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GE Healthcare Confidential and Proprietary Information The information contained in this document is disclosed in confidence and is subject to a confidentiality agreement between GE Healthcare and the customer. It is the property of GE Healthcare. This notice shall appear on any reproduction, in whole or in part. The information contained herein should not be used by others, or disclosed to others, without the express written consent of GE Healthcare.
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GE a Global Company
Operations in over 100+ countries 300,000+ employees worldwide Manufacturing facilities in 40+ countries
Industrial NBC Universal
Commercial Finance
Infrastructure Healthcare
Consumer Finance
GE is a family of businesses aligned with our customers needs and acting as one company to drive growth.
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GE Healthcare
GE Healthcare brings the world medical science and technologies that are helping to transform healthcare. We are working with our partners in healthcare to help them predict, diagnose, inform, and treat disease earlier than ever.
Continuing Innovation
By inventing the high vacuum x-ray tube in 1913, we enabled the first modern x-ray tube. Throughout the past century we've led medical breakthroughs, such as the recent creation of the first all-digital hospital, with real-time electronic patient records and medical images accessible to doctors worldwide
MOLECULAR MEDICINE Combining today's sophisticated diagnostic imaging with an increasing understanding of both the human genome and the body's chemistry, GE is helping to transform after-the-fact treatment to before-onset care
Diagnostic Imaging Interventional Cardiology & Surgery Clinical Systems Healthcare Information Technologies Services Life Sciences Medical Diagnostics
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Success Factors Based on our extensive experience of delivering programmes of transformational change in the NHS, we know there are three things critical for success: Solid and deep methodology, tailored to the NHS and needs of particular trusts Clinical engagement and acceptance of change Accountability supported by strong leadership
GE Healthcare are not like other consultants, they use these tools internally as well, in one of the worlds largest and most successful companies. James Barbour, CEO NHS Lothian
Copyright GE All Rights Reserved. GE Healthcare Performance Solutions Northern Europe Rev2008.01KE
Outpatients
Theatres
Discharge points Value Stream Management Scheduling Booking Bed Discharge Management Planning
Leadership Leadership
We We bring bring experience experience and and understanding understanding of of delivering delivering process process transformation transformation in in healthcare healthcare
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Our Delivery
Key Offerings
Performance & Process Improvement Change Acceleration & Management Productivity Improvement Initiatives Cultural Change Leadership Development Six Sigma Black Belt & Lean Leader Development Management & Leadership System Resource Development Coaching & Mentoring
Examples of Projects
Cancer Pathways Pharmacy Trauma Mental Health Cardiac Theatres A&E Skills Transfer Business Planning
Examples of clients
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Quality
Lean
X Acceptance Accountability
=
Change Acceleration Process
Effective Results
Project Framework
Copyright GE All Rights Reserved. GE Healthcare Performance Solutions Northern Europe Rev2008.01KE
Lean Principles
1 Specify Value
5 Work to Perfection
Lean
Thinking
4 Implement Pull 3 Establish Flow
Lean is based on 5 Principles which form the foundation for all of the tools and structures within the Methodology
Copyright GE All Rights Reserved. GE Healthcare Performance Solutions Northern Europe Rev2008.01KE
Benefits of Lean
Lean eliminates or minimises waste / non value add activity within a process which either shortens the overall cycle time or allows for more quality value add activities to take place or both.
Before
Work . . . Value Add Time Wait / Waste . . . Non Value Add Time
After
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1 VA = Value-Added
Lean defines a value from the patients point of view.
Value-Added work are all processes ..which add direct value to the patient. ..All contact with a clinician is considered .. value Examples: Consultant talking to a patient a nurse taking blood radiologist looking at X-ray scans surgery
2 VE = Value-Enabling
No Value in the patients eyes but necessary for the process
Value-Enabling steps are steps which the patient would not be willing to pay for but cannot be deleted from the process Steps regard to work which have to be done because of laws and regulations.
