Verfügbarkeit: Lean hospitals

Lean hospitals: improving quality, patient safety, and employee engagement

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1. Verfasser:	Graban, Mark (VerfasserIn)
Format:	Buch
Sprache:	English
Veröffentlicht:	Boca Raton [u.a.] CRC Press 2012
Ausgabe:	2. ed.
Schriftenreihe:	Lean / Healthcare process improvement
Schlagworte:	Hospital Administration > methods Hospital Administration > economics Efficiency, Organizational Total Quality Management > organization & administration Total Quality Management > methods Krankenhaus Lean Management Sicherheit Qualitätsmanagement Arbeitszufriedenheit
Online-Zugang:	Inhaltsverzeichnis Klappentext
Beschreibung:	XXI, 245 S. Ill., graph. Darst.
ISBN:	9781439870433

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adam_text	Contents Foreword..........................................................................xv Preface.........................................................................xvii About the Author.................................................................xxi 1 The Case for Lean Hospitals...................................................1 Why Do Hospitals Need Lean?...................................................1 A Renewed Sense of Purpose....................................................2 Lean Methods Are Not New to Healthcare........................................2 Toyota’s Role in Popularizing Lean............................................2 Origins of the Term Lean......................................................3 Lean Is Proven to Work Outside Automotive Factories...........................4 Lean Is Helping Hospitals Improve.............................................4 Problems in Healthcare........................................................5 Price Pressures and Cost Challenges......................................6 Coping with Employee Shortages...........................................7 Poor Quality of Care.....................................................7 Good Quality Costs Less.......................................................8 A Snapshot of Department Success: Laboratory, Childrens Medical Center Dallas.9 From Departmental to Hospital-Wide Success...................................12 Conclusion.................................................................. 12 Lean Lessons.................................................................13 Points for Group Discussion..................................................13 Notes........................................................................14 2 Overview of Lean for Hospitals...............................................17 What Is Lean?................................................................17 Ohno’s Definition of Lean....................................................17 Lean Thinking................................................................18 The Toyota Triangle: Tools, Culture, and Management System...................19 Human Development.......................................................19 Philosophy..............................................................20 Technical Tools.........................................................20 Managerial Methods......................................................21 The “Toyota Way” Philosophy..................................................21 i * VII 22 22 24 24 .25 26 27 28 28 28 29 31 .31 .31 32 34 34 .35 .35 36 37 37 39 40 40 40 .41 .41 42 42 43 44 44 46 46 46 .47 .47 49 49 49 ■ Contents Continuous Improvement............................................... Respect for People................................................... Four Organizational Capabilities for Lean................................. Capability 1: Work Is Designed as a Series of Ongoing Experiments that Immediately Reveal Problems.......................................... Capability 2: Problems Are Addressed Immediately through Rapid Experimentation...................................................... Capability 3: Solutions Are Disseminated Adaptively through Collaborative Experimentation...................................................... Capability 4: People at All Levels of the Organization Are Taught to Become Experimentalists..................................................... Conclusion................................................................ Lean Lessons.............................................................. Points for Group Discussion............................................... Notes..................................................................... Value and Waste........................................................... Waste Is Not the Same as Cost............................................. What Is Waste?............................................................ What Is Value? Start with the Customer.................................... How Do We Define Value?................................................... Rule 1: The Customer Must Be Willing to Pay for the Activity......... Rule 2: The Activity Must Transform the Product or Service in Some Way.... Rule 3: The Activity Must Be Done Correctly the First Time........... Examples of Value-Added and Non Value-Added Activities.................... Learning to Identify and Describe Waste................................... Waste of Defects..................................................... Waste of Overproduction.............................................. Waste of Transportation.............................................. Waste of Waiting..................................................... Patients and Products Waiting.................................. Employees Waiting.............................................. Waste of Inventory................................................... Waste of Motion...................................................... Waste of Nursing Motion........................................ Waste of Overprocessing.............................................. Waste of Talent...................................................... What Non Value-Added Activities Are Required?............................. Non Value-Added, Pure Waste............................................... Conclusion................................................................ Lean Lessons.............................................................. Points for Group Discussion............................................... Notes..................................................................... Observing the Process and Value Streams................................... How Do We Find Waste? Go and See.......................................... What Is a Value Stream?................................................... Contents ■ IX Value Stream Mapping........................................................... 50 Creating a Current-State Value Stream Map........................................50 The Future-State Maps............................................................52 Breaking Down Silos and Reducing Suboptimization.................................52 Observing the Process............................................................53 Activity of the Product..........................................................54 Activity of the Product—Laboratory..........................................56 Activity of the Employee.........................................................57 Activity of the Employee—Nursing............................................59 Activity of the Employee—Primary Care.......................................60 Activity of the Employee—Perioperative Services.............................62 Conclusion.......................................................................63 Lean Lessons.....................................................................63 Points for Group Discussion......................................................63 Notes............................................................................64 5 Standardized Work as a Foundation of Lean..........................................65 The Need for Standardized Work...................................................65 