Advancing Patient Safety Using Lean Methods: Advancing Patient Safety Using Lean Methods The Concept of Lean: Term coined to describe Toyota Production Systems (TPS) and The 14 Principles of The Toyota Way David M. Munch M.D.


Early Adopters in Healthcare: Early Adopters in Healthcare University of Michigan Thedacare Virginia Mason Park Nicollette Exempla


Slide3: Philosophy Customer First People are most important asset Kaizen Go and See: Focus on Floor Give feedback to team, earn respect Efficiency Thinking True (vs. apparent) condition Total (vs. individual) team involvement Technical Stability JIT Jidoka Kaizen Heijunka Management True North Tools to focus mgmt. attention Go and See Problem-solving Presentation skills Project Mgmt Supportive culture People are the Long Term Asset and gain value by learning skills Machines depreciate and lose value Toyota Production System: Gary Convis, President of TMMK


Slide4: Philosophy: Long Term Process: Eliminate Waste Problem Solving: People and Partners: Respect Challenge and Grow 14. Continue Organizational Learning through kaizen 13. Go see for yourself to thoroughly understand the situation Genchi Genbutsu 12. Make Decisions slowly by Consensus considering all options; Implement rapidly 11. Grow Leaders who live the philosophy 10. Respect, Develop and Challenge your People and teams 9. Respect, Challenge and Help your suppliers 8. Create process “flow” to surface problems 7. Use pull systems to avoid overproduction 6. Level out the work load (Hejunka) 5. Stop when there is a problem (Jidoka) 4. Standardize tasks for continuous improvement 3. Use visual control so no problems are hidden 2. Use only reliable thoroughly tested technology 1. Base management decisions on long- term philosophy: even at the expense of short term financial goals The 4 “P’s” and 14 Principles of The Toyota Way Kaizen “Good Change” The Toyota Way: Jeffrey K. Liker


Take Home MessageLean is not just a set of tools. It is an organizational state of being that is manifest through:: Take Home Message Lean is not just a set of tools. It is an organizational state of being that is manifest through: Continuous Improvement Driven by the front line Team All work is Focused on the Customer needs Eliminating Waste Eliminating Defects Malcolm Baldridge Pursuit, Shared Governance Patient Centered Care Waste of time, lives, materials Eliminating Medical Errors Toyota Model Hospital Model


Slide6: The Need: The 8 Wastes Waiting: E.D. Overproduction: Scheduling XS transport: Patient transfers Defects: Med Errors XS movement: Supply location XS Inventory: 3 pyxis drawers Waste Over processing: Writing VS x4 Unused employee creativity: Grass roots improvement


Lean Tools to Advance Patient Safety: Lean Tools to Advance Patient Safety Standard Work Jidoka Heijunka Poka Yoke Kaizen 6S: (do not confuse with 6 sigma)


Standard Work: Standard Work All Bundles are Standard Work M.I. Care Central Line Infection Prevention Surgical Infection Prevention Ventilator Associated Pneumonia Converting Standard Work into Standard Practice Visual Controls Stop when there is a Quality Problem: Jidoka


Stop when there is a Quality Problem: Jidoka The Toyota Assembly Line: Stop when there is a Quality Problem: Jidoka The Toyota Assembly Line


Stop when there is a Quality Problem: Jidoka Hospital Examples: Stop when there is a Quality Problem: Jidoka Hospital Examples Stop until: Full Sterile barriers before Placement of Central Lines Scrubbing and Gloves before Surgery is performed Rapid Response Teams Recognizing the Defect: Criteria based Stopping the Line: Immediate response to solve the problem Worrisome Fetal Monitor Strip: 3 minute window Initial Antibiotic Timing for Surgery


Poke Yoke: error proofing, forcing function: Poke Yoke: error proofing, forcing function Everyday experiences Applying breaks before car will allow reverse gear Shutting the Microwave Door Anesthesia gas line couplings Opportunity for I.V. connections? Smoking Cessation Counseling: forcing function in Nurse assessment


Level Out the Workload: Heijunka: Level Out the Workload: Heijunka Variable Demand: Artificial vs Natural Nurse Patient Ratio and Mortality: Every additional patient/nurse = 7% mortality increase Boston University Study: Eugene Litvak Ph.D Natural Variability: E.D. admissions Artificial Variability: elective admissions/surgery (eg.block time) http://www.ajmc.com/files/articlefines/AJMC2000MarLitvak305_312.pdf British Health Systems: Kate Sylvester M.D. E.D. admissions at shift change Floor Transfers


Kaizen: Good Change: Kaizen: Good Change Multi-disciplinary and Multi-level Addresses 1 of the “8 Wastes” Unused Employee Creativity The Effectiveness of Current State Analysis The Empowerment and Expectation Efficiency of Improvement Process


Slide14: Sort Straighten Scrub Safety Standardize Sustain The “6S” Tool Remove Unnecessary materials Organize remainder in Visual manner Clean Up Address Unsafe Conditions Establish Standard approach to work space Assign champion to anchor new process


Exempla Lutheran Medical Center Pharmacy: 1 year later: Exempla Lutheran Medical Center Pharmacy: 1 year later 50% reduction in medication delivery time 78% reduction in waste/recycling on IVPB Saved 11 miles/day pharmacist walking 54% reduction in stock movement $100,000 reduction in E.D. inventory 72% reduction in work to access EMR data


Pharmacy Financial Performance: Pharmacy Financial Performance We have analyzed our iBenchmarks database in which you and your hospital participate and your Pharmacy function has an exceptionally strong cost position...what some would call a "best practice."  Congratulations! HMC-Benchmarks inc.


Starting the Journey slide 1 : Starting the Journey slide 1 Have a Real Conversation with your CEO and other Leadership Lean as high priority Strategic and Operational Plans incorporate Lean Improvements at all Levels, including measures


Starting the Journey slide 2 : Starting the Journey slide 2 Learn by Doing Perfection is the Enemy of Progress Consultant may help early on Baby Steps: consider 6s or small scope Grow capacity to do Lean through the efficiencies you create Advance your Culture of Continuous Improvement


Thank you: Thank you Questions and Discussion