Overview of Lean Principles and

Continuous Improvement

Lean in Healthcare

What is Lean?

Definition-The endless

transformation of waste into value

from the customers perspective.

IT is a System Thinking Concept.

A little History

The 4P model
Problem
Solving
(Continuous
Improvement
And
Learning)

Process
(Eliminate Waste)

People and Partners

(Respect, Challenge, and Grow
Them)

Philosophy
(Long-Term Thinking)

Impact of Lean in the Industry

Direct Labor/productivity improved

45-75%

Cost Reduced

25-55%

Throughput/Flow Increased

60-90%

Quality (Defects/Scrap) Reduced

50-90%

Inventory Reduced

60-90%

Space Reduced

35-50%

Lead Time Reduced

50-90%

Source: Virginia Mason Medical Center

Examples of Lean in Healthcare

Adding greater value-added

services
Same

day office visits

Next day outpatient surgery
Next day mammogram
Quick & errorless billing
No wait emergency room

TRADITIONAL CULTURE VS. LEAN CULTURE

TRADITIONAL
Functional Silos

LEAN
Interdisciplinary teams

Managers direct
Benchmark to justify not
improving; just as good

Managers teach/enable
Seek the ultimate
performance, the absence
of waste
Root cause analysis
Rewards: group sharing
Supplier is ally
Share information
Removing waste lowers cost
Customer focus
Process driven

Blame people
Rewards: individual
Supplier is enemy
Guard Information
Volume lowers cost
Internal focus
Expert driven

Examples of process
improvement tools

A3 reporting

Clean it up, Make it Visual

SORT

STRAIGHTEN

SUSTAIN

SHINE

STANDARDIZE

What is Waste in Healthcare?

Eliminating Waste

Overproduction
Pills given out
early
Treatments done
to balance staff
Duplication of test

Eliminating Waste

Transportation
Moving same
patient,
specimens, or
supplies,
workers

Eliminating Waste

Motion
Searching

for

patients,
needed meds,
right charts,
supplies

Eliminating Waste

Waiting
for bed
assignments
or
discharge,
or
testing results

Eliminating Waste

Processing
Retesting
More paperwork
Duplicate procedures

Eliminating Waste

Inventory
Linen (laundry)

Pharmacy stock
Supplies
Specimens waiting for
analysis

Eliminating Waste

Defects

Medication error
Wrong procedure
Wrong patient
Missing information

The Toyota Way

Management Principles
to LEAN Development Process
14

LEAN Development Process

1.

Establish the vision for the future

Focus the organization on the PATIENTS

Align Performance Measurements
Set high expectations for success and low
tolerance for failure
Method:
Establish a core team of implementers
Focused training, reading, and benchmarking
Standardized, systematic, methodical
approach
Clearly define objectives and time table
Create success through pilots and spread

Mission Statement
Develop the ability:
To recognize and identify waste
To have the courage to call it waste
To have the desire to eliminate it
Eliminate the waste
Understand that waste simply
Raises costs
Produces no corresponding benefit
Threatens all of our jobs

You get what you expect and you

deserve what you tolerate.

LEAN Development Process

2.

Develop your objectives

Look at your key processes or VALUE

STREAMS

Patient Journey (ERRadiologyClinicORBilling)

Charge capture (Clinical ServiceBilling Insurance)
Operating Room flow (Scheduling, consent, pre-op
visit, prep,.)

These support your Products which might be

Office visit
Inpatient stay
Visit to the ED

How do your Internal and External Customers

define Value

LEAN Development Process

3.

Selection of Team Members

Characteristics:
Technology curiosity
Common sense
Inner confidence
(create structure, Win allegiance, instinctive
reactions)
Cross Functional Team:
Manager/Supervisor from the area
Operators from area
Functional departments
(HR, Lab, Pharmacy, Admitting, Surgery,
Materials Management,etc.)

RESOURCE MATRIX
NAME TITLE SKILL SKILL SKILL SKILL
1
2
3
4
Larry
Moe
Curly

LEAN Development Process

4.

