cheap Ventolin Lean Thinking – Efficiency and Reliability Part One (cf Part Two)

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Muda

According to lean thinking priniciples, “waste is the use of any material or resource beyond what the customer requires and is willing to pay for.”
In healthcare, waste might be said to be any activity that does not add value to the patient experience or improve their health outcome.

I’m currently participating in a series of Webinars from the IHI called Efficieny and Reliable Design in the Office Practice.
http://www.ihi.org/IHI/Programs/AudioAndWebPrograms/WebACTIONEfficiencyReliableDesignintheOfficePractice.htm

Waste is undeniably a feature of health care delivery.

Why Is It important to increase our efficiency?

Removing waste –
• Adds value to care (increases quality)
• Can take cost out of the system while maintaining or increasing the quality of care
• Can increase the number of patients served through increased productivity

Shigeo Shingo is a Japanese industrial engineer who distinguished himself as one of the world’s leading experts on manufacturing practices and the Toyota Production System.

Muda is the Japanese word for an activity that is wasteful. Shingo identified “Seven” forms of muda, and in the health care context we add another : the eighth waste, under-utilization of people. These 8 forms of waste then are:

• Overproduction – To produce sooner, faster or in greater quantities than the absolute customer demand
• Waiting – Standard operating procedure in healthcare
• Re-work – Correcting mistakes, or having to re-do work done by someone else, or handling something that could have been finished on a prior occasion

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• Motion – Unnecessary movement of people
• Transport – Unnecessary movement of things
• Inventory – Things or people sitting around not adding value or having value added to them
• Overprocessing – Doing stuff beyond the standard required by the customer, doing more activity than is required
• Waste of Talent – Not utilising the skills of your team

What can we do with all this muda?

My seminar class have been challenged to assess our practice through the eyes of our patients.

The Handbook for this activity is based on the Green Book from Clinical Microsystems, a project of the Dartmouth Institute.
http://clinicalmicrosystem.org/cms/materials/workbooks/outpatient_primary_care.doc
(mirrored at http://practiceimprovement.com.au/wp-content/uploads/2011/02/outpatient_primary_care.doc)
This workbook is an excellent resource for all practices.

Step One is to do a practice walk through, role playing the part of a patient in your practice – booking an appointment, registering at the desk, waiting, seeing the doctor, seeing the nurse, leaving. What are the positives and negatives? What is surprising? What is frustrating? What is gratifying? This is outlined on page 9 of the GreenBook.

Step Two is to look at the Patient Cycle Time – How long do they spend in each part of their ‘journey’ through your practice? Which parts of this are ‘value-adding’ and which are wasteful.

The challenge to us – using the improvement model, can we pick a core process to improve, and decrease our non-value added time by 50%?

I’ll report back on what I find and what we change.