Monday, December 6, 2010

Lean Tools for Healthcare

The second title in the Lean Tools for Healthcare is about to enter production at CRC Press. This little book, based upon the Shingo Prize-winning Shopfloor Series, presents the core methods and tools of lean healthcare:

1. Standard worksheet or spaghetti diagram;
2. Time observation form;
3. Percent load chart; and
4. Standard work instruction.

Future posts will include excerpts from this and other books in the Lean Tools Series, including 5S for Healthcare (already on the shelves) as well as the next two books in the Series: Kaizen for Healthcare and Mistake-proofing for Healthcare.

Tom Jackson
Portland, Oregon

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Monday, November 29, 2010

And that includes you...

It is often said that 5S, the Japanese system of workplace organization, is for everyone. And that includes you, Mr/Mdm Healthcare Executive.

For example, today I have been working with the executive assistants of a large healthcare organization in the San Francisco Bay Area. Of course these are people who owe their jobs to their very high level of function and exceptional organization skills. On the surface there may not appear to be much opportunity, until we stop to consider how valuable their time (and their bosses' time) is.

Okay, so they may not hoard paper and pens. (Well, maybe they do.) And everything is reasonably neat and clean. (Sort of.)

Tell me again why you can't get your feet under your desk. What about the placement of that printer? And what is that CPU doing on your desktop? When exactly was the last time you used that thing? Do you really need all these forms? If I had to do your job, where would I begin? I notice that you can't see each other (in your cubicles and private offices), so you rely on email and the telephone to communicate with each other. How is that working?

The point is that despite appearances there is plenty of room for improvement in the C-suite. 5S can free precious space and executive time and mitigate communication defects. Not to mention the power of leading by example...

It is not for nothing that 5S is called the foundation of lean healthcare. It prepares the environment for the implementation of standard work and ensures adherence to standard work when implementation is done.

The foundation stone is laid--where? In the C-suite, of course!

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Sunday, June 27, 2010

Teaching lean healthcare. What a humbling experience.

This Saturday, I spent eight hours face-to-face with a new cohort of Executive Management of Healthcare Administration (EMHA) students at the University of Washington's School of Public Health. Doctors, nurses, pharmacists, IT specialists, finance people, food service people: all so very very bright and so very motivated to improve our healthcare system, in the United States--and healthcare systems all over the world.

The content of our interaction in this, the first of three 8-hour classroom experiences in June, July, and August, was the application of the Toyota Production System to healthcare operations. Without belaboring details, this means that we talked about ways to reduce healthcare "lead time," as defined by the total time experienced by the patient, from the beginning to end of what (in healthcare terminology) we might call a "treatment experience." (In healthcare we sometimes refer to this as a "patient encounter," which is rather revealing, as if we didn't know they were coming to see us...)

In a clinical or emergency room experience, this experience might normally include:

1. registration
2. waiting
3. assessment
4. waiting
5. treatment
6. waiting
7. discharge

Of course, this is an extremely truncated view of the patient experience, but it captures the essentials:

a. Who are you?
b. What's wrong with you?
c. What can we do about it?
d. Let's do what we can.
e. Get out of here...

Clearly, from the patient's perspective, we would like this experience to be over quickly, so that we can go home and rejoin life in progress. As quickly as possible, thank you very much.

Unfortunately, the clinician's experience is, for practical reasons, often determined by a compelling need to get on to the next patient.

Of course, that is all well and good if I am the next patient. But what if I am this patient? And, life begin what it is, I am normally this patient.

Hello. Remember me? Your patient?

And, I am waiting for you to get around to me.