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" Leveraging lean in surgical services : "
Joyce Kerpchar, Charles Protzman, George Mayzell, MD.
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BL
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754893
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b574855
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Joyce Kerpchar, Charles Protzman, George Mayzell, MD.
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Leveraging lean in surgical services : : creating a cost effective, standardized, high quality, patient-focused operation\ Joyce Kerpchar, Charles Protzman, George Mayzell, MD.
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| Publication Statement
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Boca Raton: FL CRC Press Taylor & Francis Group, 2015
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| ISBN
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1482234505
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: 9781482234503
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| Notes
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A Productivity Press book.
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| Contents
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Introduction to LeanThe Need for ChangeNational and Global CompetitionChallenges for the Healthcare Worker Lean and LayoffsTraditional Healthcare ModelIntroduction - So What is Lean? Lean and Hospitals What Results can you Expect?The CEO and LeanTypical Lean Metrics and Outcomes Potential Lean Returns by Department Typical Results/Return on Investments (ROI) and Implementing LeanLean and Systems Thinking Boiled Frog Syndrome Systems Thinking Principles Viewing the Hospital with Systems ThinkingWhat is a Lean Business Delivery System? Lean Business Delivery System Vision Understanding the Value of the Lean Business Delivery System Just In Time: The First Pillar of the Toyota Production System Model An Example of One of the Rocks-Short-Staffed Jidoka-The Second Pillar of the Toyota Production System Jidoka Means: Never Pass on a Bad Part or Patient Applying Jidoka to HealthcareThe Top of the Toyota House-Respect for HumanityLean is a JourneyBatching vs. Lean Thinking and FlowBatching vs. Lean Thinking and FlowBatching vs. Flow in a Healthcare Environment Bathing Examples Process Definition Batching Systems Why People Love to Batch? One-Piece/Patient Flow One-Piece Flow Example Group TechnologyProductivity - DefinitionBatching The Domino EffectPeak Demand Examples of Batching in Healthcare Chart PreparationApplication of One-Piece Flow to HealthcareFlow-One-Piece Flow or Small LotLean and Change ManagementImplementing Lean is about BalanceLean Culture Change Paradigms Change Equation C Compelling Need to Change Why Change? V Vision N Next Steps Change and What's In It For MeLean and Change ManagementLean and Organizational Change - "Right Seat on the Right Bus" Resistance to Change Changes... Highs and Lows Rule of Unintended Consequences and Bumps in the Road Change is a Funny Thing We are all Interconnected but not Typically Measured that Way Horse Analogy Comparison to Where We are Today Employee Suggestion Systems Barriers to Change Most Loved Words Does Your Organization have Sacred Cows?Leadership and Organizational ChangesCommunication, Change and Lean SummaryLean FoundationLean Foundation Baseline in the Basics ModelThink-See-Act LeanSystem Lean Implementation Approach Utilizing the Basics Model A Customer Service StoryBaseline Metrics Data, Revenue, and HospitalsThe Impact of Data on Lean - Process Focused Metrics Customer Satisfaction Voice of the Customer SurveysThe VIP Visit Easy to Do Business WithCentralized = Batching What Does All This Have to Do with Hospitals?Customer Value-Added Proposition Customer Quality IndexBaseline the Process Value Stream Map (VSM) the Process Value Stream Discussion Value Stream Mapping and Healthcare Value Streams Objectives Traditional Hospital Systems - SILOS Lean Goals Parts of