lean presentation amc
TRANSCRIPT
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Arab Medical Center
Lean Thinking by: Wafa AlAhmed BSc, PgD, MLS(ASCP)cm Senior Quality Assurance Officer
Arab Medical Center-Jordan [email protected]
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Definition Lean is the culture of creating value & eliminating ‘waste’
• Improve quality• Enhance safety• Improve productivity• Improve efficiency• Reduce cost
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Lean Thinking
• Lean thinking was derived from Toyota organization in 1950
• Healthcare sector adopted lean in 2000 to improve the quality of its services
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1st Lean Principles Specify value from the customer viewpoint
Value Customer
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2nd Lean Principles
• Identify the value stream and eliminate waste
• Value Stream: A set of activities necessary to bring a service to the customer
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Value Stream Mapping
Phlebotomy Work Flow for Out Patients
Enter Patie
nt Data in LIs
Payment
Phlebotomy
Enter Patient Data in
LIsPayment Phleboto
my
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Types of Work Activities
Activities that Contribute to Satisfy the customer
Activities that must be
performed for legal or
regulatory requirements
Activities that the customer
would be unwilling to
pay for
Optimize Minimize Eliminate
Value-Add Business non- Non-Value Add Value Add
Types of Waste
The elimination of waste is the main characteristic of Lean. Waste is everything that doesn’t add value to the patient or process.
NON-UTILIZED TALENT
AUTOMATING INEFFICIENT PROCESS
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DefectsInformation, products or services that are inaccurate or incomplete.
• Repeated errors • Customer dissatisfaction• data entry errors• Fixing paper work that is not completely filled
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OverproductionMaking more, earlier or faster.
• The most serious of all wastes• Large batch sizes If defects discovered in small batch production then the economic loss is minimized • Printing 20 copies of a report but only
need 3 people to look at
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WaitingInvolves waiting for man, machine, materials or information.
• Excessive cycle time• High amount of wait time vs. work time• Waiting for files or information• Delays due to needing a signature
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Not utilizing people’s experience, skills knowledge, or creativity.
• Lack of empowerment• Not utilizing employees’ brains• Lack of suggestions• “That’s not my job” attitude• Lack of cross training
Non-Utilized Talent
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TransportUn-necessary movement of material around an organization.
• Inefficient “Flow”• Carrying large quantities in & out of storage• Moving equipment or files• Sending emails between departments• Redundant movement of materials
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InventoryAny supply (materials or goods) in excess of appropriate quantity at the appropriate time.
• Purchasing excess inventory• Long cycle times for certain parts or supplies• Risk of obsolescence (oldness) “First come- First go”
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MotionAny movement that does not add value to the product or service.
• Inefficient workplace organization• Inefficient placement of frequently used supplies,
tools,….etc.• Opening up multiple software applications• How far does the paperwork travel?• Where are critical resources located?
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Extra-ProcessingAny effort that does not add value to the product or service
• Re-work loops or work-around• Redundant process steps• Multiple signature• Extra fields requiring unused information• Un-necessary completion of templates, forms, documents
Over-processing is often inserted into a process as a result of dealing with defects, overproduction or excess inventory.
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3rd Lean Principles• Make value flow at the pull of the customer
• Flow is the goal
Value Customer
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4th Lean PrinciplesSupply what is pulled by the customer
• Buffer Holding area between two processes.
• Kanban Visual signs
Kanban Visual managementhttps://www.youtube.com/watch?v=rkpadFfyCqo
Perfection
5th Lean Principles Problem Solving
By Root Cause Analysis
People & Partners(Respect, Challenge, Teamwork & Grown them Process
(Eliminate Waste)Right process will deliver right product
Philosophy (Long-Term Thinking) (Continuous Improvement & Learning)
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Patient Wait Time• Definition Wait time from the patients’ arrival to the laboratory reception area and the time at which the blood collected.
• Problem Patient waiting time in the reception area seem to be higher
between 10:30 AM – 12:00 PM. • Consequences -Excessive time spent away from work or personal activities. -Patients might leave and seek care elsewhere.
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Value Stream Mapping
Phlebotomy Work Flow for Out Patients
Enter Patie
nt Data in LIs
Payment
Phlebotomy
Enter Patient Data in
LIsPayment Phleboto
myWaitTime
WaitTime
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How to minimize Patient Wait Time
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How to minimize Patient Wait Time
• Insurance approval in the lab reception area
• Two med tech for registering the patients’ data, answering phone calls, delivering patients’ results.
• Two phlebotomists dedicated only for blood collection.
• Educate the patient by signs, posts, or through their physicians to get the approval for lab tests before visiting the lab.
