Download - Walking the Wards
1EXCELLENCE SYSTEMS GROUP
Consultants
Applying Lean to the wards
Michael Ballé
Lean is a system
2EXCELLENCE SYSTEMS GROUP
Consultants
Many have heard about the lean « tools »: 5S, Value Stream mapping, Kaizen events, etc.
Lean veterans insist on applying the tools rigorously
But mostly on the fact that lean is a « system », or a way of « thinking »
What do they mean by that?
Lean as a learning system
3EXCELLENCE SYSTEMS GROUP
Consultants
thinkingthinking
toolstools
systemsystem
What is lean thinking?
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Consultants
Visualize performance problems in the ward
Solve problems without « going around » them
In a « lean » way: using ideas rather than investment
By involving all employees
And developing a kaizen mentality in everyone
Lean thinking is guided by a lean system
5EXCELLENCE SYSTEMS GROUP
Consultants
Reactat
firstdefect
Reactat
firstdefect
Flowat
takttime
Flowat
takttime
CUSTOMER SATISFACTIONCUSTOMER SATISFACTION
StandardizationStandardization ContinuousImprovementContinuous
Improvement
EmployeeInvolvement
Lean success needs working at all three levels
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Consultants
tool 5S Staff never have to look for parts or equipment
system Standard work
So they can keep to the work standard without being interrupted
thinking Visualize problems
Interruptions can then be recognized right away as problems, and lead to quick response and problem solving
To begin with: walk the wards
7EXCELLENCE SYSTEMS GROUP
Consultants
Go and seeGo and see
Gemba walkGemba walk
CustomersatisfactionCustomer
satisfaction
Gemba walk
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Consultants
Gemba walk
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Consultants
Gemba walk
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Consultants
Customer satisfaction: metrics
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Consultants
performancemindset
performancemindset
metricsmetrics
customer satisfactioncustomer
satisfaction
What is a customer incident?
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Consultants
TC4 MS3 RF2 Total
Chutes 12 5 5 22
Fugues 5 3 0 8
Infection Urinaire 9 0 0 9
Escarres 0 1 0 1
Réactions médicamenteuses 1 0 0 1
Réclamations 2 2 0 4
Infection pulmonaire 1 0 0 1
Pertes ou vols d'objet 2 2 0 4
Erreurs de médicaments 0 0 0 0
Pansements 2 0 0 2
Accident avec Exposition au Sang 0 0 0 0
Infection s/ Sondes Urinaires 0 1 0 1
Kt périphériques 0 0 0 0
Allergie 0 0 0 0
SUIVI des INDICATEURS
Standardize work areas
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Consultants
Involve the teams in visual management and quick response to problems
Involve the teams in visual management and quick response to problems
5S5S
StandardizationStandardization
5S
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Consultants
Clear the workspaces, identify locations
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Consultants
16EXCELLENCE SYSTEMS GROUP
Consultants
Create supermarkets and hunt for out-of-date or missing material
Visualize out of date ormissing material and eliminate
Visualize out of date ormissing material and eliminate
SupermarketsSupermarkets
FlowFlow
supermarkets
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Consultants
All the way to housekeeping material
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Consultants
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Consultants
Make sure material is desinfected after each use
Visualize problem and solve it by involving the team
Visualize problem and solve it by involving the team
Teamproblem-solving
Teamproblem-solving
Standard/kaizenStandard/kaizen
Clear and clean after every use
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Consultants
Clear and clean after every use
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Consultants
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Consultants
Reduce inventory on hand so problems can be seen at one glance
Visual managementAnd quick responseVisual managementAnd quick response
Daily ward walkDaily ward walk
React at first defectReact at
first defect
Bacterial bombs!
