CreateASoft, Inc.
The Process Improvement Company

Applying lean to the healthcare




Hosni Adra
Product Manager/Partner


 

How to Proceed

• Need to identify the area requiring the most improvement.
• Requires a high level analysis of the flow
  • Can be done through simulated value stream maps, or simulated process flow.
  • A manual analysis can be performed.
      • Static, does not include the time element in the analysis.
• Value Stream maps become a critical component to determine potential

Outline

• Introduction
• Basic concepts of Lean.
• Applying lean to Healthcare systems.
• Benefits of Lean in Healthcare.
• Q&A
  
  
  
  
  
  
   

The value stream map

• Build a high level value stream of the critical flows.
  • Ignore detail during the initial phase.
  • View and validate the control flow.
• If Dynamic Value stream mapping is available, perform analysis to determine the effect of variability on the map.
  • Averages without variability will only provide a window into reality. Not enough for thorough analysis.

About CreateASoft, Inc.

• In business since 1992
• Core technology: Simcad Process Simulator software
• Provides Simulation and Process Improvement services to the manufacturing and service industries in the areas of
• Automation, manufacturing, and process improvement.
• Lean transition and implementation.

Example of a high level map

Download this presentation

What is Lean?

• Lean manufacturing concepts.
  • Eliminate waste time.
  • Increase throughput.
  • Reduce overall cost.
  • Increase efficiency.
  • Improve Quality.
• Heavily used in manufacturing.
• Finding its way to the service sector slowly.
   

Dynamic Analysis

• Example using Simulation.
• Shows the effect of variability on the value stream.
• Allows for analysis of Best, Worst and average case scenarios.
• Provides a base line for future improvement.
• Helps in identifying potential improvement.
   

Demand > Flow > Leveling

• Demand identified by
  • Takt time, buffer inventory, safety inventory,…
• The Flow
  • Continuous flow, work cells, Kanban system, FIFO lanes, …
• Leveling
  • Paced withdrawal, Heijunka (load leveling)…

Expanding the VSM

• Processes that can contain multiple operations should be expanded.
  • In our example: Treatment and Triage need to be expanded
• Second step is to expand the customers, Admitting can be a new value stream map with its own process flows.
• Applying lean to Healthcare systems.
• Benefits of Lean in Healthcare.
• Q&A

Lean Methods

• The Kanban
  • Required in process inventory to maintain high efficiency.
• The Supremarket
  • An inventory buffer used to reduce the customer and variability
• Single Piece Flow paradigm.
• Processing to “Takt”.

Applying Lean

• To main issues that provide big returns:
  • Resource Travel.
  • Inventory reduction.
  • Inventory positioning.
• Process flow changes may be required to achieve results.
   

Components of a Non-Lean environment

• Traditional batch implementation
  • Through the use of carts, bins, …
• High inventory cost.
• Long lead time, with high dependence on order variability.
• Excessive resource travel – specially in the service sector.
• Reduced process and system efficiency.

Reducing travel
 

• Through simulation or tracking, the travel distance, and pattern of travel can be determined.
• Determine the longest set of Paths in “travel time” not in distance.
  • Lean implies reduced time of travel, or waste time.
• Solution can include:
  • Repositioning of inventory locations.
  • Repositioning of terminals.
  • Modified flow patterns.

The Healthcare Sector

• Traditionally viewed as “Patient Flow”.
• Should include
  • Resource travel, and schedules.
  • Inventory size and locations.
  • Document trail and document management
  • Support operations such as cleaning, disinfecting, …
• The healthcare sector involves all aspects the sector not just hospitals.
  
  
   

Determine the best solution

• For each potential solution, the following must be analyzed:
  • The effect of change on the current operation.
  • The effect of change on the rest of the operation.
  • Best, worst, and average case must be analyzed.
      • The best case may prove to be the most expensive.
• Plan a transition to the new flow.
  • If simulation is available, the transition system can be analyzed in more detail, and with less Risk.

Traditional Healthcare issues

• Most healthcare systems suffer from one or more of
  • Lack of a well defined process flow.
  • Excessive resource travel
  • Inefficient processes, excessive wait time.
  • Long delays throughout the operation.
  • The human factor – How well do resources commit to the schedules.

Things to watch for

• Perform small changes at a time.
  • Major changes require more training, and incur additional costs.
• Document your progress.
  • With every change, allow the system to stabilize and people to adapt.
  • Provide a visual flow of the change if possible.
• Keep everyone informs of the progress and future improvement
   

Connecting lean concepts
 

• Waste in Healthcare
  • Long delays throughout the operation.
  • Doctor’s availability, lab delays, medicine availability.
  • Patient wait for services.
• Inventory sizing – the Kanban
  • Inventory levels for replenishment.
• Simplified processes – well defined flow.

CreateASoft, Inc.
The Process Improvement Company

Applying Lean to the Healthcare

 Sector

Q & A