Leveraging lean in ancillary hospital services : creating a cost effective, standardized, high quality, patient-focused operation

348 Pages·2015·40.99 MB·English

by  Charles Protzman

Healthcare Management / Process Improvement MKP Leveraging Lean in
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Leveraging Lean in Healthcare: Transforming Your Enterprise into a High Quality Patient lrn
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There are many departments within a hospital that support the primary function of caregiving
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and each can benefit from implementing Lean methodologies. Leveraging Lean in Ancillary
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Hospital Services: Creating a Cost Effective, Standardized, High Quality, Patient-
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improvement techniques in nutritional services, inpatient floors, pharmacy, and radiology. g Creating a Cost Effective, Standardized,
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inquisitive frontline workers who want to implement and leverage Lean. Supplying detailed
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descriptions of Lean tools and methodologies, it identifies powerful Lean solutions specific to
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the needs of ancillary hospital services. Charles Protzman • Joyce Kerpchar • George Mayzell, MD
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The second section focuses on the application of Lean in the ancillary hospital services n
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K23162
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K23162 cvr mech.indd 1 11/13/14 9:53 AM

Leveraging Lean in
Ancillary
Hospital Services
Creating a Cost Effective, Standardized,
High Quality, Patient-Focused Operation

Leveraging Lean in
Ancillary
Hospital Services
Creating a Cost Effective, Standardized,
High Quality, Patient-Focused Operation
Charles Protzman • Joyce Kerpchar • George Mayzell, MD
CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
© 2015 by Charles Protzman, Joyce Kerpchar, and George Mayzell
CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
Version Date: 20141107
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Contents
Preface: Ancillary Hospital Services .............................................................................................xvii
Acknowledgments ...........................................................................................................................xxi
Authors .........................................................................................................................................xxiii
SECTION I
Chapter 1 Introduction to Lean .....................................................................................................3
The Need for Change ...................................................................................................3
National and Global Competition .................................................................................4
Challenges for the Healthcare Worker .........................................................................5
Lean and Layoffs .....................................................................................................5
Traditional Healthcare Model ......................................................................................5
Introduction – So What Is Lean? .................................................................................7
Lean and Hospitals .......................................................................................................8
What Results Can You Expect? ...............................................................................9
The CEO and Lean .....................................................................................................10
Typical Lean Metrics and Outcomes .........................................................................11
Potential Lean Returns by Department .................................................................11
Typical Results/Return on Investments (ROI) and Implementing Lean ...............11
Lean and Systems Thinking .......................................................................................16
Boiled Frog Syndrome...........................................................................................16
Systems Thinking Principles .................................................................................16
Viewing the Hospital with Systems Thinking ......................................................17
What Is a Lean Business Delivery System? ...............................................................20
Lean Business Delivery System Vision .................................................................21
Understanding the Value of the Lean Business Delivery System .........................21
Just In Time: The First Pillar of the Toyota Production System Model ................22
An Example of One of the Rocks—Short-Staffed ...........................................23
Jidoka—The Second Pillar of the Toyota Production System ...............................24
Jidoka Means: Never Pass on a Bad Part or Patient ..............................................25
Applying Jidoka to Healthcare ..............................................................................25
The Top of the Toyota House—Respect for Humanity ..............................................26
Lean Is a Journey .......................................................................................................27
Chapter 2 Batching vs. Lean Thinking and Flow .......................................................................29
Batching vs. Lean Thinking and Flow .......................................................................29
Batching vs. Flow in a Healthcare Environment .......................................................30
Batching Examples ................................................................................................30
Process Definition .............................................................................................30
Batching Systems ..................................................................................................31
Why People Love to Batch? ...................................................................................31
One-Piece/Patient Flow ....................................................................................33
One-Piece Flow Example ......................................................................................36
v
vi Contents
Group Technology .................................................................................................38
Productivity - Definition ............................................................................................38
Batching the Domino Effect ......................................................................................38
Peak Demand .............................................................................................................38
Examples of Batching in Healthcare .....................................................................39
Chart Preparation..............................................................................................39
The Chart Problem ...........................................................................................40
Application of One-Piece Flow to Healthcare ...........................................................40
Flow—One-Piece Flow or Small Lot ........................................................................42
Chapter 3 Lean and Change Management ..................................................................................45
Implementing Lean Is about Balance .........................................................................45
Lean Culture Change .................................................................................................45
Paradigms ..............................................................................................................46
Change Equation ...................................................................................................46
C ∙ Compelling Need to Change ............................................................................47
Why Change? .........................................................................................................47
V ∙ Vision ...............................................................................................................49
N ∙ Next Steps ........................................................................................................50
S ∙ Sustain ..............................................................................................................50
Change and What’s In It For Me ...........................................................................50
Lean and Change Management ..................................................................................51
Lean and Organizational Change - “Right Seat on the Right Bus” ...........................51
Resistance to Change .............................................................................................52
Changes… Highs and Lows ..................................................................................52
Rule of Unintended Consequences and Bumps in the Road .................................53
Change Is a Funny Thing ......................................................................................53
We Are All Interconnected but Not Typically Measured That Way .....................53
Horse Analogy .......................................................................................................53
Comparison to Where We Are Today ...................................................................54
Employee Suggestion Systems ..............................................................................54
Barriers to Change .................................................................................................55
Most Loved Words ................................................................................................56
Does Your Organization Have Sacred Cows? .......................................................56
Leadership and Organizational Changes ...................................................................57
Communication, Change and Lean ............................................................................58
Summary ...............................................................................................................59
Chapter 4 Lean Foundation .........................................................................................................61
Lean Foundation - The BASICS Model - Baseline ....................................................61
Think—See—Act Lean ........................................................................................61
System Lean Implementation Approach Utilizing the Basics Model ........................61
A Customer Service Story .....................................................................................64
Baseline Metrics .........................................................................................................66
Data, Revenue, and Hospitals ................................................................................66
The Impact of Data on Lean – Process Focused Metrics ..........................................67
