Moving to the Lean Enterprise in Healthcare

For internal use only / Copyright © Siemens AG 2006. All rights reserved.Copyright © Siemens AG 2006. All rights reserved.

Moving to the LEAN Enterprise in HealthcareGlobal Solutions Consulting

First LEAN Global Healthcare Summit 2007

Page 2 June-07 Copyright © Siemens AG 2006. All rights reserved.

What is the Global Solutions Division

Establish Siemens Medical Solutions as the leader in integrated clinical solutions by combining trendsetting technology, clinical workflow know-how and consulting experience based on outstanding partnerships with our customers.


Healthcare Consulting Together we rethink

The team is comprised ofhealthcare professionals, medicaltechnology engineers, medical ITspecialists, business managementexperts, and healthcareeconomists.

Our strength lies in connecting strategy, process and technology.

Understanding these interactions allows us to work with our customers to develop and implement solutions that have a proven outcome on cost and quality

Strategy and Management

Clinical and Business Process Optimization

Technology and Infrastructure Planning, and Integration


Our LEAN Journey began at the Factory

550 Employees

2320 Customer specific system deliveries per year

2490 Components / Subsystems

21 System types

92 % Of all systems are exported

Forchheim FactoryForchheim Factory

Factory AX =>Factory AX =>

Factory CT =>Factory CT =>


Information – Planned and Stuctured

AXAX--CustomisingCustomisingAX SCM InfosystemAX SCM InfosystemInfo through Management

1 x month

Info through group leader1 x week

11 o‘clock round

1 x day

ONLINEcontinuous


Striving toward perfection

Every system is shippable within 4 weeks (60% reduction from 2000)

Technical and deadline related changes are allowed until 3 days priorto start of fabrication

On-Time-Delivery > 98 %

Percentage of complete delivered systems > 99 %


Why bring LEAN to Healthcare

MUDA (Waste) wherever one looks:Overproduction (producing something before it is needed)

When do I admit patients for planned procedures (i.e. occupy a bed)?WaitingTransporting

Orthopaedic patients moving to the radiology departmentInpatient receives an x-ray; 3 hours later receives a CT Scan

Inappropriate processingWhy is door to balloon time an issue only in the US?

Unnecessary inventoryWhy is this patient staying over the weekend?

Unnecessary excess motion (ergonomics)Are you using plain film?

DefectsIncomplete Medical Records, Medication Errors


Why bring LEAN to Healthcare

MUDA (Waste) can cost lives; Quality of LifeEvery patient handover exposes patients to risk

Information needs to be exchangedMedication needs to be carried overPatients need to be liftedIntubation needs to be exchanged

The longer a patient stays in a hospital the longer their exposure to nosocomial infectionIf the Institute of Medicine is correct in their assumptions Medical Errors are the 8th leading cause of death in the USA.


90,000 deaths2,000,000 adverse drug events …in the US every year**

Canada in 2000,9,250 – 23,750 deaths from adverse events*

‘Adverse Events’

Actual(without ‘Adverse Events‘)

Ideal

Actual(without ‘Adverse Events‘)

‘Adverse Events’

Why Bring LEAN to Healthcare

Cos

ts fo

r the

Insu

red

**Source: Institute of Medicine, To Err is Human, 1999, p.26. American Hospital Association. Hospital Statistics. Chicago. 1999;RAND study, Journal of Health affairs, September 2005

Prevention /Early Detection Diagnosis Therapy Care

*Source: The Canadian Institute for Health Information, CMAJ, The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada • May 25, 2004; 170 (11). doi:10.1503/cmaj.1040498.


Why is healthcare LEAN resistant

Who is the end customer?PatientReferrerPayer (private insurer, NHS, taxpayer)Answering this question is important because the value to the end customer drives the shape of the value chain

What is the product?HealthInformationPatient

The buildings are full of “monuments” (which are changing at a breakneck pace)

Caregivers don’t like to be LEAN and MEAN


The Evolution of Medicine

Efficiency

Horizon 1Craft Medicine

Horizon 2Disease Management

Requires IT that captures and analyzes workflow

Every patient uniqueVery expensiveQuality highly variableTechnology drives progressPatient, provider & industry act independently

Disease standardsWorkflows optimized & measuredStronger product integrationStronger collaboration of providers in value chain

