The Lean Doctors Workbook

Carolyn Suneja, Aneesh Suneja

Description

The content of this workbook is based on the book Lean Doctors: A Bold and Practical Guide to Transforming Healthcare Systems, One Doctor at a Time, and on the authors’ years of transforming care delivery systems with lean. The Six Success Steps discussed in the book are presented here with a focus on implementing them to achieve dramatic and sustainable change. The Success Steps are building blocks; the order in which you apply them matters. They are presented here in an order that has worked in the real world; working through them logically will help you on the path to successful implementation.
Each Success Step includes a practical explanation of the theory and maps that illustrate how that particular step impacts the care process in the context of a detailed case study. The authors use several Lean mapping tools, including lean process maps, spaghetti diagrams, and swim lane diagrams. In addition to illustrating lean concepts and their application in the context of a case study discussed throughout the book, these maps provide instructive examples that can help you create similar maps for the processes you operate.
With its interactive format and step-by-step design, this workbook is ideal for use in the classroom to teach Lean principles, or with a lean project team to guide a clinical implementation. Together with Lean Doctors, this workbook will help the student of lean or the lean project team learn and apply a complete lean system in a healthcare setting.

Sujets

• Business
• Qualité, hygiène, sécurité, environnement
• Medical
• Médecine
• Administration

Informations

• Publié par: ASQ Quality Press
• Date de parution: 19 novembre 2010
• Nombre de lectures: 0
• EAN13: 9781636940779
• Langue: English
• Poids de l'ouvrage: 4 Mo

Extrait

The Lean Doçtors Workbook

Also available from ASQ Quality Press:

Lean Doctors: A Bold and Practical Guide to Using Lean Principles to Transform Healthcare Systems, One Doctor at a Time Aneesh Suneja with Carolyn Suneja

Quality Function Deployment and Lean Six Sigma Applications in Public Health Grace L. Duffy, John W. Moran, and William Riley

The Public Health Quality Improvement Handbook Ron Bialek, John W. Moran, and Grace L. Duffy

Root Cause Analysis and Improvement in the Healthcare Sector: A Step-by-Step Guide Bjørn Andersen, Tom Fagerhaug, and Marti Beltz

Solutions to the Healthcare Quality Crisis: Cases and Examples of Lean Six Sigma in Healthcare Soren Bisgaard, editor

On Becoming Exceptional: SSM Health Care’s Journey to Baldrige and Beyond Sister Mary Jean Ryan, FSM

Journey to Excellence: Baldrige Health Care Leaders Speak Out Kathleen Goonan, editor

A Lean Guide to Transforming Healthcare: How to Implement Lean Principles in Hospitals, Medical Ofîces, Clinics, and Other Healthcare Organizations Thomas G. Zidel

Benchmarking for Hospitals: Achieving Best-in-Class Performance without Having to Reinvent the Wheel Victor Sower, Jo Ann Duffy, and Gerald Kohers

Lean-Six Sigma for Healthcare, Second Edition: A Senior Leader Guide to Improving Cost and Throughput Greg Butler, Chip Caldwell, and Nancy Poston

Lean Six Sigma for the Healthcare Practice: A Pocket Guide Roderick A. Munro

Lean for Service Organizations and Ofîces: A Holistic Approach for Achieving Operational Excellence and Improvements Debashis Sarkar

To request a complimentary catalog of ASQ Quality Press publications, call 800-248-1946, or visit our Web site at http://www.asq.org/quality-press.

The Lean Doçtors Workbook

An Application Guide for Transforming Outpatient Clinic Systems with Lean

Aneesh and Carolyn Suneja

ASQ Quality Press Milwaukee, Wisconsin

American Society for Quality, Quality Press, Milwaukee, WI 53203 © 2011 by ASQ All rights reserved. Published 2011. Printed in the United States of America.

17 16 15 14 13 12 11 5 4 3 2 1

Library of Congress Cataloging-in-Publication Data

Suneja, Aneesh, 1968- The lean doctors workbook: an application guide for transforming outpatient clinic systems with Lean/by Aneesh and Carolyn Suneja.  p. cm. Includes bibliographical references and index. ISBN 978-0-87389-813-3 (alk. paper) 1. Medical ofîces–Planning–Handbooks, manuals, etc. 2. Lean manufacturing–Handbooks, manuals, etc. I. Suneja, Carolyn, 1968–II. Title. R728.S94 2010 610.68–dc22

 2010046239

No part of this book may be reproduced in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher.

Publisher: William A. Tony Acquisitions Editor: Matt T. Meinholz Project Editor: Paul O’Mara Production Administrator: Randall Benson

ASQ Mission: The American Society for Quality advances individual, organizational, and community excellence worldwide through learning, quality improvement, and knowledge exchange.

Attention Bookstores, Wholesalers, Schools, and Corporations: ASQ Quality Press books, video, audio, and software are available at quantity discounts with bulk purchases for business, educational, or instructional use. For information, please contact ASQ Quality Press at 800-248-1946, or write to ASQ Quality Press, P.O. Box 3005, Milwaukee, WI 53201-3005.

