Oct 10, 2014

1. 2014 Annual Healthcare Symposium: Lean Strategies in Transforming Patient Care Waste Not, Want Not Conducting a Lean Assessment Oct 10, 2014

2. Challenges facing Healthcare Basic concepts and philosophy of Lean Waste in Healthcare Case Studies Managing Change Today’s Talking Points It is not necessary to change. Survival is not mandatory.- W. Edwards Deming

3. Challenges Facing Healthcare Shortage of healthcare professionals Financial challenges Declining volumes Changing needs Changing health care systems

4. Physician wait times up, expected to keep increasing A growing physician shortage, payment decreases and adoption of electronic health records may be to blame as patients wait longer for care in doctors’ offices. Affordable Care Act (Obamacare)

5. What is Lean?

6. What is Lean? Determine goals to be achieved and the methods to reach them If goals were achieved adopt the new methods permanently. If not, determine root cause of failure and return to ‘Plan’ Adjust Plan Check Do Implement the methods Examine the results Based on… The Deming Cycle - PDCA

7. What is Lean? Determine goals to be achieved and the methods to reach them If goals were achieved adopt the new methods permanently. If not, determine root cause of failure and return to ‘Plan’ Adjust Plan Study Do Implement the methods Examine the results Based on… The Deming Cycle - PDSA

8. What is Lean? 1. Define value from the customer’s perspective and express value in terms of a specific product 5. The complete elimination of waste so all activities create value for the customer Lean Thinking Womack & Jones 2. Map all of the steps…value added & non-value added…that bring a product of service to the customer 4. Nothing is done by the upstream process until the downstream customer signals the need 3. The continuous movement of products, services and information from end to end through the process

9. Shifting from Traditional to Lean Healthcare Improving the quality of patient care Eliminating non-value added waste Reduce non-value added cost Improving the Patient Experience Environment transformation

10. What is Lean Thinking? “Lean is not a program; it is not a set of quality improvement tools; it is not a quick fix; it is not a responsibility that can be delegated.” “Rather, Lean is a cultural transformation that changes how an organization works . . . It requires new habits, new skills and often a new attitude throughout the organization.” Dr. John Toussaint, CEO, ThedaCare Center for Healthcare Value Leonard Berry, Professor, Texas A&M

11. A New Way of Thinking Get Creative New Knowledge Question Everything Look Beyond Traditional Metrics What is over-valued and under-valued at your organization?

12. Waste in Healthcare 20-30% of health spending is "waste" with no benefit to patients, because of overtreatment, failure to coordinate care, administrative complexity and fraud

13. Waste in Healthcare • Once waste has been identified and removed, and standardization has been introduced you will begin to see change in your workplace!

14. Value and Waste

15. Value and Waste Value-Added Work Non Value-Added Work Value-Enabling Work • Essential Steps • Change Product or Service • Done Right the First Time • Customer/Business wants and is willing to pay for them • Non-Essential Steps • Not done correctly first time • Customer/business doesn’t want them or is unwilling to pay for them • Non-Essential Steps • Allow the Value- Added tasks to be done better and faster • Mandatory from a • regulatory standpoint • A Practical Lean Managers Goal is to: • Eliminate the Non-Value-Added activities • Minimize the Value-Enabling Work • Maximize the Value-Added Work

16. Waste in Healthcare Eliminating waste will accomplish the following: • Improve patient care and safety • Improve productivity and process efficiency • Improve quality (reduce the opportunity for errors or mistakes) • Reduce cost to the facility • Reduce wait (queue) time between processes • Make the facility more competitive • Encourage teamwork and staff involvement

17. Waste in Healthcare To fully grasp the power of Lean you first need to be able to understand and identify waste. Waste is a symptom and Lean tools and concepts are used to find and eliminate its root cause(s).

18. Waste in Healthcare There are eight major wastes in healthcare Never mistake activity for achievement. - John Wooden

19. Waste in Healthcare WASTE-An activity that is unneeded, unwanted or involves excess effort

20. Repeating Why Five Times “…the Toyota production system (i.e., Lean) has been built on the practice and evolution of this scientific approach” TaiichiOhno – Toyota Production System, Page 17

21. Problem: Delays in performing x-rays. • Why are the x-rays delayed?Because the exam takes longer than scheduled • Whydoes the exam take longer?Because the rad tech is busy with other things • Whyis the rad tech busy? Because they have to answer the phone • Why do they have to answer the phone? Because there’s a phone that rings in the area • Why does the phone ring in the area? Because it hasn’t been programmed to ring at the clerk’s station… 5 Whys

22. 5 Whys • See if you can drill down to the root cause of the problem – go beyond the symptom • Avoid the easy answers – “because we don’t have enough staff” or “because the computer system is bad” • Collect data on the identified root cause – is it really a problem? If you can't describe what you are doing as a process, you don't know what you're doing. - W. Edward Deming

23. Consisted of two on-site visits by our team Over thirty (30) hours of observation Used Lean tools to identify and gather information Background of Assessments

24. Case Study Review All we are doing is looking at the timeline. From the moment the patient gives us a complaint to the point of care. And we are reducing that timeline by removing non value-added wastes. Adapted from Taiichi Ohno’s book “Toyota Production System”

25. Case Study A - Observations Rural Health Clinic or a Family Practice? Signage need to be updated.

26. Case Study A - Observations This is a Band-Aid not a solution to a problem in the process.

27. Case Study A - Observations A quick inspection of all exam rooms showed that supplies varied depending on the room. Hidden supplies can lead to over ordering.

28. Case Study A - Observations Unorganized. Materials/supplies randomly placed on the shelf. Cluttered cabinets lead to time wasted looking for materials.

29. Case Study B - Observations

30. Case Study B - Observations

31. Case Study B - Observations

32. Potential Impact - Case Study A

33. Potential Impact - Case Study B

34. Why Initiatives Fail • Complacency • Failure to create a sufficiently • powerful guiding coalition • Under-estimating the power • of the vision • Under-communicating the vision • by a factor of 10 (or 100 or 1,000)

35. Why Initiatives Fail • Permit obstacles to • block the new vision • Fail to create short-term wins • Declare victory “too” soon • Neglect to anchor changes firmly • in the corporate culture

36. Why Initiatives Succeed Simplicity Active and visible executive sponsorship Structured approach

37. Why Initiatives Succeed Frequent and open communications around need for change Dedicated resources for change management Total Employee Involvement

38. “We don’t have enough time or resources to do it right the first time… …we only have enough time and resources to do it over again, again, and again when we’ve done it wrong the first time.” Why Lean?

39. A New of Way of Thinking Leaders need to think and manage differently!

40. Questions

41. Resources Coming Soon Winter 2014

42. Questions “If your actions inspire others to dream more, learn more, do more and become more, you are a leader” John Quincy Adams Todd Sperl Managing Partner Lean Fox Solutions, LLC 248.798.7984 tsperl@leanfoxsolutions.com