Value Stream Management for Lean Healthcare

ISE 491 Fall 2009

The Elimination of Waste in Healthcare - Lecture 5

Fall 2009 ISE 491 Dr. Burtner Lecture 5 Slide 2

Eight Categories of Waste (in Healthcare)

Overproduction Waiting Excess Motion Excess Conveyance Over-processing Inventory Defects Unused Creativity

Fall 2009 ISE 491 Dr. Burtner

Fall 2009 ISE 491 Dr. Burtner Lecture 5 Slide 3

Overproduction (Unnecessary Services)

Producing work or providing a service before it is required or requested

Some Elimination Strategies Establish continuous work flow in terms of product or

service needed at the appropriate time (for the downstream customer)

Create visual controls to prevent early processing of information or services

Ensure information is only entered into one common database for authorized users

Create checklists to ensure all necessary information is collected at the appropriate time

Ensure email distribution lists and reports are distributed to necessary staff only

Fall 2009 ISE 491 Dr. Burtner

Fall 2009 ISE 491 Dr. Burtner Lecture 5 Slide 4

Waiting

Waiting for people, equipment, signatures, supplies, information, etc.

Some Elimination Strategies Review and standardize signature and approval

requirements. Cross-train staff to accommodate changes in service

demands Balance workloads throughout the day and ensure staff

members are working optimally. Ensure equipment and supplies are located in close

proximity to their required use. Ensure work items are labeled and a point-of-use (as

appropriate)

Fall 2009 ISE 491 Dr. Burtner

Fall 2009 ISE 491 Dr. Burtner Lecture 5 Slide 5

Excess Motion

Excess movement of people, equipment, paperwork, electronic communication that does not add value

Some Elimination Strategies Ensure supply areas are well organized utilizing color codes

and labels for quick access Organize computer files for easy retrieval Establish file naming conventions within departments Establish standards of communication ensuring doctor’s

orders and charts are easily accessible for authorized staff. Relocate staff, equipment, to closest area that requires

service

Fall 2009 ISE 491 Dr. Burtner

Fall 2009 ISE 491 Dr. Burtner Lecture 5 Slide 6

Excessive Conveyance (Excessive Transportation)

Delivering work products without adding value In the healthcare environment, the patient is a “work

product” that flows through the system Examples

Delivery of equipment too early or too late Transporting patients to surgery prematurely Moving samples or specimens to the wrong location “Placing a gurney in the hall and constantly having to more

it”

Fall 2009 ISE 491 Dr. Burtner

Fall 2009 ISE 491 Dr. Burtner Lecture 5 Slide 7

Overprocessing

Putting work into accomplishing something that the patient, physician, or healthcare provider either does not ask for or does not want

Results in non-value added work that the customer does not want to pay for

Examples Retesting (eg. Performing a second 24-hour urine test

because a staff member obtained the first specimen incorrectly)

Ordering more diagnostic tests than the diagnosis warrants (eg. ordering a Chem 24 when a Chem 6 will suffice

Entering repetitive form information Completing excessive paperwork

Fall 2009 ISE 491 Dr. Burtner

Fall 2009 ISE 491 Dr. Burtner Lecture 5 Slide 8

Inventory

Excess or outdated supplies; excess work piles Elimination of inventory frees up space and makes it

easier to find essential items quickly Examples

Duplicate medications and supplies in excess of normal usage

Obsolete office equipment Excessive office supplies Obsolete charts, files, and medical equipment Extra or outdated manuals, newsletters, or magazines

Fall 2009 ISE 491 Dr. Burtner

Fall 2009 ISE 491 Dr. Burtner Lecture 5 Slide 9

Defects

Also known as mistakes or errors

Defect waste includes all processing required to correct a defect or mistake

It takes less time to do it right the first time than to discover and correct the mistakes

Examples Medication errors Incorrect patient information Incorrect procedure Missing information Redraws

Fall 2009 ISE 491 Dr. Burtner

Fall 2009 ISE 491 Dr. Burtner Lecture 5 Slide 10

Unused Creativity

Not utilizing the available talents and skills of the staff to their fullest

Examples Insufficient cross-training of staff

Reluctance to elicit process improvement ideas from workers closest to the process

Design of policies, procedures, and practices without sufficient input from workers

Fall 2009 ISE 491 Dr. Burtner

Fall 2009 ISE 491 Dr. Burtner Lecture 5 Slide 11

Primary Sources

The Lean Healthcare Pocket Guide XL (2008) Authors: Debra Hadfield, RN MSN and Shelagh Holmes, RN

Value Stream Management for Lean Healthcare (2009) Authors: Don Tapping, Sue Kozlowski (CSSBB), Laura Archbold (RN, BSN,MBA), and Todd Sperl (MBB)