Lean Healthcare by Daniel T Jones

Lean Thinking

and Healthcare

Daniel T Jones

Our Journey

LEA is helping lean pioneers in many sectors

8 years leading proof of concept

experiments in healthcare

In search of a robust do-it-yourself

methodology – which we published

Now helping hospitals follow this

in the UK, Italy and the USA

www.leanuk.org

Stable Demand – Created Chaos

Calderdale & Huddersfield NHS Foundation Trust

Variability is

created by the

system

Which means

managing the

system

www.leanuk.org

Attendances

Admitted Patients

Patient Journeys

REHAB

UNIT

HOME

NURSING

HOME

GP

PHARMACY SUPPLIES

PATHOLOGY THERAPIES

EMERGENCY

DEPARTMENT

MAU

SAU

CLINIC

CLINIC

CLINIC

CLINIC

SURGUCAL

WARDS

OPERATING

ROOM

MEDICAL

WARDS

IMAGING

OTHER

WARDS

D

I

S

C

H

A

R

G

E

HOME

NURSING

HOME

www.leanuk.org

Mapping the Patient Journey

6.5 days waiting for 3 hours of work! www.leanuk.org

Visual Hospital Building Blocks

www.leanuk.org

Hospital Level

Visual Hospital

Ward Level

Plan for Every Patient

Plan for Every Support Service

Safety Valve

Replace Top

Management

Write-off Deficits

The Bermuda Triangle

Squeezed

Commissioning

Budgets

Blizzard of

Policies and

Directives

Broken Patient Journey

“We never see Management”

Poor Patient

Experience

Long LOS

Delays

& Queues

everywhere

Silo working &

Unsynchronised

support Poor Operations Management

350 Targets

500 Projects

Many

Meetings

Unfunded

Work

Too many Beds & Staff Big B+A spend

No time for

Improvement

Hospital Management

www.leanuk.org

Focusing on the Vital Few

Reducing Hospital Acquired Infections

Seeing emergency patients within 4 hours

Seeing elective patients within 18 weeks

Reducing length

of stay

Reducing costs

www.leanuk.org

X X X X X X X X X X X X X X R I A I I X X X X

X X X

X X X X

X X X X

X X X X

X X X X

X X X

X X X X X X X

X X

X X X X X X X X X

X X

X X X X X X

J F M A M J J A S O N D

Status

On target

Target may be missed

Target missed

X X X X X X X X X X X X X X X X X X

X X X X X X X X X X X X X X X X X X X X X X

X X X X X X X X X X X X X

X X Improve Patient Experience X X X X X X X X X X X X X X X X X X

X X X X Improve Teamworking X X X X

X X X X X X X X X X X X X X X X X X X X X X X X X

X X X X X

X X Increased Organisational Research X X X X X X X X X X X X X X X X X X X X X

X X X X X X X X X X X

X X X X X X X X X X X X X X

X X X X X X X X X X X X


X X X X X X X X X X X X X X X X

X X X Improve Capacity/Demand Understanding X X X X X X X X X X X X X X X X X X

X Negate further T&O Consultant Expansion X X X X X X X X X X X X

X X X X X X X X X X X X X X X X X

X X Achieve full Theatre utilisation at YYF X X X X X X X X X X X X X

X X X X X Produce a 5 year plan for service change X X X X X X X X X X X X

Improve Organisational Learning

Improve Ophthalmology Services

Improve Organisational reflection

Improved Sickness Management

Achieve financial control limit of £2.7m

Optimise workforce levels

Improved DOSA rates of 90%

Improve early finish rates

Achieve UK top quartile day case rates

Improve RTT rates

Improve Trauma Services

Lindse

y

Com

mis

sion Y

YF w

ith a

lloca

ted o

utp

atient ca

paci

ty

5 y

ear

pla

n in p

lace

????

incl

ude c

om

mis

sionin

g a

n S

CCC

Pete

r

Hiro

Julie

P

Ale

d

ach

ieve c

ontr

ol lim

it o

f £2.7

m

To h

ave r

obust

speci

alty d

em

and a

naly

sis

Abolis

h w

aitin

g lis

ts

Halt c

onsu

ltant exp

ansi

on in T

&O

Ach

ieve s

ust

ain

able

work

forc

e levels

Com

mis

sion Y

YF w

ith full

utilis

ation o

f th

eatr

e

Impro

ve s

ickness

managem

ent by h

ow

much

????

