Keen to be Lean

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Keen to be Lean

• Alison Cole
• Head of Quality Improvement
• North Lancashire Teaching Primary Care Trust
• RCN Careers Fair

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So what is Lean?

• Process which originated in manufacturing
• Since been used in many different organisations
• Tesco
• Easy Jet
• Public sector
• Healthcare
• It is about improving processes
• Not just a big tidy up!!!

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The Manufacturing Institute

• Centre for Excellence
• The Manufacturing Institute was established in
  1994 as a non-profit making organisation to
  improve the competitiveness and productivity of
  manufacturing firms
• More than 10,000 customers from all sectors
• Delivered 50m financial benefit last year
• 20m Value Added

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What have these organisations got in common?

• Want to make money now and in the future by
  delivering value to their customers!

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The Best Example - Toyota
A way to make money!

• The most valuable car maker in the world
• Cash Rich
• 20bn cash reserves
• Results
• Increased sales by 500,000 vehicles every year
  for the last 5 years
• Now the worlds largest automotive producer
• More profit than the top US three combined
• Even BMW cannot match the operating margin

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How have Toyota achieved this?

• Simultaneously,
• Increasing throughput
• Focusing on what the customer values
• Adapting to volatile markets faster
• Investing profits back into new products and
  technology

• Reducing operating expense
• Training every employee to see with the eyes of
  the customer
• Implementing cost prevention and waste reduction
  measures
• Applying Lean tools and techniques

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Understanding the Link to Bottom Line Measurements
Cash Flow
Margin
Patient Journey Time
Operating Expense
Throughput
(Future)
COMPETITIVE EDGE FACTORS
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Financial Failure of Lean Initiatives

• Lean initiatives mostly build potential for a
  future bottom line improvement or cost avoidance
  step
• Failure to recognise this potential and exploit
  it will lead to frustration and ultimately The
  Quit Point!
• It is therefore imperative that any improvement
  activity is focused on delivering strategically
  important objectives

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Lean Summary

• Lean is a way to improve the bottom line and
  provide improved customer care
• The challenge is to link improvements to bottom
  line benefits (financial clinical)
• Leadership must drive and focus Lean activities
  on strategically important areas
• Value Stream Identification is imperative for
  this
• Value Stream Mapping helps you to see the whole
  and identify the constraints
• Applying lean tools and techniques at
  constraining process steps frees up capacity for
  growth and/or cost reduction

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Lean Thinking Principles
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First Steps

• Who are our customers
• What are their expectations
• What are our objectives strategic and
  operational?
• How are we going to measure the improvements?
• Look again at the lean principles how aligned
  are we?

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Continuous Improvement
Improvement activity
Standardised work
Visual Management
7 wastes / TIM WOODY
6S
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6S in the office

• Sort - Determine what is required and what is
  not, in the amount needed and only when needed.
• Straighten - Arrange items that are needed so
  that they are easy to use, labelled and anyone
  can find them and put them away.
• Sweep / Shine - Clean and sweep on a regular and
  frequent basis, so that when you need something,
  its there and it works
• Safety - ensure all equipment / work areas pass
  health safety standards
• Standardise - Revisit the first three of the 6S
  on a regular and frequent basis and consolidate
  with standard procedures
• Sustain - to sustain and improve 6S activities
  through policy.

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7 wastes - TIM WOODY

• Transportation moving things unnecessarily,
  double handling.
• Inventory to much stock / work in progress.
  Waiting lists. Pts waiting to be discharged
• Motion unnecessary people movement. Not having
  basic equipment in each room
• Waiting waiting for people, results, drs,
  nurses
• Overprocessing duplication of information /
  steps that dont add value to staff or pts
• Overproduction producing more than needed or
  too early tests , keeping slots etc.
• Defects rework due to faulty process, repeating
  tests, readmission, drug reaction
• Your Skills untapped expertise in all staff in
  all department. Sharing of improvement ideas

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Approach

• Small team of 8 training in Lean techniques
• Value Stream Mapping
• 3 Rapid improvement events with medical records /
  outpatient and 2 secretarial areas at same site

• 5 day Kaizen Blitz week - empowering staff to
  make fast and significant changes to their
  working environment and ways of working
• Follow up post Kaizen Blitz activities

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Lean Training

• Advanced Route to Lean Healthcare
• Lean awareness
• Understanding Teams
• Concepts of quality
• Planning scheduling
• 6S, TPM SMED
• Cell layout
• Blitz events
• Implementation Policy

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Pilot Project - Medical Records

• All patient pathways
• Significant customer dissatisfaction
• Wasted internal capacity
• Clinical governance

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Value Stream Mapping

• Identified the patient journey
• Mapped out current state, patient information
  flow
• Analysed waiting turnaround times, staff
  numbers, value added and non value added steps.
• Used problem solving techniques
• Designed future state map

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Rapid Improvement Events Objectives

• Medical Records
• To make it easier to and quicker to pull files
• Re-designing Process in Microfilming
• Outpatients Department
• Minimise number missing clinic notes
• Decrease number patients not seen
• Keeping to allotted time
• Clinical governance
• Medical Secretaries
• Create capacity, clear filing backlog
• Return notes in timely fashion
• Create safer, tidier working environment

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Medical Records

• What we did
• 6S
• Created the perfect aisle
• Redesigned microfilm flow

• Learning Points
• Set standards
• Staff involvement at pre-planning phase
• Root cause visibility understanding

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Microfilming Journey

• Learning Point
• The staff involvement at the planning stage was
  crucial to finding the most suitable solutions
  and to ensure a continuation of service.

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Medical Records
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Outpatients Department

• What we did
• Viewed area with customer eyes
• 6S
• Set standards
• Involved whole team
• Standardisation clinic rooms

• Learning Points
• Creating good first impressions
• Lack organisation large inefficiency
• Easier to sustain with whole team engagement

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OPD Outcomes
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Medical Secretaries

• What we did
• 2 Areas Respiratory/ ENT Head Neck
• 6S
• Set standards
• Minimise non-value added activities
• Removed backlog

• Learning Points
• Contingency planning
• Panic trigger
• 130 weeks to clear
• Senior support
• Standardisation of clinical dictation
• Created capacity

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Medical Secretaries Outcomes
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Lean Results

• Core team trained staff
• Demonstrated ability translate Lean into
  healthcare service improvement
• Gained executive board support
• Engaged stimulated the pilot area workforce
• Requests for Lean in other areas

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Lean Learning Points

• Team working, hearts minds
• Credible data
• Standard procedures
• Executive sponsor
• Minimisation of waste non-value added
  activities
• Value stream structure Vs scatter gun
• Preventative Medicine

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Summary

• Lean more than a process, a way working seeing
• A tool within continuous service improvement
• Positive but painful
• Challenge of sustaining the improvements
• Cultural revolution

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Next Steps?

• Lean is in the job description of Director of
  Nursing Modernisation
• Recognised at Board level
• Support sponsorship
• Divisional requests for areas of development
• Establishment of a core service improvement team?

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Contact Details

• Alison Cole
• Head of Quality Improvement
• North Lancashire Teaching PCT
• Moor lane Mills
• Moor lane
• Lancaster
• LA1 1QD
• Tel [phone]