Prevention Diagnosis

Horizon 3Patient-CentricHealthcare

Requires IT that captures and analyzes knowledge

Time

Patient predisposition-tailored medicinePatient-specific real-time diagnosis & treatmentCost & quality continually optimizedEvidence-based

Therapy Care


A New ParadigmWorkflow Technology in Healthcare

Traditional HIS Healthcare Process Management System

Linear, passive

Collect data

Report results

Manage orders

Capture documentation

Manage processes

Track, monitor, drive next steps

Automatic notification & escalation

Manage & monitor clinical best practice


Coronary Artery Disease

CAD Management

Germany has created new legislation to encourage contact between the inpatient and the outpatient sectors

Despite the legislation, the change has not occurred

Actors are still not looking at the entire value stream

Tools and processes that support changing the value stream are not yet widespread

Clinical Challenge: patient receives suboptimal care due to lost information, duplicate procedures, longer wait times

Health Services #1


Current state: Coronary Artery Disease Care Path

Prevent Outpatient Inpatient

RehabPCP

InternistCardiologist

Follow-up/ Rehabilitation

Intern/Cardiol.Medication

Admit Detect Treat Discharge Admit Detect Treat Discharge

Interface

Primary Care ProviderInternist

Cardiologist

Conservative

Interventional

Hospital

Cardiologist

Interface Interface

CAD Management


Current state: Coronary Artery Disease Care Path

Prevent

Admit Data & History


68 – 163 Minuten

RehabPCP



Interface


Cardiologist

Conservative

Interventional

Hospital

Cardiologist

Interface Interface

Outpatient Inpatient Follow-up/ Rehabilitation

Admit Detect Treat Discharge Admit Detect Treat Discharge

CAD Management


Future state: Coronary Artery Disease Care Path

Prevent


Electr. Report

S-IC

RehabPCP



Interface


Cardiologist

Conservative

Interventional

Hospital

Cardiologist

Interface Interface

Outpatient Inpatient Follow-up/ Rehabilitation

Admit Detect Treat Discharge Treat Discharge

CAD Management


Future state: Coronary Artery Disease Care Path

Prevent Outpatient Inpatient Follow-up/ Rehabilitation

Admit Detect Treat Discharge Treat Discharge


Electr. Report

S-IC

RehabPCP



Interface


Cardiologist

Conservative

Interventional

Hospital

Cardiologist

Interface Interface

CAD Management


Technology can change the reference point completely

Parameter Unit Current Potential

Missing Documentation at Central Admissions

Share 10% 0%

Daily Time collectingdocumentation for central Admit

Minutes 10-15 min/Patient 3 mouse clicks

Waiting time until patient files found Minutes 10-15 min/Patient 3 mouse clicks

# of repeated procedures due to missing documentation

Share Ca 75% in ED20% in scheduled patients

Reduction to 20 % in EDReduction to 0 in scheduled patients

# of repeated procedures due to quality failure

Share Ca. 20% in ED7% in Scheduled Patients

Reduction to 10 % in EDReduction to 0% in scheduled

Average waiting time by admit Minutes 35 min/Patient Reduction to 10 min

Time required to find patient records in inpatient areas, to prep eg for Bypass OP

Minutes 120 Minuten/Patient

5 mouse clicks


How else can the LEAN Enterprise develop

Customers can demand that suppliers stop building monuments.Substituting contrast enhanced ultrasound for MR in peri-operative confirmation of uterine fibroid embolisationUsing Biomarkers and ultrasound to monitor liver disease, detectbreast cancer (reduce or eliminate biopsies)

Customers can demand that more information or options come from one monument

Hybrid equipment – PET CTHybrid Rooms – Cath Lab / Heart ORTotal Body Imaging“Theranostics” - Using iron coated nano-particles to provide diagnostic information and then thermal therapy of hard to reach tumors with MR

Customers can demand that partners move beyond transactional relationships


Take Away Ideas

LEAN can be a powerful way of transforming healthcare’s organisational cultures

The iterative approach and RIEs are keys to moving forward but you do have to have “the vision thing” if you want to drive a LEAN enterprise

One can alter value streams drastically with simple common sensechanges. In healthcare, technology allows one to eliminate entire value streams or change completely their perspective


Thank You

Education

Moving to the Lean Enterprise in Healthcare