What's

the im

pro

vem

ent ta

rget here

????

Ach

ieve D

OSA r

ate

s of 90%

Ach

ieve a

n e

arly fin

ish r

ate

of 10%

Ach

ieve U

K T

op Q

uart

ile for

day c

ase

rate

s

Ach

ieve W

els

h N

ational RTT r

ate

s

Impro

ve the p

atient exp

erience

by h

ow

much

????

Impro

ved team

work

ing b

y h

ow

much

????

Deco

mis

ion 6

bedded T

raum

a b

ay

Ass

ess

or

inst

alle

d u

sing a

modifie

d g

lobal tr

igger

tool

Main

tain

curr

ent co

mpla

int re

sponse

rate

s at above 7

0%

What's

the im

pro

vem

ent ta

rget here

????

RG

H #

NoF m

ort

alit

y r

ate

to top 2

0 p

erc

entile

peer

Reduce

all

Tra

um

a a

ve L

oS b

y 1

5%

Reduce

tim

e to p

roce

dure

for

all

Tra

um

a p

atients

Reduce

#N

oF T

ime to p

roce

dure

to <

24 h

ours

Reduce

#N

oF L

oS b

y ?

?%

Zero

patient si

ght lo

ss d

ue to d

ela

ys

in follo

w u

p

1. Im

pro

ved Q

ualit

y a

nd P

atient Safe

ty

2. In

crease

d O

rganis

ational D

evelo

pm

ent

3. Im

pro

ved P

roce

sses

4. Pla

nnin

g

4. Im

pro

ved F

inanci

al Perf

orm

ance

Management vignettes and research in Div/Dir Meetings

Implement a structured approach to Sickness Management

Research on organisational development

What activities will contribute to this????

What activities will contribute to this other than ours??

Produce a 5 year plan for service change

Lean Trauma Project

Investigate potentially avoidable deaths

Train selected SCD personnel in complaints response

Provide a paper on changes to the Ophthalmology

Implement Tony DiGioia's methodology

Employ Aston Team Working

SCHEDULED CARE DIVISIONAL TARGETS

ACTIVITIES/PROJECTS/EVENTS

AB

HB

OB

JE

CT

IVE

S

IMP

RO

VE

ME

NT

TA

RG

ET

/C

ON

TR

IBU

TIO

N

R = Responsible (Leads/Coaches)A = Accountable (For Delivery)

C = ConsultedI = Involved/Informed

Trust Level Hoshin Check – every 30 days

Site Level Hoshin Check - every 7 days

Site Level Project (Specific) Plans Check - every day

Closed Loop

Deployment

and Feedback

www.leanuk.org

Closed Loop

Deployment

and Feedback Mon

Tue

Wed

Thu

Fri

Sat

Sun

Mon

Tue

Wed

Thu

Fri

Sat

Sun

Mon

Tue

Wed

Thu

Fri

Sat

Sun

Mon

Tue

Wed

Thu

Fri

Sat

Sun

WHAT WHO

24-N

ov

25-N

ov

26-N

ov

27-N

ov

28-N

ov

29-N

ov

30-N

ov

01-D

ec

02-D

ec

03-D

ec

04-D

ec

05-D

ec

06-D

ec

07-D

ec

08-D

ec

09-D

ec

10-D

ec

11-D

ec

12-D

ec

13-D

ec

14-D

ec

15-D

ec

16-D

ec

17-D

ec

18-D

ec

19-D

ec

20-D

ec

21-D

ec

Identify project lead SG X

Identify project team & roles & responsibilities SG X X X

Establish process for STaR SG X X X

Draw the process for STaR JM X X X

Develop communication plan JM X X X X

Execute communication plan JM X X X X X

Establish skill mix required for STaR IG X

Produce a visual rota for the trial (Medical) SG X X X

Produce a visual rota for the trial (Nursing) IG X X X

Identify risks in each process step (Failure mode effects analysis) JM X X X X X X X

