Lean Strategies For Office Practices University of Michigan Medical Administrative Assistants Ann Arbor, Michigan Steve Mandell, MD University of Michigan

Lean Strategies For Office Practices

University of Michigan Medical Administrative AssistantsAnn Arbor, Michigan

Steve Mandell, MDUniversity of Michigan

Medical Director, MLABS

September 9, 2008Noon-1

“The work we do today is designed to deliver us the exact type and rate of defects we get everyday.

Our processes are inherently defective.”

“Insanity is doing the same thing over and over again and expecting different results.”

Albert Einstein

Telling people to “be more careful” doesn’t work!

Key Observation

“No problem can be solved from the same level of consciousness that created it.”

Albert Einstein

“What got you here won’t get you there.”

Marshall Goldsmith

Burning Platform for Change?

Justification

Burning PlatformHealthcare Environment Pressures• Patient Safety / Ownership• Reduced Reimbursement / Pay for Quality

Work Processes Changing• Automation / Barcodes / Computers / Software• Growth Orientation• Busier Population – Do More With Less• Work Smarter Not Harder

Business Culture Changing• Lean Leaders• Lean Hospitals• Lean Labs

MQS

Continuous Continuous ImprovementImprovement StandardizationStandardization

BuiltBuilt--InIn--QualityQuality

ShortShortLead TimeLead Time

People People InvolvementInvolvement

MQS





The Clinic Appointment• Call the clinic, 3 voice prompts, on hold, leave message.• Clerk calls back and sets a date next week.• Arrive for the visit, check in, sit in waiting room.• Called into the exam room, wait for doctor.• Doctor sees you, saying she’s been waiting for you• Diagnoses a URI, and BP is worse.• Doctor prints antibiotic prescription, goes to the staffroom

to get it. You are allergic to that drug. • Doctor says to return in a week for the BP.• Medical assistant does an EKG.• At check out you ask the cost – clerk says they’ll bill you, • No appointment is available next week.• Pharmacist says your insurance prefers a different drug.

Is there a problem?

Lean Outcomes

Why Lean?Customers• Improves service level and quality• Reduces cost

Workplace efficiency• 40-50% reduction in cost of poor quality • 30-60% reduction in inventory• 20-40% reduction of floor space required• 30-60% reduction in service turnaround time• 20-50% improvement in productivity• 20-30% improvement in equipment capacity• Helps plan for growth

Employees – THE KEY• Higher morale; they are empowered to own and control their own

processes• Eliminates staffing shortages and overwork• Incorporates employee safety and ergonomics• Work is easier and makes sense!

What is Lean?What is Lean?Principles over 100 years oldPrinciples over 100 years old

Named by a graduate student of an engineer.Named by a graduate student of an engineer.

Lean focuses on eliminating Lean focuses on eliminating wastewaste in processes in processes

Lean is Lean is NOTNOT about eliminating about eliminating PEOPLEPEOPLE !!! !!!

Focuses on the CustomerFocuses on the Customer

What is Lean Thinking?What is Lean Thinking?

“The endless transformation of waste into value from the customer’s perspective”.

---Womack and Jones, Lean Thinking

Lean Perspective

This glass is…..

LEAN - ToolkitLEAN - Toolkit Standardized WorkStandardized Work Standardized Problem SolvingStandardized Problem Solving Single Piece FlowSingle Piece Flow Value Stream MappingValue Stream Mapping KaizenKaizen Workload LevelingWorkload Leveling 5S5S Visual FactoryVisual Factory Kanban SystemsKanban Systems Cellular DesignCellular Design Error Proofing (Poka Yoke)Error Proofing (Poka Yoke)

Value from the patient’s perspectiveValue from the patient’s perspective Pass no defectsPass no defects Commitment to continuous learning / improvementCommitment to continuous learning / improvement Standardization is the road to improvementStandardization is the road to improvement Go see for yourself to understandGo see for yourself to understand Flow where you canFlow where you can Pull where you mustPull where you must You get what you expect and deserve what you tolerateYou get what you expect and deserve what you tolerate

& Philosophy& Philosophy

TOOLS

PHILOSOPHY

Quality TOOLS P H IL O S O P H Y

Quality

What you are about to see are tools used to CHANGE PEOPLE by teaching them to identify waste, savings and opportunity.