The Toyota House Metaphor........................................................65 Overview of the Lean Foundations.................................................67 Lean Foundations: Standardized Work..............................................67 Definition of Standardized Work..................................................67 “Current”...................................................................68 “Proper Outcome and the Highest Quality”....................................68 “To Safely Complete”........................................................69 “One Best Way”..............................................................69 “Fewest Possible Resources”.................................................70 Standardized, Not Identical......................................................70 Written by Those Who Do the Work.................................................71 Considering How Long Tasks Take..................................................72 Staffing Based on Data......................................................... 72 Types of Standardized Work Documents.............................................73 Standardizing Daily Routines.....................................................74 Defining Roles and Responsibilities..............................................74 Quick Changeover as Standardized Work............................................75 Explaining Why through Standardized Work.........................................76 Standardized Work Documents and the Standardized Work System.....................77 Measuring and Observing for Standardized Work Adherence..........................78 “Resistance” to Standardized Work?...............................................78 Asking Why When Standardized Work Is Not Followed................................79 Standardized Work Can Apply to Physicians........................................80 Lean and Checklists..............................................................82 Standardized Work Can Apply to Managers..........................................82 Training through Standardized Work...............................................83 Conclusion.......................................................................84 Lean Lessons.....................................................................84 x ■ Contents Points for Group Discussion....................................................84 Notes..........................................................................85 6 Lean Methods: Visual Management, 5S, and Kanban................................87 Lean Is More than Tools, but Tools Can Help...................................87 Reducing Waste through Visual Management.......................................87 Examples of Visual Management for Patient Flow................................88 Examples of Visual Management to Prevent Process Problems.....................89 5S: Sort, Store, Shine, Standardize, and Sustain..............................89 First S: Sort.............................................................90 Second S: Store...........................................................91 Third S: Shine............................................................92 Fourth S: Standardize.....................................................93 Fifth S: Sustain........................................................ 96 Safety as a Sixth S?....................................................... 96 Kanban: A Lean Approach to Managing Materials.......!.........................97 Problems with Traditional Materials Systems....................................98 Trade-offs with Inventory......................................................99 Using Kanban to Replenish Supplies............................................101 Conclusion....................................................................108 Lean Lessons..................................................................109 Points for Group Discussion...................................................109 Notes.........................................................................109 7 Proactive Root Cause Problem Solving...................................... Ill The Mary McClinton Story......................................................Ill Improving Quality and Patient Safety..........................................112 Cultural Obstacles to Quality Improvement.....................................112 Why Do Errors Occur?..........................................................113 Violations and Errors, Lapses, and Slips.................................113 Examples of Quality Improvement...................„...........................114 Finding Root Causes and Preventing Errors.....................................115 Workarounds and the Need for Fixing Root Causes...............................115 Asking Why Instead of Who.....................................................117 Start at the Gemba............................................................118 Find Root Causes Using Simple Methods.........................................119 A3 Problem Solving............................................................119 Be Proactive and Use Failure Modes and Effects Analysis...................... 126 Proactive Resolution of Near-Miss Problems....................................127 The Safety Pyramid........................................................... 128 Conclusion....................................................................129 Lean Lessons.................................................................„129 Points for Group Discussion................................................. 129 Notes.........................................................................130 8 Preventing Errors and Harm....................................................133 A Problem That Is Not Going Away..............................................133 Moving Beyond Blaming Individuals.............................................133 Contents ■ xi The Darrie Eason Case.........................................................134 Creating Quality at the Source through Error Proofing.........................134 Being Careful Is Not Enough...................................................135 Why 100% Inspection Is Not 100% Effective..................................... 136 Types of Error Proofing.......................................................137 Make It Impossible to Create the Error...................................137 Make It Harder to Create the Error.......................................137 Make It Obvious the Error Has Occurred...................................140 Make the System Robust So It Tolerates the Error.........................141 Error Proofing, Not Dummy Proofing............................................141 Examples of Error Proofing in Hospitals.......................................142 Banned Abbreviations as Error Proofing...................................142 Computer Systems as Error Proofing.......................................143 Preventing Surgery Errors through Error Proofing.........................144 Stopping the Line (Andon).....................................................144 Error Proofing the Error Proofing.............................................146 Conclusion....................................................................147 Lean Lessons..................................................................147 Points for Group Discussion...................................................147 Notes.........................................................................147 9 Improving Flow................................................................151 Waiting: A Worldwide Problem..................................................151 Focusing on Flow..............................................................152 Value Streams Should Flow Like a River........................................152 Uneven Workloads as a Barrier to Flow.........................................154 Naturally Occurring Unevenness...........................................154 Mura Caused by Morning Rounds............................................154 