More Related Content More from Mark Graban (20) Mark Graban - Kaizen Presentation for Spain1. The Present and Future of
Lean Healthcare
Mark Graban
Jornadas Lean Healthcare
en a
September 20, 2012
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
2. Why Lean for Healthcare?
No waiting
No waste
Zero harm
Source: an NHS hospital, UK
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
3. Hospital Layoffs & Cost Cutting
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4. “No Layoffs Due to Lean”
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
5. Layoffs Aren’t a Long-Term Fix
• "After a year or so, the employee
count is back up and the savings
evaporate.”
• "There has to be a better, longer
lasting and less traumatic way to
deal with such fiscal situations."
Gary J. Passama, CEO NorthBay Healthcare
(Fairfield, CA)
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
6. TPS: “Equally Important Pillars”
Continuous Respect
Improvement
For
People
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7. Kaizen is for Everyone!
“… emphasizes morale-
boosting benefits and
positive employee
participation over the
economic and financial
incentives…”
- Masaaki Imai
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
8. Dr. Berwick’s
Call for Kaizen (1989)
– Kaizen = “the continuous search for
opportunities for all processes to get better”
• Dr. Donald Berwick
– Founder, Institute for Healthcare Improvement
– Former Administrator, Medicare and Medicaid (CMS)
Citation: Berwick, DM, “Continuous improvement as an ideal in health care,” New
England Journal of Medicine, 1989 May 25;320(21):1424-5.
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
9. Easier to Say Than to Do
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11. 11
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12. 5S
A3
Kaizen
VSM
Std Work
Kanban
12
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13. 5S A3
Kaizen
Kanban
Std Work VSM
Management System
Philosophy
Culture
Thinking
Mindsets
13
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14. St. Elisabeth Hospital: The Netherlands
Dr. Jacob Caron, Orthopedic Surgeon
Chairman of the medical staff
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
15. • 90% reduction in CR-BSI in MICU and Oncology
• Saved $1.7M
• Saved 17 days L.O.S. per case
Source: Dr. Richard Shannon
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
16. Improving Radiology
/MRI Access Time
14
12
Weeks Waiting Time
10
8
6
4
2
0
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
17. ThedaCare “Door to Balloon” Time
100
90
91
80
70 65
60
50 52
40 37 37 45
30
20
10
0
2005 2006 2007 2008 2009 2010
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
18. ThedaCare’s Collaborative Care
Med Rec Errors per Chart Patient Satisfaction
1.2 100%
1 80%
0.8
60%
0.6
40%
0.4
0.2 20% n/a
0 0%
2006 2008 Traditional 2008 Collaborative 2006 2008 Traditional 2008 Collaborative
Pneumonia Bundle Compliance Cost per Case
120% $8,000
$7,000
100%
$6,000
80% $5,000
60% $4,000
$3,000
40%
$2,000
20% $1,000
0% $0
2006 2008 Traditional 2008 Collaborative 2006 2008 Traditional 2008 Collaborative
Source: Health Affairs
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
19. Denver Health
• “Denver Health Lean process
has generated more than $135
million in financial benefit since
2006 (as of early 2012)”
• Without those savings, Denver
Health would "absolutely have
had to cut jobs," CEO Patricia
Gabow said.
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
20. Kaizen = Change for the Better
• ‘Kai’ means “change.”
• ‘zen’ means “good.”
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
21. “What Sets Us Apart?”
“Every Toyota team member is
empowered with the ability to
improve their work environment. This
includes everything from quality and
safety to the environment and
productivity. Improvements and
suggestions by team members are
the cornerstone of Toyota's success.”
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
22. Different Levels of Kaizen
Very few
Large issues System
Kaizen
Six
Few Sigma
Medium issues
Lean
Event
Many
Small issues
Daily Kaizen
Adapted from: “The Toyota Way Fieldbook,” Liker and Meier
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
23. “Quick and Easy” Kaizen
Find
1. Find
2. Discuss Discuss
3. Implement
Implement
4. Document
5. Share Document
Share
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
25. © 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
26. Kaizen: Real, Daily, Visual
(Visual Idea Board)
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved. Children’s Medical Center Dallas (Lab)
28. Kaizen: Real, Daily, Visual
(Electronic - KaiNexus)
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
29. Kaizen as a Way of Thinking
Greg Jacobson, MD
CEO & Co-Founder, KaiNexus
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
30. Kaizen Principles
• Continually improve, with no
idea being too small
Adapted from: Jacobson, Gregory H. MD, Nicole Streiff McCoin MD, Richard Lescallette, Stephan Russ MD, MPH, and Corey M. Slovis MD, “Kaizen: A
Method of Process Improvement in the Emergency Department,” Academic Emergency Medicine, Volume 16, Issue 12, pages 1341-
1349, December 2009.
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
31. Kaizen Principles
• A major source of quality defects
is problems in the process
Adapted from: Jacobson, Gregory H. MD, Nicole Streiff McCoin MD, Richard Lescallette, Stephan Russ MD, MPH, and Corey M. Slovis MD, “Kaizen: A
Method of Process Improvement in the Emergency Department,” Academic Emergency Medicine, Volume 16, Issue 12, pages 1341-
1349, December 2009.
