 0
Agreement Time
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23. The hospital's strategy for emergency flows
Management Team Meeting
X-ray/ 3 X-ray/ 3
Laboratory Laboratory
Emergency
Ward
Dept.
1 2
Continuous Improvement
Work groups
Operation
4
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24. RESULTS
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25. Signs of improvement
• More available beds
• Higher production compared to 2009, 2010 and 2011
• Hospital related infection reduction
• No waiting times to important specialities
• Reduction in internal lead times
• Staff sick leave reduction
• Staff satisfaction increases
• Improvement leadership at all levels
• Balanced economy
• Stronger competitiveness in R&D
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26. As Is
Phase 3
Excellent Continuous Improvement Work
Health Care with PDSA
Phase 1
Prototype with PDSA
Phase 2
Implementation with PDSA
Time
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27. PLAN FORWARD
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28. Plan forward
• Improve the methodology and training to enable continuous improvement
work better
• Speed up implementation cross organisation
• Secure ownership and training for Managers
• Develop performance management and visualisation for daily control and
continuous improvement work
• Establish organisation for local and central Lean method support
• Collaborate within central functions to improve the best support to core
business
......... and continue to live in the Lean system
Strategic Business Development, Anna Rasmuson

29. Key resources for Lean implementation
- The Leaders
and then
- Lean Managers
- Lean Coaches
- Logistic Experts
and then
- External Lean Consultants
Strategic Business Development, Anna Rasmuson

30. Plan forward
• Improve the methodology and training to enable continuous improvement
work better
• Speed up implementation cross organisation
• Secure ownership and training for Managers
• Develop performance management and visualisation for daily control and
continuous improvement work
• Establish organisation for local and central Lean method support
• Collaborate within central functions to improve the best support to core
business
......... and continue to live in the Lean system
Strategic Business Development, Anna Rasmuson

31. Key success factors Lean Journey
• Openness to learn from others
• Focus on the patient flow
• Standardised way of working
• Not a project
• Focused and committed Management Team
• Engaged employees
• Ownership within line organisation
• Willingness to challenge and improve
• Integrated in everyday life
• Long-term thinking
• Simplicity
• Visual control
• Extend to administrative support
Strategic Business Development, Anna Rasmuson

32. Strategic Business Development, Anna Rasmuson