The lean hospital what is mean
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This document discusses Lean and Six Sigma quality improvement methodologies used in healthcare. It explains that Lean focuses on eliminating waste using tools like 5S and value stream mapping. Six Sigma aims for near-perfect processes by reducing defects to 3.4 per million opportunities through the DMAIC methodology of define, measure, analyze, improve, and control. The document provides examples of different types of waste in healthcare like unnecessary motion, waiting, and overproduction. It emphasizes that adopting Lean thinking can help improve patient safety, satisfaction, productivity and other goals by standardizing processes and eliminating waste.
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The lean hospital what is mean
- 1. The Lean Hospital: ? What does it mean DR EMAD KOTB QUALITY MANEGMENT DIRECTOR RAFHA CENTRAL HOSPITAL
- 2. QI Process Methodologies •FOCUS-PDCA •Six Sigma “DMAIC” “3.4/million defects” •Lean QI Process “No waste”
- 3. The FOCUS -PDCA Methodology IND AN OPPORTUNITY ORGANIZE A TEAM CLARIFY THE PROCESS UNDERSTAND THE PROBLEM(S) SELECT A DESIRED OUTCOME
- 4. ?What does Six Sigma mean The term “Sigma” is a measurement of how far a given process deviates from perfection – a measure of the number of “defects”. Six Sigma correlates to just 3.4 defects per .million opportunities A quality improvement methodology that • applies statistics to measure and reduce .variation in processes A management system that is • comprehensive and flexible for achieving, .sustaining, and maximizing success 2 308,537 3 66,807 4 5 6 6,210 233 3.4
- 5. Measurement: Six Sigma as a Quality Goal The higher the sigma, the 3 fewer the defects. A increase from 3 to 6 Sigma represents a 20,000 fold improvement in quality. σ Defects Per Million Opportunities 1 2 3 4 5 6 697,672.15 308,770.21 66,810.63 6,209.70 232.67 3.40 99% “Good” (3.8 Sigma) 99.99966% “Good” (6 Sigma) No electricity for 7 hours per month No electricity for 1 hour every 34 years 5,000 incorrect operations per week 1.7 incorrect operations per week 20,000 wrong prescriptions per year 68 wrong prescriptions per year The Quality Colloquium Introduction to Track IC: Six Sigma as a Healthcare Quality Initiative
- 6. ”Improvement Methodology: DMAIC “Backbone VE O PR IM Performance Improvement Benchmarking L RO T ON C E YZ AL AN Sustain improvement Devise solution(s) and implement …and validate root cause(s) RE U AS ME …the current process capability (get the data!) NE I EF D …the problem in a measurable way Project Timeline The Quality Colloquium Introduction to Track IC: Six Sigma as a Healthcare Quality Initiative Return on Investment (ROI) Control Tools
- 7. ? Happy at 99.9% …If 99.9% is acceptable to you, then• Your heart fails To beat 32,000 Times each year• surgical Operations are performed wrongly 500• Every week wrong Drug prescriptions Made every year 20,000 babies are dropped by doctors At birth 19,000
- 8. 2,000 unsafe airplane landings are made every day • 2 major airplane accidents per week
- 9. ?What is Lean Thinking A methodology to produce the • highest quality product in the shortest amount of time, at the lowest possible cost by ”.eliminating the “seven wastes Fosters a culture which encourages • all employees to continually look for improvement
- 10. Waste in healthcare The national numbers for waste in“ healthcare are between 30% and 40% but the reality of what we’ve observed by minute-to-minute observation over ... the last three years is closer to 60% It’s everywhere: patient care and non”.patient care alike
- 12. Toyota in Healthcare Creating an environment of stability • Elimination of waste • Rapid identification and correction • of errors
