The Lean Hospital: The Lean Hospital: What does it meanWhat does it mean ? ?

DR EMAD KOTBDR EMAD KOTBQUALITY MANEGMENTQUALITY MANEGMENT

DIRECTOR RAFHA CENTRAL DIRECTOR RAFHA CENTRAL HOSPITALHOSPITAL

QI Process MethodologiesQI Process Methodologies•FOCUS-PDCA•Six Sigma “DMAIC” “3.4/million defects”•Lean QI Process “No waste”

The FOCUS -PDCA The FOCUS -PDCA MethodologyMethodology

IND AN OPPORTUNITY

ORGANIZE A TEAM

CLARIFY THE PROCESS

UNDERSTAND THE PROBLEM(S)

SELECT A DESIRED OUTCOME

What does Six Sigma meanWhat does Six Sigma mean??The term The term ““SigmaSigma”” is a is a measurement measurement of how of how

far a given process deviates from perfection far a given process deviates from perfection –– a measure of the number of a measure of the number of ““defectsdefects””. Six . Six Sigma correlates to just 3.4 defects per million Sigma correlates to just 3.4 defects per million opportunitiesopportunities..

•A qualityA quality improvement methodologyimprovement methodology that that applies statistics to measure and reduce applies statistics to measure and reduce variation in processesvariation in processes..

•A A management systemmanagement system that is that is comprehensive and flexible for achieving, comprehensive and flexible for achieving, sustaining, and maximizing successsustaining, and maximizing success..

23

456

308,537

66,807

6,2102333.4

The Quality ColloquiumIntroduction to Track IC:

Six Sigma as a Healthcare Quality Initiative

Measurement:Measurement: Six Sigma as a Quality Goal

The higher the sigma, the fewer the defects.

A increase from 3 to 6 Sigma represents a 20,000 fold improvement in quality.

3 697,672.15308,770.2166,810.636,209.70232.67

3.40

123456

Defects Per Million

Opportunitiesσ

697,672.15308,770.2166,810.636,209.70232.67

3.40

123456

Defects Per Million

Opportunitiesσ

99% “Good” (3.8 Sigma)No electricity for 7 hours per month

5,000 incorrect operations per week

20,000 wrong prescriptions per year

99.99966% “Good” (6 Sigma)No electricity for 1 hour every 34 years

1.7 incorrect operations per week

68 wrong prescriptions per year

The Quality ColloquiumIntroduction to Track IC:

Six Sigma as a Healthcare Quality Initiative

Improvement Methodology:Improvement Methodology: DMAIC “Backbone”

…the current process capability (get the data!)

…the problem in a measurable way

…and validate root cause(s)

Devise solution(s) and implement

PerformanceImprovement

Benchmarking

Control Tools

DEFINEMEASURE

ANALYZEIMPROVE

CONTROL

Sustain improvement

Project Timeline

Retu

rn o

n In

vest

men

t (R

OI)

Happy at 99.9% ? •If 99.9% is acceptable to you, then…

•Your heart fails To beat 32,000 Times each year

•500 surgical Operations are performed wrongly Every week

20,000 wrong Drug prescriptions Made every year

19,000 babies are dropped by doctors At birth

••

2,000 unsafe airplane landings are

madeevery day

• 2 major airplane accidents per

week

What is Lean ThinkingWhat is Lean Thinking??•• A methodology to produce the A methodology to produce the

highest highest quality product in the shortest amount quality product in the shortest amount of time, at the lowest possible cost by of time, at the lowest possible cost by

eliminating the eliminating the ““seven wastesseven wastes..”” •• Fosters a culture which encourages all Fosters a culture which encourages all

employees to continually look for employees to continually look for improvementimprovement

Waste in healthcareWaste in healthcare

““The national numbers for waste inThe national numbers for waste in healthcare are between 30% and 40% healthcare are between 30% and 40%

but the reality of what webut the reality of what we’’ve observed ve observed by minute-to-minute observation over by minute-to-minute observation over

the last three years is closer to 60%the last three years is closer to 60% ... ...ItIt’’s everywhere: patient care and non-s everywhere: patient care and non-

patient care alikepatient care alike..””

Toyota in HealthcareToyota in Healthcare

•• Creating an environment of stabilityCreating an environment of stability •• Elimination of wasteElimination of waste •• Rapid identification and correction Rapid identification and correction

of of errorserrors

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88 Forms of WasteForms of Waste

WASTED HUMAN TALENTWASTED HUMAN TALENT Human Potential Human Potential Not engaging employees in problem solving Not engaging employees in problem solving

DEFECTSDEFECTS paperwork, med errorspaperwork, med errorsINVENTORYINVENTORY unneeded stock or suppliesunneeded stock or suppliesOVERPRODUCTION OVERPRODUCTION unnecessary testsunnecessary tests

WAITING TIMEWAITING TIME delays in diagnosis and treatmentdelays in diagnosis and treatmentMOTIONMOTION movement of staff and informationmovement of staff and information

TRANSPORTATIONTRANSPORTATION movement of patients or movement of patients or equipmentequipment

PROCESSING WASTEPROCESSING WASTE filling out extra paperworkfilling out extra paperwork

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Not asking the staff that works the process how to improve it

1. Wasted Human Talent1. Wasted Human Talent

I’ve made a few changes to the

process.

