What is Lean?
Lean…the relentless pursuit
of the perfect process
through waste elimination …
Lean in Healthcare…
… can a manufacturing philosophy work for us?
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6 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 Quick Registration
Volunteers Triage Triage
Volunteers Full Registration Full Registration
Volunteers Treatment Treatment
Volunteers Discharge Discharge
Volunteers Transport/Supplies Transport / Supplies
Volunteers Quality Assurance Quality Assurance
Volunteers Observers/Lean leaders
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Simulation I
Objectives
• To understand current state of a typical business through
a simulation exercise Quick Reg Triage Registration
(red) (green) (black)
What do I need to know
Treatment Discharge Quality
• Just be yourself (blue) (yellow) Assurance
• Understand the rules of simulation
• 5 minute simulation
Time remaining in
simulation: 0:00
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4:45
5:00 Click here to begin timer
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Simulation I – debrief
Round
Target 1 2
Complete patients
(successfully) 20
Patients in process
(WIP) 5
Defective procedures
0
Patient cycle time 0:30
How did it feel?
What worked?
What didn’t work?
How could it be improved?
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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
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19 January 2007
Defining value
Value Added Activity
Any activity that changes the
form, fit, or function of a Minimize Eliminate
product/transaction
— OR —
Something customers are willing
to pay for essential
waste unnecessary
waste
Non-Value-Added Activity
All other actions and unwanted value
features are by definition —
WASTE
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19 January 2007
Defining value in A&E
Examples
Value add steps: • Procedure
Direct contribution to what patient values • Pt.
interaction
Value enabling steps:
• Lab tests
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: • Transit
Everything else! • Wait
Strict definition of value based on customer’s view
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Benefits of Lean …
. . . any process or value stream Higher customer
Lead Time / Cycle Time
satisfaction
Before • Reduced cycles
• Better delivery
Work . . .
Value Add Time
• More capacity
After • Better quality
Wait / Waste . . .
Non Value Add Time
• Productivity
Lean attacks waste
Increased process velocity, reduced
waste, improved customer experience
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19 January 2007
Using VSMs to identify
opportunities… OPPORTUNITY
• Reorganize
front end
process
• Standardize
Opportunity layout and
Opportunity streamline
throughput
• Accelerate
1 admitting
Opportunity 3 process
2 (admitting
physician)
IMPACT
• Reduced wait times and hand-offs
• Debottlenecking leading to reduced cycle times and increased
capacity
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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, re-
testing
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 /
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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
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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
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Improve to perfection cycle time
months
Reducing waste brings us closer to
perfection days
hours
As we reduce inventory/overproduction
in the process, bottleneck can be minutes
exposed and worked on as next steps seconds
Continuously find ways to improve the
process
Keep the customer in focus…are we
adding value?
Kaizen is the road to perfection…
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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!
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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 Registration
(red) (green) (black)
What do I need to know
Treatment Discharge Quality
• Just be yourself (blue) (yellow) 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
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GE Performance Solutions /
19 January 2007
Simulation II – debrief
Round
Target 1 2
Complete patients
(successfully) 20
Patients in process
(WIP) 5
Defective procedures
0
Patient cycle time 0:30
How did it feel?
What worked?
What didn’t work?
How could it be improved?
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19 January 2007
GE Healthcare improved productivity
tremendously by LeanSixSigma
(+303%)
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GE Performance Solutions /
19 January 2007
Lean principles
Lean
Transaction
• Single Piece Production System • Autonomation
Just-in-Time
Flow
• Stopping at
Jidoka
• Pull Abnormalities
Production
• TAKT Time
Production Heijunka
• Level Loading
• Sequencing
The House of Lean – More Advanced Lean
Principles 21 /
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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