Advancing Patient Safety Using Lean Methods The Concept of

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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.

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Early Adopters in Healthcare

• University of Michigan
• Thedacare
• Virginia Mason
• Park Nicollette
• Exempla

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Toyota Production System Gary Convis, President
of TMMK
People are the Long Term Asset and gain value
by learning skills Machines depreciate and lose
value

• 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

• 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

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The Toyota Way Jeffrey K. Liker
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
The 4 Ps and 14 Principles of The Toyota Way
Problem Solving
11. Grow Leaders who live the philosophy 10.
Respect, Develop and Challenge your People and
teams 9. Respect, Challenge and Help your
suppliers
Kaizen Good Change
People and Partners Respect Challenge and Grow
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
Process Eliminate Waste
1. Base management decisions on long- term
philosophy even at the expense of short term
financial goals
Philosophy Long Term
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Take Home MessageLean is not just a set of
tools. It is an organizational state of being
that is manifest through
Toyota Model
Hospital Model

• 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

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

• Standard Work
• Jidoka
• Heijunka
• Poka Yoke
• Kaizen
• 6S (do not confuse with 6 sigma)

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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

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

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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

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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/AJMC2000Mar
  Litvak305_312.pdf
• British Health Systems Kate Sylvester M.D.
• E.D. admissions at shift change
• Floor Transfers

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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

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

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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.

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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

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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

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Thank you

• Questions and Discussion