Customer Satisfaction ............................................................................................67
Voice of the Customer Surveys .............................................................................68
The VIP Visit .............................................................................................................69
Easy to Do Business With .....................................................................................69
Contents vii
Centralized = Batching ..............................................................................................70
What Does All This Have to Do with Hospitals? .................................................70
Customer Value-Added Proposition ...........................................................................70
Customer Quality Index ........................................................................................71
KANO Model ........................................................................................................71
Baseline the Process ...................................................................................................72
Value Stream Map (VSM) the Process .................................................................72
Value Stream Discussion .......................................................................................74
Value Stream Mapping and Healthcare .................................................................74
Value Streams Objectives ......................................................................................75
Traditional Hospital Systems - SILOS ..................................................................75
Lean Goals.............................................................................................................75
Parts of a Value Stream Map .................................................................................76
Value Stream Map Icons .......................................................................................76
Value Stream Map Definitions ..............................................................................76
Day 1 .................................................................................................................78
Day 2 .................................................................................................................78
Day 3 .................................................................................................................78
Day 4 .................................................................................................................78
Day 5 .................................................................................................................79
Current State Value Stream Mapping ...................................................................79
Ideal State ..............................................................................................................79
Future State Value Stream Mapping .....................................................................80
Value Stream Map Project Lists, Prioritization Matrix, and Tracking .................80
Value Stream Layout Maps (Sometimes Referred to as Skitumi Maps) ...............84
Baselining the Process—Data Collection and Analysis—Current State ..................84
Takt Time/Production Smoothing .........................................................................84
Available Time ......................................................................................................84
Customer Demand .................................................................................................84
Peak Demand .........................................................................................................85
Cycle Time .............................................................................................................86
Cycle Time and Takt Time—What’s the Difference? ...........................................86
Designing Cycle Time to Takt Time .....................................................................87
Length of Stay (LOS) ............................................................................................88
Length of Stay Is Directly Correlated to Inventory...............................................89
Length of Stay—A Key Metric .............................................................................89
Reducing Length of Stay ............................................................................................90
Number of Staff Required .....................................................................................91
Total Labor Time ...................................................................................................92
Quiz .......................................................................................................................92
Weighted Average ..................................................................................................92
Financial Metrics ........................................................................................................93
Measuring Inventory and Cash Flow ....................................................................93
Work in Process Inventory ....................................................................................94
Sales of Reimbursement Per Employee .................................................................94
Contribution Margin ..............................................................................................95
Cost Per Case .........................................................................................................95
Data and What People Think ................................................................................95
Sustainability and Accountability ..............................................................................96
Process Owners Do Not Always Have the Skill Sets Necessary to Manage
in a Lean Environment ..........................................................................................97
viii Contents
Chapter 5 Basic Lean Concepts and Tools – Assessment and Analyze .....................................99
Levels of Waste ..........................................................................................................99
Low-Hanging Fruit ................................................................................................99
Five S Wastes .........................................................................................................99
The Seven (Eight) Wastes ......................................................................................99
How Do You Find Waste? ........................................................................................102
30-30-30 Exercise ................................................................................................103
People ..................................................................................................................103
Equipment ............................................................................................................103
Communication ...................................................................................................104
Visual Controls ....................................................................................................104
Leadership ...........................................................................................................104
Cost of Waste ............................................................................................................106
Baseline Entitlement Benchmark .............................................................................106
Five Why’s ................................................................................................................106
Example: ..............................................................................................................106
Another Tool to Get Rid of Waste: The Five W’s and Two H’s ...............................107
Root Cause Analysis—A3 Strategy .........................................................................107
Fishbones and Lean ..................................................................................................108
Problem-Solving Model ...........................................................................................108
Problem Statements ..................................................................................................110
Lean Tools - Analyze/Assessment ............................................................................111
Basics—Assess the Process .................................................................................113
Step One: Understand and Assess the Overall Process ..................................113
Value-Added ........................................................................................................113
Non-Value-Added Activities/Work ......................................................................114
Non-Value-Added But Necessary Work ..............................................................114
Unnecessary Work ...............................................................................................114
Idle Time .............................................................................................................114
Warranted IDLE Time Exceptions ......................................................................114
The Patient Physical Examination ..................................................................115
Step 1: Process Flow Analysis (PFA)—Following the Product/Patient ..................115
Mapping the Process—Identifying Process Boxes .............................................116
Product Process Flow Analysis Tool ........................................................................116
The Four Components of PFA - Tips Analysis ........................................................117
Basic Lean Tools Understanding Types of Storage ..................................................119
Raw Material Storage ..........................................................................................119
Work in Process Storage ......................................................................................119
Finished Goods Storage.......................................................................................120
Further Delineating Storage—Types of Work in Process ...................................120
Lot Delay .............................................................................................................120
Potential Lean Solution Example #1 ...................................................................121
Potential Lean Solution Example #2 ...................................................................121
Between Process Delay .......................................................................................121
Within Process Delay ..........................................................................................122
Why Break Down Types of Storage? ..................................................................122
Total Throughput Time .......................................................................................122
Product Flow Analysis Worksheet ......................................................................123
Product Flow Point-to-Point Diagrams ...............................................................123
How to Do a Point-to-Point Diagram ..................................................................125