Lean HealthcareLean HealthcarePresented by:Melanie Sudduth

Director of Lean Healthcare South Carolinamsudduth@scmep.org

864-354-4773

Why Are We Here Today?Why Are We Here Today?

Provide a brief introduction to SCMEPProvide a brief introduction to SCMEP Provide an overview of Lean HealthcareProvide an overview of Lean Healthcare Spotlighting Spotlighting

- Lean – An - Lean – An Overview of the ToolsOverview of the Tools

- reVIEW Program - reVIEW Program

- TWI- TWI

Who is SCMEPWho is SCMEP

An independent, non-profit 501c3 organization with An independent, non-profit 501c3 organization with its own charter and board of directorsits own charter and board of directors made up of made up of SC manufacturing company owners and senior SC manufacturing company owners and senior executives, as well as representatives from the state executives, as well as representatives from the state technical college system, research universities and technical college system, research universities and Department of Commerce.Department of Commerce.

Mission - To Strengthen the Global Mission - To Strengthen the Global Competitiveness of South Carolina BusinessesCompetitiveness of South Carolina Businesses

Vision - To be a primary resource for the South Vision - To be a primary resource for the South Carolina business community in providing highly-Carolina business community in providing highly-valued technological, workforce, and business valued technological, workforce, and business solutions that improve competitivenesssolutions that improve competitiveness

Services for BusinessServices for Business

Executive Leadership Services (Strategic Planning, M&A, Executive Leadership Services (Strategic Planning, M&A, Business Valuations, Succession Planning & Exit Business Valuations, Succession Planning & Exit Strategies, etc.)Strategies, etc.)

Top Line Growth (Marketing, Sales, Eureka Winning Top Line Growth (Marketing, Sales, Eureka Winning Ways and Lean Product Development)Ways and Lean Product Development)

Productivity/Process Improvements (Lean, TOC, Productivity/Process Improvements (Lean, TOC, Engineering Design, etc.)Engineering Design, etc.)

Quality System Implementation (6 Sigma, ISO, QS/ TS Quality System Implementation (6 Sigma, ISO, QS/ TS Automotive, AS Aerospace standards)Automotive, AS Aerospace standards)

ISO 14001, Energy AssessmentsISO 14001, Energy Assessments Environmental, Health & Safety AssistanceEnvironmental, Health & Safety Assistance Human Resource SolutionsHuman Resource Solutions

SCMEP – Impacts for 2008SCMEP – Impacts for 2008

Companies ServedCompanies Served 1,8231,823 InvestmentInvestment $36.3 MM$36.3 MM New and Retained SalesNew and Retained Sales $152 $152

MMMM Cost SavingsCost Savings $49.9 MM$49.9 MM Jobs Created/RetainedJobs Created/Retained 1,3601,360 Overall Economic ImpactOverall Economic Impact $254.8 MM$254.8 MM

Defining LeanDefining Lean

Lean is:Lean is:

““A systematic approach to identifying and eliminating A systematic approach to identifying and eliminating waste (non-value added activities) through continuous waste (non-value added activities) through continuous improvement by flowing the product or service at the improvement by flowing the product or service at the pull of the customer in pursuit of perfection.”pull of the customer in pursuit of perfection.”

— — The MEP Lean NetworkThe MEP Lean Network

Definition of Value-AddedDefinition of Value-Added

Value-AddedValue-Added

Any activity that Any activity that increases the market increases the market form or function of form or function of the product or the product or service. (These are service. (These are things the customer is things the customer is willing to pay for.)willing to pay for.)

Non-Value-AddedNon-Value-Added

Any activity that does Any activity that does not add market form not add market form or function or is not or function or is not necessary. (These necessary. (These activities should be activities should be eliminated, simplified, eliminated, simplified, reduced, or reduced, or integrated.)integrated.)

Lean = Eliminating NVALean = Eliminating NVA

Non-Value-Added (Muda)Non-Value-Added (Muda)

• OverproductionOverproduction

• WaitingWaiting

• ConfusionConfusion

• ProcessingProcessing

• InventoryInventory

• DefectsDefects

• Motion/TravelMotion/Travel

Typically >60% of the total lead time is non-value-added.

