improving “my care” overview · 2009-02-25 · kaizen cross kaizen team kaizen event...

© National Healthcare Group Pte Ltd, 2006

Improving “My Care” OverviewPresented by Prof. Philip Choo

Chairman, Medical Board

Tan Tock Seng Hospital

• My Care will benefit my work

• My Care will benefit patients

• My Care basic tools are easy to use

1


The Challenge to us

- Eliminating duplication, gaps and flaws in our internal processes

- Optimising the whole system for better integration of patient care

• Eliminating Bottlenecks- Acute care patients, 80% of admissions stem from emergency patients

- High No-Shows

- Discharging patients to step-down care facilities

Burning Platform for Change?

2


The Challenge to us - Increased Demands for Healthcare Facilities & Manpower

• Ageing Population

- By 2030, 1 in 5 Singaporeans will be over 65 years old

- TTSH has the largest percentage of subsidized & elderly patients

- Need more beds and resources to cope with high workload


3


The Challenge to us - Establishing a dynamic patient flow system

• Rising Sophistication & Expectations of Patients- More affluent (generally)

- More health-conscious

- Better educated & Informed

- Choose the Hospital they want to use for their medical care


Information

Clinical

assessment

Investi-

gations

Clinical

decision

Admi-

ssion

Treat-

ment

Dis-

charge

Patients

4


• Long term focus on Quality, Cost, Delivery, Safety and Morale (Safety first)

• Uses the manufacturing philosophy of shortening the time between the customer order and the product build / shipment by eliminating sources of waste.

Total Efficiency Vs. Individual Efficiency

What is “My Care”

5


8 Categories of Waste - DOWNTIME


• Defects

• Over Production

• Waiting

• Not Utilizing Staff Ideas

• Transportation

• Inventories

• Motion

• Extra Processes

- Medication errors, blood redraw

- Unused printed results, Unnecessary labs/visit

- People, machine idle time

- Nurses making appointments

- Material movement to temporary locations

- Excess stored supplies

- Unnecessary staff movement

- Repeat collection of data, retesting

6



Continuous Elimination of Process Waste

90 % Non Value Adding 10%

Value

Adding

Need Outcome

Improvement will be more likely succeed

by focussing on & removing the non-value added

activities (waste)

vs

trying to improve the value adding element

7


Core of “My Care”Sequential tools to eliminate waste

90 % Non Value Adding 10%

Value

Adding

Need Outcome

Continuous elimination of waste

1. 6S

Design work

area based

on patient’s

process flow

2. Visual

Management

Using visual

aids to

communicate

sustained

improvement

3. One Patient

Flow

One patient

at a time in

each process

step;

Small

Batches

4.Standardize

Every staff

practices the

best adopted

standards.

5. Pull

Pull starts

from

processes

downstream

6. PDSA/

PDCA

Problem

solving

technique

7. Daily Improvement Board

Continuous improvement

8


Typical Company Approach to Problem SolvingBlack Belt

Six Sigma Project

X Funct .ProjectRapid Process Imprv.

(Kaizen) Event

Power of “My Care”

9


“My Care” Approach: Focus and LeverageManagement

Kaizen

Individual

Kaizen

Cross Kaizen

Team

Kaizen Event

Expectation: quick solutions from the floor.Many people solving many problems!

Real Power of “My Care”

10


Core of “My Care” – 6 S

Get rid of what’s

not neededOrganize

what belongs

Clean up, see

& solve problems

Assign tasks,

track visually

Keep It Up

(audit & insist)

SELDOM USEFREQUENT USE

DISCARDFREQUENT USE

Visual Management

What are the primary reasons for the improvement?

What are the primary reasons for the improvement?

5S -

Han

db

oo

k 1

5S -

Han

db

oo

k 2

5S -

Han

db

oo

k 3

Case Studies

Case Studies

5S - Handbook SortSet-in-OrderShineStandardizeSustain

Kaizen Books Case Studies

12 Dec 2007 Make work

area safe

6S is a systematic way of creating a safe, clean & orderly workplace

and keeping it that way

11


Core of “My Care” - Visual Management

Visual cue for additional counters

to speed up registration at clinics

Color lines indicate correct

position to return COWs after use 12


One by One Patient Flow

A Process, where the ‘Target

Object’ moves quickly from one

value adding activity to another

without interruption by any of the 8

types of waste.

13


Daily Improvement Board Department

________________________

Are

a f

or

Imp

rovem

en

tR

evie

w

Ro

ot

Cau

se

Acti

on

Taken

Su

ccess S

tatu

s

Area for Improvement

Sticky Pad


Sticky Pad


Sticky Pad

Root

Causes

Area for

Improveme

nt

Reviewed Implementor

Assigned

Implemente

d on

______

___

1

23

4


Sticky Pad


Sticky Pad

Root

Causes

Area for

Improveme

nt


Assigned

Implemente

d on

______

___

1

23

4

Root

Causes

Area for

Improveme

nt


Assigned

Implemente

d on

______

___

1

23

4

Root

Causes

Area for

Improveme

nt


Assigned

Implemente

d on

______

___

1

23

4

Root

Causes

Area for

Improveme

nt


Assigned

Implemente

d on

______

___

1

23

4

Ask, “Why did the issue

happen?” At least 5

times till you find the

root cause.




root cause.




root cause.




root cause.




root cause.

Just-

Do-It

Inter-

Dept

RapidImprovement Event

6S

Core of “My Care” - Daily ImprovementFor staff use:For staff use:

For manager use:RapidImprovement Event

6S

Just Do-It

Inter-Dept


6S

Just Do-It

Inter-Dept


6S

Just Do-It

Inter-Dept


6S

Just Do-It

Inter-Dept


____________________________________

____________________________________

____________________________________

____________________________________

Solutions

____________________________________

____________________________________

____________________________________

____________________________________

Benefit

Patient Safety

Cost Saving

Value-added to customer

Name _______________________________

Date ___________

Root Causes

____________________________________

____________________________________

____________________________________

____________________________________

14

improving “my care” overview · 2009-02-25 · kaizen cross kaizen team kaizen event...

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