Agree data collection set for trial SG X X X

Plan observational studies of current process CC X

Undertake observational studies CC X

Undertake spaghetti mapping CC X

Analyse all data CC X

Assess whether there needs to be a board outside STaR room IG X

Plan physical changes to department IG X

Complete physical changes to the department JM X X X X X X X X

Clear out STaR room IG X X X

Assess what IT needed for STaR room IG

Assess what equipment is needed for trial IG

Identify any shortfalls in equipment IG

Identify a supply for missing equipment IG

Ensure equipment available for trial IG

Ensure grab board is fitted in cubicles 7 & 8 JM X

Check physical changes to department complete JM X X X X

Ensure defibralator (crash trolley) equipment in place IG X

Implement 5S in STaR room IG

Check all necessary materials are available within the room IG

Check Gratnell trolley/notes IG

Carry out final assessment to ensure that room is safe to use for STaR IG X

Clarify roles and responsibilities IG X

Agree start date for STaR SG X

Go live with STaR trial SG X X X X X X X X X X

Action Plan for STaR (Stream Treat and Refer)

Mon

Tue

Wed

Thu

Fri

Sat

Sun

Mon

Tue

Wed

Thu

Fri

Sat

Sun

Mon

Tue

Wed

Thu

Fri

Sat

Sun

Mon

Tue

Wed

Thu

Fri

Sat

Sun

WHAT WHO

24-N

ov

25-N

ov

26-N

ov

27-N

ov

28-N

ov

29-N

ov

30-N

ov

01-D

ec

02-D

ec

03-D

ec

04-D

ec

05-D

ec

06-D

ec

07-D

ec

08-D

ec

09-D

ec

10-D

ec

11-D

ec

12-D

ec

13-D

ec

14-D

ec

15-D

ec

16-D

ec

17-D

ec

18-D

ec

19-D

ec

20-D

ec

21-D

ec




































Mon

Tue

Wed

Thu

Fri

Sat

Sun

Mon

Tue

Wed

Thu

Fri

Sat

Sun

Mon

Tue

Wed

Thu

Fri

Sat

Sun

Mon

Tue

Wed

Thu

Fri

Sat

Sun

WHAT WHO

24-N

ov

25-N

ov

26-N

ov

27-N

ov

28-N

ov

29-N

ov

30-N

ov

01-D

ec

02-D

ec

03-D

ec

04-D

ec

05-D

ec

06-D

ec

07-D

ec

08-D

ec

09-D

ec

10-D

ec

11-D

ec

12-D

ec

13-D

ec

14-D

ec

15-D

ec

16-D

ec

17-D

ec

18-D

ec

19-D

ec

20-D

ec

21-D

ec





































X X X

X X X X

X X X X

X X X X

X X X X

X X X

X X X X X X X

X X

X X X X X X X X X

X X

X X X X X X


Status

On target


Target missed







X X X X X





















Improve RTT rates


Lindse

y

Com

mis

sion Y

YF w

ith a

lloca

ted o

utp

atient ca

paci

ty

5 y

ear

pla

n in p

lace

????

incl

ude c

om

mis

sionin

g a

n S

CCC

Pete

r

Hiro

Julie

P

Ale

d

ach

ieve c

ontr

ol lim

it o

f £2.7

m

To h

ave r

obust

speci

alty d

em

and a

naly

sis

Abolis

h w

aitin

g lis

ts

Halt c

onsu

ltant exp

ansi

on in T

&O

Ach

ieve s

ust

ain

able

work

forc

e levels

Com

mis

sion Y

YF w

ith full

utilis

ation o

f th

eatr

e

Impro

ve s

ickness

managem

ent by h

ow

much

????

What's

the im

pro

vem

ent ta

rget here

????

