Implementing Lean in

Healthcare Organizations
Methods and Results
John Beakes, Jr.
President and CEO
Operational Performance Solutions,
Inc.

Denver
Health
Results
from Lean,
2006-2011

Dr. Berwick on Lean

If you doubt that we know what to do, visit
Denver Health or ThedaCare or Virginia Mason,
and see the Toyota principles of lean production
learned, mastered, adapted, and deployed
through entire systems and into the skills and
psyches of entire workforces.
The result, over $100 million in savings at
Denver Health while vastly improving the
experience and outcomes of patients.

Observation from Donald M. Berwick, MD at the Keynote Presentation at IHIs 23rd Annual National Forum on Quality Improvement
in Health Care
December 7, 2011
Orlando, Florida

an
b
an
k
G

n
a
Le

Kaiz
e

Six
Si g
ma

JIT

ba
m
e
Gg
e
k
o
y
a
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o
P
5S

E
RI

MB
B

FME
A
A3

GSM

ED

Transformation Has Two

Elements
Technical and Social

Pursuit of Perfection
Value Stream Thinking
Disconnected Process
Improvement

Social
Tools and Techniques

The Path to Lean

Technical
Tools and Techniques

Learning Organization
Advanced Teambuilding
Employee
Empowerment

Tools Deployment

Employee Engagement

Quality
True North

Quality
Em
nt

t
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plo
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t
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P
t
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c
True
North
a
ora
f
s
i
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a
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Lean Deployment Guide

10

Healthcare People Get

Lean
Healthcare is the diagnosis and
treatment of illness
Lean is the diagnosis and treatment
of processes
The goal is to give healthcare
professionals a new way to look at
their processes using a small Lean
toolset
11

Lean System Models

12

Denver
Health
Results
from Lean,
2006-2011

13

14

15

Ref: Going Lean In Healthcare. Institute for Healthcare Improvement.

2005

16

A Medical Center Management System

Model

Medical Center

17

Benefits of a System Model

Provides an integrating framewor

Clarifies system interactions
Facilitates communications
Embodies the story

Promotes consistency of purpose

Enhances new employee training

18

Benefits of a System Model

Provides an integrating framewor

Clarifies system interactions
Facilitates communications
Embodies the story

Promotes consistency of purpose

Enhances new employee training

KEY TO SUSTAINMENT
19

Quality
Em
nt

Copyright 2008-2012. Operational Performance Solutions, Inc.

t
os
C

plo
ie ion
t
a
yee
P
t
M
c
True
North
a
o
f
ral
Va
s
i
lue
t
e
Str
PDCA
Sa
g
e
n
a
m
lvi
An
y
o
S
aly
t
sis
m
e
e
l
P ro
f
b
Mistake Proofing
Pull Systems
o
ces
r
a
P
s(
3
S A
VS
A
Continuous Flow
5S/Visual Management

P)

Standard Work

The Lean System of Patient Care

Principles

Objectives

Patient Centered
Quality at the Source
Standard Processes
Engaged Employees
Pursuit of Perfection
Supplier Partnerships

Defect Free
Without Waste
Just-in-Time
Continuous Flow
Continuous Improvement

Leadership Commitment and Support

Go See

Ask Why

- Culture Centered on Patient Care

Leadership (EPIC)
- Employee Engagement

Show Respect
- Servant
- Cascading

Quality
True North

21

Quality
Em
nt

t
os
C

plo
ie ion
t
a
yee
P
t
M
c
True
North
a
ora
f
s
i
t
le
a
S
y
t
e
f
Sa

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Quality
Em
nt

Copyright 2008-2012. Operational Performance Solutions, Inc.

t
os
C

plo
ie ion
t
a
yee
P
t
M
c
True
North
a
o
f
ral
Va
s
i
lue
t
e
Str
PDCA
Sa
g
e
n
a
m
lvi
An
y
o
S
aly
t
sis
m
e
e
l
P ro
f
b
Mistake Proofing
Pull Systems
o
ces
r
a
P
s(
3
S A
VS
A
Continuous Flow
5S/Visual Management

P)

Standard Work

The Lean System of Patient Care

Principles

Objectives

Patient Centered
Quality at the Source
Standard Processes
Engaged Employees
Pursuit of Perfection
Supplier Partnerships

Defect Free
Without Waste
Just-in-Time
Continuous Flow
Continuous Improvement

Leadership Commitment and Support

Go See

Ask Why

- Culture Centered on Patient Care

Leadership (EPIC)
- Employee Engagement

Show Respect
- Servant
- Cascading

24

Quality
Em
nt

Copyright 2008-2012. Operational Performance Solutions, Inc.

t
os
C

plo
ie ion
t
a
yee
P
t
M
c
True
North
a
o
f
ral
Va
s
i
lue
t
e
Str
PDCA
Sa
g
e
n
a
m
lvi
An
y
o
S
aly
t
sis
m
e
e
l
P ro
f
b
Mistake Proofing
Pull Systems
o
ces
r
a
P
s(
3
S A
VS
A
Continuous Flow
5S/Visual Management

P)

Standard Work

The Lean System of Patient Care

Principles

Objectives

Patient Centered
Quality at the Source
Standard Processes
Engaged Employees
Pursuit of Perfection
Supplier Partnerships

Defect Free
Without Waste
Just-in-Time
Continuous Flow
Continuous Improvement

Leadership Commitment and Support

Go See

Ask Why

- Culture Centered on Patient Care

Leadership (EPIC)
- Employee Engagement

Show Respect
- Servant
- Cascading

Leadership Commitment and Support

26

Leadership Commitment
and Support

Go See Ask Why

Show Respect

27

Leadership Commitment
and Support
Go See Ask Why Show
Respect
Culture Centered on Patient Care
Servant Leadership (EPIC)
Employee Engagement
Cascading Annual Planning Process
28

