Leveraging Lean in Ancillary Hospital Services Creating a Cost Effective, Standardized, High Quality, Patient-Focused Operation

This book is part of a series of titles that are a spin-off of the Shingo Prize-winning book Leveraging Lean in Healthcare: Transforming Your Enterprise into a High Quality Patient Care Delivery System. Each book in the series focuses on a specific aspect of healthcare that has demonstrated significant process and quality improvements after a Lean implementation. There are many departments within a hospital that support the primary function of caregiving and each can benefit from implementing Lean methodologies. Leveraging Lean in Ancillary Hospital Services: Creating a Cost Effective, Standardized, High Quality, Patient-Focused Operation provides a functional understanding of Lean processes and quality improvement techniques in nutritional services, inpatient floors, pharmacy, and radiology. This book is ideal for healthcare executives, leaders, process improvement team members, and inquisitive frontline workers who want to implement and leverage Lean. Supplying detailed descriptions of Lean tools and methodologies, it identifies powerful Lean solutions specific to the needs of ancillary hospital services.
The first section provides an overview of Lean concepts, tools, methodologies, and applications. The second section focuses on the application of Lean in the ancillary hospital services environment. Presenting numerous examples, stories, case studies, and lessons learned, it examines the normal operation of each area in radiology, pharmacy, and nutritional services and highlights the areas where typical problems occur. The case studies walk readers through various Lean initiatives and demonstrate how Lean tools and concepts have been used to achieve lasting improvements to processes and quality of care. It also introduces actionable blueprints that readers can duplicate or modify for use in their own institutions. Illustrating leadership's role in achieving departmental goals, this book will provide you with a well-rounded understanding of how Lean can be applied to achieve significant improvements throughout the entire continuum of care.

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 ExampleGroup 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 4Day 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. 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 Genera