Ach

ieve D

OSA r

ate

s of 90%

Ach

ieve a

n e

arly fin

ish r

ate

of 10%

Ach

ieve U

K T

op Q

uart

ile for

day c

ase

rate

s

Ach

ieve W

els

h N

ational RTT r

ate

s

Impro

ve the p

atient exp

erience

by h

ow

much

????

Impro

ved team

work

ing b

y h

ow

much

????

Deco

mis

ion 6

bedded T

raum

a b

ay

Ass

ess

or

inst

alle

d u

sing a

modifie

d g

lobal tr

igger

tool

Main

tain

curr

ent co

mpla

int re

sponse

rate

s at above 7

0%

What's

the im

pro

vem

ent ta

rget here

????

RG

H #

NoF m

ort

alit

y r

ate

to top 2

0 p

erc

entile

peer

Reduce

all

Tra

um

a a

ve L

oS b

y 1

5%

Reduce

tim

e to p

roce

dure

for

all

Tra

um

a p

atients

Reduce

#N

oF T

ime to p

roce

dure

to <

24 h

ours

Reduce

#N

oF L

oS b

y ?

?%

Zero

patient si

ght lo

ss d

ue to d

ela

ys

in follo

w u

p

1. Im

pro

ved Q

ualit

y a

nd P

atient Safe

ty

2. In

crease

d O

rganis

ational D

evelo

pm

ent

3. Im

pro

ved P

roce

sses

4. Pla

nnin

g

4. Im

pro

ved F

inanci

al Perf

orm

ance







Lean Trauma Project








AB

HB

OB

JE

CT

IVE

S

IMP

RO

VE

ME

NT

TA

RG

ET

/C

ON

TR

IBU

TIO

N




X X X

X X X X

X X X X

X X X X

X X X X

X X X

X X X X X X X

X X

X X X X X X X X X

X X

X X X X X X


Status

On target


Target missed







X X X X X





















Improve RTT rates


Lindse

y

Com

mis

sion Y

YF w

ith a

lloca

ted o

utp

atient ca

paci

ty

5 y

ear

pla

n in p

lace

????

incl

ude c

om

mis

sionin

g a

n S

CCC

Pete

r

Hiro

Julie

P

Ale

d

ach

ieve c

ontr

ol lim

it o

f £2.7

m

To h

ave r

obust

speci

alty d

em

and a

naly

sis

Abolis

h w

aitin

g lis

ts

Halt c

onsu

ltant exp

ansi

on in T

&O

Ach

ieve s

ust

ain

able

work

forc

e levels

Com

mis

sion Y

YF w

ith full

utilis

ation o

f th

eatr

e

Impro

ve s

ickness

managem

ent by h

ow

much

????

What's

the im

pro

vem

ent ta

rget here

????

Ach

ieve D

OSA r

ate

s of 90%

Ach

ieve a

n e

arly fin

ish r

ate

of 10%

Ach

ieve U

K T

op Q

uart

ile for

day c

ase

rate

s

Ach

ieve W

els

h N

ational RTT r

ate

s

Impro

ve the p

atient exp

erience

by h

ow

much

????

Impro

ved team

work

ing b

y h

ow

much

????

Deco

mis

ion 6

bedded T

raum

a b

ay

Ass

ess

or

inst

alle

d u

sing a

modifie

d g

lobal tr

igger

tool

Main

tain

curr

ent co

mpla

int re

sponse

rate

s at above 7

0%

What's

the im

pro

vem

ent ta

rget here

????

RG

H #

NoF m

ort

alit

y r

ate

to top 2

0 p

erc

entile

peer

Reduce

all

Tra

um

a a

ve L

oS b

y 1

5%

Reduce

tim

e to p

roce

dure

for

all

Tra

um

a p

atients

Reduce

#N

oF T

ime to p

roce

dure

to <

24 h

ours

Reduce

#N

oF L

oS b

y ?

