Value Stream Mapping for Flow in Healthcare (part 2)

Applying flow to healthcare (part 2)

The rules to follow for smooth patient flow are the same as those of the Toyota Production System:

#1: Specify timing, sequence, and outcome of all work
#2: Connect all customers and supplier relationships with “one-piece pull”
#3: Flow product or service directly one at a time
#4: Signal problems at each step through “stop the line”
#5: Start at the process owner solve problems using the scientific method

There are three main problems likely to be encountered with patient flow at any hospital.

These are: 1) scheduling, 2) inflexibility of the layout of hospital facilities, and 3) the functional or “silo” mentality between departments.

1) Smoothing out schedule of capacity of value streams across capacity constrained resources, such as operating rooms, is a theme common to all Lean implementations. One example of a barrier to flow is the lack of beds. One root cause of slow turns of beds is a delay in discharge. The root cause can be something as simple as scheduling discharge times at the convenience of the physician rather than based on the pace of customer demand or a target turn time for beds.

Not having a bed available creates the waste of waiting for the patient, motion for the nurses who must search for an available bed, transportation for the patient who must be relocated to the bed, and extra processing to make sure the charts, meds and resources are diverted to the new location. A common goal must be set to improve patient flow and increase velocity so that competing interests can be resolved and behaviors can change.

2) Compared to a factory layout where equipment and even non-structural walls can be moved with ease to accommodate improved flow, hospitals tend to be multi-story, multi-building structures with complex infrastructures that do not lend themselves to a quick rearrangement processes to accommodate patient flow. Although the best opportunities are to take advantage of new construction or remodeling, we are seeing hospitals that are willing to remove physical walls and convert room, offices, and storage space to accommodate patient flow.

3) As in any industry, a strong “silo” mentality exists in hospitals between the facilities a hospitals provide, physicians, specialists, RNs and staff all trying to optimize their part of the value stream of providing care without looking at it from the perspective of the patient. This must be addressed long-term through a team approach and conversion to value stream management.

Patient flow is an exciting area of Lean Healthcare, as it holds the promise of lower costs, improved quality of care, and a better patient experience for all of us.

For more information on implementing or learning flow through our Value Stream Mapping classes and simulation please contact us- Office- (704) 274-2050 email- info@gdc-tbs.com

Feel free to leave comments, if you would like to converse with us on any of our blogs feel free to reach us on

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403 Gilead Rd.,  Suite L
Huntersville, NC 28078

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Value Stream Mapping for Flow in Healthcare (part 1)

The consultants in our Lean Healthcare practice are speaking with an increasing number of hospitals and healthcare organizations interested in Lean. As we all know, healthcare costs are high and patient wait times are long. Anyone who has had experience sitting in a waiting room, examination room, or in a hospital bed can attest to the fact that there is a distinct lack of flow in the way healthcare is provided today.

One of the key ideas in Lean is to increase velocity, or the amount of profit generated over a period of time. Velocity is increased by examining the revenue generating sequence of activities called Value Streams. When waste such as delays, errors, transportation, motion, and so forth are eliminated from these operations what remains is the ability to provide the same value in less time. Flow is the key to increasing velocity.

Assuming that assets such as beds, medical equipment, and surgery rooms are fixed, the revenue generated through these over a set amount of time must increase. We usually cannot add resources without spending money. We cannot increase the amount of time available to us in a 24 hour day. We must increase velocity by speeding up the flow of value through the system. This is done by examining and eliminating the non-value-added and waste (muda) elements of the process of providing care.

What is the impact of better patient flow for hospitals? As waiting time is reduced, the healthcare experience for the patient improves, reducing waiting time and speeding recovery. As patients flow from process to process (from sickness to health) beds turn faster, and more patients can be served. More patients served equals to more revenue for the hospitals. By increasing revenue with the existing fixed costs (rooms, beds, overhead) hospitals can increase profitability.

The first step is to identify the healthcare value streams that are the target of conversion to flow by asking the following questions of process and service mapping: What types of care does the hospital provide? What volumes of patients are experienced for each? What are the resources needed for each? What is the sequence of steps to provide care?

Then, we design a ‘just in time’ system through a relationship of “one-piece pull” of work (patients, samples, x-rays, etc.) at the pace of customer demand (takt time). We do this through a live simulation by walking a patient through the process of care without delay, one at a time. The results are documented, challenges and problems are identified, and a system to support smooth patient flow is defined.

For more information on implementing or learning flow through our Value Stream Mapping classes and simulation please contact us- Office- (704) 274-2050 email- info@gdc-tbs.com

Feel free to leave comments, if you would like to converse with us on any of our blogs feel free to reach us on

Facebook at Facebook.com/GDC.TBS    Twitter @GDC_TBS    Linkedin http://tinyurl.com/GDCTBS

http://www.GDCTBS.com

403 Gilead Rd.,  Suite L
Huntersville, NC 28078

LEANing in on Healthcare

There is a “petition” that is building momentum in the Healthcare industry – “We need to become Lean…”  Although the need has been there for some time, the direction (the how-to) has been nebulous and ill-defined.  “We are unique,”~the healthcare practitioners. With the change in the healthcare structure, and the rules set forth by administration most believe it is virtually impossible for hospitals to become lean. Yet they are highly aware that something needs to change in order to provide the highest of quality to patients.

However, while it is true that there are many unique facets to ANY business, in ANY industry, it is also true that the principles and practices of Lean are applicable to any environment where the management and staff are willing to look at their business through “new eyes.”

The foundation of Lean is the elimination of waste through continuous improvement initiatives.  Anyone who works in the Healthcare industry, or even those of us who have been on the receiving end of healthcare, knows that there is countless waste in the industry: from long waits to astronomical costs, from lack of standardization, inordinate quantities of inventory, massive amounts of paperwork, errors and the one we all love to hate REWORK.

The very recognition of these inadequacies in the existing system(s) means that Healthcare practitioners have already begun the first step of Lean – seeing things more clearly, and realizing that you CAN improve.  Lean simply provides the tools that allow you to attack the individual problems through a structured and systematic approach.

One of the major differences in the healthcare industry, versus say, manufacturing, is the potential consequences.  In manufacturing, if we make mistakes, the cost translates into lost time and money.  In Healthcare, however, mistakes can translate into “life or death”.

Therefore, and most assuredly, because of this fact, it is all the more important for the industry to “Face their fears” and start looking at the systems/processes that allow errors to occur.

  Along with being bested by the U.K., America’s health care system ranked worse than those of Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, and Sweden. In comparison, our doctors and hospitals are terrible at providing low-cost, efficient, and equitable care, and we have much higher infant mortality and low life expectancy. (takepart.com/article June 2014)

Here’s a table that describers where the United States ranks in elements of healthcare compared to other “leading countries”

Healthcare Cost Ranking for leading countries.
Healthcare Cost Ranking for leading countries.

Cost is high and quality is low, of course we would recommend a lean approach (we’ve already done the research) but even if Hospitals decided against it, our question is… What Will They Do?

 

Feel free to leave comments, if you would like to converse with us on any of our blogs feel free to reach us on

Facebook at Facebook.com/GDC.TBS    Twitter @GDC_TBS    Linkedin http://tinyurl.com/GDCTBS

http://www.GDCTBS.com

403 Gilead Rd.,  Suite L
Huntersville, NC 28078

Phone: (704) 274-2050

E-mail: info@gdc-tbs.com