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Lean Six Sigma in Healthcare
Presented By: Joseph Duhig Senior Vice President Juran Institute, Inc. April 25, 2008
History Timeline For Lean Manufacturing
8005 Lean Overview 2 .PPT
All Rights Reserved, Juran Institute, Inc.
All Rights Reserved, Juran Institute, Inc.
8005 Lean Overview 4 . Juran Institute.LEAN OVERVIEW Key Principles of Lean Thinking . Inc.adapted from James Womack Specify value in the eyes of the customer Identify the value stream for each product Make value flow without interruptions Let customers pull value Pursue perfection Becoming a Lean Enterprise requires a fundamental rethinking of the design of our production system . Inc. In health care we batch-and-queue people. The Language of Lean Thinking… Batch-and-Queue – the mass production practice of making large lots of a part and then se d g e batch o a sending the ba c to wait in the queue be o e e before the next operation in the production process.PPT All Rights Reserved.. Inc. Juran Institute.A Value Stream / Kaizen approach will not give us the transformation we need. 8005 Lean Overview 3 . Juran Institute. All Rights Reserved.PPT All Rights Reserved. 2 . Single-piece-flow – a situation where products (or people) proceed one complete product at a time through various operations..
flow. 3 . work processes and information system must be designed to support the delivery of services in a process oriented vs. milk runs. monuments. five S’s. kanban. Juran Institute. Inc. Placing a patient “off-service” increases risk of harm 8005 Lean Overview 6 . In healthcare the product lines are the clinical programs and we must design delivery systems that p g y y provide value as p patient’s access and utilize our services for specific diseases or conditions. a financial / administrative model. turnback analysis All these terms apply in healthcare. lean enterprise. Juran Institute. Juran Institute. JIT. value streams.LEAN OVERVIEW The Language of Lean Thinking… Other Terms: andon boards. We work in a complex and highly specialized world and our healthcare providers. changeover.visual control. but some q translation is required. Quality Function Deployment QFD. Inc. facilities. Our Business is Clinical Medicine The health system of the future must transform from a batch and queue production-like system to a continuous flow. pull vs. poka-yoke. push. cells. right-sized tool. All Rights Reserved. Inc.PPT All Rights Reserved. 8005 Lean Overview 5 . takt time. five whys. process villages. level schedule.PPT All Rights Reserved.
Hospitalist and Intensivist who drive the quality agenda Hand-offs between levels of care not only causes safety problems. but most lack a “Mental Model” of how we get the cases to roll. 3. Professional practice model. 8005 Lean Overview 8 . Juran Institute. Inc. All Rights Reserved. 4 . Juran Institute. Juran Institute.PPT All Rights Reserved. Quality Improvement is the Science of Process Management Healthcare must adopt a “Process Mental Model” Process Model For Example: Each morning we prepare the operating rooms for a busy day of cases. but results in a 30% loss of bed capacity each day 8005 Lean Overview 7 . Inc. 4.PPT All Rights Reserved. Clinical program “Door” Theory – we need to help p patients find the right door to access the system and g y then that should be the last door they have to find. Inc. 2. Healthcare has been slow to adopt the process discipline for understanding how we do the things we do every day. Universal beds / Every bed is capable of being converted to an intensive care bed.LEAN OVERVIEW Our Business is Clinical Medicine Required Changes: 1.
Juran Institute. 5 . All Rights Reserved.PPT All Rights Reserved. low risk performance of a process. Inc. Juran Institute.LEAN OVERVIEW The Hierarchical Nature of Process Level 1: Macro Process Level 2 – Business Process Level 3 – Sub-process Level 4 – Activity & Decision Level 5 – Task This is where EBM is implemented A documented written model for each level is essential for consistent.PPT All Rights Reserved. Inc. Inc. 8005 Lean Overview 9 . Six Sigma .“Every system is perfectly designed to achieve the results it gets” Y = f(x) Mortality = f(x) Surgical Infections = f(x) S i l I f ti f( ) Patient Satisfaction = f(x) Beta Blocker Compliance = f(x) Medication Errors = f(x) Define the Practical Problem Translate to Statistical Problem Y = f(x) Solve the Statistical Problem Translate back to the Practical Problem 8005 Lean Overview 10 . Juran Institute.
