Lean Hospitals : Improving Quality, Patient Safety, and Employee Engagement, 3rd Edition

Organizations around the world are using Lean to redesign care and improve processes in a way that achieves and sustains meaningful results for patients, staff, physicians, and health systems. Lean Hospitals, Third Edition explains how to use the Lean methodology and mindsets to improve safety, quality, access, and morale while reducing costs, increasing capacity, and strengthening the long-term bottom line.

This updated edition of a Shingo Research Award recipient begins with an overview of Lean methods. It explains how Lean practices can help reduce various frustrations for caregivers, prevent delays and harm for patients, and improve the long-term health of your organization.

The second edition of this book presented new material on identifying waste, A3 problem solving, engaging employees in continuous improvement, and strategy deployment. This third edition adds new sections on structured Lean problem solving methods (including Toyota Kata), Lean Design, and other topics. Additional examples, case studies, and explanations are also included throughout the book.

Mark Graban is also the co-author, with Joe Swartz, of the book Healthcare Kaizen: Engaging Frontline Staff in Sustainable Continuous Improvements, which is also a Shingo Research Award recipient. Mark and Joe also wrote The Executive’s Guide to Healthcare Kaizen.

Foreword
Preface
Author

Chapter 1 : The Need for Lean Hospitals

• Better Results with Lean
• Why Do Hospitals Need Lean?
• A Renewed Sense of Purpose
• Lean Methods Are Not New to Healthcare
• Toyota’s Role in Popularizing Lean
• Origins of the Term Lean
• Lean Is Proven to Work outside Automotive Factories
• Lean Is Helping Hospitals Improve
• Problems in Healthcare
• Good Quality Costs Less
• Interconnected Benefits
• A Snapshot of Department Success: Laboratory, Children’s Health Dallas
• From Departmental to Hospital- and System-Wide Success
• Conclusion
• Lean Lessons
• Points for Group Discussion
• Notes

Chapter 2 : Overview of Lean for Hospitals and Health Systems

• What Is Lean?
• Ohno’s Definition of Lean
• Lean Thinking
• The Toyota Triangle: Tools, Culture, and Management System
• The "Toyota Way" Philosophy
• Four Organizational Capabilities for Lean
• Lean and Other Methodologies
• What Lean Is Not
• Conclusion
• Lean Lessons
• Points for Group Discussion
• Notes

Chapter 3 : Value and Waste

• Waste: A Global Problem with Local Solutions
• Reducing Waste Is a Better Goal Than Reducing Cost
• What Is Waste?
• What Is Value? Start with the Customer
• How Do We Define Value in a Broad Sense?
• How Does Lean Define "Value?"
• Examples of Value-Added and Non-Value-Added Activities
• Learning to Identify and Describe Waste
• There’s Not Always an Easy Answer
• What Non-Value-Added Activities Are Required?
• Non-Value-Added, Pure Waste
• Conclusion
• Lean Lessons
• Points for Group Discussion
• Notes

Chapter 4 : Observing the Process and Value Streams

• Learning to See
• How Do We Find Waste? Go and See
• What Is a Value Stream?
• Value Stream Mapping
• Creating a Current-State Value Stream Map
• The Future-State Maps
• Breaking Down Silos and Reducing Suboptimization
• Observing the Process
• Activity of the Product
• Activity of the Employee
• Conclusion
• Lean Lessons
• Points for Group Discussion
• Notes

Chapter 5 : Standardized Work as a Foundation of Lean

• Helpful Standardization: From 171 Forms to Just Six
• The Need for Standardized Work
• The Toyota House Metaphor
• Overview of the Lean Foundations
• Lean Foundations: Standardized Work
• Definition of Standardized Work
• Standardized, Not Identical
• Written by Those Who Do the Work
• Considering How Long Tasks Take
• Staffing Based on Data
• Types of Standardized Work Documents
• Standardizing Daily Routines
• Defining Roles and Responsibilities
• Quick Changeover as Standardized Work
• Explaining Why through Standardized Work
• Standardized Work Documents and the Standardized Work System
• Measuring and Observing for Standardized Work Adherence
• "Resistance" to Standardized Work?
• Asking Why When Standardized Work Is Not Followed
• Standardized Work Can Apply to Physicians
• Lean and Checklists
• Standardized Work for Raising Concerns
• Standardized Work Can Apply to Leaders
• Training through Standardized Work
• Conclusion
• Lean Lessons
• Points for Group Discussion
• Notes

