My blog is focused primarily on the Theory of Constraints and how to use it to maximize the profitability of any company. I also discuss why integrating TOC with Lean and Six Sigma is the most dynamic improvement methodology available today.
Continuing with my
series on healthcare and my push for everyone to get a copy of Performance Improvement for Healthcare,
let’s talk a little bit about how Lean, Six Sigma and Constraints Management
might apply in a healthcare environment.I’ll start this post by talking about examples of the 7 deadly wastes as
depicted in this great book and once again, I’ll be using direct quotes.No matter what industry you represent, these
same type wastes exist in your world just like they do in a typical hospital.The more I read this book, the more I
appreciate its contents and the impact it could have on the healthcare systems
not just here in the US, but on the healthcare systems throughout the world.
the 1950s, one could argue that the United States owned the automobile
market worldwide. Then, in 1950, a Japanese engineer named Eiji Toyoda spent
three months at Ford’s Rouge Plant in Detroit. This was the seminal point in
the evolution of Lean. Between 1937 and 1950, Toyota had produced 2,685
automobiles total, compared with the almost 7,000 produced daily at the Rouge
effort to compete in the marketplace, Toyoda—along with others—adapted what he
saw at Ford into the beginning of what came to be called the Toyota
Production System. In 1990, Womack, Jones, and Roos coined the phrase Lean
Manufacturing, and nothing has been the same ever since.According to the Lean Enterprise Institute,
Lean as a concept includes five basic principles:
·Specify value from the end customer’s perspective.
·Identify all the steps in the value stream for each service, eliminating
·Make the value-adding steps flow without interruption to the
·Implement a pull system based on customer demand.
·As value is specified, value streams are identified,
“In alignment with
these principles, all processes should—must—add value to the customer,
include only value-adding steps, and flow continuously from customer order to
delivery. This Lean archetype, along with recognition that perfection is
a journey, is equally applicable to manufacturing, services, and healthcare.”
“Efforts to apply
Lean are focused on addressing specific issues or wastes.Seven deadly wastes have been
identified. While these were developed originally for applicability within
manufacturing, they are equally relevant in healthcare. An explanation of
wastes as they relate to healthcare appears in the image below.”
·Transport. Any time people,
materials, or information must be moved, it is defined as waste. Moving
patients from room to room is an example of waste. While in many cases
necessary, this transportation nonetheless is viewed as waste. Use of a
spaghetti diagram may help to minimize this type of waste.
·Inventory. While it is necessary to maintain
inventories to ensure availability, anything short of just-in-time (JIT)
availability is categorized as waste. Tools such as kanban can mitigate this
kind of waste.
·Motion. A nurse’s station with a
desktop computer at one end and a printer at the other that requires nurses to
move excessively to pick up printouts is an example of waste. Good ergonomic
practices and more efficient workspace layouts can moderate this waste.
·Waiting. This waste is endemic to
healthcare. We even call our primary customers patients—is this because it is
an expectation? Elimination of non-value-adding activities can diminish this
too many tests and printing too many copies of paperwork are examples of
overproduction. Reviewing standard lab panels or pursuing paperless processes
can mitigate this type of waste.
excess approvals and running the same test twice are examples of
overprocessing. The elimination of non-valueadding activities can lessen this
sort of waste dramatically.
·Defects. When a product or service
does not meet specification or customer expectations, it is a defect. Defects
often result in rework, and the associated costs frequently go unaccounted for.
value-stream analysis (PVSA) and rapid improvement workshop (RIW)
are often applied toward eliminating or reducing these wastes. These aspects are
addressed in much more detail in Chapter 6 of this book.”
“The power of Lean is
its ability to eliminate waste and improve flow, which is central to the
simplification of processes and reduction of delays and handoffs. Examples of
Lean applications include reduction of nonvalue-added steps in the delivery of
care, mistake-proofing hand sanitation, and standardizing referral management.”
In my next posting, I’ll
show you what these authors have to say about Six Sigma and then Constraints
Management.I know I’ve said it already,
but if you’re in a healthcare environment (and even if you aren’t), you really
need to grab a copy of this book for your own personal library!It’s a gem!!