a Value Stream Map Value Stream Map Icons Value Stream Map Definitions Day 1 Day 2 Day 3 Day 4 Day 5 Current State Value Stream Mapping Ideal State Future State Value Stream Mapping Value Stream Map Project Lists, Prioritization Matrix, and Tracking Value Stream Layout Maps (sometimes referred to as Skitumi maps)Baselining the Process-Data Collection and Analysis-Current State Takt Time/Production Smoothing Available Time Customer Demand Peak Demand Cycle Time Cycle Time and Takt Time-What's The Difference? Designing Cycle Time to Takt Time Length of Stay (LOS) Length of Stay (LOS) Length of Stay is Directly Correlated to Inventory Length of Stay-A Key MetricReducing Length of Stay Number of Staff Required Total Labor Time Quiz Weighted AverageFinancial Metrics Measuring Inventory and Cash Flow Work in Process Inventory Sales of Reimbursement per Employee Contribution Margin Cost Per Case Data and What People ThinkSustainability and Accountability Process Owners Do Not Always have the Skill Sets Necessary to Manage in a Lean EnvironmentNotesBasic Lean Concepts and Tools - Assessment and AnalyzeLevels of Waste Low-Hanging Fruit Five S Wastes The Seven (Eight) WastesHow do you Find Waste? 30-30-30 Exercise People Equipment Communication Visual Controls LeadershipCost of WasteBaseline Entitlement BenchmarkFive Why's ExampleAnother Tool to Get Rid of Waste: The Five W's and Two H'sRoot Cause Analysis-A3 StrategyFishbones and LeanProblem-Solving ModelProblem StatementsLean Tools - Analyze/Assessment BASICS-Assess the Process Step One: Understand and Assess the Overall Process Value-Added Non-Value-Added Activities/Work Non-Value-Added but Necessary Work Unnecessary Work Idle Time Warranted IDLE Time ExceptionsThe Patient Physical ExaminationStep 1: Process Flow Analysis (PFA)-Following the Product/Patient Mapping the Process-Identifying Process BoxesProduct Process Flow Analysis ToolThe Four Components Of PFA - Tips AnalysisBasic Lean Tools Understanding Types of Storage Raw Material Storage Work in Process Storage Finished Goods Storage Further Delineating Storage-Types of Work in Process Lot Delay Potential Lean Solution Example #1 Potential Lean Solution Example #2 Between Process Delay Within Process Delay Why Break Down Types of Storage? Total Throughput Time Product Process Flow Worksheet Product Flow Point-to-Point Diagrams How to Do a Point-to-Point Diagram Network of Process vs. Operations DefinedGroup Technology Matrix-Stratification Analysis Example: Group Technology Applied to a Surgical Services UnitStep II: Assess the Process-Operator Analysis or Full Work Analysis Why Make the Operator's (Staff Person's) Job Easier? Total Labor Time Workload Balancing How To Balance The Work Separate Worker from Machine Machine Time vs. Labor Time Diagrams: Spaghetti Diagramming-Operator Walk Patterns How to Do a Spaghetti Diagram Network of Process vs. Operations DefinedMotion Study-Just When You Thought You Were "There" Time is a Shadow of Motion 100% Efficiency with Humans Operator ResistanceStep III: Assess the Process-Changeover Analysis Internal Vs External Time Four Parts of a Setup/Changeover Process Healthcare Setup Translation Why Reduce Setups? Benefits of Smed/SMER (Single Minute Exchange of Rooms)SummaryPutting It All TogetherUnderstanding Demand and Resource NeedsAppropriate Resourcing Can Drive Metrics True Bottlenecks Cross-Training How to Construct a Cross-Training MatrixHeijunka-Sequencing Activities, Load BalancingStandard Work Story Job Breakdown/Work Flow AnalysisDeveloping Standard Work Standard Work Form Work Standards Eventually Standard Work Can Lead to Semi- or Complete Automation Leader Standard Work Capacity Analysis-Part Production Capacity SheetLayout Design Master Layouts Creativity Before Capital Lean Layout Design-Configurations-Determining the New Flow for the Area The "U-Shaped" Layout Straight Line Layouts Parallel Layouts Other Layout Considerations Guidelines to Layout Re-design-Non-Negotiable How Do We Know When the Layout is Right? Work Station Design Stand Up vs.