Mura Caused by Suboptimizing Courier Routes..............................155 Mura Created by Clinic Scheduling........................................156 Mura in the Patient Discharge Process....................................157 Addressing Mura by Matching Staffing to Workloads.............................159 Improving Patient Flow........................................................162 Improving Patient Flow in the Emergency Department.......................162 Reducing “Door-to-Balloon” Time..........................................164 Improving Patient Flow in Outpatient Cancer Treatment....................165 Improving Flow for Ancillary Support Departments..............................166 Improving Flow in Clinical Laboratories..................................167 Reducing Delays in Specimen Collection...................................167 Reducing Delays in the Receiving Areas of the Lab........................168 Improving Flow Also Improves Quality and Teamwork........................169 Reducing Delays Inside the Testing Areas of the Lab......................170 Improving Flow in Anatomic Pathology.....................................170 Improving Flow in Pharmacies.............................................172 Conclusion....................................................................174 Lean Lessons..................................................................174 xii ■ Contents Points for Group Discussion...................................................174 Notes.........................................................................174 10 Engaging and Leading Employees................................................177 Changing How We Manage........................................................177 What Is a Manager’s Role?.....................................................179 Strategy Deployment...........................................................180 Common Management Problems.................................................. 181 Lean as a Management System and Philosophy....................................182 A Daily Lean Management System................................................182 Process Audits or Rounding..............................................183 Standardized Audits of the Standardized Work.......................184 A Hierarchy of Rounding............................................184 Performance Measures....................................................186 Timely Measures Drive Timely Improvement...........................186 A Balanced Scorecard Focuses on All Stakeholders...................187 Metrics Should Be Visible, Visual, and Statistically Meaningful....188 Daily Stand-up Team Meetings............................................191 Kaizen and Suggestion Management........................................192 Problems with Suggestion Boxes.....................................193 The Role of Supervisors in Kaizen..................................193 Finding a Better Method for Managing Kaizen...................... 194 Visual Tracking of Suggestions.....................................197 Communicating Kaizen Changes.......................................198 Conclusion....................................................................198 Lean Lessons..................................................................199 Points for Group Discussion...................................................200 Notes.........................................................................200 11 Getting Started with Lean.....................................................203 How Do We Start?..............................................................203 Where Do We Start?............................................................204 What Do We Call It?...........................................................206 Types of Kaizen............................................................. 207 Kaizen Events.................................................................207 Pitfalls of Kaizen Events...............................................208 Lean Transformation...........................................................210 Executive Sponsorship and Leadership..........................................211 Starting from the Middle......................................................212 Establishing a Model Line and a Road Map......................................213 Chartering a Project..........................................................214 Dedicating Internal Resources: The Lean Team..................................214 The Importance of Change Management...........................................216 A Snapshot of Hospital Success: Avera McKennan Hospital.......................217 Conclusion....................................................................220 Lean Lessons..................................................................221 Contents ■ xiii Points for Group Discussion.....................................................221 Notes...........................................................................221 12 A Vision for a Lean Hospital.....................................................223 Introduction.....................................................................223 When Is a Hospital Lean?.........................................................223 What Would a Lean Hospital Look Like?............................................224 What Would a Patient Experience in a Lean Hospital?..............................224 What Would It Be Like to Work in a Lean Hospital?................................225 How Would We Describe a Lean Hospital?...........................................226 Strategy and Management System.............................................226 Patients...................................................................227 Employees..................................................................227 Waste and Kaizen...........................................................227 Technology and Infrastructure..............................................228 Points for Group Discussion......................................................228 Notes............................................................................229 Glossary Terms........................................................................231 Index.................................................................................237 Building on the success of the Shingo Prize-Winning first edition, Hospitals: Improving Quality, Patient Safety, and Employee Engagement, Second Edition explains how to use the Lean management system to improve safety, quality, access, and morale while reducing costs. Lean healthcare expert Mark Graban examines the challenges facing today’s health systems, including rising costs, falling reimbursement rates, employee retention, and patient safety. The new edition of this international bestseller begins with an overview of Lean methods. It explains how Lean practices such as value stream mapping and process observation can help reduce wasted motion for caregivers, prevent delays for patients, and improve the long-term health of your organization. In addition to a new introduction from John Toussaint, this updated edition includes: • New material on process audits, performance measures, employee suggestion management, and strategy deployment • New case studies—including a new Kanban case study (Northampton General Hospital) and another that ties together the themes of standardized work, Kanban, 5S, visual management, and Lean leadership • New examples throughout, including revised chapters on patient safety and medical errors Detailing the steps needed for a successful transition to a Lean culture, the book provides the understanding of Lean methods—including standardized work, error proofing, root cause problem solving, and daily improvement processes—needed to reduce common hospital errors. The balanced approach outlined in this book will guide you through the process of improving quality of service while reducing costs in your hospital.
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