2. Once upon a time a Birth Center and NICU had a dream. To resuscitate fragile patients with the best processes possible. The leadership team had a meeting: The family birth center leader, the NICU leader, and the respiratory care leader.
3. A Kaizen was suggested by one wise leader. “What is a Kaizen,” Asked the other two leaders? A Kaizen is a process of examining a work flow and making it streamline or lean from the clients point of view.
6. Kaizen Improvements are generally not intended to be radical, earth-shattering improvements. Instead, they’re regular incremental improvements that eliminate waste, here, there, and everywhere, bit by bit. Kaizen Event
7. “The most important thing is to take the best care of our babies,” said the NICU leader. “The babies and their families are our customers. They must come first,” said the birth center leader. “Yes, lets have a kaizen,” said the respiratory care leader!
8. Standard Training Current State – understand (gemba) Identify wastes and opportunities Prioritize Future state Action list Implement – execute Sustainability - audits
10. Principles of Lean Thinking IdentifyValue from the customer’s perspective Identify the Value Stream for the product or service Remove waste and design the value stream to improve Flow Produce based on customer Pull Continuously improve the value stream towards Perfection Lean Thinking, Womack and Jones, 1996
11. Principle #2: What’s a Value Stream? Value Stream: All of the actions / activities, both value-added and non-value-added, that are accomplished to deliver completed customer value. (ACTIVITIES, not people) Value Stream Process Process Process Customer Request Customer Receipt
12. Taking out wasted time The value stream from the customers perspective. The baby deserves a resuscitation process that flows quickly and smoothly. We examined the equipment placement, staff positioning, and role responsibilities. This was to take out any lag time for equipment being available and ready to use. Positions were analyzed for the best place for each person, based on role, to stand.
13. Customer pull In a resuscitation work process, the customer pull is a baby being born who has specific criteria related to the labor process. There is no waste in the pull arena because the resuscitation team is only called in specific circumstances.
15. Efficient designs were thought through. Three different areas were evaluated. The birthing, the operating, and the neonatal rooms. All three areas had recommended changes. The changes were trialed for two weeks. Recommendations were reviewed. Changes evaluated Equipment and work flow changes finalized. Roll out of changes organized Roll out implemented
18. Changes identified The Doctor or Neonatal Nurse Practioner stands at the head of the bed. The head of the patient is placed in front of the Doctor or Practioner to intubate, if needed. A respiratory therapist (RT) or 2nd RN on the right of the head of the patient. This person helps manage the airway and assists with intubation. The RN is on the left of the baby and monitors the heart rate and effectiveness of airway management.
19. Outcomes Changes evaluated and implemented Final decisions made to change the process of equipment preparation, staff roles, and staff positioning. The streamline outcome is a smooth running resuscitation with wasted time taken out of the work flow. Everyone knows their function based on where they are standing. The patient is placed first and it shows.
20. Kaizen The Kaizen standardize process is useful to standardize work flow process. The Kaizen takes out nonproductive wasted time. The Customer is placed first. Changes are made from the customer’s perspective. Wasted steps are removed. Overproduction is stopped by allowing demand from the customer to pull resources instead of just producing a product. Kaizen is applicable to every work process.