- 13. Forms of Waste 8 WASTED HUMAN TALENT Human Potential Not engaging employees in problem solving DEFECTS paperwork, med errors INVENTORY unneeded stock or supplies OVERPRODUCTION unnecessary tests WAITING TIME delays in diagnosis and treatment MOTION movement of staff and information TRANSPORTATION movement of patients or equipment PROCESSING WASTE filling out extra paperwork 13
- 14. 1. Wasted Human Talent I’ve made a few changes to the process. I wish someone would ask OUR opinion…! Staff Staff Manager Staff Staff Staff Not asking the staff that works the process how to improve it 14
- 15. 2. Defects Another defect!! @*&#! ! A negative outcome from process failure 15
- 16. 3. Inventory Did I really order this much?? Items in greater quantities than can be immediately processed or used. 16
- 17. 4. Over Production Hey…are these multiple orders for the same thing? @#$&*!! Pharmacist I didn’t get my order yet… I’ll send another fax. Staff Generating more work than is really required 17
- 18. 5. Waiting People waiting for items (patients, supplies, specimens, etc.) to process 18
- 19. 7. Transportation Waiting Area I’ll bring the patient right over. I have orders to run some tests. Sigh…..!! Unnecessary movement or relocation of items 19
- 21. 8. Over Processing I’m the final approval. Please ?? The final approve. ? approval?!! + Applying effort to activities that are not required in the process 21
- 23. Step 1: Sort Before After Separate the needed from the not needed 23
- 24. Step 2: Straighten BEFORE AFTER A place for everything & everything in its place! 24
- 25. (Step 3: Scrub (inspect “Scrub” and inspect equipment to ensure it is in perfect working condition... Add inspecting equipment into your work routine. Regularly “scrub” to ensure everything is in perfect working condition 25
- 26. Step 4: Standardize Note: Blue taped outlines and labels ensure equipment is quickly found and returned to the same spot every time. Standard Work requires determining the best method then following that method every time. 26
- 27. Step 5: Sustain Develop a method for sustaining your gains 27
- 28. ?How do I Conduct a 6S 28
- 29. aration Observe the process first hand Create a diagram - a hand drawn :map of your process including Tasks in the sequence they are done • Location of supplies and equipment • Measure distance traveled and time • spent searching or waiting Good preparation is the key to successful results! 29
- 30. ?How Can We Improve ?What would you do to improve Sort out the need from the not needed Have a place for everything so there is no searching Move supplies or equipment closer to where they are needed Co-locate tasks or people Change the sequence in which tasks are done Be creative with your solutions – you, after !all, are the expert Applying 6S eliminates waste! 30
- 31. photo Suggest you insert some before and after pictures/examples of 6S results .in the next few slides 31
- 32. ?How Can We Use 6S to Improve Sort – Separate the needed from the 1. Straighten – A place for everything 2. not needed and everything in its place Scrub – Ensure everything is in perfect working condition 3. Standardize – Determine the best .method – visual queues, labeling, etc Sustain – Develop Standard Work Safety – Safety first at all times 4. 5. 6. 32
- 33. ?What Waste Did You Observe 1. Wasted Human Talent 2. Defects 3. Inventory 4. Over Producing 5. Waiting 6. Motion 7. Transportation 8. Over Processing 33
- 34. Goals Patient Safety Patient Satisfaction Employee, Staff Satisfaction Employee Engagement Low Turnover Productivity Space Utilization
- 35. That’s just the way work is done around here Waste becomes accepted
- 36. Challenge We don’t see it as waste!
- 37. Total Lead Time Value Added 5% NonValue Added 95%
- 38. WE MUST THINK ABOUT LEAN
- 39. THANK YOU
Notas del editor
- Operating Margins Consistently above 15% (5+ percent increase from historic average) Six Sigma is uniquely driven by close understanding of customer needs, disciplined use of facts, data and statistical analysis, and diligent attention to managing, improving and reinventing business processes.