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Consultants
Visual management for quick response
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Consultants
From the work environment to care itself
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Consultants
Involve team in creating their work standards
Involve team in creating their work standards
Work standardsWork standards
StandardizationStandardization
Work standards for care
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Consultants
TOILETTE AU LIT
LA TOILETTE IMPORTANT SÉCURITÉ
Repères :
1 – Planification murale à vérifier. 2 – Prendre connaissance de l’ état du patient. 3 – Préparation du matériel. 4 - Installation du patient. 5 – Déroulement de la toilette. 6 – S’assurer d e l’état des téguments. 7 – Réinstallation du patient. 8 – Environnement du patient. 9 – Nettoyage et rangement.
- Doit être à jour, - Plan de Soins actualisé. - Transmissions du jour, - Autonomie du patient - S’enquérir de la douleur. - Vérifier dans la ch ambre si tout le matériel nécessaire est présent et propre (cuvette, gants, serviettes…), - Apporter le matériel adapté aux besoins du patient (changes, produits…), - Vêtements propres - Position ergonomique, respect de la pudeur et de la sécurité, - Commencer par la toilette du siège si le patient est souillé, - Favoriser l’autonomie du patient - Relationnel. - Prévention d’escarres. - Installation au fauteuil, - Réfection du lit, - Nettoyer le dentier et s oins de bouche - Réaménager l’environnement avec tout le nécessaire à proximité. - Proposer de boire. - Désinfecter la cuvette, - Nettoyer et ranger le matériel utilisé, - Mettre de côté le l inge sale personnel au patient.
- Sécurité : - Gestes et postures respect des
capacités à faire du pati ent ; utiliser les a ides techniques (lève malade, drap de transfert) .
- Risque de chute : réinstaller la contention du patient au fauteuil si prescrite ; sonnette à p ortée de main ; déambulateur ou canne à proximité ; dégager le passage dans la chambre ; attention au sol mouillé !!!
- Organiser l’espace : pour l e confort et la sécurité des gestes et postures du patient et du personnel.
- Hygiène : Lavage des mains avant et après la toilette ; Utiliser la solution Hydro alcoolique entre chaque acte, et quand nécessaire ; Mettre tablier et gants vinyle non poudrés ; Respecter les circuits du linge et des déchets :
-Matériel : Linge nécessaire à la réfection du
lit ; Tablier à usage unique ; Gants vinyles non poudrés ; Solution Hydro alcoolique ; Change adapté à la taille du
patient ; Gant de toilette � usag e unique si
patient souillˇ ; Nécessaire de t oilette propre à la
personne ; Utiliser un gant et une serviette
de toilette pour le haut ; un gant et une serviette de toilette pour le bas.
-Auto-contrôle visuel : Vérifier l’installation du patient ; S’assurer de son confort ; Réfection du lit faite ; Vérifier qu’il ait à porté de mains
les affaires personnelles dont il a besoin : (sonnette, téléphone, verre, eau, revues…).
Vérifier le rang ement du mat ériel et des affaires personnelles du patient (linge sale).
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Consultants
And more complex problems: preparing patients for physiotherapy
Develop teamwork betweenSpecialisms and solve
Patient problems
Develop teamwork betweenSpecialisms and solve
Patient problems
Value StreamMapping
Value StreamMapping
Patient flowPatient flow
And further challenges
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Consultants
Moving to kanban for all supplies (which means convincing hospital logistics)
Tracking the path of BMR through the wards
Improving patient journey and getting involvement from the doctors
What results?
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Consultants
Over two years, the rate of incidents per patient halved (that is, the probability each patient admitted has of facing an incident reduced by 45%)
Lean is a learning system
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Consultants
The lean environment (visual management, pull system) helps people to see cause and effect
The lean tools are learning opportunities, for people to learn to produce with better, quality, delivery, productivity and flexibility
The tools only highlight problems, resolution with PDCA is the point!
Lean is a management system
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Consultants
Using the tools will not transform the culture
The lean culture is about solving all problems rigorously
To understand real priorities
And create another type of relationship with workers
Based on developing abilities
And creating better products, through better thinking
The team!
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Consultants
Thank you
33EXCELLENCE SYSTEMS GROUP
Consultants
To the team from Villeneuve, Nord 92
To visitors from Bolton Hospitals
To you, for your attention