StaffStaff

StaffStaff

StaffStaff

ManagerManager

I wish someone would ask OUR

opinion…!

StaffStaff

StaffStaff

1515

@*&#!!

A negative outcome from process failureA negative outcome from process failure

2. Defects2. Defects

Another defect!!

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Items in greater quantities than can be immediately Items in greater quantities than can be immediately processed or used.processed or used.

3. Inventory3. Inventory

Did I really order this much??

1717

Generating more work than is really requiredGenerating more work than is really required

4. Over Production4. Over Production

StaffStaff

Hey…are these multiple orders for the same thing? @#$&*!!

I didn’t get my order yet… I’ll send another

fax.

PharmacistPharmacist

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People waiting for items (patients, supplies, People waiting for items (patients, supplies, specimens, etc.) to processspecimens, etc.) to process

5. Waiting5. Waiting

1919

Unnecessary movement or relocation of itemsUnnecessary movement or relocation of items

7. Transportation7. Transportation

I have orders to run some tests.I’ll bring the

patient right over.

Waiting Area

Sigh…..!!

2020

8. Over Processing8. Over Processing

Please approve.

Please approve.

Please approve.

Please approve.

Please approve.

Please approve.

2121

8. Over Processing8. Over Processing

I’m the final approval.

The final approval?!!

Applying effort to activities that are not required Applying effort to activities that are not required in the processin the process

Please approve.

+

???

2222

.1.1SortSort

.2.2StraightenStraighten

.3.3ScrubScrub

.4.4StandardizStandardizee

.5.5SustainSustain

What is 6S?What is 6S?

6.6. SafetySafety

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Step 1: SortStep 1: Sort

Separate the needed from the not neededSeparate the needed from the not needed

Before After

2424

Step 2: StraightenStep 2: Straighten

A place for everything & everything in its place!

BEFOREBEFORE AFTERAFTER

2525

Step 3: Scrub (inspect)Step 3: Scrub (inspect)

Regularly “scrub” to ensure everything is in Regularly “scrub” to ensure everything is in perfect working conditionperfect working condition

“Scrub” and inspect equipment to ensure it is in perfect working condition...

Add inspecting equipment into your work routine.

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Step 4: StandardizeStep 4: Standardize

Standard Work requires determining the best method then following that method every time.

Note: Blue taped outlines and labels ensure equipment is quickly found and returned to the same spot every time.

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Step 5: SustainStep 5: Sustain

Develop a method for sustaining your gainsDevelop a method for sustaining your gains

2828

How do I Conduct a 6SHow do I Conduct a 6S??

2929

PreparationPreparation Observe the process first hand Observe the process first hand

Create a diagram - Create a diagram - a hand drawn a hand drawn map of your process includingmap of your process including::

•Tasks in the sequence they are doneTasks in the sequence they are done •Location of supplies and equipmentLocation of supplies and equipment•Measure distance traveled and time Measure distance traveled and time

spent searching or waitingspent searching or waiting

Good preparation is the key to successful results!Good preparation is the key to successful results!

3030

What would you do to improveWhat would you do to improve??Sort out the need from the not neededSort out the need from the not needed

Have a place for everything so there is no Have a place for everything so there is no searchingsearching

Move supplies or equipment closer to where Move supplies or equipment closer to where they are neededthey are needed

Co-locate tasks or peopleCo-locate tasks or peopleChange the sequence in which tasks are doneChange the sequence in which tasks are done

Be creative with your solutions Be creative with your solutions –– you, you, after all, are the expertafter all, are the expert!!

How Can We ImproveHow Can We Improve??

Applying 6S eliminates waste!

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photophoto

Suggest you insert some before and Suggest you insert some before and after pictures/examples of 6S results after pictures/examples of 6S results

in the next few slidesin the next few slides..

3232

How Can We Use 6S to ImproveHow Can We Use 6S to Improve??

.1Sort – Separate the needed from the not needed

.2Straighten – A place for everything and everything in its place

.3Scrub – Ensure everything is in perfect working condition

.4Standardize – Determine the best method – visual queues, labeling, etc.

.5Sustain – Develop Standard Work.6Safety – Safety first at all times

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What Waste Did You ObserveWhat Waste Did You Observe??

1.1. Wasted Human TalentWasted Human Talent2.2. DefectsDefects3.3. InventoryInventory4.4. Over ProducingOver Producing5.5. WaitingWaiting

6.6. MotionMotion7.7. TransportationTransportation8.8. Over ProcessingOver Processing

GoalsGoals

Patient SafetyPatient SatisfactionEmployee, Staff SatisfactionEmployee EngagementLow TurnoverProductivitySpace Utilization

Waste becomes acceptedWaste becomes accepted

That’s just the way work is done

around here

Challenge

We don’t see it as waste!

95%

5%

Non-Value Added

Value AddedTotal Lead Time

WE MUST THINK ABOUT

LEAN

THANK YOU