process mapping and lean principles to enhance care 2 willoughby lean principle… · lean...

© Health Quality Council 2007

Process Mapping and Lean Principles to Enhance Care

Keith A. Willoughby, Ph.D.Senior Operations Research Specialist

Health Quality Council

© Health Quality Council 2007 2

One-slide bio• Born and raised in Melfort, SK• B. Comm. (U of S)• M.Sc. (UBC)• Transportation analyst (Vancouver Regional Transit

System)• Ph.D. (U of Calgary)• Professor (U of S, 1997-1999; Bucknell University -

Pennsylvania, 1999-2005)• Senior Operations Research Specialist, HQC for

the past 2½ years


Outline of Presentation • Lean 101… in 38 slides!

– History, principles, tools

• The role of process mapping

• Saskatchewan Lean health care examples

• The contributions of operations research (OR)


What I hope to accomplish• Acquaint you with the concepts of Lean

• Introduce some of the language

• Answer the questions, “Why Lean? Why now?”


Pop Quiz• Who started this whole notion of Lean

principles, and when did they do this?


Answer A?• Institute for Healthcare

Improvement

• 2005: Published the seminal white paper “Going Lean in Health Care”


How about… Answer B?• Virginia Mason

Medical Center

• Seattle, WA

• Began Lean journey in 2002


It might be… Answer C?• Jim Womack (1990)

• 5-year, $5 million study of global vehicle production – International Motor Vehicle

Program

• Co-authored “The Machine That Changed the World”with Dan Jones and Dan Roos

• Coined the term “Lean”


Is it…Answer D?• Taiichi Ohno (1912-1990)

• 1950’s: Toyota Production System

– Continuous Flow Production– Just-in-Time (JIT)– Eliminate defects– Top management commitment– Employee participation

• 1969: Established the Operations Management Consulting Group

– “Trainers” commissioned to promote Lean thinking within Toyota and the firms in its supplier group


Or, how about… Answer E?• C.R. Dooley

• Helped to develop the “Training Within Industry” program (1940s)

• Infiltrated into Japanese industry by the Allied forces after World War II


Could it be…Answer F?• Henry Ford, 1920s

• Continuous Flow Assembly

• Reduce wasted time– 1913-1914: doubled

production with no increase in workforce

– 1920-1926: Cycle time from 21 days to 2 days


But maybe it is…Answer G?• Eli Whitney (1700’s)

• Quick production of high-quality muskets – Standard

interchangeable parts– Minimal product

variation– Ordered and integrated

workflow


Another choice…Answer H?• The Venetian arsenal

• Republic of Venice, early 16th century

• Could produce nearly one ship each day– Standardized parts – Production-line basis


What does this show us? • “(Lean ideas) are

not new.”

• John R. Black– Director, Lean

Manufacturing R&D (Boeing, Seattle)

– Virginia-Mason “Sensei”


The $64,000 question• If these ideas are not new, why all the

buzz today?– 2005: IHI white paper

– June 25-26, 2007: UK hosted First Global Lean Healthcare summit


Does Lean apply to healthcare?“Toyota” Production System Healthcare

Production processes (thousands, complex) (thousands, complex)

Quality

Safety

Customer satisfaction

Staff satisfaction

Cost effectiveness

Failures may cause fatality


What is “Lean”? • Providing value with less waste

• Making common sense common practice


Lean definitions• A set of quality improvement tools and philosophy

designed to eliminate the sources of waste in a system

• “The least wasteful way to provide better, safer healthcare to patients – with no delays”– Going Lean in the NHS (2007)

• Providing exactly what the patient needs, safely, when needed, in precisely the right quantity, and without waste


The 8 sources of wasteCorrection (defects) Waiting

Overproduction Inventory

Motion Overprocessing

Material movement (transportation)

Underutilized human talent


What Lean is NOT• Layoffs

• Patients = widgets

• Making people work faster


Lean principles• 1. What is value from the customer’s

perspective? • 2. Understand your process• 3. Smooth the flow• 4. Shift from “push” to “pull”• 5. Continue to attack waste


The principle of “Pull”• “Supplier doesn’t

produce until the customer signals a need”

• Is there smooth communication between process steps?

• Represents a fundamental paradigm shift


Pull systems in practice


Lean tools: A quick survey• Poka-Yokes

– Eliminates the opportunities for mistakes– Poka: Inadvertent errors– Yokeru: To avoid

• Check John Grout's PokaYoke Page on www.mistakeproofing.com

http://www.mistakeproofing.com/


Vehicles• Arrow to indicate

location of fuel tanks (driver/ passenger side) – Great for rental

vehicles

• Gas cap tether does not allow the motorist to drive off without the cap


European streets• Tourists used to

right-hand side driving need some help in London

• Instructions are printed right on the asphalt


At the airport • If your bag fits in

the size-wise unit it will fit in the overhead compartment


Here’s one from my old neck of the woods!

• Route 220 in central Pennsylvania

• In theory… helps motorists to drive safely

• Is it followed?


Poka-Yokes in health care • Error: Putting a tube into

a patient’s stomach which was intended for their lungs.

• Solution: Squeeze the plastic bulb and put it on the tube. If bulb inflates, the tube is in the lungs. If not, an error has occurred.


Another medical example• The U.S. Consumer

Product Safety Commission has recorded 167 deaths due to wheelchair related accidents from 1997-1999. – Of these, 105 were

wheelchairs rolling away from the person for one reason or another.

(www.saferwheelchairs.com)

• The response? A mistake-proofing device that locks the wheelchair when no one is sitting in it.

http://www.saferwheelchairs.com/


One more medical example• Medical gas outlets are

designed so that the proper valves will only fit in their corresponding outlets

• Note the pins for “Medical Air” at 12 o’clock and 4 o’clock positions


Visual control systems• Labels, colour-coding to:

– make it easier to find items

– quicker ability to detect abnormal from normal

• Examples:– Surgical shadowboards– Diagonal stripe along

the fronts of binders


Other visual control systems

• This one may not work so well!


Exploring 5S• “A visually-oriented system

for organizing the workplace to minimize the waste of time” (IHI, 2005)

• “Clears the clouds”– Eliminates the waste of

motion/ looking for things

• Makes the abnormal visually obvious


Does this look familiar?


Some more on 5S• It is NOT simply cleaning

up!

• Following 5S principles helps provide the disciplined habits necessary for further phases of Lean implementation


More on 5S • Stands for 5 Japanese words each beginning with

the letter “S”

• Translated into English as either:– Sort, Simplify, Sweep, Standardize, Self-Discipline

– Sort, Set, Shine, Standardize, Sustain


5S in practice: Five Hills Health Region

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