Examples: Check in at reception booking and scheduling anaesthetic Reporting regulations Data collection
Copyright GE All Rights Reserved. GE Healthcare Performance Solutions Northern Europe Rev2008.01KE
6. Excessive processing
Not necessary or duplicated processes
2.Transportation
Unnecessary transportation while providing a service direct to the patient
7. Under utilization
Staff working on processes under their specific
=> Examples: Bring wheel chair patient to skill wrong treatment room, multiple be moves => Examples: Doctors transporting patients to treatment rooms
3.Inventory
Everything that ties up resources
8. Defects
A mistake in the process => very dangerous in healthcare
4.Motion
Not optimized and standardized processes creating unnecessary motion
5. Overproduction
Producing more to the patient than required or needed
Value Stream
Visualize your processes and find the waste
A Value Stream Map is a pictorial view of Value-Added and NonValue-Added activities that are required to bring the patient through the whole process A Value Stream is the set of activities that convert patients needs into delivered services
Home/
Admitted
iPAS
Opera
KAIZEN!
KAIZEN! KAIZEN!
I
Reception
I
Ward Assessment Holding Bay Anaesthetic Room OR Recovery
17 Minutes 39 Minutes
66 Minutes 15 Minutes
Patient
Transport
1 operators
Number of
Patient inventory
Care Provider
Data System
Phone Call
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Flow
Let processes flow like water => find the easy way!
One continuous flow of a patient or material. One at a time
Why
Have a Lean look on movement (flow) of products, services and information down the value stream
Target
Create a continuous flow as product, service and information is transformed by continuously adding value
How
Flow is created by eliminating queues and stops, and improving process flexibility and reliability
In Healthcare:
An example of flow is the patient journey
Patient is booked in at Reception Patient arrives in Hospital Patient is brought to Ward Patient has Surgery Patient recovers on ward Patient leaves hospital
Copyright GE All Rights Reserved. GE Healthcare Performance Solutions Northern Europe Rev2008.01KE
Pull
When the Flow is determined by pull from further down the Process. As opposed to being pushed through the process To produce only requested amounts
Why
To create processes where only the required amount is taken
Target
No action is taken until the downstream process initiates it
How
Let the end customer pull the product/service through the value stream. => Each step pulls the product/transaction when needed from the preceding step
In Healthcare:
an Example of Pull
When a patient is called by theatres to an operation. It is theatre who determines the rate of flow and that only the required amount of patients are pulled into the next step
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Copyright GE All Rights Reserved. GE Healthcare Performance Solutions Northern Europe Rev2008.01KE
Future State
Current State
Original State
HEALTHCARE EXAMPLE
Current State 23 Days
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5S
1. Sort 2. Set in Order 3. Shine 4. Standardise 5. Sustain
to separate the needed items from the un-needed items which are then removed to a "red-tagged" location
SAFETY IN EVERYTHING
to arrange in a way for how the remaining items will be used to maintain the work area for the already sorted and set-in-order items to ensure sort, set-in-order, and shine are consistently followed across all users to maintain and improve sort, set-inorder, shine, and standardise
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Spaghetti Map
A diagram that shows the motion and transportation of the patient / family / caregiver / supply throughout the care experience or process
How
Draw a layout from the birds eyes perspective of the focus area Observe a patient/family/caregiver while doing their job and draw it on the layout by not lifting the pencil from the paper
Paper Referral Trail in Booking Centre
Why
Creates a better understanding an overview of the whole process Visualizes waste in transportation and motion like no other lean tool Quantifies travel time/ distance elimination
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QxA=E
VSM
Current & Future State Value Stream Map. Quick Win actions. Prioritised options for focus of RIE
RIE
Implemented improvements. Success Metrics. Ongoing tracking mechanism. Sustainability Plan. Further Action Plan
Sustainability
Success Metrics. Further improvements implemented. Feedback from team & staff. Further opportunities identified
Copyright GE All Rights Reserved. GE Healthcare Performance Solutions Northern Europe Rev2008.01KE
KAI-ZEN
Organise Event
Try-Storming Very Hands On try new ways, stop at any issues, solve them and continue Continuous evaluation & tracking Communicate & Celebrate successes
