Académique Documents
Professionnel Documents
Culture Documents
Lean Methods
Lean Methods
Definition of Lean
Types of waste
Kaizen
Value stream mapping
Tools
• Takt time, throughput time, five Ss, spaghetti diagrams,
kaizen events, standardized work, jidoka, andon, kanban,
SMED, flow and pull, heijunka, advanced access
What Is Lean?
Elimination of waste
• Toyota Production System (TPS)
Philosophy
• Produce only what is needed, when it is needed, with no
waste
Methodology
• Determination of value added in the process
Tools
• Five Ss, kaizen event, standardized work, etc.
Lean Organization – Inverted Pyramid
Front-line Staff
Implementation
Senior
Administration
Support
CEO
Waste (Muda)
Types of Waste (Muda)
Overproduction
Waiting
Transportation
Inventory
Motion
Overprocessing
Defects
Seven Wastes of Healthcare
Overproduction
Producing more than
the customer needs
right now
• Working ahead rather
than waiting
• Just‐in‐case thinking
• Mixing drugs in
anticipation of patient
needs
• Forcing admit to Critical
Care when not needed
Seven Wastes of Healthcare
2. Transportation
Movement of product
that does not add
value
• Moving patients for
testing or treatment
• Centralized storage
• Transporting lab
specimens
• Transporting
medication and
supplies
Seven Wastes of Healthcare
3. Motion
Movement of people that
does not add value
• Searching for charts
• Gathering supplies
• Cross ward Nursing care
Seven Wastes of Healthcare
4. Waiting
Idle time created when
material, information,
people, or equipment is not
ready
• Waiting for lab result
• Waiting for a bed
assignment
• Waiting for discharge
• Waiting for treatment
• Waiting for doctor, nurse
Seven Wastes of Healthcare
5. Over Processing
Effort that adds no value from
the patient’s viewpoint
• Excessive paperwork
• Redundant processes
• Unnecessary tests
• Multiple bed moves
• Requiring approval of sure
things
Seven Wastes of Healthcare
6. Inventory
More materials,
medications, or goods on
hand than needed to serve
patients right now
• Lab specimen awaiting
analysis,
• ED patients waiting for
bed,
• Excess pharmacy stock
• Excess supplies
Seven Wastes of Healthcare
7. Defects
Work that contains errors,
rework, mistakes or lacks
something necessary
• Medication errors
• Wrong patient – wrong
procedure
• Improper labeling of specimen
• Multiple puncture for blood
draw
• Failure to provide antibiotics in
time
Kaizen Philosophy
Kaizen Philosophy
Masaaki Imai coined the term in his book – Kaizen : The key to
Japan’s Competitive Success (1986)
The Outcome
The hospital realized:
• $75,000 annual tangible savings in payroll costs associated with staff
time spent searching for information
• 57% reduction in Same‐Day Surgery patient wait times resulting in
improved patient satisfaction.
• Elimination of loose sheets of patient information, improved
documentation accuracy and increased physician satisfaction.
Case Study - Results of 175 Rapid Process Improvement
Source: Womack, J. P., A. P. Byrne, O. J. Fiume, G. S. Kaplan, and J.Toussaint. 2005. "Going Lean in Healthcare."
Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement. Online information available at:
http://www.ihi.org/IHI/Results/WhitePapers/GoingLeaninHealthCare.htm.
Value Stream Mapping
Value Stream Mapping
Process Name
Takt time =
Cycle Time =
# of People =
Process Box
Laboratory
Reception
Test Orders
Database
Reception Phlebotomy
Takt time = 270 sec Takt time = 270 sec
Cycle Time = 240 sec Cycle Time = 180 sec
# of People = 2 # of People = 1
VSM – Exercise – OPD Lab tests
Process Efficiency Percent
(22%) = Test Results
Value Added Time (320) Laboratory Report
Report Delivered Dispatch
Lead Time (1440) 1X daily
Reception
Report Delivered
Test Orders 1X daily
Test Results
Database
Specimen
Test Orders Delivered 2 Hourly
Specimen
Test Orders Label
Doctors Doctors
Office Office
Patient Info
0-15 0-20
Reception Phlebotomy
Takt time = 270 sec Takt time = 270 sec
Cycle Time = 240 sec Cycle Time = 180 sec
# of People = 2 # of People = 1 320 /
15 05 300 Next Day Next Day
90 10 120
Value Stream Mapping
System cycle time is equal to the longest task cycle time in the
system—the rate at which customers or products exit the
system, or “drip time.”
Calculating Takt Time
Calculating Manning Levels
Throughput Time
Wait 15
minutes
Valued‐added tasks:
• Nurse preliminary exam
• Physician exam and consultation
Non‐value‐added steps, necessary:
• Patient check‐in
Value‐added time = 5 minutes (nurse preliminary exam) + 20
minutes (physician exam and consultation) = 25 minutes.
Percentage value‐added time = 25 minutes/70 minutes = 35
percent.
Case Study – Central OPD Scheduling
Issues Identified –
• Wide variances in the amount of time different employees took to
complete the same task
• Poor execution of critical tasks such as obtaining physician’s orders or
scheduling imminent procedures.
The Outcome –
• With the solution in place, scheduling efficiency and effectiveness
increased dramatically.
• Total work time for the scheduling process decreased 56%, accompanied
by a noticeable drop in the number of postponed or cancelled patient
procedures.
• With backup staff assigned to scheduling, the department is able to
maintain this level of excellence even during peak workload hours.
5S
5S Principles
Elimination of waste
Every body is involved, Co-operative effort
Attack root cause
Human being is not infalliable
Objectives
Improve housekeeping
Make every individual responsible for
housekeeping
Beautify by simple means
Productivity improvement by saving time,
space etc.
