What is Lean

What is Lean? Lean…the relentless pursuit of the perfect process through waste elimination … Lean in Healthcare… … can a manufacturing philosophy work for us? 6 2/ GE Performance Solutions / 19 January 2007 Imagine a hospital somewhere... ...and the patient's path through 5 different services. 3/ GE Performance Solutions / 19 January 2007 The dot exercise … Demonstrating basic Lean principles We need:  Volunteers  Quick Registration  Volunteers  Triage  Volunteers  Full Registration  Volunteers  Treatment  Volunteers  Discharge  Volunteers  Transport/Supplies  Volunteers  Quality Assurance  Volunteers  Observers/Lean leaders 4/ GE Performance Solutions / 19 January 2007 Quick Registration Triage Full Registration Treatment Discharge Transport / Supplies Quality Assurance Simulation I Objectives • To understand current state of a typical business through a simulation exercise Quick Reg Triage (red) (green) Registration (black) What do I need to know • Just be yourself Treatment (blue) Discharge (yellow) Quality Assurance • Understand the rules of simulation • 5 minute simulation Time remaining in simulation: 0:00 0:05 0:10 0:15 0:30 0:45 1:00 1:15 1:30 1:45 2:00 2:15 2:30 2:45 3:00 3:15 3:30 3:45 4:00 4:15 4:30 4:45 5:00 Click here to begin timer 5/ GE Performance Solutions / 19 January 2007 Simulation I – debrief Round Target Complete patients (successfully) Patients in process (WIP) Defective procedures Patient cycle time 20 5 0 0:30 1 2 How did it feel? What worked? What didn’t work? How could it be improved? 6/ GE Performance Solutions / 19 January 2007 Lean thinking fundamentals Define value from the end Customer back Identify the value stream Establish flow Pull from the supplier where you cannot flow Continuously improve the process to perfection 7/ GE Performance Solutions / 19 January 2007 Defining value Value Added Activity Any activity that changes the form, fit, or function of a product/transaction — OR — Something customers are willing to pay for Minimize Eliminate essential waste unnecessary waste Non-Value-Added Activity All other actions and unwanted features are by definition — WASTE value 8/ GE Performance Solutions / 19 January 2007 Defining value in A&E Examples Value add steps: Direct contribution to what patient values • Procedure • Pt. interaction • Lab tests Value enabling steps: Required to allow value add steps to occur • Triage Non-value added but essential steps: Required by law or regulations • Registration Non-value added steps: Everything else! • Transit • Wait Strict definition of value based on customer’s view 9/ GE Performance Solutions / 19 January 2007 Benefits of Lean … . . . any process or value stream Lead Time / Cycle Time Higher customer satisfaction • • • • • Reduced cycles Better delivery More capacity Better quality Productivity Before Work . . . Value Add Time Wait / Waste . . . Non Value Add Time After Lean attacks waste Increased process velocity, reduced waste, improved customer experience 10 / GE Performance Solutions / 19 January 2007 Using VSMs to identify opportunities… OPPORTUNITY • Reorganize front end process Opportunity Opportunity • Standardize layout and streamline throughput • Accelerate admitting process (admitting physician) 1 Opportunity 3 2 IMPACT • Reduced wait times and hand-offs • Debottlenecking leading to reduced cycle times and increased capacity 11 / GE Performance Solutions / 19 January 2007 The 8 wastes in healthcare Defects: Re-sticks, med errors Overproduction: Blood draws done early to accommodate lab Inventories: Patients waiting for bed assignments, lab samples batched, dictation waiting for transcription Movement: Looking for patients, missing meds, missing charts or equipment Excessive Processing: Multiple bed moves, retesting Transportation: Moving patients to tests Waiting: Inpatients waiting in ED, patients waiting for discharge, physicians waiting for test results Under-utilization: Physicians transporting patients 12 / GE Performance Solutions / 19 January 2007 Flow • Movement of products, services and information down the value stream • Objective is continuous flow as product, service and information is transformed by continuously adding value • Flow is created by eliminating queues and stops, and improving process flexibility and reliability 13 / GE Performance Solutions / 19 January 2007 Pull End customer pulls product/transaction through the value stream Each step pulls the product/transaction when needed from the preceding step Only the amount required is taken No action is taken until the downstream process initiates it 14 / GE Performance Solutions / 19 January 2007 Improve to perfection Reducing waste brings us closer to perfection As we reduce inventory/overproduction in the process, bottleneck can be exposed and worked on as next steps Continuously find ways to improve the process Keep the customer in focus…are we adding value? cycle time months days hours minutes seconds Kaizen is the road to perfection… 15 / GE Performance Solutions / 19 January 2007 Kaizen: the catalyst for improvement Change process to apply the Lean principles, targeting waste Not traditional meetings…intense, focus on action and speed Key concept: try-storm instead of brainstorm – New ideas are tried quickly, observe results – Quick iterations: try-observe-improve and repeat No money…it’s about creativity, not $ solutions Hands on…turn ideas into action! 16 / GE Performance Solutions / 19 January 2007 Are you ready for Round 2? Make changes to your process based on what you learned! • Eliminate waste • Improve flow • Implement pull 5 minutes Simulation II Objectives • To understand current state of a typical business through a simulation exercise Quick Reg Triage (red) (green) Registration (black) What do I need to know • Just be yourself Treatment (blue) Discharge (yellow) Quality Assurance • Understand the rules of simulation • 5 minute simulation Time remaining in simulation: 0:00 0:05 0:10 0:15 0:30 0:45 1:00 1:15 1:30 1:45 2:00 2:15 2:30 2:45 3:00 3:15 3:30 3:45 4:00 4:15 4:30 4:45 5:00 Click here to begin timer 18 / GE Performance Solutions / 19 January 2007 Simulation II – debrief Round Target Complete patients (successfully) Patients in process (WIP) Defective procedures Patient cycle time 20 5 0 0:30 1 2 How did it feel? What worked? What didn’t work? How could it be improved? 19 / GE Performance Solutions / 19 January 2007 GE Healthcare improved productivity tremendously by LeanSixSigma (+303%) 20 / GE Performance Solutions / 19 January 2007 Lean principles Lean Transaction Production System Jidoka Heijunka Just-in-Time • Single Piece Flow • Pull Production • TAKT Time Production • Autonomation • Stopping at Abnormalities • Level Loading • Sequencing The House of Lean – More Advanced Lean Principles 21 / GE Performance Solutions / 19 January 2007 Any Questions? Talk to the GE team during coffee or email andrewarchibald@ge.com Liz.howarth@ge.com kevin.evans@ge.com Ruth.nelmes@ge.com