Initiate Team

Training:
Read required literature
Attend team and leadership training, lean
overview
Tools:
Standardized analysis and simulation tools
Video cameras, TVs, and VCRs
Computers, Printer, and Projector
Facilities:
Lean War Room located in the operational area
Office area appropriately furnished and supplied

Resource and Innovation

Center

LEAN Development Process

Select Pilot Area
Selection Criteria:
Contributes to key competitive strengths of
business
Innovation has a good chance of success
Significantly tests the innovation
Solutions are transferable to other areas
5.

Baseline the current process

Do an initial walkthrough

Baseline Analysis
1.

2.
3.

# patients transferred from ED to

inpatient bed within 1 hour of
decision to admit
Time to third next available appt
# tests/day or # tests/week

Keep it simple - look at 25 patients/wk

collected over some time period
including weekends and at night

LEAN Development Process

Activity of Product
Videotape: selected products
Analyze videotape and segregate:
travel time and distance
storage time and type
inspection time
non-value added processing time
value added processing time
Map the flow of the product:
6.

Process Charts
Process:
Subject:
Beginning:
Ending:

Emergency room admission

Ankle injury patient
Enter emergency room
Leave hospital
Insert Step
Append Step
Remove Step

Step
no.

Time
(min)

Distance
(ft)

1
2
3
4
5

0.50
10.0
0.75
3.00
0.75

15
40
40

6
7
8
9
10

1.00
1.00
4.00
5.00
2.00

60
200

11
12
13
14
15

3.00
2.00
3.00
2.00
1.00
4.00
2.00
4.00
1.00

200
60
180
20

16
17
18
19

Summary
Activity
Operation
Transport
Inspect
Delay
Store

Number
of steps
5
9
2
3

Time
(min)

Distance
(ft)

23
11
8
8

815

Step description
X

Enter emergency room, approach patient window

Sit down and fill out patient history
Nurse escorts patient to ER triage room
Nurse inspects injury
Return to waiting room

X
X
X
X
X
X

Wait for available bed

Go to ER bed
Wait for doctor
Doctor inspects injury and questions patient
Nurse takes patient to radiology

Technician x-rays patient

Return to bed in ER
Wait for doctor to return
Doctor provides diagnosis and advice
Return to emergency entrance area

X
X
X
X
X
X
X
X
X
X
X

Check out
Walk to pharmacy
Pick up prescription
Leave the building

LEAN Development Process

7.

Group Technology Analysis

Process sequence
Pre- Post data collection
Identify number of possibilities and
combinations
Identify commonality within each
product family
Plan analysis phase

A3 reporting

LEAN Development Process

8.

Line/Cell vision
Product flow
Operator activity
Flexibility
Zero defect production

Group Technology
One Worker, Multiple Machines

Machine
2

Machine
3

Machine
1

Materials in

Finished
goods out

Machine
5

Machine
4

LEAN Development Process

9.

Activity of Operator

Map work pattern

Videotape
Analyze what is value added, required waste,
and pure waste
Point to Point diagram representing movement
of operator in work area

Time studies analysis

Document new process

Point to Point

LEAN Development Process

Develop Standard Work
Define job steps, standard times, and
material location within each order
of process
Define takt time
Establish Line Balance
10.

LEAN Development Process

11.

Improve Line flexibility

Videotape selected setups and

operators
Document improvement suggestions
related to preparation, organization
Milk runs
Document new process

LEAN Development Process

12.

Design and approve Line Layout

Design Considerations

Steps to approve new Layout

LEAN Development Process

13.

Performance Measurements

ID standard work, source quality

control
Monitor performance and Post results
ID hit list and resolve identified
problems on a 90 day cycle
Monitor changes on 30/60/90 days
cycle

LEAN Development Process

14.

Develop a business case

Compare base conditions with projected lean

conditions (benchmark or audit)

Output rates
Floor space
Inventory
Labor

Document cost of implementation

Present findings to senior management

Include all stakeholders and decision makers

Let the facts speak loudly