5S’s
Seiri - Sorting
Seiton - Systematic arrangement
Seiso - Cleaning
Inspection while cleaning
Seiketsu - Standardization
Shitsuke - Self Discipline
5S
• Contingency Parts
Critically decide the quantity of contingency parts to
be retained and criteria for such parts
Organization
Frequency of use Storage Method
3. Contingency Parts
• Many times storage place for contingency parts become
a last refuge for broken parts, surplus items and things
nobody is likely to use
Identifying unnecessary
2. Operational Analysis
Preparing the sequence of operations for system
eg. How to perform Seiri (sorting)
3. Check List
A check sheet is used to decide what sort of main system
and sub system are necessary.
Dealing with papers
a) Immediate action
b) Low priority
c) Pending
d) Reading material
e) For information
Dealing with papers
4 D Principle
DO
DELEGATE
DELAY
DUMP
SEITION = Systematic Arrangement
Japanese Meaning:
Dictionary meaning of Seiton is “to be correctly
prepared” and “to prepare correctly”.
Improvement Methods
USE :
1 ) Signboards
2) Colour codes
3) Outline markings
4) Labels
SEITION = Systematic Arrangement
Functional
Storage
SEITION = Systematic Arrangement
Functional Storage
SEITION = Systematic Arrangement
Functional Storage
SEITION = Systematic Arrangement
• Oils
- Reduce number of oils used (Standardize)
- Colour code for oil
- Safety aspects - fire prevention, pollution, leak,
spillage
Japanese Meaning :
Meaning
Meaning Setting
Settingupupstandards
standards//Norms
Normsfor
foraaneat,
neat,
clean,
clean,workplace
workplaceand
anddetails
detailsof
ofhow
howto
to
maintain
maintainthe
thenorm
norm(Procedure)
(Procedure)
Japanese Meaning :
Dictionary meaning
“unsoiled things, purity and cleanliness”
Clean manners ,
Visual Management
SEIKETSU = Standardization
What visual control communicates ?
• Alert us to an abnormality
• Help us recover quickly
• Promote adherence and prevention
• Enable successful self management
SEIKETSU = Standardization
Some methods for visual communication
⇒ Colour coding
⇒ Use of Labels
⇒ Danger alerts
⇒ Indication where things should be put
⇒ Directional arrows/ marks
⇒ Transparent covers
⇒ Performance indicators
SEIKETSU = Standardization
Some methods for visual communication
Labels
⇒ Precision management labels
⇒ Inspection labels
⇒ Temperature labels
⇒ Responsibility labels
SEIKETSU = Standardization
Points to remember in making visual control tools
Meaning
Meaning Every
Everyone
onesticks
sticksto
tothe
therule
ruleand
andmakes
makesitit
aahabit
habit
Activity - Participation of everyone in developing
good habits
- Regular audits and aiming for higher
level
Japanese
JapaneseMeaning
Meaning::
Dictionary
Dictionarymeaning
meaningisis
“learning
“learningof
ofthe
themanners”
manners”
“having
“havingmanners,
manners,dressing
dressingneatly”
neatly”OR
OR
“training
“trainingchildren
childrenfor
forgood
goodcustoms”
customs”
SHITSUKE = Self Discipline
Activities
Activities::
5S
5SCommittee
Committee
5S
5STraining
Training
5S
5SCompetition
Competition//evaluation
evaluation
5S
5SMonth
Month
Posters
Posters,,Literature
Literatureetc.
etc.
SHITSUKE = Self Discipline
Booking
Investigation
The Outcome –
• Standardized Patient Room Layout/Equipment
• Patient Supplies Stocked at the Point of Use
• 43% Overall Waste Reduction
• 30% Increase in Care Related Activities
• 27% Increase in Bedside Time
• 12% Decrease in Wasted Motion (Steps)
Standardized Work
Standardized Work
Work Sequence
1. The order in which the work is done in a given process.
2. Can be a powerful tool to define safety and ergonomic issues
In‐Process Stock
1. Minimum number of unfinished work pieces required for the
operator to complete the process
Implementing Standardized Work
Evaluate the
current
situation
Workers may feel threatened that their jobs are at risk and
therefore may not participate fully in optimizing the
process.
Outcomes
The O.R. staff realized an initial reduction of 46% of time
dedicated to the O.R. turnover process. Since inception of
lean management, efficiency has grown to a 60% reduction
of time needed in the O.R. changeover process.
Case Study – Operating Room Turnover
Case Study – Operating Room Turnover
Jidoka and Andon
Jidoka and Andon
Empty Empty
Kanban Kanban
Full Full
Kanban Kanban
Task 1 Task 2
Customer
Workstation Workstation
Order
1 2
Kanban
Single Minute Exchange of Die (SMED)
Used to reduce changeover or setup time, which is the time
needed between the completion of one procedure and
the start of the next procedure
Pioneered by Shigeo Shingo
Steps
1. Identify and classify internal and external activities
2. Separate internal activities from external activities
3. Convert internal setup activities to external activities
4. Apply changes to convert remaining internal activities
to external activities
5. Streamline all setup activities
Single Minute Exchange of Die (SMED)
Healthcare examples –
1. The changeover times in Operation Theaters, i.e.,
the time between the surgeries typically account
for high valued OT utilization time. These also
account for variations in OT scheduling effecting
overall utilization, increasing cancellation and
reducing revenue generation
2. The higher room arrangement and bedmaking
turn around times account for increased waiting
times for the patients waiting for admission
Flow and Pull