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Sit Down Stations with Chart Flow Work Station Design SummaryMaster Layouts and Lean Design Lean and Architects Do We Really Need to Add More Rooms or Space? Layouts Drive Waste in the Form of Increased Labor Costs-Consider Adjacencies Some Practical Examples of Lean Designs Nursing Floors Other Design ConsiderationsLean and Regulatory Environment Rate Companies on the Ability to Sustain Continuous Improvement Plan for Every Part-Amount of Supplies/Inventory Needed Labeling Kanban What Parts Do We Kanban? Constant Time or Constant QuantityImplementing Lean in a Healthcare EnvironmentHow to Implement Lean MethodologyThe Lean System Implementation-Are You Ready for It? What Type of Commitment is Required? What is Kaikaku? Kakushin Importance of Lean Pilots Keep the Ownership with the Line OrganizationLean Implementation Objections and Retail Sales Techniques Objections are Good! Types of Closing QuestionsGeneral Overarching Lean Implementation TipsTeam Charters Guidelines for the Supervisor Train the Staff in the New Process Types of Training Overview Training On the Job Lean Training Executive TrainingThe Lean Implementation Model General Discussion of the Four Methods Kaizen (Method 3) vs. the Traditional Point Kaizen (Method 2) Event Approach Kaizen Point Kaizen Events Potential Pitfalls of the Traditional Point Kaizen Approach Disadvantages of Point Kaizen Events Used for First Time Implementation Advantages/Results of Kaizen EventsVisual Management System Components Five S Visual Displays Visual Controls Story Visual Management System Lean Goal is Zero Defects-Difference Between an Error and a Defect Poka Yoke Types of Control and Warning Devices Examples of Cause and EffectTotal Productivity Maintenance Total Productivity Maintenance Goals Overall Equipment Effectiveness New Maintenance Paradigm Lean and Maintenance in Hospitals Construction ChallengesHospital and IT Systems BASICS-Checking the New Process BASICS-Sustaining the ProcessSustaining Tools Sustain Plans/Control Plans Leader Standard Work Visual Management Accountability Discipline Staff InvolvementYou Get What You Expect; You Deserve What You TolerateAdditional Sustaining ToolsRepeat the Cycle!Lean Practitioners.Lean Hospital Implementation (System Kaizen and Point Kaizen) Lessons Learned Create the Leadership Road Map Make Sure Your Organization is Ready Create a Lean Steering Committee-But Make It the Senior Leadership Team Lean Consultants Should Report to the CEO Create a Lean Organizational Infrastructure Communication Plan Training Plan Leadership Cannot Stay in Their Ivory Tower Leadership Must Lead and Drive Lean Changes, Not Just Support Them Leaders Must Participate in Lean. You Cannot "Get It" in a Two hour or Four Hour PowerPoint Pitch Don't Let Lean Turn into Finance-Driven FTE Witch Hunts Work to Establish the Lean Culture, Not Just the Tools Insist On Updating Standard Work Do Not Reward Work Arounds Don't Encourage the Victim Syndrome Physician Resistance to Lean Get Everyone Involved in the Analysis Phase Give Lean System Implementation Time to Work Before Trying to Change the Underpinnings Dedicate Resources Up Front Include a Strategy for Accountability and Sustaining as Part of the Continuous Improvement Road Map Listen to Your Lean Consultants/Experts Adopt and Integrate Standard Work and Create a Suggestion and Reward Systems Don't Leave Managers in Place Who Aren't Going to Get It Don't Lay People Off After Lean Implementation Don't Shortcut the Tools Encourage Lean Architectural Designs Include a "Go Forward" Person on the Team Train, Train, Train Create an Escalation Process Identify the Process Owner and the Team Leader Up Front Change Reward System It's Just a Bump in the RoadMultiple Site Rollout Strategies Site/Area Selection Trying to Implement Several Projects at Once without Sufficient ResourcesExecutives and LeanIntroduction Been There, Done ThatMore than just a Competitive AdvantageBoard of Directors TrainingDifferences Between Lean and Six Sigma Define Reality for the Lean Initiative Resources and Accountability Lean Should Be Where the Action Is Removing Barriers Measurements to Drive Outcomes Who is to Blame? You are What You Measure Control or Sustain ProcessLean and Audits "Project-itis" Human Error Factor Fair and Just Culture Communication, Communication, and more Communication Gemba - Where the Truth Can Be Found What Questions Should You Ask When Doing a Gemba Walk? Meetings Paying for Suggestions Physician Engagement The Cog in the Chain of Command Value Stream Managers in the Lean Organization Role of the External ConsultantSummaryPunch List of Considerations/Ideas for the Executive LeaderRoles and Responsibilities of Managers and SupervisorsSetting the Stage: Role of Managers and SupervisorsDo You Really Want to Know What I See? Do You Really Want to KnowWhat I ThinkKey Responsibilities and Tools for Managers and Supervisors