Presented by Andrew Hudson Mercer University School of Engineering

1. Lean Hospitals: Improving Quality, Patient Safety, and Employee EngagementCh. 2 Overview of Lean for Hospitals and Health Systems Presented by Andrew Hudson Mercer University School of Engineering

2. Lean • A tool set and management system • Method for continuous improvement and employee engagement • An approach to solve problems that are important to leaders and organizations Andrew Hudson Lean Hospitals Ch. 2

3. Ohno’s Lean Definition • TaiichiOhno and Shigeo Shingo were the primary creators of Toyota Production System (TPS) • Main idea was that Lean was defined as business goals that included more than just the factory • Waste • Is a problem that interferes with people doing any activity that doesn’t provide value to the customer • Time based approach • “Just in time” - improving flow to provide the right care at the right time • “Jidoka” – the idea of building quality at the source • Ohno was focused on flow not efficiency based management Andrew Hudson Lean Hospitals Ch. 2

4. Lean Thinking • Provides a way to do more with less such as: less equipment, less time, less human effort, and less space • 5 key principles: • Specify what creates value from the customer’s perspective • Identify all steps across the whole value stream • Make those actions that create value flow • Only make what is pulled by the customer just in time • Strive for perfection by continually removing successive layers of waste Andrew Hudson Lean Hospitals Ch. 2

5. Toyota Triangle Found on page: 26 Andrew Hudson Lean Hospitals Ch. 2

6. Toyota Triangle Cont. • Human Development • Toyota places people at the center • Primary goal to the improvement of work is the development and learning of people • Secondary goal is the impact that improvement might have on performance • Philosophy • Customer first and provide them with what they want and when they want it • People are the most valuable resource • Continuous improvement (kaizen), engage everyone • Shop floor (gemba) focus, go to where the work is done to find the problems Andrew Hudson Lean Hospitals Ch. 2

7. Toyota Triangle Cont. • Technical Tools • Kanban – method for managing inventory • 5S – method for organizing workplaces to reduce wasted time and motion for employees • A3 – structured problem solving which is tracked and reported on a sheet of paper • Error proofing – method for designing or improving a process to reduce errors • Visual management – method for making problems visible that allow for a fast response and problem solving • Managerial Methods • Show passionate commitment for improvement and TPS • Learn TPS principles well enough to teach to others • Build an organizational culture that surfaces and solves problems • Be active in the gemba Andrew Hudson Lean Hospitals Ch. 2

8. The “Toyota Way” • Continuous Improvement • Kaizen – used to describe continuous improvement • Focus on reducing waste • Waste in the U.S. healthcare has resulted in a loss of half a trillion dollars • Example of waste: when a patient spends time waiting for an appointment • Respect for People • Managers and leaders frequently verify the details of how work has been done to ensure proper quality • Can include challenging people and pushing them to do their best • “Deadwood” – employees who have burned out and left • “Live wood” – current employees who grow in the company instead of leaving and going to a competing company Andrew Hudson Lean Hospitals Ch. 2

9. Organizational Capabilities for Lean • Work is designed as a series of ongoing experiments that immediately reveal problems • The way things are done are not random, inconsistent, or haphazard • Obligation to find new ways of improving the work • Structure work so problems are made readily apparent so they can be fixed quickly • Problems are addressed immediately through rapid experimentation • Plan-do-check-act (PDCA) cycle • when a problem is solved, the proposed change is a hypothesis that is presented for testing Found on page: 34 Andrew Hudson Lean Hospitals Ch. 2

10. Organizational Capabilities for Lean Cont. • Solutions are disseminated adaptively through collaborative experimentation • Local improvements made in one area should be shared with other departments • Allows other areas to consider the improvement at an earlier starting point • If other departments find a better way, they are obligated to share the improvement • People at all levels of the organization are taught to become experimentalists • This is done through continuous coaching, training, and mentoring • Lean helps employees to see their work in a new light which allows them to see problems they couldn’t see before and provide solutions to them Andrew Hudson Lean Hospitals Ch. 2

11. Lean and Other Methodologies • Total Quality Management • Became popular in the 1980s and 1990s • “seven basic QC tools” – ex: Pareto charts and fishbone diagrams • Malcolm Baldrige National Quality Award • “comprehensive framework for performance excellence” • Endorses Lean and other methods of process improvement • Six Sigma • 6 standard deviations around the mean by reducing variation • 3.4 defects per million in a process • Magnet Recognition Program • Recognizes healthcare organizations for quality patient care, nursing excellence, and innovations in professional nursing practice Andrew Hudson Lean Hospitals Ch. 2

12. Lean and Other Methodologies Cont. • Studer Group • Consulting firm that coaches healthcare executives and leaders • High Reliability Organizations • Industries who have achieved high levels of safety • Principles include having a preoccupation with failure, sensitivity towards operations, and others • TeamSTEPPS • Developed by the U.S. government that is a healthcare teamwork and patient safety improvement system • Just Culture • The balance between learning, reflection, and disciplining individuals Andrew Hudson Lean Hospitals Ch. 2

13. Lean Lessons • While its roots may be in manufacturing, Lean can be successful in other industries, including healthcare. • Lean is an organizational culture that develops from an integrated systems of tools, management practices, and philosophy. • Developing employees, their careers, and their talents is important for Lean to succeed. • Continuously improving and having respect for people are equally important and mutually supportive. • Work should be designed, rather than letting methods evolve. • “No problems is a problem” – we have to be open about having problems. • In a Lean culture, new methods are not spread by forcing them onto other units. • Our goal is to have all of our employees participate in solving problems and eliminating waste. • Lean can be combined with complementary methodologies Andrew Hudson Lean Hospitals Ch. 2

14. Source Graban, M. (2017). Lean hospitals: Improving quality, patient safety, and employee engagement. Boca Raton: Taylor & Francis. Andrew Hudson Lean Hospitals Ch. 2