A Guide To Lean Healthcare Workflows

Is Lean a fit for your healthcare organization? Various methodologies can be used to help organizations achieve their objectives depending on their criteria: lowest risk of failure, fast to resolution, or lowest cost for deployment. But what every organization should consider is which methodology will have the greatest impact. Lean, a systematic approach to understanding and optimizing processes, may be the fit for your organization. Learn more in this new IBM® RedpaperTM publication, A Guide to Lean Healthcare Workflows, by Jerry Green and Amy Valentini of Phytel (An IBM Company). The paper delves into the five steps of Lean: Define value from the patient's perspective Map the value stream, and identify issues and constraints Remove waste, and make the value flow without interruption Implement the solution, and allow patients to pull value Maintain the gain, and pursue perfection It describes each step in-depth and includes techniques, example worksheets, and materials that can be used during the overall analysis and implementation process. And it provides insights that are derived from the real-world experience of the authors. This paper is intended to serve as a guide for readers during a process-improvement project and is not necessarily intended to be read end-to-end in one sitting. It is written primarily for clinical practitioners to use as a step-by-step guide to lean out clinical workflows without having to rely on complex statistical hypothesis-testing tools. This guide can also be used by clinical or nonclinical practitioners in non-patient-centered workflows. The steps are based on a universal Lean language that uses industry-standard terms and techniques and, therefore, can be applied to almost any process.

The book shows readers exactly how to use Lean tools to design healthcare work that is smooth, efficient, error free and focused on patients and patient outcomes. It includes in-depth discussions of every important Lean tool, including value stream maps, takt time, spaghetti diagrams, workcell design, 5S, SMED, A3, Kanban, Kaizen and many more, all presented in the context of healthcare. For example, the book explains the importance of quick operating room or exam room changeovers and shows the reader specific methods for drastically reducing changeover time. Readers will learn to create healthcare value streams where workflows are based on the pull of customer/patient demand. The book also presents a variety of ways to continue improving after initial Lean successes. Methods for finding the root causes of problems and implementing effective solutions are described and demonstrated. The approach taught here is based on the Toyota Production System, which has been adopted worldwide by healthcare organizations for use in clinical, non-clinical and administrative areas.

It has been almost 20 years since the Institute of Medicine released the seminal report titled, Crossing the Quality Chasm. In it, the IoM identified six domains of care quality (safe, timely, effective, efficient, equitable, and patient-centric) and noted a huge gap between the current state and the desired state. Although this report received a great deal of attention, sadly there has been little progress in these areas. In the U.S., healthcare still has huge disparities, is inefficient, and is fragmented with delays in care that are often unsafe. Most U.S. citizens are expected to suffer from a diagnostic error sometime during their lifetime, not receive a large fraction of recommended care, and pay for one of the most expensive systems in the world. Much has been written about quality improvement over the years but many prominent quality and safety experts. Yet progress has been slow. Some have called on the healthcare professions to look outside of healthcare to other industries using examples in nuclear power and airlines for safety, the hotel and entertainment industry for a ‘customer’ focus, and the automotive industry, particularly Toyota for efficiency (Lean). This book by Dr. Oppenheim on lean healthcare systems engineering (LHSE) is a fresh approach that brings forth concepts that systems engineers have used in huge national defense projects. What’s unique in this book is that these powerful system engineering tools are modified to be able to address smaller sized healthcare problems that still involve similar problems in fragmentation and poor communication and coordination. This book is an invaluable reference for a new powerful process named Lean Healthcare Systems Engineering (LHSE) for managing workflow and care improvement projects in all clinical environments. The book applies to ambulatory clinics and hospitals of all types including operating rooms, emergency departments, and ancillary departments, clinical and imaging laboratories, pharmacies, and population health. The book presents a generic rigorous but not mathematical step-by-step process of integrated healthcare, systems engineering and Lean. The book also contains the first major product created with the LHSE process, namely tabularized summaries of representative projects in healthcare delivery applications, called Lean Enablers for Healthcare Projects. Each full-page enabler table lists the challenges and wastes, powerful improvement goals, risks, and expected benefits, and some useful descriptions of the healthcare system of interest. The book provides user-friendly solutions to major problems in healthcare delivery operations in all clinical environments, addressing fragmentation, wastes, wrong incentives, ad-hoc and stove-piped management, lack of optimized processes, hierarchy gradient, lack of systems thinking, “blaming and shaming culture”, burnout of providers and many others.

Provider-Led Population Health Management: Key Healthcare Strategies in the Cognitive Era, Second Edition draws connections among the new care-delivery models, the components of population health management, and the types of health IT that are required to support those components. The key concept that ties all of this together is that PHM requires a high degree of automation to reach everyone in a population, engage those patients in self-care, and maximize the chance that they will receive the proper preventive, chronic, and acute care. While this book is intended for healthcare executives and policy experts, anyone who is interested in health care can learn something from its exploration of the major issues that are stirring health care today. In the end, the momentous changes going on in health care will affect us all.

