Lean Healthcare Forum 2006

Lean Healthcare ForumNational Motorcycle Museum

Kate Silvester with thanks to Richard Steyn

& a cast of thousandsJanuary 25th 2006

How ‘lean’ are you ?

Improved flow,timeliness

and efficiencySpecifyvalue

Understand demand

Make it Flow Level Perfect

Have you mapped your laundry process?• Is your mashing machine

• in or near the kitchen?• in or near the bathroom?

• Is the 100% utilisation of Charles Kennedy’s liver:• A good thing?• A bad thing?

Objectives: How ‘lean’ are you?

1. Specify value: Process view:– Redesign – Impact on quality– Measures for improvement

2. Understand demand – Understand flow

• Which group to go into this afternoon

The clinical processDiagnosis and plan

Working diagnosis

Invest’s& tests

TreatmentExaminationHistory

Review

Discharge (or death)

Doctor requests ‘test’Porter picks up requestPorter delivers request to departmentClerk logs request Clerks puts request for prioritisationConsultant for prioritises requestConsultant returns requestClerk files request in priority orderClerk files request Clerk draws request from fileClerk makes appointment madeClerk sends appointment by post (>6 steps)Patient receives appointmentPatient checks in at receptionetc

Value?

Impact on Quality Probability of Performing Perfectly

No.processsteps

Probability of Success, Each Process Step

1

25

50

100

0.95 0.990 0.999 0.999999

0.95 0.990 0.999 0.9999

0.28 0.78 0.98 0.998

0.08 0.61 0.95 0.995

0.006 0.37 0.90 0.99

Improve the quality of each step

Remove the steps….Carol Haraden IHI

Referral to 1st Treatment- Lung Cancer patients

0

50

100

150

200

250

1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76 79 82 85

Consecutive patients

Day

s

Waiting TimeMeanUCLLCL

Direct referral from radiologist

New radiologistunaware

Measure for Improvement

Understand demand

• Why do queues form?a. Demand exceeds Capacity.b. Mismatch between the variations in demand

and variations in capacityc. Too keep utilisation (artificially) high

If av. Demand = av. Capacity, variation mismatch = queue

time

Demand Capacity

Queue

Can’t pass unused capacity forward to next week

The road to ruin:Capacity planning and contracts based on average past activity

Income less than expected

Fail to deliver required activity

Guarantees waiting times beyond emergency and elective targets

Cost cuttinginitiatives

Reduces effective capacity

Increased staff overtime & waiting list initiatives

Increased costs

Increased variationsin capacity

Fails to account for variation in capacity

Fails to account for variation in demand +

Lean Thinking I

Demand

time

Capacity

Queue

1. Why is capacity varying?

Demand

time

Capacity

Queue

2. Set average capacity at 80% of variation in demand

Lean Thinking II

3. Why is demand varying?

Demand time

Capacity

Queue

Demand time

Capacity

Queue

4. Reduce variation in demand

Demand = requests for proceduresAdditions to one surgeon’s Daycase Waiting List

02468

101214161820

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07 S

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19 O

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Week Ending

Add

ition

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Lis

t

Special Cause Flag

How many operating slots required to prevent the waiting list ?

The road to financial health

Capacity planning and contracts based on variation in demand Staff capacity to reduce

variation in capacity

Required activityguaranteed

Income guaranteed Costs controlled

No waiting beyond emergency orelective targets

increasesproductivity

Increased income

Which Group ?

Improved flow,timeliness

and efficiencySpecifyvalue

Understand demand

Make it Flow Level Perfect

Dan and David’s group

Ian and Carol’s group

Lean Healthcare Forum 2006