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
32. Kaizen Principles
• Focus change on common
sense, low-cost, and low-risk
improvements, not major
innovations
Adapted from: Jacobson, Gregory H. MD, Nicole Streiff McCoin MD, Richard Lescallette, Stephan Russ MD, MPH, and Corey M. Slovis MD, “Kaizen: A
Method of Process Improvement in the Emergency Department,” Academic Emergency Medicine, Volume 16, Issue 12, pages 1341-
1349, December 2009.
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
33. Kaizen Principles
• All ideas are addressed and
responded to in some way
Adapted from: Jacobson, Gregory H. MD, Nicole Streiff McCoin MD, Richard Lescallette, Stephan Russ MD, MPH, and Corey M. Slovis MD, “Kaizen: A
Method of Process Improvement in the Emergency Department,” Academic Emergency Medicine, Volume 16, Issue 12, pages 1341-
1349, December 2009.
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
34. Kaizen Principles
• Empower the worker to enact
change
Adapted from: Jacobson, Gregory H. MD, Nicole Streiff McCoin MD, Richard Lescallette, Stephan Russ MD, MPH, and Corey M. Slovis MD, “Kaizen: A
Method of Process Improvement in the Emergency Department,” Academic Emergency Medicine, Volume 16, Issue 12, pages 1341-
1349, December 2009.
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
35. Kaizen Principles
• Collect, verify, and analyze data
to enact change
Adapted from: Jacobson, Gregory H. MD, Nicole Streiff McCoin MD, Richard Lescallette, Stephan Russ MD, MPH, and Corey M. Slovis MD, “Kaizen: A
Method of Process Improvement in the Emergency Department,” Academic Emergency Medicine, Volume 16, Issue 12, pages 1341-
1349, December 2009.
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
36. Before / After Data from CMC Lab
Before Lean 12 Months
After Starting
Lean
3. I have the opportunity to do what I do
best every day.
3.11 3.92
8. I feel free to make suggestions for
improvement.
2.84 3.48
10. I feel secure in my job.
2.32 3.42
13. Stress at work is manageable.
2.43 3.23
17. I am satisfied with the lab as a place
to work.
2.51 3.43
18. I would recommend my work area as
a good place to work to others.
2.38 3.46
Grand Average
2.96 3.69
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
37. KaiNexus Data / Charts
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved. Whitepaper: http://bit.ly/KaiNexus
38. Franciscan Participation
100%
90%
80%
70%
60% 56%
50% 46%
40%
30%
20%
10%
0%
2011 Since 2007
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved. Source: Healthcare Kaizen
39. # of Recorded Kaizens
4,500 4,225
3,951
4,000
3,500
3,000 2,822
2,500
2,046
2,000
1,500
1,000
500 281
-
2007 2008 2009 2010 2011
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved. Source: Healthcare Kaizen
40. Franciscan Savings Impact
$2,000,000
$1,738,161
EMR
$1,500,000
$1,000,000 $887,491 $925,518
$667,238
$500,000
$190,000
$-
2007 2008 2009 2010 2011
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved. Source: Healthcare Kaizen
41. Q&A / Contact Info
• Email: mark@LeanBlog.org
• Blog: www.LeanBlog.org
• Startup: www.KaiNexus.com
• Twitter: www.twitter.com/MarkGraban
• Books:
– www.LeanHospitalsBook.com
– www.HCkaizen.com
www.leanblog.org
© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.
Editor's Notes Aging population (more demand, fewer workers), outrageously high costs (highest in the world by far) and poor quality (200,000 a year dying from infections and preventable errors). Uncertainty of what’s called the Patient Protection and Affordable Care Act (ObamaCare) – payments to hospitals are being cut… so many hospitals are laying off people. Michel – it’s a short-term fix, but not a good fix Staff morale patient sat and outcomes So where is all of the improvement?He called these “self-development and the pursuit of completeness are “familiar themes in medical instruction and history.” Bad apples instead of improving the processNeed to lead people toward solutionsShift away from finger pointing, name blame and shame The 2nd one is from Australia What does THIS have to do with THIS? What if…. the story of the consultant thrown out of a hospital for suggesting a moving assembly line. This isn’t about tools – it’s about defining an ideal condition and working tirelessly to close the gap between current state (ACCURATE version) and the ideal state. Can we challenge assumptions? Test – first day on your job--- ask why something is done or why can’t we do it a better way? How does the organization respond? Start from need… Guideline = 120 min “door- to-balloon” – 70% success“Did not have a clear, standardized response to heart attacks.”Now 100% success against 90 minute targetFocus on the patient as customerRespect the patient’s timeIdentify systemic causes of patient waitingStandardized workVisual managementStaffing levelsScheduling practicesLook across the entire “value stream”Minimize delays from handoffs Cost per case actually DECREASED compared to the 2006 baseline. Sometimes you One dysfunction is thinking kaizen (or improvement) is about episodic events Need ALL of these steps Suggestion boxes are well intended… perhaps. I’ll give them that much credit. But they seem like they don’t usually work. It’s not the fault of the box… it’s how they are managed. What are the two common features of these boxes, and more you can buy online? The lock… and their opaqueness. David Mann They have 100 idea boards Berwick – stop looking for bad apples Intermountain has similar data 36% 53% 75% of departments had at least ONE person participate in Kaizen If you include POTENTIAL SAVINGS – this number was $3M in 2010. Keep in mind they do NOT add up the financial impact of everything… CALL TO ACTION: GO BACK AND DO ONE KAIZEN WHEN BACK TO WORK