Barbara Versage

8/8/2019 Barbara Versage

1/38

Using Toyota Lean PrincipalstoImprove Inpatient Flow Process

May 18, 2009Improving Inpatient Flow

Barbara Versage RN, MSN, MBA

System for Partners in Performance Improvement

Lehigh Valley Health NetworkLean Consultant

Barbara Versage has no relevant financial relationships or affiliations to disclose in regard to the content of thispresentation.


2/38

Presentation Objectives1) Application of Toyota Production System (TPS)

concepts to Improve Inpatient Flow

2) Using Value Stream Analysis to ensure cross-functional department performance

3) Identify a measurement matrix used to

determine the success of applying lean in

hospital flow.


3/38

14 Toyota Way Principals

I. Long Term Philosophies1) Base decisions on long term philosophies

II. Right Process Produce Right Results

2) Create continuous flow

3) Use pull systems

4) Level out the workload

5) Build a culture of stopping to fix problems6) Standardize tasks

7) Use visual control

8) Use only reliable well tested technology


4/38


III. Add Value to the Organization by DevelopingYour People and Partners9) Grow leaders who understand and use the concepts

10) Develop exceptional people and teams who follow yourphilosophies

11) Respect your extended network of supplies and partners

IV. Continuously Solving Root Problem DrivesOrganizational Learning

12) Go and see for yourself to thoroughly understand

13) Make decisions slowly by consensus; implement rapidly

14) Learn through continuous improvement & reflection


5/38





3) Use pull systems






6/38

The Times They Are Changing

.Bob Dylan

Decreasing reimbursement Increasing uncompensated care

Increased cost of capital

Medical Tourism Consumer Expectation


7/38

The patient


8/38





3) Use pull systems






9/38

Department

ActivityUnit

Department

ActivityUnit

Value Stream

Department

ActivityUnit

VALUE STREAM

Department

ActivityUnit

Department

ActivityUnit

Department

ActivityUnit


10/38

CONSULTS

PHYSIC

ALTHERAPYPH

YSICIAN

COLLOBORATIVERO

UNDS

Value Stream

ADMISSION

VALUE STREAM

LAB&HEARTSTATION

SUP

PLIES&EQUIPM

ENT

DISCHARGE


11/38

Total Flow Time for Patient

90 % NVA 10%

Value

Adding

Arrive Leave

Value Adding Work

30%-40% of Health care costs are due to waste.

Education for Lean Healthcare Institute


12/38

8 Wastes in Healthcare: U-WIT-D-MOP

Unused Human Potential: Untapped creativity/talent/injuries

Waiting: patients/providers/material

Inventory: stacks of work/piles of supplies

Transportation: transporting people, paperwork

Defects: wrong information/rework

Motion: finding information/double entry/searching

Overproduction: duplication/extra information

Processing: extra steps/checks/workarounds


13/38

ProcessMap


14/38

Communication Circle


15/38

Spaghetti

Diagram


16/38

Time Study

Prep

Wait

Test

Misc


17/38

8 Wastes in Healthcare: U-WIT-D-MOP

Unused Human Potential: Untapped creativity/talent/injuries

Waiting: patients/providers/material

Inventory: stacks of work/piles of supplies

Transportation: transporting people, paperwork

Defects: wrong information/rework

Motion: finding information/double entry/searching

Overproduction: duplication/extra information

Processing: extra steps/checks/workarounds


18/38







5) Use pull system6) Standardize tasks

7) Build a culture of stopping to fix problems



19/38

Where is your stuff?


20/38


21/38


22/38


23/38


24/38

Sort

Remove items not needed daily (red-tag process)

Set in Order Label items and make it obvious where they belong

Shine/Sweep Clean and inspect everything, inside and out Visually sweep area to make sure everything is in its place

Safety Required safety information is posted

Exits and emergency equipment are clearly marked and functional

Standardize Establish policies and Standard Work to ensure 6S

Sustain Training, discipline, daily activities, self-audits

6S


25/38


26/38


27/38


28/38

Total Calls from 5Kto SDS for Supplies

0

10

20

30

40

50

60

70

80

90

8/4 8/18 9/1 9/15 9/29 10/13

#ofCalls


29/38

5KStaff Satisfaction with changes

4.8

Equipment Room 1 -------------------------------- 5

4.0

Supply Room 1 -------------------------------- 5


30/38











31/38

Discharge Work Load

0

1

2

34

5

6

7

Day ShiftRN

EveningShift RN

Night ShiftRN

Provider CaseManager

#

ofTa

sks

BeforeAfter


32/38

Order to Results Available - Echo

Random Weekday Sample

0

5

10

15

20

25

30

35

40

Patient#

14

Patient#

13

Patient

#1

Patient

#8

Patient

#2

Patient#

10

Patient

#9

Patient#

12

Patient

#6

Patient

#7

Patient#

15

Patient

#4

Patient#

11

Patient

#3

Patient

#5

Patient#

16

Hrs

Random Readingunsure of when tests available


33/38

Heart Station Readings-

Load Level

0

2

4

6

8

10

12

14

#1 #4 #7 #10 #13 #16 #19 #22 #25

Patients

Hours

Complete to Results Available

05

10

15

20

25

30

35

40

#1 #2 #3 #4 #5 #6 #7 #8 #9 #10 #11 #12 #13 #14 #15 #16

Patient Number

Hours


34/38











35/38

Standard Work

Defines the most efficient way to performthat task

Is known and followed by all who performthat task

Is the basis for all continuous improvement


36/38


II. Right Process Produce Right Results7) Build a culture of stopping to fix problems


III. Add Value to the Organization by Developing Your Peopleand Partners9) Grow leaders who understand and use the concepts

10) Develop exceptional people and teams who follow your philosophies

11) Respect your extended network of supplies and partners

IV. Continuously Solving Root Problem Drives Organizational

Learning12) Go and see for yourself to thoroughly understand

13) Make decisions slowly by consensus; implement rapidly

14) Learn through continuous improvement & reflection


37/38

Objectives Summary

1) Application of Toyota Production System (TPS)

concepts to Improve Inpatient Flow

2) Using Value Stream Analysis to ensure cross-functional department performance

3) Identify a measurement matrix used to

determine the success of applying lean in

hospital flow.


38/38

References:

Liker, Jeffrey, The Toyota Way. McGraw-Hill Publishers,Madison, WI 2004.

Maskell, Brian and Baggaley, Bruce. Lean Accounting:Whats It All About? Association for Manufacturing

Excellence's, Target Magazine. September 2006.http://www.leanaccountingsummit.com/LeanAccountingDefined-Target.pdf

Johnson, H.Thomas, Lean Dilemma: Choose SystemProncipals or Management Accounting Controls, Not

Both, September 2006http://www.in2in.org/insights/TomJohnson-LeanDilemma.pdf

Documents

Barbara Versage