- How good is good? Why "Sigma"? The word is a statistical term that measures how far a given process deviates from perfection – a measure of number of “defects”. Goal is to achieve “zero defects” Six Sigma is a management philosophy aimed at customer satisfaction. If a corporation is producing a product or service which does not meet the customer’s needs, then they will not be competitive or profitable. Reworking a product or service as a result of inefficient processes results not only in cost of material, labor and time but also in lost customers and poor reputation. It is key to involve the customer to determine what is important to them. It is not only important to gain a customer but also to retain the customer. From here the corporation should go backwards and look at their processes to improve the product based on the customers requirements. Once these processes are identified, then there must be a numerical, objective approach to evaluate current practices and future goals. Six Sigma is not only the processes involved to improve practices but also the statistical measurement to do this. The goal is to improve processes to achieve only 3.4 defects in one million opportunities.
- Framework, common language, checklist To define the problem a numerical parameter must be used. There must be an objective way to measure the problem. In addition, the goal is not to manage the problem but to solve the problem. Therefore, there must be a focus on the problem not on the outcome. Again, a numerical measurement of the current process is necessary in order to change the process. What is the results of the current process? What are the competitor’s processes? A focus must be on the critical to quality issues that the customer finds important. Once measurements are available, it is necessary to analyze this data. This will eliminate the gap between the current practice and the desired goal. The whole goal in the Six Sigma program is to improve processes to achieve 3.4 defects in one million opportunities. After analysis, changes need to be implemented to achieve this goal. Everyone should be involved in suggesting ways to improve the process, especially those that work directly with the process. The Green Belts and Black Belts act on these suggestions. Once changes have been made to the process to achieve new operating limits then the Black Belt must oversee measures to keep these operating limits in place. And then on to the next project in order to achieve the six sigma goal. This project is only one in several to incrementally achieve the six sigma goal.
- Ask participants to provide an example of each WASTED HUMAN TALENT – Staff members using their talent and skill to follow a broken process, instead of using the talent and skill to improve the process. DEFECTS – Hospital Acquired Infection INVENTORY – Items expire, cost associated with storage and handling OVERPRODUCTION – We need 3 IV Bags, but I have time so I will make up 10 (that may never get used). WAITING TIME – We need a bigger waiting room, we need scripting on why they are waiting, we need to update our magazines….Do we? Or do we need to find out why they are waiting. MOTION – Radiology would walk past each room to see if one was available. Now they have a light that lets them know a room is in use. TRANSPORTATION – Birthplace Facilities use to have a labor room, delivery room and a room for the hospital stay. New Moms were transported from room to room. Now they labor, deliver and stay all in the same room. PROCESSING - Marking through all of the patient names on the Well mark Report, except for the patient specific to the set of medical records
- The 6th S, Safety, is not a separate step. Safety should be a consideration as we do all of the other steps. Each of these steps will be explained in further detail in following slides.
- The first step is sorting… separating all the things you need from the things that you don’t. Q: How will this help the organization? A: Removes obsolete items and reduces excess inventory. It costs Mercy to store and manage inventory. If we have too many of anything, they may expire/become obsolete….costs $$$
- Now that you have sorted the needed from not needed items, designate a place for everything and move your sorted items into their new location. Tip: Prioritize where you place items by putting the items that are used most often in the most readily accessible spots. Heaviest on the bottom (safety) Most used – most readily accessible location Consider height requirements - shortest & tallest users Place supplies next to equipment – where they will be used.
- Use scrubbing and cleaning to make certain equipment is in perfect working order. Add equipment inspection into you regular work routine. Again, making certain everything is in working order allows you to reduce your inventory levels to a few good working units.
- Before the 6S, equipment was just shoved into this room. One of the Radiologists talks about being sent here to locate equipment, searching for 15 minutes and still not finding what he needed. Note the labeling on the floor, now there is a place for everything and everything is in its place…every time. e can tell at a glance when something is missing. Q: What would this labeling do for a new employee? Don’t need to ask for help from someone else who is busy.
- The team will need to find a method for ensuring things don’t go back to the way they were prior to the 6S. Create diagrams like the ones above as guides Determine inventory par levels to indicate when items should be reordered Use maintenance checklists to have the team share responsibility for keeping the area in order
- In a Gemba walk it is important to observe: Movement of things Movement of staff Movement of patients Time spent searching Distance traveled between tasks or locating things.
- Capture measurements and timings on flip chart paper.