This book is an implementation manual for lean tools and principles in a healthcare environment. Lean is a growth strategy, a survival strategy, and an improvement strategy. The goal of lean is, first and foremost, to provide value to the patient/customer, and in so doing eliminate the delays, overcrowding, and frustration associated with the existing care delivery system. Lean creates a better working environment where what is supposed to happen does happen. On time, every time. It allows clinicians to spend more of their time caring for patients and improves the quality of care these patients receive. A lean organization values its employees and encourages their involvement in organizational initiatives which, in turn, sustains hospital-wide quality improvements. The opportunities for lean in healthcare are limitless. This is not a book to be read and forgotten, nor is it meant to sit on a book shelf as another addition to an impressive but underutilized collection of how-to books. As the name implies, it is a guide; a companion to be referenced again and again as the organization moves forward with its lean transformation. "This is a well-researched, well-written work by an individual who understands the current healthcare environment. It provides a practical and sound understanding of the concepts and application for Lean and Six Sigma." James R. Bente Vice President, Quality & Organizational Development Memorial Health System "Healthcare quality professionals in the U.S. and abroad could benefit from the content of this book...Comprehensive discussion of lean and its relevance to healthcare, excellent description of techniques and tools, and excellent examples and figures." Luc R. Pelletier, MSN APRN BC FNAHQ FAAN Editor in Chief Journal for Healthcare Quality COMMENTS FROM OTHER CUSTOMERS Average Customer Rating (4.5 of 5 based on 4 reviews) "This book is easy to read and demystifies the complex world of Lean by clearly explaining what Lean is, what it does, and the tools used; all in the context of healthcare. Because examples illustrate the benefit of Lean not just to the healthcare industry, but to us as patients, the business case is especially compelling. Instructions address technical challenges and draw from best practices in change management. The guide provides a road map for implementation and seasoned insights that leave one trusting that Lean is very doable, and a necessity." A reader in Seattle, Washington "I thoroughly enjoyed this book as it provides concrete and detailed examples of Lean principles applied to a healthcare environment. I myself am new to healthcare and am overwhelmed at the wealth of opportunities for improvement. I plan on using some lean principles to demonstrate that improvements don't have to be complex or costly to achieve results" A reader in Montreal, Quebec "This is an excellent resource. I consider it 'required reading' for all that are new to Lean / Process Improvement. In my role, I facilitate 5-10 concurrent process improvement projects. This book has been invaluable as a teaching tool. I've asked each project leader to buy, read and study this book. All have commented that it has an easy read, helped them to understand the Lean concepts, and quickly implement the tools. As a group, we're better able to speak the same language and have a common understanding of the tools.brI highly recommended this book. I would also recommend the website (www.leanhospitals.org), wh..." A reader in Wausau, Wisconsin

Unlike other books on Lean Healthcare, The Lean Healthcare Handbook goes beyond merely describing tools, it shows you exactly how to USE these tools to design healthcare work that is smooth, efficient, error-free and focused on patients and patient outcomes. It includes in-depth discussions of every important Lean tool, including value stream maps, takt time, spaghetti diagrams, workcell design, 5S, SMED, A3, Kanban, Kaizen and many more, all presented in the context of healthcare. For example, the book explains the importance of quick changeovers (for example, operating room or exam room changeovers) and shows you specific methods for drastically reducing changeover time. You will learn to create healthcare value streams where work flows based on the pull of customer/patient demand. You will also learn a variety of ways to continue improving after your initial Lean successes. Methods for finding the root causes of problems and implementing effective solutions are described and demonstrated.The approach taught here is based on the the Toyota Production System, which has been adopted worldwide by healthcare organizations in clinical, non-clinical and administrative areas. The topics covered in this book are also taught in online training courses at www.pyzdekinstitute.com, where you can earn certification and recognition of your skills from an acclaimed and accredited training organization, The Pyzdek Institute.Thomas Pyzdek worked with Dr. W. Edwards Deming in the 1980s and 1990s to help spread the word about a new and better way to run organizations. This book is the latest contribution to this ongoing mission.

The change from traditional ways of producing and managing healthcare services to a just-in-time approach requires a new understanding about what adds value for the patient or customer, and what does not. Just-in-Time for Healthcare is intended to share powerful knowledge that will help you participate effectively in the change to just-in-time. Part of the Lean Tools for Healthcare series, this user-friendly book is designed to improve understanding of the just-in-time (JIT) system that is fundamental to providing lean healthcare services and eliminating waste from healthcare processes. The book covers why JIT is important for healthcare by explaining how it enables a healthcare organization to efficiently and reliably produce the quality services its patients require—when they need them, where they need them, and in the amount they need. This book also - Addresses the basic concepts of just-in-time in healthcare, including flow, pull, and kanban systems Describes the principles and benefits of process flow layouts versus operations-based layouts Reviews the importance of standard work as the foundation for continuous improvement Outlines support techniques for just-in-time such as 5S, visual management techniques, quick setup, mistake proofing, and the essential concepts of lean management Includes real-world healthcare examples. Presented in practical terms, this fundamental book shows how lean principles and tools connect in a just-in-time system. It is ideally suited for both individual and group learning.

Process Redesign for Health Care Using Lean Thinking is a response to a simple, but hard to answer, question and is the result of the experiences of a working doctor who was also the chief safety and quality officer of an Australian teaching hospital. At this hospital, he observed that the Emergency Department was staff by talented, well-trained, and respected doctors and nurses. The facilities were modern, and the work load unexceptional, but the department was close to melt down. Bad things were happening to patients, everyone was blaming each other, lots of things had been tried but nothing was getting better and no one could explain why. The problem was not a lack of technical knowledge or expertise, the problem was that no one stood back and said, "what’s the best way to move 200 or 300 patients a day through the complicated and varying, sequence of steps needed to sort out the many different problems that bring patients to our department?" These challenges are faced by hospitals and health services all over the world. There are difficulties with patient flow, congestion, queues, inefficient utilization of resources, problems engaging clinical staff in improvement programs, adverse incidents, and budget constraints. Lean thinking and value stream analysis gives hospitals and health services struggling with these issues the insights they need to help themselves. This book provides a method that systematically turns those insights into working programs of service and system redesign. The book is divided into two sections. The first section gives the background to the approach, and systematically works through the Process Redesign methodology, step-by-step. The second section is a series of case studies that show the methodology in action, what worked and what didn’t work. The goal of any process redesign is simple: the right care, for the right person, at the right time, in the right place, and right the first time. This book helps the people who work in hospitals and health services realize these goals by working together.