To place orders or to request ASQ membership information, call 800-248-1946. Visit our Web site at www.asq.org/quality-press.

Printed on acid-free paper

contents

List of Figures and Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Learning Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

How to Use This Book . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  The Six Success Steps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Lean Mapping Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Application Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Your Turn Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Case Study Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Main Street Orthopedics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Minimize Patient Wait Times . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Low Patient Wait Times Indicate a Healthy System . . . . . . . . . . . . . . . . . . . . . . . . .  Application Exercise: Minimize Patient Wait Times . . . . . . . . . . . . . . . . . . . . . . . . .

Begin One Doctor at a Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Application Exercise: Begin One Doctor at a Time . . . . . . . . . . . . . . . . . . . . . . . . . .

Success Step 1: Create Physician Flow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Shared Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Changeover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Lean Process Mapping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Application Exercise: Create Physician Flow. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

v

vii

1 1

3 3 3 4 4

5 5

7 8 11

13 15

17 20 21 23 27

viContents

Success Step 2: Support Physician Value-Added Time . . . . . . . . . . . . . . . . . . . . . . . .  Team Leader Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Beneîts of the Team Leader Position . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Developing Team Leaders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Application Exercise: Support Physician Value-Added Time . . . . . . . . . . . . . . . . .

Success Step 3: Communicate Patient Stages Visually . . . . . . . . . . . . . . . . . . . . . . . .  Visual Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Patient Status Boards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Application Exercise: Communicate Patient Stages Visually . . . . . . . . . . . . . . . . .

Success Step 4: Standardize Everyone’s Work. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Deînition of Standard Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Beneîts of Standard Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Application Exercise: Standardize Everyone’s Work . . . . . . . . . . . . . . . . . . . . . . . .

Success Step 5: Lay Out the Clinic for Minimal Motion . . . . . . . . . . . . . . . . . . . . . .  Spaghetti Mapping and 5S for Individual Workstations . . . . . . . . . . . . . . . . . . . . .  Communication Flow Considerations Across the Clinic . . . . . . . . . . . . . . . . . . . . .  Application Exercise: Lay Out the Clinic for Minimal Motion . . . . . . . . . . . . . . . .

Success Step 6: Change the Care Delivery Model . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Application Exercise: Change the Care Delivery Model . . . . . . . . . . . . . . . . . . . . .

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

29 32 35 36 40

41 43 44 48

51 53 53 61

65 67 72 78

81 88

91

Standard work chart example in a fractures clinic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

39

44

Main Street Orthopedics process with changeover and a team leader . . . . . . . . . . . . . . .

A patient status board from an orthopedic clinic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

42

Figure 14

Figure 22

Figure 21

Figure 13

Figure 15

Figure 18

Figure 11

Figure 9

Figure 19

Figure 17

Figure 25

24

24

Figure 10

26

Main Street Orthopedics with physician ow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Forms pull system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

vii

Spaghetti diagram of the front desk of a busy clinic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hand-offs, delays, and communication barriers caused by inefîcient layout . . . . . . . . .

75

Main Street Orthopedics without visual communication . . . . . . . . . . . . . . . . . . . . . . . . . .

Cleaned and organized supply closet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Physician assistant–to–physician handoff with standard work . . . . . . . . . . . . . . . . . . . . .

Standard work improvement process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Figure 24

Figure 20

Figure 16

Figure 12

Figure 8

Inefîcient Main Street Orthopedics front desk layout . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FIFO lane . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Standard work chart example for day surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

57

Commonly used forms moved to point of use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

30

23

Physician Lean process map. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Main Street Orthopedics with visual communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

46

69

List of Figures and Tables

Figure 4

18

Current state at Main Street Orthopedics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9

21

Main Street process with bottlenecks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Physician Lean process map (one patient ow) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Figure 1

Main Street Orthopedics without physician ow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Physician Lean process map with communication ow. . . . . . . . . . . . . . . . . . . . . . . . . . . .

Figure 3

Figure 2

68

61

66

Figure 23

56

Physician assistant–to–physician handoff without standard work . . . . . . . . . . . . . . . . . .

54

52

69

Efîcient Main Street Orthopedics front desk layout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

72

70

Figure 6

Figure 5

Figure 7

73

Spaghetti diagram of Main Street Orthopedics layout. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

viii

List of Figures and Tables

Figure 26

Figure 27

Figure 28

Figure 29

Figure 30

Figure 31

Common staff area redesign. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Improved Main Street Orthopedics layout spaghetti diagram . . . . . . . . . . . . . . . . . . . . . .

Main Street Orthopedics casting process spaghetti diagram . . . . . . . . . . . . . . . . . . . . . . .

Departmental separation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

A cell. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Main Street Orthopedics in-room casting process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

76

77

82

84

84

87

LEARNING GOALS

Introduction

What do you hope to learn by working through The Lean Doctors Workbook?

1