Mobilise Team
Trystorm Improvements
Track Success
ACTION PLAN
Task No. Category Transition to In-Pt Ward 2 Transition to In-Pt Ward 3 Transition to In-Pt Ward 4 Transition to In-Pt Ward 5 Transition to In-Pt Ward 6 Transition to In-Pt Ward 7 Transition to In-Pt Ward 8 Transition to In-Pt Ward 9 Transition to In-Pt Ward 10 Transition to In-Pt Ward 11 Admission Support 12 Admission Support 13 Admission Support 14 Admission Support 15 Admission Support 16 Monitoring staff take-up and use of new obs forms Examining feasibility of staff scanning forms (worker allocation, exit and entry, level 3 obs, handover) and saving electronically - discussion with Anne Warburton/ward managers Observing handovers and obtaining feedback from staff. Responding to staff feedback and amending handover sheet as indicated A Denham/B Earp 11-Apr 9-May Complete Ratify Role of shift co ordinator Ensuring information packs (basic black and white format) are on K2 Examining feasibility of double-sided colour printing on K1 for future stocks of information packs and alternatives if required Undertaking weekly evaluation of new admissions on K2 Amending patient information based on evaluation and informal feedback from patients/staff Angela Murphy S Johnson 11-Apr 11-Apr 9-May 18-Apr Complete
30.00
Task Implementation of Discharge Coordinator / Bed Manager as pilot Implementation of Discharge Coordinator / Bed Manager as Acting up opprtunity Re affirmed shift coordinator allocated through the duty rota Re affirmed A&Eliason Nurse allocated through the duty rota Sectorisation of Crisis Teams Qualified Practioner Teams Launch Role of the bleep holder Review Operational policy Adult inpatients from feedback Review operational policy Maple House From feedback Review operational policy CRHT team
Owner Debs Horrocks /Angela Murpy Angela Murphy Angela Murphy Angela Murphy Angela Murphy Sharon.Morrison Sharon.Morrison Sharon.Morrison Angela Murphy Paula Solomon
Date Assigned 11-Apr 11-Apr 11-Apr 11-Apr 11-Apr 11-Apr 11-Apr 11-Apr 11-Apr
Target Completion 9-May 9-May 9-May 9-May 9-May 9-May 9-May 9-May 9-May
Status Complete Complete Complete Complete Complete Complete In progress In progress In progress
40.00 100.00 90.00 80.00 70.00 60.00 50.00 Average of LoS
Complete
20.00
10.00 0.00 7-2007 8-2007 9-2007 10-2007 11-2007 12-2007 1-2008 2-2008 3-2008 4-2008 5-2008 6-2008
Discharge period
Copyright GE All Rights Reserved. GE Healthcare Performance Solutions Northern Europe Rev2008.01KE
Copyright GE All Rights Reserved. GE Healthcare Performance Solutions Northern Europe Rev2008.01KE
Jidoka
One of the 3 main principles of Lean
1) Stop at an Abnormality:
Stopping the process when an abnormality has been detected Countermeasure implemented to prevent repeat occurrences
2) Autonomation:
Building human intelligence into machines or software giving automation the ability to make a decision to shut down automatically in the case of an abnormality in order to stop defective products from flowing into the next process. Example: Automatic loom can detect a broken thread
Healthcare Example:
Impact: Visual Timeline Highlights delays Prompts action Instant Progress Snapshot for all Clear plan to meet Estimated ..Discharge Date
Copyright GE All Rights Reserved. GE Healthcare Performance Solutions Northern Europe Rev2008.01KE
Benefits
Poka-Yoke supports efforts to eliminate MUDA/ waste: Waiting Inventory Quality Transportation Motion Excess Processing Over Production People's Skills
Applications
Poka Yoke can be used wherever something can go wrong. It is a technique, a tool that can be applied to any type of processes
Healthcare Example:
Cat scan placed wrong way around on an X-ray viewing box = doctor performs surgery on the wrong side of the brain POKA YOKE: Mark patient side of brain to be operated on in advance Design a X-ray box where the scan can only be placed on correctly
Copyright GE All Rights Reserved. GE Healthcare Performance Solutions Northern Europe Rev2008.01KE
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Heijunka
A Methodology to establish stability in a System where Customer Demand is erratic
Copyright GE All Rights Reserved. GE Healthcare Performance Solutions Northern Europe Rev2008.01KE
Takt-Time
The heartbeat of the organization
Specific production time showing the needed completion time of a process to hit customers satisfaction.
Takt Time =
Healthcare Example:
60 Patients arrive at a X-Ray on a given day and X-Ray dept. is working 8 hours per day => Takt-Time here would be calculated as follows:
Takt Time = 8 hrs. (480min, 28800sec) work per day = 8 min (480 secs)
60 patients per day
Takt time here shows that every 8 min an exam needs to be completed to hit patients demand
* excluding breaks, meetings, etc.
