Saturday, May 19, 2012

Focus and Leverage Part 114

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.

“Prior to 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 Plant.”

“In an 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 non-value-adding steps.

·         Make the value-adding steps flow without interruption to the customer.

·         Implement a pull system based on customer demand.

·         As value is specified, value streams are identified, non-value-added steps”

“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 waste.

·         Overproduction. Running 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.

·         Overprocessing. Requiring 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.

“A process-level 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!!

Bob Sproull

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