Communication Identify and Provide Resources Time Management and the "Fires"Standard Work and Healthcare Following Standard Work Does Not Mean We Stop ThinkingImplementationProblems with BehaviorsUnderstanding Employee SatisfactionManagement and Supervisor Performance DelegationThe Journey of a Lean Sensei with a Star Wars AnalogyOn-Line Lean TrainingWhat It Means to Have a Lean CultureOrganizational Dissemination of LeanUnderstanding what a Lean Culture Looks Like-"the People Piece" Importance of the 50% People Piece People vs. Task-We Need a Balance Vision Organizational Value Systems Pearls of Advice Managing Resistance to a Lean Culture Change Lean Culture Assessment Assessment Issues and Discussion Motivation and Continuous ImprovementHigh-Level Steps to Implementing a Lean Culture Step 1: Utilize Skip Levels to See What Your Employees are Thinking Step 2: Education and Training Step 3: Create a Pull for Lean Step 4: Create a Lean Implementation Plan Step 5: Create a Lean Steering Committee Step 6: Baseline Metrics Step 7: Implement a Pilot-Utilize the BASICS Model Step 8: Gemba Walks Step 9: Sustain-Hoshin and Suggestion System Step 10: Continuous ImprovementBarriers to Continuous Improvement Effort to Overcome Each Barrier TypesWork to Sustain and Improve with Lean How Do You Get the CEO on Board? Story...Lean in County Government Committing the Right Resources to Sustain Human Resources and LeanSustaining the Continuous Improvement CultureLeveraging Lean in Perioperative ServicesPart 1 - OverviewTraditionally What We Find in Most Operating RoomsGlobal Impact of Operating Room Flow-Organizational Conflicts-Competition for BedsImplementing the BASICS MODEL - BASELININGI. Surgical related Physician Satisfaction IssuesII. OR Surgical Team (Staff and Administrative) IssuesConclusion - Do you consider the Operating Room a Cost Center or a Profit Center?Part II - Surgical Services: DetailIntroduction-What We FindTypical Surgery ProjectsHow Can Lean Improve Operating Rooms? Using the BASICS model.
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-BaseliningSection I - Everything Starts with DemandSurgery Is Like a Repair ShopSection II Pre-Testing-the Path to Patient ReadinessTypical Pre-Testing "Patient Readiness for Surgery" ProjectsThe Pre-Testing ModelTraditional Pre-Testing ProcessNeed for Standard OrdersStandard Pre-Testing and Pre-Op Order SetsHow to: The Procedure to Create Standard Orders for "Medical Clearance for Surgery"Key ConsiderationsStandard Orders Rollout-General Lean Project System Implementation ConsiderationsPhysician Acceptance and AdoptionHow to Implement the Physician Office ComponentPhysician Office EducationSelection of Pilot OfficesNecessity for Pre-TestingLean Pre-Testing ModelPre-Testing InfrastructureTraditional Process Flow and Issues of the "Readiness for Surgery Process"Pre-Testing Phone Call ProcessPre-Testing Patient InterviewThe Pre-Testing Model-Patient VisitProblems Typically EncounteredHospital X Lean Results in Pre-Testing are ProvenLevel Loading the ScheduleHospital B-Standard Work-Thoughts and Discussions Surrounding the Introduction of Standard Work to Staff in a Pre-Testing ClinicStep 1-Grab the chartsStep 2-Introduce yourself to the patientStep 3-Take vitalsLessons Learned and Ideas Implemented from Various Lean Pre-Testing InitiativesPre-Testing Model CalculationsSection III Pre-OpPRE-OP Time StudyBenefits of Team Nursing in Pre-OpLet's Examine Pre-Op on the Day of SurgeryHospital X Pre-Op Lean ImprovementsSection IV Group Tech MatrixGroup Matrix BenefitsSection V OR Layout/CapacityOperating Room CalculationsSection VI OR Room TurnoverHow Do We Improve Turnover?ExampleLean Results Impact of Turnover ProjectsTurnover ExampleOther Turnover/Setup StrategiesInduction RoomsPros for Induction RoomCons for Induction RoomsFlip RoomsPros for Flip RoomsCons for Flip RoomsNew Room for a "to Follow" Case Referred to as "Move"Pros for Move RoomsCons for Move RoomsFamily WaitingSection VII Surgical Services Materials ReadinessPreference CardsCase PickingSection VIII Post-Anesthesia Care Unit (PACU)What We FindPACU OpportunitiesPACU Initial first month Lean resultsSection IX Lean Leadership and Staff Readiness in the ORCultureConclusionSection X Overarching ResultsOther Hospital Results-Surgery Pre-Testing ResultsPre-OpOther Misc. ResultsConclusionSteps for your Surgical/Procedural Lean Project ChecklistIndex
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Hospitals -- Administration.
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| LC Classification
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RD110.J693 2015
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| Added Entry
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Charles Protzman
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George Mayzell
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Joyce Kerpchar
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