implementaciÓn de la metodologÍa lean en ... - ssch.gob.mx · developing emergency room key...
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IMPLEMENTACIÓN DELA METODOLOGÍA LEAN
EN INSTITUCIONES DE SALUD
SIMPOSIUM ESTATAL DE CALIDAD EN SALUD
Dr. Omar Nevárez, CalidadCHRISTUS MUGUERZA Hospital Del Parque
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iMPLEMENTACIÓN DE LA METODOLOGÍA LEAN EN INSTITUCIONES DE SALUD
¿Cual es el valor para el paciente?
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GRUPO FILOSOFÍAS Y MÉTODOS QUE AYUDAN A GENERAR EL MÁXIMO VALORPARA LOS PACIENTES
iMPLEMENTACIÓN DE LA METODOLOGÍA LEAN EN INSTITUCIONES DE SALUD
¿Que es LEAN?
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Fritze, Christopher. (2016). The Toyota Production System - The Key Elements and the Role of Kaizen within the System.
iMPLEMENTACIÓN DE LA METODOLOGÍA LEAN EN INSTITUCIONES DE SALUD
Taiichi Ohno"Hacer solo lo necesario, cuando es
necesario y en la cantidad suficiente"
¿Como comenzó LEAN?
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ObjetivosCalidad
Bajo costoSeguraRápida
"Las claves del éxito de Toyota". LEAN, más que un conjunto de herramientas y técnicas Cuadernos de Gestión Toledano De Diego, Asier; Mañes Sierra, Nagore; García, Sergio Julián
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ObjetivosCalidad
Bajo costoSeguraRápida
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Abordajes LEAN
iMPLEMENTACIÓN DE LA METODOLOGÍA LEAN EN INSTITUCIONES DE SALUD
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iMPLEMENTACIÓN DE LA METODOLOGÍA LEAN EN INSTITUCIONES DE SALUD
Flujo de valorValue steam mapping
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iMPLEMENTACIÓN DE LA METODOLOGÍA LEAN EN INSTITUCIONES DE SALUD
Verificación del procesoJidoka
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iMPLEMENTACIÓN DE LA METODOLOGÍA LEAN EN INSTITUCIONES DE SALUD
Nivelación de la producciónHeijunka
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Seiri
Seiton
Seiso
Seiketsu
Shitsuke
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Clasificación
Orden
LimpiezaEstandarizar
Disciplina
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8 desperdicios y ejemplosQue aplican al cuidado de la salud
iMPLEMENTACIÓN DE LA METODOLOGÍA LEAN EN INSTITUCIONES DE SALUD
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TIEMPOS DE ESPERA
Cuando el paciente espera, se produce el desperdicio
1
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INDICADORES CLAVE DE RENDIMIENTO (KPI) URGENCIAS1
Khalifa, Mohamed & Zabani, Ibrahim. (2016). Developing Emergency Room Key Performance Indicators: What to Measure and Why Should We Measure It?. Studies in health technology and informatics. 226. 179-182. 10.3233/978-1-61499-664-4-179.
1 2 3Ingreso Estancia Egreso
Cantidad de consultas por turno
Pacientes que se van
Tiempo de triage a consulta
Tiempo para estudios
Porcentaje de admisiones
Porcentaje de egresos a domicilio
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TRASPORTESe utilizan mutiples recursos para lograrlo.
2
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"Ticket to ride"2
Pesanka, Deborah & Greenhouse, Pamela & Rack, Laurie & Delucia, Gail & Perret, Robert & Scholle, Carol & Johnson, Marlon & Janov, Cheryl. (2008). Ticket to Ride Reducing Handoff Risk During Hospital Patient Transport. Journal of nursing care quality. 24. 10.1097/01.NCQ.0000335134.76121.49.
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Point of care2
Rooney, Kevin & Schilling, Ulf. (2014). Point-of-care testing in the overcrowded emergency department - Can it make a difference?. Critical Care. 18. 10.1186/s13054-014-0692-9.
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SOBREPRODUCCIÓN
Redundancias, creando demás de lo necesario.
3
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Reduciendo tiempo de estancia3Admisió
n
Enfermerí
a
Ambulanci
a
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Reduciendo tiempo de estancia3
Khalifa, Mohamed. (2017). Reducing Length of Stay by Enhancing Patients' Discharge: A Practical Approach to Improve Hospital Efficiency.Studies in health technology and informatics. 238. 157. 10.3233/978-1-61499-781-8-157.
Admisió
n
Enfermerí
a
Ambulanci
a
Aseo
s
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INVENTARIOS
Representan capital detenido y costos de almacenamiento.
4
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Comunicación efectiva4
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DEFECTOS
Errores medicos, readmisiones o tratamientos inapropiados
5
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Sistema de alerta de seguridad digital5
Applying the Toyota Production System: using a patient safety alert system to reduce error. Furman C1, Caplan R.Jt Comm J Qual Patient Saf. 2007 Jul;33(7):376-86.
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SOBREPROCESAMIENTOOcurre cuando realizamos trabajo innecesario en el proceso de atención.
6
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Medición de códigos6
Prince, C. R., Hines, E. J., Chyou, P. H., & Heegeman, D. J. (2014). Finding the key to a better code: code team restructure to improve performance and outcomes. Clinical medicine & research, 12(1-2), 47–57. doi:10.3121/cmr.2014.1201
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MOVIMIENTOOcurre cuando los colaboradores realizan movimientos que no agregan
valor al paciente.
7
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Rutinas y patrón de movimiento7
Hendrich, A., Chow, M. P., Skierczynski, B. A., & Lu, Z. (2008). A 36-hospital time and motion study: how do medical-surgical nurses spend their time?. The Permanente journal, 12(3), 25–34. doi:10.7812/tpp/08-021
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Rutinas y patrón de movimiento7
Hendrich, A., Chow, M. P., Skierczynski, B. A., & Lu, Z. (2008). A 36-hospital time and motion study: how do medical-surgical nurses spend their time?. The Permanente journal, 12(3), 25–34. doi:10.7812/tpp/08-021
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POTENCIAL HUMANO NO APROVECHADO
Cuando el tiempo de los colaboradores es consumido en desperdicios son incapaces de demostrar su creatividad y talento.
8
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Potencial humano no aprovechado
8
How six sigma methodology improved doctors’performanceVol. 10(18), pp. 2590-2598, 23 September, 2015DOI: 10.5897/ERR2015.2356
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Potencial humano no aprovechado
8
How six sigma methodology improved doctors’performanceVol. 10(18), pp. 2590-2598, 23 September, 2015DOI: 10.5897/ERR2015.2356
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INVOLUCRAR A TODOS
Incluyendo dirección, personal administrativo y operativo.
Comenzar trazando áreas con mayor flujo de pacientes
REALIZAR IMPLEMENTACIÓN GRADUAL
IMPLANTAR LA CULTURA LEAN
Realizar acciones con enfoque permanente
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HLDC 2020
¿Que podemos utilizar?FLUJO DE VALOR, VERIFICACIÓN DEL PROCESO, NIVELACIÓN DE
LA PRODUCCIÓN, CINCO S, ETC.
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En los grandes proyectosNO HAY LUGAR PARA EL INDIVIDUALISMO