Value-AddedValue-Added

OverproductionOverproduction

Producing more than is required by the next Producing more than is required by the next processprocess

Producing earlier than is required by the Producing earlier than is required by the next processnext process

Producing faster than is required by the Producing faster than is required by the next processnext process

Examples of overproduction:Examples of overproduction: Duplicate chartingDuplicate charting Multiple forms with the same informationMultiple forms with the same information Copies of reports sent automaticallyCopies of reports sent automatically

Inventory WasteInventory Waste

Any supply or purchase in excess of the Any supply or purchase in excess of the current demand current demand

Examples of excess inventory:Examples of excess inventory: Overstocked medications on unitsOverstocked medications on units Purchasing excess because the piece price is cheaperPurchasing excess because the piece price is cheaper Stocking too much at point of use (large cabinet = fill it Stocking too much at point of use (large cabinet = fill it

up!)up!) Disorganization – can’t find it, so we buy moreDisorganization – can’t find it, so we buy more

Defects/ErrorsDefects/Errors

Inspection and correction of mistakesInspection and correction of mistakes

Examples of Defects/Errors:Examples of Defects/Errors: Wrong dosage/wrong medication administeredWrong dosage/wrong medication administered

Rework of any kindRework of any kind

Inconclusive testsInconclusive tests

Incorrect charges/billingIncorrect charges/billing

Surgical errorsSurgical errors

Processing WasteProcessing Waste

Effort that adds no value from the Effort that adds no value from the patient/customer’s perspectivepatient/customer’s perspective

Examples of processing waste:Examples of processing waste: True requirements not clearly defined – Clarifying True requirements not clearly defined – Clarifying

ordersorders

Extra copies or excessive informationExtra copies or excessive information

Missing medicationsMissing medications

Regulatory paperworkRegulatory paperwork

Waiting WasteWaiting Waste

Idle time created when people, information, Idle time created when people, information, equipment or materials are not at hand.equipment or materials are not at hand.

Examples of waiting waste:Examples of waiting waste: Waiting on test resultsWaiting on test results

Waiting on doctor/nurse, etc.Waiting on doctor/nurse, etc.

Waiting on availability of equipment or treatment Waiting on availability of equipment or treatment roomsrooms

Waiting on cleaning of roomsWaiting on cleaning of rooms

Waiting for “now” medicationsWaiting for “now” medications

Waiting on suppliesWaiting on supplies

ConfusionConfusion

People doing the work are confused or not People doing the work are confused or not sure about what should be done. sure about what should be done.

Examples of confusion:Examples of confusion: Unclear MD orders Unclear MD orders

Unclear route for medicine administrationUnclear route for medicine administration

Unclear system for indicating charges for billingUnclear system for indicating charges for billing

Same activities being performed different ways Same activities being performed different ways different peopledifferent people

Motion/Travel WasteMotion/Travel Waste

Any movement of people, equipment, Any movement of people, equipment, supplies, etc. that does not add value.supplies, etc. that does not add value.

Examples of motion waste:Examples of motion waste:

Looking for information, supplies, people, etc.Looking for information, supplies, people, etc.

Supplies not located at point of useSupplies not located at point of use

Unfavorable layoutUnfavorable layout

Supplies not prepped prior to patient treatmentSupplies not prepped prior to patient treatment

Lean Building BlocksLean Building Blocks

Quick Changeover

Standardized Work Batch Reduction Teams

Quality at Source

5S SystemVisual Facility Layout

POUS

Cellular/FlowPull/Kanban TPM

Continuous Improvement

ValueStreamMapping

Standardized WorkStandardized Work

All work is safely conducted with all tasks All work is safely conducted with all tasks organized in the best known sequence, and organized in the best known sequence, and using the most effective combination of these using the most effective combination of these resources:resources:

• PeoplePeople• MaterialsMaterials• MethodsMethods• EquipmentEquipment

5S =5S =

SSortort

SSet in Order et in Order

SShinehine

SStandardizetandardize

SSustainustain

5S – Workplace 5S – Workplace Organization & Organization & StandardizationStandardization

A safe, clean, neat A safe, clean, neat arrangement of the arrangement of the

workplace provides a workplace provides a specific location for specific location for

everything, and everything, and eliminates anything not eliminates anything not

required.required.

Visual ControlsVisual Controls

Simple signals that provide an immediate Simple signals that provide an immediate understanding of a situation or condition. understanding of a situation or condition. They are efficient, self-regulating, and worker-They are efficient, self-regulating, and worker-managed.managed.

