REALIZING THE POTENTIAL OF LEAN

THINKING IN HEALTHCARE

Daniel T Jones

ChairmanLean Enterprise

AcademyUK

Why am I here?

• Jim Womack and I have helped many industries get big benefits from following Toyota in using Lean thinking

• Consumer goods, construction and the public sector• I volunteered to try in healthcare - the time is right!• I took many walks – following the flow of work • I brought the pioneers together – to share experiences

and create awareness of the opportunities• We then conducted many experiments – to hone and

write down how lean methods work in healthcare• Now helping to build management systems to go

beyond point improvements and pilots to deliver results

Quality and Lean Thinking

• The Quality movement strives to define best practice interventions and to eliminate variation and errors

• Lean focuses on the context of the flow of work to eliminate delays for patients, wasted effort for staff and unnecessary costs for hospitals

• They complement each other – quality > stability < flow• They also share a common evidence based methodology• Lean begins with engaging staff in improving their work• But these point improvements are hard to sustain without

and end-to-end perspective and a management system to support them

The District General Hospital

HOMEHOME

REHABREHAB

HOMEHOME

GPGP

PHARMACYPHARMACY SUPPLIESSUPPLIES

PATHOLOGYPATHOLOGY THERAPIESTHERAPIES

EMERGENCY DEPARTMENTEMERGENCY DEPARTMENT

MAUMAU

SAUSAUEMERGENCY

CLINICCLINICCLINICCLINIC

CLINICCLINICCLINICCLINIC

ELECTIVE

SURGUCALWARDSSURGUCALWARDSOPERATING

ROOMOPERATINGROOM

MEDICALWARDSMEDICALWARDS

IMAGINGIMAGING

OTHERWARDSOTHERWARDS

DISCHARGE

DISCHARGE

The Challenge

• Now we see the hospital as a collection of processes

• And we know how to improve most of the pieces

• What would it take to connect all these pieces together?

• This has to have the support of the top team – who need to take the time to see:-– What are all the things that could be done?– What would be the results for hospital performance?

Defining the Problem

The A3 Method

What is Demand?

Demand to Get OutDemand to Get In

Mapping the Current State

Mapping the Current State

Mapping the Current State

The Emergency Medical Value Stream

What is the rate of demand?How to create flow within departments?How to flow between departments?Where to schedule this flow?

6.5 days waiting for 3 hours of work!

The A3 so far

Creating Flow in ED

Synchronizing activities on Wards

Nursing Availability to Discharge from Wards

How to Level Discharge?

The Future State

Buffers

Pacemaker

Flow

The Emergency Medical A3 Plan

The Elective Surgical A3 Plan

The ResultsFree up capacity

Cut the Agency and Overtime Budget

Big procurement savings

Khalid’s ‘End to End’ Trial: The Perfect Week (October 2008)

• ED Cell led by Senior Decision Maker – Safe Admission Avoidance• MAU Cell led by Senior Decision Maker – Safe Admission Avoidance• MAU Buffer• Discharge Lounge Buffer• Plan for Every patient (on medical wards)• Visual Hospital (Bed Management)

The Implementation

• If there is a will to act• Someone has to have the end-to-end responsibility

- a value stream manager• Who works to establish the foundations

- stability and visibility• Gaining agreement from the team on the right actions

- based on the facts• With the backing to resolve conflicts between

Departmental and value stream objectives• And to deliver results – in length of stay and $ saved

Plan for Every Patient Boards

By the Hour in ED

By the Day on Wards

Line Management

The Tasks

Establish Stability – Plan for Every Patient BoardsRespond to Variances – Delays and Escalation

Solve Problems – Root Cause Analysis

Management

Standard Management – Frequent Regular ReviewsOngoing Role – Develop Staff Problem Solving Capabilities

The Visual Hospital Board

Managing the Hub

Escalation Management

System

Value Stream Management

The Tasks

Establish Stability – Visual Hospital Hub and Status BoardRespond to Variances – Buffers and Escalation

Redesign Processes – Design Experiments and Review progress

Management

Standard Management – Regular Value Stream WalksOngoing Role – Develop the A3 Analytic skills of the team

Top Management

$

• Understand the scale of the Opportunity and how to translate this into Money

• Focus on the Vital Few – emergency medical length of stay• Deselect other activities to free up the Capacity to act• Appoint and support a Value Stream Manager and Team• Resolve Conflicts between Departmental Objectives

and the needs of the Value Stream• Go to Review Progress regularly

A Lean Management System

Establish Respond to DesignStability Variances Experiments

A PC D

TopManagement

Value StreamManagement

LineManagement

$ Deselect

Responses

Value Stream Manager

PlanHub

Problem SolvingPatient Boards

In Conclusion

• This takes an end-to-end perspective

• And a different management system

• We call this Lean Management

• You might call it – Evidence Based Management

• Or “a New Common Sense”

REALIZING THE POTENTIAL OF LEAN

THINKING IN HEALTHCARE

Daniel T Jones

www.leanuk.org