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Facts & Data CollectionDate 17/8/2015, Time 10:30 Am-1:00 Pm
Note: children were excluded
Patient No. Time In Time Out Wait Time (min)
1 10:30 10:50 202 11:00 11:20 203 11:00 11:15 154 11:05 11:20 155 11:10 11:32 226 11:15 11:53 387 11:30 11:55 258 11:30 12:00 309 11:40 12.05 2510 12:10 12:25 1511 12:12 12:30 1812 12:40 12:50 2013 12:45 12:53 814 12:50 1:00 10
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Takt Time per 24 hourson 16th august, 2015
Takt Time Calculator
Working Shifts per Day
3 Shifts
Hours per Shift 8 Hours
Break Time per Shift 5 Minutes
Lunch Time per Shift 30 Minutes
Planned Downtime per Shift
10 Minutes
Customer Demand per Day
135 Units
Available Time per Shift
480 Minutes
Net Working Time per Shift
435 Minutes
Net Working Time per Shift
26,100 Seconds
Net Available Time per Day
78,300 Seconds
Takt Time = 580 Seconds per Piece
Takt Time = 9.7 Minutes per Piece
Definition Takt time is the time required to deliver quality services (to produce customer requirements)
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Takt TimeFor Shift A on 16th August, 2015
Takt Time Calculator
Working Shifts per Day
1 Shifts
Hours per Shift 8 Hours
Break Time per Shift 5 Minutes
Lunch Time per Shift 30 Minutes
Planned Downtime per Shift
10 Minutes
Customer Demand per Day
80 Units
Available Time per Shift
480 Minutes
Net Working Time per Shift
435 Minutes
Net Working Time per Shift
26,100 Seconds
Net Available Time per Day
26,100 Seconds
Takt Time = 326 Seconds per Piece
Takt Time = 5.4 Minutes per Piece
Plan, Do, Check, Adjust (PDCA) Sometimes known as PDSA (Plan, Do, Study, Act) cycle
• (PDCA) cycle provides a means of conducting safe experimentation or a number of trials to see the effect of any changes made in a bid to make improvement
Plan, Do, Check, Adjust (PDCA) Cycle
P - Plan: The trial is the most important part of the process.
• What you are planning to trial?• What are your objectives?• Who is needed to be involved/informed?• How are you going to do it?• How long will the trial run?• How are you going to measure improvement?• What is your communication plan?
D - Do: Carry out the trial
• Test the change and collect the data.
C - Check: Study the results
• Analyze the data you collected in the ‘plan’ and ‘do’ phase• Discuss outcomes with colleagues?• What went well?• What went wrong?• Did anything unexpected happen?• Could the process be improved?• If the trial didn’t go to plan, what was the root cause?
A - Adjust: Act on the results
• If the trial did not improve the process, could you treat the root cause in your next PDCA cycle?
• If the change was a measurable success, adopt and spread the improvement in your PDCA cycle.
Using 5S to improve safety5S is the basis for standardizing work to make the processes and environment safe.It is used to improve efficiency byeliminating waste, promoting flow,improving staff morale and mostimportantly improving safety.
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Why Standardized work is important?
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Why Standardized work is important?
• Employee involvement and empowerment,• Consistency (reduction of variation) among staff
members performing the work,• Improved productivity without added stress,• Improved, consistent quality,• Reduction or elimination of errors and mistakes
(causes of defects),• Work process stability,• Increased employee safety,• Improved cost management as wastes are removed,• Availability of a great tool for staff training, • Visual management--managers and supervisors can
see when processes are not operating normally.
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Medical Technologist Task
• To implement lean in each department.• Each medical technologist need to do a change in his/her
department that will improve AMC services.• It is recommended to discuss the idea of change by
27/8/2015 with the laboratory Director Mrs Randa Al-Ahmad & the senior QA officer Mrs Wafa Al-Ahmed & QA & Safety officer & Aphaeresis specialist Mrs Tasneem Al-Nsour for approval.
• You have two weeks time to perform a trial for your idea starting from 29/8/2015 to 12/9/2015.
• Measure the effect of the change you made.• Then demonstrate your work to your colleagues.
The Key to Success Is Small, Incremental
Improvement
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References• Improvement, N. H. S. Bringing lean to life.
Leicester, UK: NHS Improvement. 2010.• https://leansixsigmahealthcare.wordpress.com/20
15/06/24/using-lean-six-sigma-analytics-to-improve-patient-wait-times/
• http://www.6ixconsulting.co.uk/IGLC-Application-of-Batch-size-reduction-in-construction.pdf