Rad.LEAN OVERVIEW What is Six Sigma? Sigma Defects per Million opportunities 2 3 4 5 6 8005 Lean Overview 11 .3% good) 6. 6 Desk Unit Supply Misc. Juran Institute.20.99966% good) . Inc.. Staff Radiology Duplicate coding g 20 Diag. Records 80 Billing Admin.000 Times Improvement.98% good) 3.PPT 308. g . A True Quantum Leap All Rights Reserved. Radiology Work around Hospital Utilization Inspection/rew work (Completion Desk) 40 Hospital patient cost variation Brand scop reduction & standardization pe Coding/charge collection Employee drug plan OR Utilization Area B Diag.. Inc. 3s to 6s .4% good) 233 (99.1% good) 66. Inc.210 (99. Med. Juran Institute. Juran Institute.807 (93. MRI Claims rejections $200MM Rework (Lab transc cription) Unnecessary visits 80 Inspection/rew work Unbillable write-offs S Secondary Opportunities 60 Area A Diag. All Rights Reserved.4 (99.537 308 537 (69.PPT All Rights Reserved. Pareto Principle – Focus on the Vital Few Pharmacy usage 100% Travel expenses Inventory turns Misc. Radiology A Administrative staff levels and procedures CT head & Body 0 20 40 60 Patient Care Practice Variation Hospital Utilization Primary Opportunities 8005 Lean Overview 12 .
"Within" Perf ormance PPM < LSL * PPM > USL PPM Total 799601.28 * 0 10 20 30 40 50 60 70 80 Observ ed Perf ormance PPM < LSL * PPM > USL PPM Total 710084.24 * -0.0149 USL Within Overall Potential (Within) Capability Cp CPU CPL Cpk Cpm Ov erall Capability Pp PPU PPL Ppk * -0.26 0.04 Exp. 7 . Inc.44 8005 Lean Overview 13 . Inc. Juran Institute.LEAN OVERVIEW OR First Case Start Time Process Capability Analysis for Case Rolled Process Data USL Target LSL Mean Sample N StDev (Within) StDev (Ov erall) 30.11 80. Glucose Levels of Diabetic Cardiac Surgery Patients Process Capability Analysis for Blood Sugar LSL * 80.23 -0.67 Exp. Juran Institute.PPT All Rights Reserved.21 -0.47 1.67 799601.9094 Process Data USL Target LSL Mean Sample N StDev (Within) StDev (Overall) 150.03 710084.1050 238 8.03 Exp.8392 55.000 193. Juran Institute.44 760977.24 8005 Lean Overview 14 .28 * -0.03 92.0000 * * 37.26 0.38 -0.30 76.01 92. All Rights Reserved.13 78.68 -0.000 150 000 USL Within Overall Potential (Within) Capability Cp CPU CPL p Cpk Cpm Overall Capability Pp PPU PPL Ppk 0. "Within" Performance % < LSL % > USL % Total 0.24 * -0.PPT All Rights Reserved. "Ov erall" Perf ormance PPM < LSL * PPM > USL PPM Total 760977. "Overall" Performance % < LSL % > USL % Total 2.47 * 0 100 200 300 400 Observed Performance % < LSL % > USL % Total 0. Inc.60 76.90 Exp.4564 10.386 329 30.
Inc.” – Yoda 8005 Lean Overview 16 . Inc. All Rights Reserved. In Conclusion. Juran Institute.LEAN OVERVIEW Hoshin Planning.PPT 1 Year All Rights Reserved. Strategic Deployment Strategic Quality Goals Key Strategy St t Sub-Goals Annual Goals Projects/ Initiatives Vision Key Strategy Objectives . “Trying is just a noisy way of not doing something. Juran Institute.Means 5 Years Time 8005 Lean Overview 15 ..PPT All Rights Reserved. 8 . something ” – Ken Blanchard y y just do “Try?! There is no try! There is j … and not do.. Inc. Juran Institute.
Juran Institute.PPT All Rights Reserved. Inc. Who Pays for the Cost of Error? CLABS Scorecard Optimal Care Less than optimal care Less than optimal + CLAB Patient Payor Provider Hospital Provider Physician + + ++ + --+ ++ ------+++ All Rights Reserved. Juran Institute. 8005 Lean Overview 18 . Inc.LEAN OVERVIEW No Good Deed Goes Unpunished Impact on Net Income Change to cost Discounted structure FFS Decreased cost/unit Decreased # units/case Decreased LOS Decreased # of cases Per Case Per Diem Shared Risk 8005 Lean Overview 17 . 9 .PPT All Rights Reserved. Juran Institute. Inc.
Inc. Inc. 10 .PPT All Rights Reserved. All Rights Reserved. Juran Institute. Juran Institute.LEAN OVERVIEW New Rules to Redesign and Improve Care Creating a Lean Healthcare System Care based on continuous healing relationships Customization based on patient needs and values The patient as the source of control f Shared knowledge and the free flow of information Evidenced-based Decision Making Safety as a system priority The need for transparency Anticipation of needs Continuous decrease in waste Cooperation among clinicians IOM Report – Crossing the Quality Chasm 8005 Lean Overview 19 .