gembawalk: starting your lean journey · 2018-04-19 · 1 gembawalk: starting your lean journey...

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Gemba Walk: Starting Your Lean JourneyPractice Management Boot Camp Series

Body of Knowledge Domain: OperationsApril 18, 2018

Brian Ramos, MBA, CMPE

Chief Operating Officer, Capital Anesthesia PartnersPresident-elect, Maryland MGMA

©2018 Maryland MGMA. All rights reserved. - 2 -

Abstract & Learning ObjectivesABSTRACTMade famous by the Toyota Motor Corporation, Lean has been effectively used in the healthcare industry for more than a decade. However, most healthcare professionals have not been exposed to the management philosophy. This introductory presentation will help participants understand Lean’s applicability and use in our field and learn how to identify and eliminate waste in each process in their clinical or business unit.

LEARNING OBJECTIVES1. Understand the core principles of Lean thinking.

2. Understand the process of value stream mapping and its use in Lean.

3. Learn how to identify and eliminate waste (“muda”) in your practices current processes.

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Perceptions About Lean

Let’s start at the end . . .

§ What have you heard about Lean?§ Is Lean mean?§ Is it all about the bottom line?§ Will Lean reduce staff (i.e. result in layoffs)?


Lean in Healthcare

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Reasons for ActionEconomic environment cannot sustain cost structure§ US spent 17.8% of GPD on healthcare more than the other

top 10 highest income countries.

§ Utilization rates consistent among comparison countries.

Despite spending, outcomes are worse!§ Only 90% of Americans are covered by insurance.§ Highest percentage of citizens overweight or obese (70%).§ Lowest life expectancy (78.8 years).§ Highest infant mortality (5.8 deaths per 1000 live births).

CitationPapanicolas I, Woskie LR, Jha AK. Health Care Spending in the United States and Other High-Income Countries. JAMA. 2018;319(10):1024–1039. doi:10.1001/jama.2018.1150

Patients have choices as consumers§ Price Transparency

§ Quality Outcome Reporting


Core Principles

Respect for People§ Employees know work best.

§ NOT top-down approach.

Continuous Improvement§ Strive for zero defects.

Customers (i.e. patients) define value

Based on scientific method (e.g. experimentation)

https://jamanetwork.com/journals/jama/fullarticle/2674671

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- 7 -©2018 Maryland MGMA. All rights reserved.

Value Stream Mapping

Washing Your Hands

Walk to the sink

Turn on water

Get soap

Wash hands

Get paper towels

Turn off water

Dry hands

20 sec 5 sec 10 sec 30 sec 10 sec 5 sec 20 sec

Cycle Time = 100 sec

Place 3 pumps of soap in hand.


Value Stream Mapping Identifies WasteValue Added

§ Any activity that directly contributes to satisfying the needs of a customer.

Non-Value Added§ Any activity that consumes time or resources but does not add

value.§ Some non-value added activities are necessary but still no

value to customer.

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- 9 -©2018 Maryland MGMA. All rights reserved.

8 Wastes in Healthcare

Moving anything on wheels (e.g. patients, specimens, equipment or supplies).

Transporting

Stock of medical or operational supplies, patients in beds, specimens waiting for analysis.

Inventory

People reaching, bending or searching for supplies, patients, other staff.

Motion

Unused or untapped potential of staff.People Potential

Patients in a waiting room; waiting for lab results.

Waiting

Asking patients for their information more than once; ordering more labs than needed.

Over-processing

Creating forms “just in case” you need them; ordering more labs than needed.

Over-production

Wrong patient, wrong procedure, redraws.Defects

What are examples of waste in your practice?


Case Study

Survey Conducted by§ 69% of providers delayed and 40% canceled a

patient surgery due to medical supply shortages.

§ 27% have seen or heard of an expired product used on a patient.

§ 64% have hoarded supplies.§ More than 50% responded that inventory

management is “complicated.”CitationStudy: 40% of providers have canceled surgeries over supply shortages. Becker’s Hospital Review, March 28, 2018. https://www.beckershospitalreview.com/supply-chain/study-40-of-providers-have-canceled-surgeries-over-supply-shortages.html

https://www.beckershospitalreview.com/supply-chain/study-40-of-providers-have-canceled-surgeries-over-supply-shortages.html

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Examples of WasteUnderutilized ORs

Waste(excess capacity)


Examples of Waste

Wrong-site surgery

Accounts for 13% of medical errors!

Waiting for:

Provider

Patient

Results

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Everyday LeanTools you can use right now to do “Lean Lite”


Daily Huddle

§ Ensure team communications

§ Opportunity to prevent issues from developing

§ Focuses on small, incremental, change/improvements

§ Same time, every day, for NO MORE than 5 minutes

§ Everyone attends! That means doctors, mid-levels, nurses too!

§ Initiated by manager, eventually led by all team members.

§ Stand-up! (preferably at a visual management board)

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Visual Management§ Balanced scorecard approach

§ People, Quality/Safety, Delivery, Cost, Growth

§ Set goals by doubling good / halving bad.


Visual Management Continued

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Standard Work§ current best known way to perform a task

§ Standard work secures improvement

§ Encourages root cause problem solving vs. firefighting

§ Do you use checklists? They’re a type of Standard Work

PA

DC

STD WORK

Performance

Time

PA

DC

STD WORK

Performance

Time

Lean Principles


Pareto Analysis§ A means of focusing on areas that matter the most§ Bar chart showing the affect of different categories of a given

problem

Benefits:§ Avoid working on the wrong or insignificant problem.§ Speaking with data

80/20 Rule

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PICK Chart

P Plan to Do• High benefit, Make a plan how to do it.

I Implement• High Benefit, Easy to Do. Implement Now

C Choose (which if any) To Do• Low benefit, but easy to do.

K Kick Out• Low benefit and difficult to do. Don’t

bother with these!

Do the high benefit/low difficulty actions.

Identify actions then group into benefit and difficulty


PICK Chart Continued

Low HighDIFFICULTY

BENEFIT

Low

Hig

h

1

2

3

4

5

6

7

8

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PI

C K

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Recommended Reading


Questions & Answers

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Brian Ramos, MBA, CMPE

Brian Ramos serves as Chief Operating Officer of Capital Anesthesia Partners. Prior to joining CAP, Mr. Ramos held management positions in national anesthesia management consulting firms, premier academic medical centers, independent ASCs and large multi-site private physician group practices. He was formally trained in Lean and uses these tools to create cultures of continuous improvement.

Mr. Ramos earned a BA in Mathematics from Boston College and a MBA from Fitchburg State University. He is a Certified Medical Practice Executive of the American College of Medical Practice Executives. Additionally, Mr. Ramos is president-elect and vice-chairman of the board of directors of the Maryland Medical Group Management Association.

brianramosmba

About the Presenter

Thank You.

https://twitter.com/brianramosmba

gembawalk: starting your lean journey · 2018-04-19 · 1 gembawalk: starting your lean journey...

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