Principles
Patient Centered

29

Value Stream Thinking

and
Organizational Structur

Performance Review; Professional Recognition;

Promotions

Performance Review; Professional Recognition;

Promotions

Patient

Performance Review; Professional Recognition;

Promotions

Patient
W=
WASTE

Performance Review; Professional Recognition;

Promotions

Value Stream Analysis

Process

Patient

W=
WASTE

Principles
Patient Centered
Quality at the Source
Standard Processes

37

Standard Work Chart &

SPD Lead Checklist

38

Principles
Patient Centered
Quality at the Source
Standard Processes
Engaged Employees

39

Medication Sorting
After ----->

Medication Sorting
<----- Before

After ----->

Principles
Patient Centered
Quality at the Source
Standard Processes
Engaged Employees
Pursuit of Perfection
Supplier Partnerships

42

Objectives
Defect Free
Without Waste

43

Current Rounds made by a

Floor RN

Roaming Supply Cart

Frequently needed
supplies are stored
in drawers.
Dietary items (i.e.
spoons, applesauce,
straws, thickener)
are located in
drawers separate
from the linens.

Objectives
Defect Free
Without Waste
Just-in-Time
Continuous Flow

46

Decontamination

47

Decontamination

After

Before

48

Objectives
Defect Free
Without Waste
Just-in-Time
Continuous Flow
Continuous Improvement

49

Continuous Improvement

Lower the water

level
Find rocks
Remove them
Lower the water
level
Find new rocks
Remove them
Lower the water
level
Etc., etc
Seek perfection
(a never-ending
process)

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51

Denver
Health
Results
from Lean,
2006-2011

52

Quality
Em
nt

Copyright 2008-2012. Operational Performance Solutions, Inc.

t
os
C

plo
ie ion
t
a
yee
P
t
M
c
True
North
a
o
f
ral
Va
s
i
lue
t
e
Str
PDCA
Sa
g
e
n
a
m
lvi
An
y
o
S
aly
t
sis
m
e
e
l
P ro
f
b
Mistake Proofing
Pull Systems
o
ces
r
a
P
s(
3
S A
VS
A
Continuous Flow
5S/Visual Management

P)

Standard Work

The Lean System of Patient Care

Principles

Objectives

Patient Centered
Quality at the Source
Standard Processes
Engaged Employees
Pursuit of Perfection
Supplier Partnerships

Defect Free
Without Waste
Just-in-Time
Continuous Flow
Continuous Improvement

Leadership Commitment and Support

Go See

Ask Why

- Culture Centered on Patient Care

Leadership (EPIC)
- Employee Engagement

Show Respect
- Servant
- Cascading

The Key Processes for Lean

Healthcare
A3 Problem Solving
Value Stream Analysis Process

54

Quality
Em
nt

Copyright 2008-2012. Operational Performance Solutions, Inc.

t
os
C

plo
ie ion
t
a
yee
P
t
M
c
True
North
a
o
f
ral
Va
s
i
lue
t
e
Str
PDCA
Sa
g
e
n
a
m
lvi
An
y
o
S
aly
t
sis
m
e
e
l
P ro
f
b
Mistake Proofing
Pull Systems
o
ces
r
a
P
s(
3
S A
VS
A
Continuous Flow
5S/Visual Management

P)

Standard Work

The Lean System of Patient Care

Principles

Objectives

Patient Centered
Quality at the Source
Standard Processes
Engaged Employees
Pursuit of Perfection
Supplier Partnerships

Defect Free
Without Waste
Just-in-Time
Continuous Flow
Continuous Improvement

Leadership Commitment and Support

Go See

Ask Why

- Culture Centered on Patient Care

Leadership (EPIC)
- Employee Engagement

Show Respect
- Servant
- Cascading

Building a True Lean Culture

Means winning one heart and soul at a
time
Each individual comes to a full
commitment at their own individual pace
Be patient - some who embrace it slowly
become the strongest advocates
You know youre there when all
employees engage in identifying and
eliminating waste every day
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57

58

Quality
True North

59

Quality
Em
nt

t
os
C

plo
ie ion
t
a
yee
P
t
M
c
True
North
a
ora
f
s
i
t
le
a
S
y
t
e
f
Sa

60

Quality
Em
nt

Copyright 2008-2012. Operational Performance Solutions, Inc.

t
os
C

plo
ie ion
t
a
yee
P
t
M
c
True
North
a
o
f
ral
Va
s
i
lue
t
e
Str
PDCA
Sa
g
e
n
a
m
lvi
An
y
o
S
aly
t
sis
m
e
e
l
P ro
f
b
Mistake Proofing
Pull Systems
o
ces
r
a
P
s(
3
S A
VS
A
Continuous Flow
5S/Visual Management

P)

Standard Work

The Lean System of Patient Care

Principles

Objectives

Patient Centered
Quality at the Source
Standard Processes
Engaged Employees
Pursuit of Perfection
Supplier Partnerships

Defect Free
Without Waste
Just-in-Time
Continuous Flow
Continuous Improvement

Leadership Commitment and Support

Go See

Ask Why

- Culture Centered on Patient Care

Leadership (EPIC)
- Employee Engagement

Show Respect
- Servant
- Cascading

Denver
Health
Results
from Lean,
2006-2011

62

Contact Information
Operational Performance Solutions, Inc.
77 East Main Street, Suite 402K
Westminster, MD 21158
(410) 871-0995
info@OPSgroupinc.com
www.OPSgroupinc.com

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