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.

Sunday, October 25, 2009

The Spread of Lean in Alaska

Patrick M. Anderson, Executive Director
1840 Bragaw St., Suite 110
Anchorage, Alaska 99508
(907) 334-0147

As a new chief executive for an Alaska Native non-profit organization in 2004, Chugachmiut, Inc., I heard the message about Lean from Brian Jones, President of Nypro Precision Plastics based in Clinton, MA. During lunch Brian explained Nypro’s “High Velocity System” to three of us. I asked Brian whether Nypro ever utilized Lean for their administrative processes, and while he said they did not, they were looking into it. He piqued my interest and I returned to Alaska to talk about Lean with my Executive Staff. They were willing to give it a try. I then sought out the first available conference that discussed Administrative Lean, and worked around my schedule to attend The 2004 Shingo Prize in Lexington, Kentucky. I could only attend 2 days of the conference if I traveled all night the first day and returned home in the early morning following the last day in order to fulfill obligations. My commitment to learning about Lean was intense.

At the Shingo Prize, I attended a number of presentations, but none by the host for this Blog, Dr. Tom Jackson. I was fortunate enough to stop Dr. Jackson on my way to another presentation and meet him. He ended up becoming Chugachmiut’s Sensei about a year later.

I must confess that I was already very knowledgeable about the principles taught by Dr. W. Edwards Deming, so I was predisposed to process management. The Lean training and simulations I experienced at Shingo convinced me to start a Lean initiative at Chugachmiut. 5 years later, we have achieved considerable success, and learned a lot about resistance to change.

It’s not my intention to talk about Chugachmiut’s Lean improvements here. Our website talks about a number of our lean initiatives. Instead I want to discuss resistance to Lean management in Alaska, and elsewhere, to this proven and true improvement method. What I have learned is that the Lean management message is very hard to sell. Persistence, results, and a network of true believers are necessary to make an impact.

Why am I even trying to sell the message? I explain I through one of the Lean Management principles of working with the supply chains that serve your customers. Our patients at Chugachmiut also receive health care services from two other Alaska Native health care organizations. I realized that both organizations could benefit our patients through adoption of Lean Healthcare and Lean Administration.

So in December of 2006, I sent a letter to the heads of the largest Alaska Native health care programs in the state of Alaska. By then one of the organizations had conducted a Kaizen for one of its smaller but critically important processes. They achieved about a 40 day reduction in the length of the process, an increase of quality from somewhere in the 5% range to somewhere in the 90% range, and a savings of 80% from the original cost of the process. What I found was that the middle management staff that engaged in the Kaizen were sold on the idea quickly. They have quietly advocated for slow spread of the culture. Through their efforts, and the many examples of successful hospital lean healthcare implementations such as occurred at Virginia Mason, Theda Care, Park Nicollet and others are pointing the way for other executives.

Shortly afterwards, I learned about the Lean Production advocacy coming from the Alaska Manufacturing Extension Partnership. Their staff includes a Lean Sensei. Together he and I wrote to the former Governor of Alaska recommending that she look at the use of Lean Production for managing the now defunct Matanuska Susitna Dairy and the Alaska Office of Children’s Services, two highly distressed organizations. We did not receive a response.

I also discovered the Alaska Performance Excellence Network, an organization dedicated to spread the gospel of process management and the Baldrige Quality Criteria.

Lean Healthcare is finally making some inroads in one of the two Alaska Native Healthcare organizations. One high level administrator has expressed considerable interest and a number of Kaizen events are scheduled this year. This brave executive needs support among his policy makers and the other executive leadership at his organization. This organization is on it’s way, and if Lean is implemented properly, the successes will soon pile up and hopefully encourage deeper involvement.

I also spoke to 2 heads of Alaska’s Department of Health and Social Services, 2 Anchorage Mayors, the Anchorage Chief of Police (he sent 2 of his staff to learn more and was starting an implementation when he was removed from his position), and countless other business leaders in Alaska. I don’t get discouraged. Again, our customers are served by each of these organizations, and I firmly believe they could benefit from the application of Lean Management.

By the way, if you have avoided learning about Lean and its benefits, take a second look. The quality of your organizations work will go up, the productivity of your work force will increase, and one of the nice benefits of a Lean implementation is that you will save money. You won’t even have to try if you implement well.

Thursday, October 8, 2009

9 Points (conclusion)

J. Michael Rona
Principal, Rona Consulting Group
Mercer Island, Washington

This is the fourth and final post in a series about 9 Points that define the lean heatlh care enterprise:

1. A Compelling Vision
2. Enlightened and Fearless Leadership
3. Values Driven
4. Respect for the Customer and Customer Driven
5. Quality Driven
6. Obsessed with Safety
7. Respect for Staff
8. Continuous Improvement
9. Generate Higher Margins or Create Greater Capability

These nine points help characterize a lean health care organization. When implemented and fully engrained, the organization is transformed. Then it lives the principles of the Toyota Management System and produces perfect products, one at a time, in flow synchronized to the demand of the customer. This is what a lean health care organization looks like and how it behaves.

In this post I cover Point 7, 8, and 9.

7. Respect for Staff

A lean healthcare enterprise recognizes and behaves as if its staff were its most precious and irreplaceable resource. It respects its staff and demonstrates a profound commitment to enabling the best performance of its people. It sees as its second most important challenge to its leadership, the creation of a supportive environment in which it engages its people in creating excellence. Lean health care organizations enable perfectly competent and capable people to perform at extraordinary levels. Such organizations develop processes that allow their people to soar every day.

Lean health care organizations, in their actions, recognize and believe that releasing the creativity and brilliance of their workers is the key to breakthrough innovation and the success of the company.

8. Continuous Improvement

Lean health care organizations are constantly improving their processes and reducing their lead times (delivery times) through the vigorous elimination of waste. At every level, one can see the organizational learning cycle of PDCA (Plan, Do, Check, Act) at work. They are never satisfied with the current state and while they are not routinely looking for quantum changes in their processes, their steady, tortoise like constancy on waste reduction, they far outpace their competition in perfecting their processes

9. Generate Higher Margins or Create Greater Capability

Lean health care organizations generate margins that far exceed those of organization which do not use lean management approaches. This is because their source of value creation starts with a focus on customers, respect for staff and the elimination of waste to improve unit costs, reduce lead times, dramatically improve throughput and increase capacity with no added costs. These organizations do not rely on layoffs and other short-term strategies to generate margins, they rely on their people to find better ways and see their investment in their people as their most important strategic advantage. In organizations that are on fixed budgets, the elimination of waste enables greater capacity to serve customers using the same or less resources.

The effectiveness of these nine principles are clearly demonstrated in the results of the implementation of lean healthcare at the Virginia Mason Medical Center in Seattle, where we achieved productivity increases between 45 to 75%, cost reductions between 25 to 55%, improvements in throughput between 60 to 90%, quality improvements between 50 to 90%, inventory reductions between 35 to 50%, and lead time reductions between 50 to 90%.

The effectiveness of these same principles has been demonstrated more recently by our clients, who report similar achievements and confirm that the return on their investment in lean healthcare ranges from a low of 100% to over 1000%.