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REALIZING THE POTENTIAL OF LEAN
THINKING IN HEALTHCARE
Daniel T Jones
ChairmanLean Enterprise
AcademyUK
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Why am I here?
• Jim Womack and I have helped many industries get big benefits from following Toyota in using Lean thinking
• Consumer goods, construction and the public sector• I volunteered to try in healthcare - the time is right!• I took many walks – following the flow of work • I brought the pioneers together – to share experiences
and create awareness of the opportunities• We then conducted many experiments – to hone and
write down how lean methods work in healthcare• Now helping to build management systems to go
beyond point improvements and pilots to deliver results
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Quality and Lean Thinking
• The Quality movement strives to define best practice interventions and to eliminate variation and errors
• Lean focuses on the context of the flow of work to eliminate delays for patients, wasted effort for staff and unnecessary costs for hospitals
• They complement each other – quality > stability < flow• They also share a common evidence based methodology• Lean begins with engaging staff in improving their work• But these point improvements are hard to sustain without
and end-to-end perspective and a management system to support them
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The District General Hospital
HOMEHOME
REHABREHAB
HOMEHOME
GPGP
PHARMACYPHARMACY SUPPLIESSUPPLIES
PATHOLOGYPATHOLOGY THERAPIESTHERAPIES
EMERGENCY DEPARTMENTEMERGENCY DEPARTMENT
MAUMAU
SAUSAUEMERGENCY
CLINICCLINICCLINICCLINIC
CLINICCLINICCLINICCLINIC
ELECTIVE
SURGUCALWARDSSURGUCALWARDSOPERATING
ROOMOPERATINGROOM
MEDICALWARDSMEDICALWARDS
IMAGINGIMAGING
OTHERWARDSOTHERWARDS
DISCHARGE
DISCHARGE
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The Challenge
• Now we see the hospital as a collection of processes
• And we know how to improve most of the pieces
• What would it take to connect all these pieces together?
• This has to have the support of the top team – who need to take the time to see:-– What are all the things that could be done?– What would be the results for hospital performance?
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Defining the Problem
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The A3 Method
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What is Demand?
Demand to Get OutDemand to Get In
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Mapping the Current State
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Mapping the Current State
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Mapping the Current State
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The Emergency Medical Value Stream
What is the rate of demand?How to create flow within departments?How to flow between departments?Where to schedule this flow?
6.5 days waiting for 3 hours of work!
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The A3 so far
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Creating Flow in ED
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Synchronizing activities on Wards
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Nursing Availability to Discharge from Wards
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How to Level Discharge?
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The Future State
Buffers
Pacemaker
Flow
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The Emergency Medical A3 Plan
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The Elective Surgical A3 Plan
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The ResultsFree up capacity
Cut the Agency and Overtime Budget
Big procurement savings
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Khalid’s ‘End to End’ Trial: The Perfect Week (October 2008)
• ED Cell led by Senior Decision Maker – Safe Admission Avoidance• MAU Cell led by Senior Decision Maker – Safe Admission Avoidance• MAU Buffer• Discharge Lounge Buffer• Plan for Every patient (on medical wards)• Visual Hospital (Bed Management)
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The Implementation
• If there is a will to act• Someone has to have the end-to-end responsibility
- a value stream manager• Who works to establish the foundations
- stability and visibility• Gaining agreement from the team on the right actions
- based on the facts• With the backing to resolve conflicts between
Departmental and value stream objectives• And to deliver results – in length of stay and $ saved
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Plan for Every Patient Boards
By the Hour in ED
By the Day on Wards
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Line Management
The Tasks
Establish Stability – Plan for Every Patient BoardsRespond to Variances – Delays and Escalation
Solve Problems – Root Cause Analysis
Management
Standard Management – Frequent Regular ReviewsOngoing Role – Develop Staff Problem Solving Capabilities
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The Visual Hospital Board
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Managing the Hub
Escalation Management
System
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Value Stream Management
The Tasks
Establish Stability – Visual Hospital Hub and Status BoardRespond to Variances – Buffers and Escalation
Redesign Processes – Design Experiments and Review progress
Management
Standard Management – Regular Value Stream WalksOngoing Role – Develop the A3 Analytic skills of the team
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Top Management
$
• Understand the scale of the Opportunity and how to translate this into Money
• Focus on the Vital Few – emergency medical length of stay• Deselect other activities to free up the Capacity to act• Appoint and support a Value Stream Manager and Team• Resolve Conflicts between Departmental Objectives
and the needs of the Value Stream• Go to Review Progress regularly
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A Lean Management System
Establish Respond to DesignStability Variances Experiments
A PC D
TopManagement
Value StreamManagement
LineManagement
$ Deselect
Responses
Value Stream Manager
PlanHub
Problem SolvingPatient Boards
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In Conclusion
• This takes an end-to-end perspective
• And a different management system
• We call this Lean Management
• You might call it – Evidence Based Management
• Or “a New Common Sense”
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REALIZING THE POTENTIAL OF LEAN
THINKING IN HEALTHCARE
Daniel T Jones
www.leanuk.org