Examples:Examples:• Kanban cardsKanban cards• Color-coded forms, supplies, etc.Color-coded forms, supplies, etc.• Lines on the floor to direct visitors to correct Lines on the floor to direct visitors to correct

departmentsdepartments• Lines on the floor to instruct staff where to return carts, Lines on the floor to instruct staff where to return carts,

equipment, gurneys, etc.equipment, gurneys, etc.• Andon lights outside patient rooms (signals)Andon lights outside patient rooms (signals)

Facility LayoutFacility Layout

TeamsTeams

Teams Cross-trained and multi-skilled Teams Cross-trained and multi-skilled personnelpersonnel

Teams for Continuous ImprovementTeams for Continuous Improvement Process quality, not inspectionProcess quality, not inspection Decision-making done by those doing the Decision-making done by those doing the

workwork

Problem solving teamsProblem solving teams

Setup or Changeover Setup or Changeover ReductionReduction

Definition: The time required from the Definition: The time required from the completion of the last procedure until the start completion of the last procedure until the start of the next procedure. Set-up includes getting of the next procedure. Set-up includes getting instruments, getting supplies, setting-up instruments, getting supplies, setting-up rooms, getting materials, and getting rooms, getting materials, and getting paperwork. paperwork.

Benefits include:Benefits include: Improvement of capacity and volumeImprovement of capacity and volume Increase in flexibility Increase in flexibility Increase in competitivenessIncrease in competitiveness Increase in Patient SatisfactionIncrease in Patient Satisfaction Increase in Physician Satisfaction Increase in Physician Satisfaction

Batch and Queue ProcessingBatch and Queue Processing

Impact of Batch Size Impact of Batch Size ReductionReduction

10 min. 10 min.

30+ min. for total order, 21+ min. for first piece

10 min.

Process

AProcess

BProcess

C

Process

BProcess

AProcess

C

Continuous Flow Continuous Flow ProcessingProcessing

12 min. for total order,3 min. for first part

Point Of Use Storage Point Of Use Storage (POUS)(POUS)

Materials, Supplies and Equipment is where Materials, Supplies and Equipment is where usedused

Benefits:Benefits: Reduced Motion/Travel Reduced Motion/Travel Decreases patient delaysDecreases patient delays Increases patient throughputIncreases patient throughput Reduces confusion and “searching’Reduces confusion and “searching’

Quality at the SourceQuality at the Source

Personnel must be certain that work is being Personnel must be certain that work is being performed correctlyperformed correctly

Techniques used:Techniques used: Samples or visual standardsSamples or visual standards Process documentation defining quality requirementsProcess documentation defining quality requirements Poka Yoke – Mistake Proofing TechniquesPoka Yoke – Mistake Proofing Techniques Root Cause Analysis Tools (A3 Problem Solving)Root Cause Analysis Tools (A3 Problem Solving)

Push versus Pull SystemsPush versus Pull Systems

In a pull system of service, the timely In a pull system of service, the timely transition of work from one step in the transition of work from one step in the process to another is the primary process to another is the primary responsibility of the downstream (i.e., responsibility of the downstream (i.e., subsequent) processsubsequent) process

Cellular FlowCellular Flow

Linking of processes into the most efficient Linking of processes into the most efficient combination to maximize value-added content combination to maximize value-added content while minimizing waste.while minimizing waste.

Total Productive Total Productive Maintenance (TPM)Maintenance (TPM)

Systematic approach to the elimination Systematic approach to the elimination of the six major equipment losses:of the six major equipment losses:

Setup and adjustmentSetup and adjustment

BreakdownsBreakdowns

Idling and minor stoppagesIdling and minor stoppages

Reduced speedReduced speed

StartupStartup

Defects and reworkDefects and rework

ConclusionConclusion

LeanLean• Simple and Simple and

visualvisual• Patient drivenPatient driven• Supplies as Supplies as

neededneeded• Reduce non-Reduce non-

value-addedvalue-added• Minimal lead Minimal lead

timetime• Quality ControlsQuality Controls• Value stream Value stream

managersmanagers

TraditionalTraditional• ComplexComplex• Internally drivenInternally driven• Excessive Excessive

suppliessupplies• Speed up value-Speed up value-

added workadded work• Long lead timeLong lead time• Rework & ErrorsRework & Errors• Functional Functional

departmentsdepartments

Thank YouThank You..