?%

Zero

patient si

ght lo

ss d

ue to d

ela

ys

in follo

w u

p

1. Im

pro

ved Q

ualit

y a

nd P

atient Safe

ty

2. In

crease

d O

rganis

ational D

evelo

pm

ent

3. Im

pro

ved P

roce

sses

4. Pla

nnin

g

4. Im

pro

ved F

inanci

al Perf

orm

ance







Lean Trauma Project








AB

HB

OB

JE

CT

IVE

S

IMP

RO

VE

ME

NT

TA

RG

ET

/C

ON

TR

IBU

TIO

N




X X X

X X X X

X X X X

X X X X

X X X X

X X X

X X X X X X X

X X

X X X X X X X X X

X X

X X X X X X


Status

On target


Target missed







X X X X X





















Improve RTT rates


Lindse

y

Com

mis

sion Y

YF w

ith a

lloca

ted o

utp

atient ca

paci

ty

5 y

ear

pla

n in p

lace

????

incl

ude c

om

mis

sionin

g a

n S

CCC

Pete

r

Hiro

Julie

P

Ale

d

ach

ieve c

ontr

ol lim

it o

f £2.7

m

To h

ave r

obust

speci

alty d

em

and a

naly

sis

Abolis

h w

aitin

g lis

ts

Halt c

onsu

ltant exp

ansi

on in T

&O

Ach

ieve s

ust

ain

able

work

forc

e levels

Com

mis

sion Y

YF w

ith full

utilis

ation o

f th

eatr

e

Impro

ve s

ickness

managem

ent by h

ow

much

????

What's

the im

pro

vem

ent ta

rget here

????

Ach

ieve D

OSA r

ate

s of 90%

Ach

ieve a

n e

arly fin

ish r

ate

of 10%

Ach

ieve U

K T

op Q

uart

ile for

day c

ase

rate

s

Ach

ieve W

els

h N

ational RTT r

ate

s

Impro

ve the p

atient exp

erience

by h

ow

much

????

Impro

ved team

work

ing b

y h

ow

much

????

Deco

mis

ion 6

bedded T

raum

a b

ay

Ass

ess

or

inst

alle

d u

sing a

modifie

d g

lobal tr

igger

tool

Main

tain

curr

ent co

mpla

int re

sponse

rate

s at above 7

0%

What's

the im

pro

vem

ent ta

rget here

????

RG

H #

NoF m

ort

alit

y r

ate

to top 2

0 p

erc

entile

peer

Reduce

all

Tra

um

a a

ve L

oS b

y 1

5%

Reduce

tim

e to p

roce

dure

for

all

Tra

um

a p

atients

Reduce

#N

oF T

ime to p

roce

dure

to <

24 h

ours

Reduce

#N

oF L

oS b

y ?

?%

Zero

patient si

ght lo

ss d

ue to d

ela

ys

in follo

w u

p

1. Im

pro

ved Q

ualit

y a

nd P

atient Safe

ty

2. In

crease

d O

rganis

ational D

evelo

pm

ent

3. Im

pro

ved P

roce

sses

4. Pla

nnin

g

4. Im

pro

ved F

inanci

al Perf

orm

ance







Lean Trauma Project








AB

HB

OB

JE

CT

IVE

S

IMP

RO

VE

ME

NT

TA

RG

ET

/C

ON

TR

IBU

TIO

N



Strategy Deployment

Escaping the Bermuda Triangle

Vital Few

Objectives

Departmental

Contributions

Escalate

Problems

Quickly

Aligned &

Resourced

Projects

Synchronise Support Services

Visual

Hospital

Plan For Every Patient No Delays

Or Queues Right LOS

www.leanuk.org

Work with

Commissioners to

align Demand with

Capacity and

eliminate

Waste

Stop the

Blizzard of

Directives

HSJ Best Acute Hospital 2010

£2.2 m savings from

closing 100 medical beds

50% reduction in

Bank and Agency spend

No compulsory redundancies

Calderdale & Huddersfield

NHS Foundation Trust

Shortest Length of Stay

No increased readmissions

Continuing to improve

www.leanuk.org

Lean Thinking

and Healthcare

from www.leanuk.org

and Amazon Kindle

Lean Healthcare by Daniel T Jones

Education

Transcript of Lean Healthcare by Daniel T Jones