Introduction to Lean

Healthcare
Presented by:
Steve Lockwood,
CITEC Business Advisor / Lean

June 2013

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 What is Lean…

Lean Enterprise is a systematic approach to identifying

and eliminating waste (non-value-added activities)
through continuous improvement by flowing the
**product at the pull of the customer in pursuit of
perfection.

**Product = Process, Information, Service, Patients

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 Definition of Value Added

• Value Added
Any activity that increases the form or function of the service.
These are the things for which our patients would be willing
to pay.

• Non-Value Added
Any activity that does not add form or function or is not
necessary. These activities should be eliminated, simplified,
reduced, or combined.

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 Lean is not…
a job reduction strategy

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 Lean in Healthcare

The tools of Lean will allow you to:

provide better service
with less waste
with improved quality

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Lean = Eliminating (8) Wastes
Non-Value-Added
Value-Added
• Defects
• Overproduction
• Waiting
• Not Utilizing Employees

• Transportation
• Inventory
• Motion
• Excess Processing

Typically 95% of all lead time is non-value-added.

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Anything that adds cost or
time without adding value
as defined by the primary
customer is WASTE.

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 Defects
 Medication error
 Wrong procedure
 Wrong patient
 Missing information
 Paperwork doesn’t match
 Information entered
incorrectly
 Incompatible software
 Lack of standard work

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 Overproduction
• Making more than is required by the next process
• Making it earlier than is required by the next process
• Making it faster than is required by the next process

 Pills given out early

 Multiple bosses & multiple jobs cause

wrong order of jobs

 Duplication of tests

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 Waiting

 For bed assignments

 Discharge,
 Testing results
 Approvals
 Equipment
 Couriers
 People…

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Not Utilizing Employee’s Knowledge, Skills, and Abilities

The waste of not using people’s abilities (mental, creative, physical, skill)

 Causes of People Waste  Examples

 Incompatible hiring practices  Bypassing procedures to hire a
 Politics favorite candidate
 Corporate culture  Start using system software
 Improperly trained employee without prior training
 Old guard thinking  Qualifications unclear
 Business culture  Not providing opportunity for
growth
 Temporary workforce
 Flawed suggestion system

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 Transportation

 Moving same
patient, specimens,
or supplies,
 Defects/rework
 Poor layout
 Poor scheduling

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 Excess Inventory
Any supply in excess of a one-piece flow through your process

• Pharmacy stock
• Supplies (discount)
• Specimens waiting for
analysis
• Files, manuals
• Patients…

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 Motion
Any movement of people or machines that does not add value to the
product or service

 Searching for patients,

needed meds right charts,
supplies
 Common items stored on
top or bottom shelves.

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 Excess Processing
Effort that adds no value to the product or service from the customers’
viewpoint

 Retesting
 More paperwork. Printing,
mailing, faxing emailing same
document
 Duplicate procedures, forms
 Use of different software in
different departments

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 Waste becomes accepted
That’s just the way work
is done around here

It’s the system

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 Lean Building Blocks

Continuous Improvement
Continuous Improvement

Pull/Kanban Cellular/Flow Teams

POUS Quality at Source Quick Changeover

Standardized Work Batch Reduction TPM

Value
Stream
Visual 5S System Layout Mapping

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VSM Improvement vs. Process Improvement

Value Stream = All steps, both value added and non value added,
Required to complete service/widget from beginning to end

Process Process Process Process

Establish
Evaluation Solicitation Distribution
Team

Value Stream Service

Initial
Delivered
Customer
Contact

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Current Value Stream Map
Dashboard

Patient departure
Registration shown in DB
info entered Lab info Patient care
into DB entered received,
Patient on DB Patient
arrival with
departs
care needs system
DB shows
DB tells RN DB notifies Labs when labs &
patient has MD of collected other
arrived patients are shown requisitions
arrival on DB are
complete

RN Completi
Triage Registra- RN Provider Provider
Collects ons of
tion Exam Exam Orders Labs and
Lab
Req
Vitals
Patient Patient Patient Lab sent
History W W History W History W W W Therapy
4 min 28 min 15 min 10 min 20 min 40 min Begins
C/T=4 min C/T=3 min C/T=5 min C/T=8 min C/T=4 min C/T=10 min C/T=12 min

U/T= U/T= U/T= U/T= U/T= U/T= U/T=

C/O= C/O= C/O= C/O= C/O= C/O= C/O=

FPY= FPY= FPY= FPY= FPY= FPY= FPY=

2 min 4 min 28 min 15 min 10 min 20 min 40 min NVA=119

4 min 3 min 5 min 8min 4 min 10 min 12 min VAT=46

Lead Time = 165 minutes

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Facility Layout:

Figure 1. Traditional racetrack configurations distance staff from their patients and
one another and increase time spent on non-patient activities.

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Facility Layout:

Figure 2. Adaptable spaces create efficient workplaces that can change as

processes and requirements change.

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 5S Workplace Organization

A safe, clean, neat, arrangement of the workplace provides a

specific location for everything, and eliminates anything not
required.

• Sort
• Set in Order
• Shine
• Standardize
• Sustain

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 5S Workplace Organization

Store room before:

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 Visual Controls

Simple signals that

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

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Visual Controls

Must be clear!

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 Standard Work

DEFINITION:
The process / method to be
used every time by everyone
to do a task safely based on the
best known work
practices.

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 Benefits of Standard Work

Keystone of continuous
I Keystone
M improvement
P Standardized
R Work Sustains S I
O Improvements
V I
S
E
M
I
E S Continuous Improvement
N Efforts
T S I
I

Time

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 Point of Use Storage (POUS)
• Material is stored at workstation where used.
• Vendor Managed Inventory (VMI) is best!

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 Lean Workforce Practices (Teams):

• Patient Care Teams – with rotation of highly specified

jobs.
• Cross-trained and multi-skilled employees.
• Continuous improvement mindset.
• Process quality, not inspection.
• Participatory decision-making.
• Leadership at all levels.

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 Quick Changeover
Definition: The time between the last good output from the current task
and the first good output from the next task at speed.

 Do changeovers occur in the office?

• One set of documents are put away and replaced by another set
• Office equipment has to be reset for the next job
• Computer files are closed down and others retrieved
• Associates go to the Boss for their next assignment
• Visits to the supply cabinet for needs
• Reconciliation of regulatory paperwork

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 A3 Problem Solving Reports

 11” x 17” sheet of paper

used to show the status
of a problem or project.
 Use pictures and
graphs versus text
 Follows the PDCA
model.

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 Kaizen

Rapid Change for the Better

OR
Rapid Continuous Improvement

“Kai” = Take Apart “Zen” = Make Better

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Questions???
Thank you
Steven Lockwood
lockwood@citec.org
(315) 268-3778 x28

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