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Appendix
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5S Action Workout
Building Blocks for process discipline and control; Sort, Shine , Set in Order, Standardize, Sustain. (Kaizen) 3-5 day team based activity focused on quickly solving problems through physical simulation and evaluation. A visual device (light) or pin-pan-pon that operators use to call attention to an abnormality. The use of this is to request immediate attention and action to the problem. The use of machines working independently of manpower. The process of separating the work of man and machine characterized by: work not movement; quality built into the process; and visual management. (see Jidoka) Any machine or process that limits flow or capacity. The optimal physical layout or machines and manpower for a product or family of products that identifies and eliminates waste. A method of conducting single-piece flow in which the operator proceeds from machine to machine (in a counter-clockwise fashion), taking a part from the previous operation and loading it in the next machine. Then taking the part just removed from that machine, checking it and loading it into the following machineetc, Carrying out one-piece-at-a-time production in order to eliminate stagnation of work (queue) in and between processing steps (see Flow) The total time required for a task to be complete. Elements include manual and travel times, automated or machine run time. Defects per unit. Work done simultaneous to or in conjunction with transportation or conveyance. e.g. (1) an assembly is moving down a line while a person is performing work, (2) a person acts as a conveyor carrying a part to the next machine in a Chaku-chaku fashion. The main purpose of flow is to quickly and continuously identify and eliminate waste. Increasing the delivery frequency of parts, such as parts from outside vendors, in order to keep inventory to a minimum. The process of level loading and sequencing the timing of production.
Andon
Automation Autonomation
Bottleneck Cell
Chaku-Chaku
Cycle Time
DPU Flow
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Jidoka
Machines that have human intelligence built into them, giving them the ability to shut down automatically in the case of an abnormality to stop defective products from flowing into the next process. Jidoka measures are incorporated in the assembly process by use of Andons and Pin-PanPon; stopping when abnormality is detected. (Just in time) theory of production characterized by (1) single piece flow, (2) producing according to TAKT time, (3) pulling of material from upstream process, keeping inventory at minimum, established levels. Change for the better; a process quality tool for improvement involving a series of activities whereby instances of waste are eliminated one by one at minimal cost, by workers pooling their ideas and increasing efficiency in a timely manner. It emphasizes manual work operations rather than equipment. (see action workout) A method/device of pulling from previous processes in order to control material flow, cap inventory levels, and to take pulse of the customer. It serves as: an instruction for when to produce; a tool for visual control against over production and a detection of irregular processing speeds. Kanban can be broadly categorized into 2 categories: Production Kanban and Pick-up Kanban. These can be further stratified into Ordinary, Signal, Transport, and Purchase. Grouping component parts used in a process or build for ease of assembly. ( see material presentation ) The total time it takes the product to go from raw inventory to the finished product. Order to remittance lead time refers to the total time from when an order is placed until the finished product is shipped.
JIT
Kaizen
Kanban
Kitting
Lead Time
Internally led Kaizen event. Overall leveling in the production schedule of the variety and volume of items produced in a given time period. ( see Heijunka) The time from machine switch on, processing, to machine returning to original position, during which there is no hands-on work by the operator. The hands-on time it takes for the worker to perform a task. Introducing material to the line or cell in a manner that is easy and effective for the operator. Usually broken into 3 categories (1) items that are too large to kit (2) items that are too small to kit (3) items that lend themselves to be kitted.
