LEAN In Healthcare - NHLC / CNLS PDFs/June 11/Pier 9/LEA… · LEAN In Healthcare Rhonda Schwartz...

LEANIn Healthcare

Rhonda Schwartz Michael EliasDirector, Quality & Corporate PerformanceRisk Management Improvement Specialist

2007 North York General Hospital

Embracing Health - www.nygh.on.ca

The NYGH Leadership Culture Transformation

IHI

Collaboratives

Canadian Collaborative

Process

TransformationProjects

Safer HealthcareNow!

LEAN

Story TellingCulture

Transformation

Shame/Blame→

Just Cultu

re

Silos→SystemsCommand & Control→Stewardship

ED-GIMToolkit

Bosses→

Coaches


What is Lean?

• A set of principles that define the way

we do things

• Defines the way we think about

improvement

• Shapes beliefs about what is possible

Lean is a management philosophy

© 2005 Simpler Consulting, Inc.


Pillars of Lean

Co

nti

nu

ou

s

Imp

rov

em

en

t

Res

pe

ct

for

Peo

ple


Continuous Improvement

Current State

Current State

Improved State

Improved State

Generate & Implement Solutions

Generate & Implement Solutions

Identify Waste

Identify Waste

© 2005 Simpler Consulting, Inc.


The Lean Approach…

Enables:

• True potential of a process to be realized

• Identification and elimination of waste

• Quantum leaps in performance

• Focused standardized approach to improvement

Is Not:

• A quick-fix; it takes time to change processes and cultures

• Easy to do; often it is quite painful for some

• Random process improvement

• Additional work, it is a new way of working


Value Stream Analysis


Cycle of Improvement

5 Day Kaizen

Day 1 – Current Condition

Day 2 – New Process

Day 3 – Implementation

Day 4 – Wash, Rinseand Tweak

Day 5 – Final Presentation

Preparation Kaizen

3 Weeks

Follow-up

1 Week 3 Weeks

Preparation

Week 1 – On your Marks

Week 2 – Get Ready

Week 3 – Get Set

Follow-up

Week 1 – All or Nothing

Week 2 – Don’t Relax

Week 3 – Hold the Gains


Kaizen (“For the Greater Good”)

• highly focused teams• right people involved

• accountability "by Friday"• identification of waste• application of proven principles• experienced coaching• rapid change

The “MAGIC” of Kaizen Events is simple…

Kaizen Week

FormingFormingTestingTesting

•• PolitePolite

•• ImpersonalImpersonal

•• WatchfulWatchful

•• GuardedGuarded

PerformingPerformingClosenessCloseness

•• ResourcefulResourceful

•• FlexibleFlexible

•• OpenOpen

•• EffectiveEffective

ThursdayFinalize and document standard work flow & control plan

MondayCurrent state map & identification of wastes

WednesdayImplement and test the new process

TuesdayElimination of wastes & creation of new process

NormingNormingGetting OrganizedGetting Organized

•• Developing SkillsDeveloping Skills

•• Giving FeedbackGiving Feedback

•• Establishing Establishing

ProceduresProcedures

StormingStormingInfightingInfighting

•• Controlling ConflictsControlling Conflicts

•• Confronting PeopleConfronting People

•• Opting OutOpting Out

•• Feeling StuckFeeling Stuck

FridayFinal Presentation



Emergency Services Program Results

74%74%0.7 hours2.8 hoursTransfer of Admitted Patients to Inpatient Beds

• Bed assigned to patient in bed

21%21%6.6 hours8.3 hoursSub Acute Care

• Triage to discharge

31%31%0.89 hours1.3 hoursAccess to CT Scan

• ED order written to results

received

16%16%2.6 hours3.1 hoursAmbulatory Care

• Card swipe to discharge

% ImprovementCurrentlyBaselineKaizen Event


In-patient Medical Unit Results

80%80%0.4 hours2.1 hoursBed Assignment

• Bed ‘dirty’ to bed assigned

45%45%0.9 hours1.6 hoursDischarge Bed Cleaning

• Response time to dirty room

82%82%

11%11%

0.4 hours

2.3 hours

2.4 hours

2.6 hours

Discharge Process• Discharge confirmed to order written

• Discharge order written to patient

leaves bed

43%43%69%39%

Hospitalist Standard Work• Identification of probable

discharges one day prior to discharge

49%49%

37%37%

17 patients

15 min/hr

11.4 patients

24 min/hr

Hospitalist Utilization• Average number of patients per

Hospitalist• Time spent traveling

% ImprovementCurrentlyBaselineKaizen Event


Lean in Nature


NYGH Before Kaizens

EVS

Admitting

Emerg

In Patient

Units

Port

ering

NYGH After Kaizens

Discharge process

Hospitalists

Bed cleaning

Bed assignment

Patient transfer

ED triage

CT test results



Results

Discharge Confirmed to Patient in Bed (in hours)

�� Discharged Confirmed to Order Written�� Order Written to Bed Empty�� Bed Empty to Cleaning in Progress�� Cleaning in Progress to ED Notification�� ED Notification to Patient in Bed

2.4 2.6 2.81.6BeforeKaizens

AfterKaizens 2.3 .9 .7

11.5 hours

4.7 hours59%

Reduction.4 .4

2.1


Lean Transformation

From:

• Staff Centred

• Role Focused

• They

• Followers

• Pessimism

• Powerless

• Problem Focused

• Reactive

• Silo Thinking

To:

• Patient Driven

• Team Focused

• We

• Leaders

• Optimism

• Empowered

• Solution Focused

• Proactive

• System Thinking


Our Common Goal

“The key is seeing everything through the eyes of the patient.”


Lean Learnings…

• Senior Leadership Support and Involvement• Physician Champion • Content Expert• Build Capacity• Identify Leaders• Strategic Event Selection• Time Commitment • Tenacity/Courage• Realistic Expectations• Rhythm for Improvement• Communicate, Communicate, Communicate• Celebrate the Successes!


Empowerment

“We are so used to having decisions

made for us and having to implement

them. It was nice to actually make

decisions ourselves and actually see

them implemented.”

Source: Staff RN


Empowerment

“I never saw the big picture, it

wasn’t important. I focused just

on my floor. I’ve learned that

everyone’s role is important –

for the patient’s satisfaction, we have to work together.”

Source: Member, Standardizing Bed Assignment Kaizen Event

LEAN In Healthcare - NHLC / CNLS PDFs/June 11/Pier 9/LEA… · LEAN In Healthcare Rhonda Schwartz...

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