Applying TPS (Toyota Production System) in our healthcare system

1. Applying TPS (Toyota Production System) in our healthcare system AHMAD SYUKRI JAMALUDIN doktordanwang.com

2. OBJECTIVE • To double or triple speed of any process • Ambulance call • Resuscitation • Patient treatment and care • Disaster • To build quality into workplace systems • To eliminate huge cost of hidden waste • To turn every employee into a quality control inspector

3. WHAT AM I PRESENTING? • One of the best system in the world. • A topic that has never been presented in medical field before. • A system that can be manipulated (to fit any kind of organization). • As big as HKL/HTJ • As small as HPD

4. LESS THAN 30 MINUTES

5. TOYOTA • From a company that produced poor quality vehicles with primitive technology to the world’s greatest manufacturer.

6. TPS • Toyota Production System-basis for much of the ‘lean production’ movement that has dominated manufacturing trends. • Time line from the moment the customer give and order to the point when we collect cash. And we are reducing that time line by removing the non-value-added waste.

7. Hospital application

8. Hospital application

9. THE HEART OF THE TOYOTA PRODUCTION SYSTEM ELIMINATING WASTE

10. Applying TPS • Start with examining the process from customer’s perspective to define value. (internal customer and external customer)-what does the customer want from the process?

11. Example-waste in a truck assembly line • Bring all components to the assembly line • Walking 25 feet to pick up the component • Removing cards and expose the components • Reaching tool for component • Picking up bolts for the component • Walking 25 feet back to the chassis on the assembly line. • Positioning the component on the chassis • Walking to the power tool • Reaching for the power tool • Walking and pulling the power tool to the component on the chassis • Pulling the power tool down to the component • Placing the bolts in the component • Tightening the bolts to the chassis with the power tool • Walking back 25 feet for the next component

12. Learning point • Operator takes many individual steps, but only a small number of the steps add value to the product • In this case, only the three steps identified add value. • Some non value added steps are necessary, eg-operator has to reach to get power tool. • The point is to minimize time spent on non-value-added operations by positioning tools and material as close as possible to the point of assembly.

13. Example 1-blood investigation • Patient seen by doctor • Doctor request for blood investigation by filling request form • Patient put request form on the registration counter • Form taken and put in the treatment room • Medical assistant prepare equipment for blood taking • Medical assistant call patient from the treatment room • Patient walk to the treatment room • Blood taken from patient • Medical assistant walk to sample table to put blood product and form • sample taken by penolongpegawaikesihatan and walk 50 meter to lab. • Penolongpegawaikesihatan walk back 50 meter to emergency department • Lab process sample • Penolongpegawaikesihatan walk 50 meter to lab to take result • Penolongpegawaikesihatan walk another 50 meter to emergency department and give result to doctor. • Doctor analyse the result and give proper treatment.

14. Waste • Overproduction. Produce items which there are no orders, which generates such wastes as overstaffing and storage and transportation cost because of excess inventory.

15. Waiting. Workers watch an automated machine or having to stand around waiting for the next processing step. Just plain having no work because of processing delays, equipment downtime, capacity bottle neck. Eg. Medical doctor waiting for blood result, PPP waiting for blood or patient to be ready for transportation, lab worker waiting for blood centrifuge.

16. 3. Unnecessary transport. Carrying work in process (eg sample) long distances, creating inefficient transport, or moving patientsor equipments between places. 4. Overprocessing or incorrect processing. Taking unneeded steps to process the parts. Inefficiently processing due to poor tool and product design, causing unnecessary motion and producing defects.

17. 5. Excess inventory. Excess material causing expiry, damaged goods, transportation and storage costs and delay. Eg. Too much sample bottle or medication ordering causing expiry.

18. 6. Unnecessary movement. Any wasted motion employees have to perform during the course of their work, such as looking for, reaching for, or stacking parts, tools. Also, walking is a waste. 7. Defects. Production of defective parts or correction. Repair or rework, scrap replacement production, and inspection mean wasteful handling, time, and effort.

19. 8. Unused employee creativity. Losing time, ideas, skills, improvements and learning opportunities by not engaging or listening to your employees.

20. Example 2- Disaster Where to set medical base camp? How big is the medical base camp? How many personnel needed? What system of communication are we using?

21. Example 3 – ambulance services How many ambulance needed? Where to position ambulance? How to service ambulance?

22. Example 4 - Resuscitation Where to place patient for resuscitation? What equipment needed and where? How many personnel needed? When and how to transport patient?