Lean Healthcare

1. Lean Healthcare Presented by: Melanie Sudduth Director of Lean Healthcare South Carolina msudduth@scmep.org 864-354-4773

2. Why Are We Here Today? Provide a brief introduction to SCMEP Provide an overview of Lean Healthcare Spotlighting - Lean – An Overview of the Tools - reVIEW Program - TWI

3. Who is SCMEP • An independent, non-profit 501c3 organization with its own charter and board of directorsmade up of SC manufacturing company owners and senior executives, as well as representatives from the state technical college system, research universities and Department of Commerce. • Mission - To Strengthen the Global Competitiveness of South Carolina Businesses • Vision - To be a primary resource for the South Carolina business community in providing highly-valued technological, workforce, and business solutions that improve competitiveness

4. Services for Business • Executive Leadership Services (Strategic Planning, M&A, Business Valuations, Succession Planning & Exit Strategies, etc.) • Top Line Growth (Marketing, Sales, Eureka Winning Ways and Lean Product Development) • Productivity/Process Improvements (Lean, TOC, Engineering Design, etc.) • Quality System Implementation (6 Sigma, ISO, QS/ TS Automotive, AS Aerospace standards) • ISO 14001, Energy Assessments • Environmental, Health & Safety Assistance • Human Resource Solutions

5. SCMEP – Impacts for 2008 • Companies Served 1,823 • Investment $36.3 MM • New and Retained Sales $152 MM • Cost Savings $49.9 MM • Jobs Created/Retained 1,360 • Overall Economic Impact $254.8 MM

6. Defining Lean Lean is: “A systematic approach to identifying and eliminating waste (non-value added activities) through continuous improvement by flowing the product or service at the pull of the customer in pursuit of perfection.” — The MEP Lean Network

7. Value-Added Any activity that increases the market form or function of the product or service. (These are things the customer is willing to pay for.) Non-Value-Added Any activity that does not add market form or function or is not necessary. (These activities should be eliminated, simplified, reduced, or integrated.) Definition of Value-Added

8. Lean = Eliminating NVA Non-Value-Added (Muda) • Overproduction • Waiting • Confusion • Processing • Inventory • Defects • Motion/Travel Value-Added Typically >60% of the total lead time is non-value-added.

9. Overproduction • Producing more than is required by the next process • Producing earlier than is required by the next process • Producing faster than is required by the next process • Examples of overproduction: • Duplicate charting • Multiple forms with the same information • Copies of reports sent automatically

10. Inventory Waste • Any supply or purchase in excess of the current demand • Examples of excess inventory: • Overstocked medications on units • Purchasing excess because the piece price is cheaper • Stocking too much at point of use (large cabinet = fill it up!) • Disorganization – can’t find it, so we buy more

11. Defects/Errors • Inspection and correction of mistakes • Examples of Defects/Errors: • Wrong dosage/wrong medication administered • Rework of any kind • Inconclusive tests • Incorrect charges/billing • Surgical errors

12. Processing Waste • Effort that adds no value from the patient/customer’s perspective • Examples of processing waste: • True requirements not clearly defined – Clarifying orders • Extra copies or excessive information • Missing medications • Regulatory paperwork

13. Waiting Waste • Idle time created when people, information, equipment or materials are not at hand. • Examples of waiting waste: • Waiting on test results • Waiting on doctor/nurse, etc. • Waiting on availability of equipment or treatment rooms • Waiting on cleaning of rooms • Waiting for “now” medications • Waiting on supplies

14. Confusion • People doing the work are confused or not sure about what should be done. • Examples of confusion: • Unclear MD orders • Unclear route for medicine administration • Unclear system for indicating charges for billing • Same activities being performed different ways different people

15. Motion/Travel Waste • Any movement of people, equipment, supplies, etc. that does not add value. • Examples of motion waste: • Looking for information, supplies, people, etc. • Supplies not located at point of use • Unfavorable layout • Supplies not prepped prior to patient treatment

16. Lean Building Blocks Continuous Improvement Pull/Kanban Cellular/Flow TPM POUS Quality at Source Quick Changeover Standardized Work Batch Reduction Teams Value Stream Mapping Visual 5S System Facility Layout

17. Standardized Work All work is safely conducted with all tasks organized in the best known sequence, and using the most effective combination of these resources: • People • Materials • Methods • Equipment

18. 5S – Workplace Organization & Standardization 5S = Sort Set in Order Shine Standardize Sustain A safe, clean, neat arrangement of the workplace provides a specific location for everything, and eliminates anything not required.

19. Visual Controls Simple signals that provide an immediate understanding of a situation or condition. They are efficient, self-regulating, and worker-managed. Examples: • Kanban cards • Color-coded forms, supplies, etc. • Lines on the floor to direct visitors to correct departments • Lines on the floor to instruct staff where to return carts, equipment, gurneys, etc. • Andon lights outside patient rooms (signals)

20. Facility Layout

21. Teams • Teams Cross-trained and multi-skilled personnel • Teams for Continuous Improvement • Process quality, not inspection • Decision-making done by those doing the work • Problem solving teams

22. Setup or Changeover Reduction • Definition: The time required from the completion of the last procedure until the start of the next procedure. Set-up includes getting instruments, getting supplies, setting-up rooms, getting materials, and getting paperwork. Benefits include: • Improvement of capacity and volume • Increase in flexibility • Increase in competitiveness • Increase in Patient Satisfaction • Increase in Physician Satisfaction

23. Impact of Batch Size Reduction Batch and Queue Processing Process C Process A Process B 10 min. 10 min. 10 min. 30+ min. for total order, 21+ min. for first piece Continuous Flow Processing Process A Process B Process C 12 min. for total order, 3 min. for first part

24. Point Of Use Storage (POUS) • Materials, Supplies and Equipment is where used • Benefits: • Reduced Motion/Travel • Decreases patient delays • Increases patient throughput • Reduces confusion and “searching’

25. Quality at the Source • Personnel must be certain that work is being performed correctly • Techniques used: • Samples or visual standards • Process documentation defining quality requirements • Poka Yoke – Mistake Proofing Techniques • Root Cause Analysis Tools (A3 Problem Solving)

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

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

28. Systematic approach to the elimination of the six major equipment losses: Setup and adjustment Breakdowns Idling and minor stoppages Reduced speed Startup Defects and rework Total Productive Maintenance (TPM)

29. Lean Simple and visual Patient driven Supplies as needed Reduce non-value-added Minimal lead time Quality Controls Value stream managers Traditional Complex Internally driven Excessive supplies Speed up value-added work Long lead time Rework & Errors Functional departments Conclusion

30. Thank You.