One of the fundamentals of Kaizen lean is the passion for continuous improvement, and the mind set of never being satisfied with the status quo.
The Kaizen Institute recently demonstrated how lean can be applied in healthcare when they delivered a Lean Problem Solving seminar at MidCentral District Health Board, in Palmerston North.
The Kaizen Institute are one of the global leaders in applying lean thinking in healthcare, and the New Zealand team have been working closely with the DHB’s, delivering lean training and coaching, tailored to their requirements.
The participants of the Lean Problem Solving training were from across the organisation, providing an excellent cross representative team to focus on solving a selection of “real” everyday problems.
The problems, we pre-selected for the training, and the outcomes of the day resulted in an action plan and follow up to implement the solutions.
Giving employees the capability of identifying and then solving problems is at the heart of Continuous Improvement, and supports a culture where everybody, everywhere in the organisation is able to make improvements.
If you are interested in hearing about how the Kaizen Institute’s Lean Healthcare experience, please contact Richard Steel at rsteel@spam.kaizen.com
Day Five (pm): Seki-Chuo General Hospital
Our final visit was a very special one. The afternoons visit was to a hospital this was the first time Lean healthcare has featured on what is traditionally a Kaizen lean manufacturing tour. Seki-Chuo General is a small privately run, government funded hospital of 150 beds, situated in Gifu, between Nagoya and Kyoto.
The visit began with a series of presentations detailing the Kaizen Lean activities implemented since its introduction in 2004. The General Manager of the hospital (a doctor) had initiated a Total Quality Management (TQM) program in 2004, and approached Professor Hideo Kunisawa from Asahi University in 2008 to help understand and implement the Toyota Production System (TPS) in the hospital. Professor Kunisawa has worked extensively with the Toyota Motor Corporation over the past few years.
The General Manager’s initial presentation gave an overview of Japanese healthcare, which is a combination of privately run and government funded services. Interestingly, the statistics show that Japanese doctors were amongst some of the busiest compared to global standards and are facing similar pressures to the western world.
The second presentation was by Professor Kunisawa, it detailed a recent project whereby TPS flow techniques had been implemented in the medicine distribution process. The presentation explained how Toyota’s internal logistics systems had been successfully introduced, resulting in dramatic reductions in Inventory and process times for the Pharmacy and nursing staff.
Our Gemba walk took us on a tour of the examples presented, and gave us an opportunity to see how a Japanese hospital ran compared to what we have experienced at home. We at the Kaizen Institute NZ have run a number of Lean healthcare workshops, so I was eager to make comparisons, and see how their Lean thinking compared.
The first part of our tour took us to the Central Pharmacy, whereby our hosts explained Professor Kunisawa’s project which reorganised the internal logistics around Medicine Distribution.
We saw great examples of 5S and visual management, and the Mizusumashi system dedicated to medicines delivery to the 4 floors of the hospital.
The second part of our tour took us up to the ward areas, where we saw the clean utility rooms where the Kaizen PDCA team had implemented their improvements in the medications delivery process. The results were the virtual elimination of patient errors and a 50% reduction in processing time which released around 2 hours per day which was available for patient care.
It was wonderful to hear the story from the nurses themselves and to be able to see how they had grasped the lean thinking and Kaizen philosophies for themselves!
Overall my impression of the Japanese healthcare system was positive. They are very focused on patient outcomes, and understand that in today’s environment, they need to focus on delivering quality care with efficiency. The general feedback is that the clinician are a little resistant and suspicious of adopting “manufacturing” techniques, but this is pretty much the same the world over!
Value Stream Mapping is a lean tool used by the KAIZEN Institute to help organisations understand and improve the flow of information and material within their organisation.
In a Value Stream Map the emphasis is placed on the end-to-end Value Stream which is “customer value”. This allows everyone present to visualise the same entire flow and ‘current condition’.
On 15 & 16 October 2009, Richard Steel, COO of KAIZEN Institute New Zealand facilitated a Value Stream Mapping training workshop at MidCentral health, with participants from the Healthcare sector. The scope was to look at the end-to-end Value Stream of a patient, 65+ years of age going through the stroke pathway from the Emergency Department through to final discharge.
The team who participated in the two day workshop consisted of 14 health professionals from District Health Boards throughout New Zealand who are currently embarking on a number of Lean healthcare initiatives, and also representation from clinicians from each department in the hospital through which the patient would travel.
The first day began with an introduction to Value Stream Mapping and an outline of the Mapping workshop. As a physical walk through is vital in any Value Stream Mapping exercise, the group subsequently went on a Gemba walk to physically ‘see for themselves’ the pathway and to look for MUDA in the processes.
Once the MUDA walk was completed and all the relevant information was gathered, the group was divided into three – each group mapping a section of the current state. The challenge of mapping the current state was to keep it at a high level focusing on the main value adding steps of the stream, unlike process mapping which delves into more detail. It only took a few hours to have the complete current state Value Stream Map of the Stroke Pathway up on the wall, clearly indicating the actual process time or “touch” time vs. the delay time between each phase.
Next the group looked for KAIZEN opportunities in the current state and questioned (why, why, why?) the present situation in the Value Stream. All aspects of a process need to be questioned by the team to challenge the status quo and verify whether it’s value adding or MUDA.
Identifying the KAIZEN opportunities allowed the group to reflect on the current state and design the future state – looking for “quick win” opportunities (what can we fix and improve today/couple of weeks?) and also set up an action plan prioritising which opportunities to work on to ultimately reach the desired future state.
As a result of this training workshop a number of major opportunities were raised and the Mid Central Team are now busy planning the subsequent implementation, and Lean Journey to reach the Kaizen vision as outlined in the future state value stream design.
Participants agreed that the workshop had been a great success in terms of learning how Value Stream mapping can be applied to Lean Healthcare, and we look forward to hearing more of the results from MidCentral in the future…
KAIZEN® helps to reduce costs and satisfy patients
KAIZEN® Institute Portugal has been working with hospitals since 2004. Antonio Costa, Consultant based in Porto, reports on initiatives and achievements at Hospital Geral Santo António (HGSA):
Top hospital executives realised that a lot of their capital was tied up in stock and warehousing. A shorter product life cycle and an exponential rise in the variety of goods created higher costs and increased the complexity of the hospital supply chain. The situation demanded that future investments were utilised wisely. It was decided to completely overhaul the supply chain from supplier to the final client (patient). The KAIZEN® project reduced stock by more than 30% through implementing KAIZEN® Institute’s Total Service Management (TSM) and Total Flow Management (TFM) approaches. Financial services now have five million Euro freed up and available for use on patient care. The HGSA mission focuses on ‘Patient Service Excellence’.
With this in mind, HGSA management identified the ‘doctor appointments process’ as a new KAIZEN® project with the objective of decreasing lead time between the appointment planning and its conclusion, less waiting for information and increased productivity in patient support activities.
Lead times are predicted to decrease from 27 days to 7 with the additional release of 10 employees to focus on other areas of patient care. In the near future The KAIZEN® Institute team will start two further projects, one in medication logistics (similar to the one developed for the clinical material), the other in the surgical area. The goal will be to increase productivity and reduce the long lists of patients waiting for surgery.
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