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30 / Performance Solutions/ 26/02/2009
Mincing Muda
Mixing of products for central services (i.e. heat treat), OV, kits for components and assemblies. Any type of waste elements that add no value to the product: i.e. Waiting, Transporting, Over production, Excess Motion, Inventory Defects, Human Touches. One shop worker operating two or more similar machines that are grouped together. An operator being able to perform more than one process (which may or may not include machines). Broadening a workers skills so that the worker can operate multiple types of equipment and processes in order to facilitate cell development and one piece flow. A product that deviates from drawing or an internal quality system. A product with a defect. Production system in which only one part at a time is processed or assembled and the work is verified before being sent along the production line to follow processes. A form of Andon that is auditoryspecial sounds are designated to certain points on the line. e.g. A pin-pin-pin repeating sound may be associated with power supply installation, calling attention to it when an abnormality has been detected. Mistake proof: usually refers to the use of fail-safe devices in the process in order to prevent defects from occurring and insure quality. When this ingredient is added to automation will yield autonomation. ( see Jidoka )
Multi-Machine Handling Multi-process Handling Multi-skill Development Non-conforming Material One Piece Flow
Pin-Pan-Pon
Pokeyoke
Process Process Capacity Process Capacity Table Process Mapping Process Route Analysis
A series of steps to achieve a desired result. Maximum amount of product that can be produced through a process for a given period of time. Indicates the maximum capacity for parts processing at any one process. Recorded on it are: the amount of time spent in manual work, machine time, setup time, etc. A technique used to follow the detailed flow of a product through a manufacturing cycle. A study of the process and machine sequence for a group of similar parts. It can be used to standardize product flow for ease of cell implementations.
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A study of the quantities demanded of different products produced at a work location. This picture of the volume and variety of products can be used to identify high impact areas to concentrate efforts or identify the need to use process razing to make products more similar. System of manufacturing in which each process withdraws the parts it needs from the preceding process when they need them, in the exact standardized amount needed. Total customer satisfaction-involves having all employees Customer focused. The time a part sits waiting to be worked on. The order in which the part is processed. The order in which an operator performs a series of repetitive tasks. Machine changeover steps that are performed while the machine is processing parts or off-line from production time. Machine changeover steps that are performed while the machine is stopped during production.
Pull System
Set-up, Internal
A quality standard of 3.4 defects per million opportunities - used to insure customer satisfaction. Single Minute Exchange Die (i.e., under 10 min) has become a title for the category of improvement devices used in manufacturing to allow for quick change over of machine/fixture set-ups. Statistical Process Control: analysis of variation in a process. Combining people and machines to accomplish production in such a way as to minimize waste. Minimum (and standardized) amount of work in process required to perform repetitive operations economically. Sequence of repeatable tasks that an operator performs. Shows the outline of work for each worker in a cell. Recorded on it are: Takt time, work sequence, standard WIP, quality checks, safety precautions, etc.
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A table that clarifies how much time is spent doing manual work and traveling at each production process. It is used to examine the range of processes that one worker can take care of within Takt time and the amount of time during which machines are operated automatically. These are recorded to help determine what combination of operations are possible. A visual system that has a predetermined amount of inventory and all facets of 5s in order to detect abnormalities. With this system, the shopper from the downstream process can buy from the supermarket. Once the purchase has been made, and material consumed, a signal can be sent to the upstream process to supply more. (see pull)
Super Market
Takt Time
Available production time / required production (fcst & act demand)..must be like units; e.g., 1 shift = 1980 min/wk
Total Productive Maintenance involves of all employees in a cell to improve the process. The time is takes a worker to move to the next station to pick up or put down parts, tools, etc. May occur during operations as well. The specific activities required to design, order, and provide a product from concept to launch order to delivery raw materials to finished goods. The process of detailing the process of converting raw material to finished goods. This is typically mapped with the 7 flows (info, people, equipment, raw material, sub-assembly, assembly,engineering) one at a time, or in a combination. Refers to the means by which anyone can tell at a glance if production activities are proceeding normally or not. A communication, discipline and pacing tool. Work In Process; inventory of materials that has been already started processing. Rework, set-ups, inspection, repair processing, transportation, unnecessary work to complete of a product. Anything that isnt directly changing the form fit or function of the part. Only necessary direct work to manufacture a product. Anything that the customer is willing to pay for or an operation that changes the form, fit, or function of the part.
Value Stream
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Topic/Focus
Lean Background / Case Studies
Becoming Lean: An inside story of US Manufacturers The Toyota Production System: Beyond Large Scale Production The Machine That Changed The World: The Story of Lean Production Learning to See Mapping Creating Continuous Flow within a cell
Creating flow
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The Goal: A Process of Excellence Ongoing improvement Poke Yoke: Improving Product Quality by Preventing Defects techniques The Toyota Production System
Operational
Detailed Implementation of TPS Management principles from Toyota Lean thinking beyond the factory floor
Lean Solutions
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