Chapter 6 : Lean Methods : Visual Management, 5S, and Kanban

• Lean Is More Than Tools, but Tools Can Help
• Reducing Waste through Visual Management
• Examples of Visual Management for Patient Flow
• Examples of Visual Management to Prevent Process Problems
• 5S: Sort, Store, Shine, Standardize, and Sustain
• Safety as a Sixth S?
• Kanban: A Lean Approach to Managing Materials
• Problems with Traditional Materials Systems
• Trade-Offs with Inventory
• Using Kanban to Replenish Supplies
• Conclusion
• Lean Lessons
• Points for Group Discussion
• Notes

Chapter 7 : Proactive Root Cause Problem Solving

• The Tragic and Preventable Mary McClinton Story
• Improving Quality and Patient Safety
• Cultural Obstacles to Quality Improvement
• Why Do Errors Occur?
• Examples of Quality Improvement
• Finding Root Causes and Preventing Errors
• Workarounds and the Need for Fixing Root Causes
• Asking Why Instead of Who
• Start at the Gemba
• Find Root Causes Using Simple Methods
• A3 Problem Solving
• Toyota’s Practical Problem Solving
• Be Proactive and Use Failure Modes and Effects Analysis
• Proactive Resolution of Near-Miss Problems
• The Heinrich Safety Pyramid
• Conclusion
• Lean Lessons
• Points for Group Discussion
• Notes

Chapter 8 : Preventing Errors and Harm

• A Serious Problem with Large, Unknowable Numbers
• Moving beyond Blaming Individuals
• The Darrie Eason Case
• Creating Quality at the Source through Error Proofing
• Being Careful Is Not Enough
• Why 100% Inspection Is Not 100% Effective
• Types of Error Proofing
• Error Proofing, Not Dummy Proofing
• Examples of Error Proofing in Hospitals
• Stopping the Line (Andon)
• Error Proofing the Error Proofing
• Conclusion
• Lean Lessons
• Points for Group Discussion
• Notes

Chapter 9 : Improving Flow

• Lean Is Both Quality and Flow
• Waiting: A Worldwide Problem
• Targets without a Means for Improvement Might Lead to Improvement or Dysfunction
• Focusing on Flow
• Value Streams Should Flow Like a River
• Uneven Workloads as a Barrier to Flow
• Addressing Mura by Matching Staffing to Workloads
• Improving Patient Flow
• Improving Flow for Ancillary Support Departments
• Conclusion
• Lean Lessons
• Points for Group Discussion
• Notes

Chapter 10 : Lean Design

• Better, Faster, and Cheaper
• Understanding the Current State before Designing the Future
• Lean Design at East Tennessee Children’s Hospital
• Integrated Lean Project Delivery at Akron Children’s Hospital
• Conclusion
• Lean Lessons
• Points for Group Discussion
• Notes

Chapter 11 : Engaging and Leading Employees

• Improving the Way We Manage
• What Is a Manager’s Role?
• Strategy Deployment
• Common Management Problems
• Lean as a Management System and Philosophy
• A Daily Lean Management System
• Performance Measures
• Conclusion
• Lean Lessons
• Points for Group Discussion
• Notes

Chapter 12 : Getting Started with Lean

• How Do We Start?
• The LEI Lean Transformation Model
• Where Do We Start?
• What Do We Call It?
• Getting Started with Kaizen
• Kaizen Events
• Lean Transformation Projects
• The Lean Project Team
• Executive Sponsorship and Leadership
• Starting from the Middle
• Establishing a Model Line and a Road Map
• Dedicating People to Lean Beyond Projects
• The Lean Department
• The Importance of Change Management
• A Snapshot of Hospital Success: Avera McKennan Hospital & University Health Center
• Conclusion
• Lean Lessons
• Points for Group Discussion
• Notes

Chapter 13 : A Vision for a Lean Hospital and Health System

• Introduction
• When Is a Health System Lean?
• What Would a Lean Health System Look Like?
• What Would a Patient Experience in a Lean Health System?
• What Would It Be Like to Work in a Lean Health System?
• How Would We Describe a Lean Health System?
• In Conclusion
• Points for Group Discussion
• Notes

Glossary
Index