CURRENTTHINKING

REQUIRED THINKING

FORMS FORMS OFOF

WASTEWASTE

II

CC

OO

MMWW

PP

MM

CorrectionCorrection

OverProduction

OverProduction

MotionMotion

MaterialMovementMaterial

Movement

WaitingWaiting

InventoryInventory

ProcessingProcessing

WASTEWASTE

Required Lean ThinkingRequired Lean Thinking

MQS





MQS





Transfer Data

Over processing: Redundant, unnecessary or ineffective processes;

work that is giving the customer more than he/she is willing to pay for or

doesn’t add value; testing not specifically requested; retesting not needed;

requiring information that is not being used

Examples:Transferring the same data from one form to anotherUnnecessary formattingPoor filing system requiring extra effort to locate itemsToo many required approvals for action to be takenToo many steps to complete a taskReports/memos published that are not understandable

MQS





MQS





Overproduction: Making more than is necessary or making things faster than downstream processes can handle; working ahead;cutting blank slides ahead of need; making more slides than needed

Starting too early in the morningProcess starting earlier than it needs to, with preliminary data, driving multiple updates/reworks as “real” data becomes availableReports that are not used or readToo many copiesRedundant work performed by different functionsPreparing paper copies of documents before final versionOral & written communication that is too wordy

MQS





MQS





Waiting: Any delay between when one process ends and the next begins. People waiting for machines or information. Information waiting on people or machines

Meetings starting lateSignature approvalsComputer processing (searches, start-ups, etc.)Photocopier and fax machine processing

MQS





MQS





Transportation: Unnecessary handoffs or transfers. Unnecessary distances material or information travels

Process involving multiple handoffs where one person/group could complete Creating temporary locations for items or information Stocking supplies far from their point-of-use Filing papers that will never be used againOrganizing unneeded items

MQS





MQS





DO IT AGAIN!!

Rework due to defects: Work done because of errors, mistakes or non-conformity to expectations in the previous process; missing or inaccurate information; patient complaints; work done in error

Reworking something due to error or requirement changesReprinting informal documents to get “perfect look”Starting tasks without knowing the end goalReworking a presentation / report / memo over and over againRe-training of personnel

MQS





MQS





Inventory: More information, material, parts or

products on hand than the customer needs right now.

Purchasing excessive quantity of materials, supplies, equipmentKeeping excessive supplies at deskFiled paperwork that is never usedComputer files not used Too many meetings

MQS





MQS





Motion: Unnecessary movements of people, travel, walking, searching; Leaving work area to gather supplies. Extra clicks or keystrokes;

reaching or re-sorting

Copy machine locate a far distance from userTravel to meetings that you don’t really need to attend or that could be conducted via conference call / net meetingSearching for misplaced items or remotely located itemsDigging through stacks of paperDialing phone numbers rather than using speed dial or distribution lists

MQS





MQS





Employee Initiative Not getting, considering or using ideas of the workforce to improve processes.

“The solution to all our problems lies in the collective wisdom of our workforce.”

MQS





MQS





Misplaced Talent Poor utilization of specialized training, skills or pay grade of personnel; skill set to job task misfits

http://www.nasa.gov/images/content/168596main_image_feature_753_ys_full.jpg

If there is time…..

The Signature Game

Part 1 – Baseline Assessment

Part 2 – Lean Process

Documents

Lean Strategies For Office Practices University of Michigan Medical Administrative Assistants Ann Arbor, Michigan Steve Mandell, MD University of Michigan