Transcript Slide 1

Presented by
Kathy Pflaum, BBA,
St. Francis Health Center, Topeka, KS
SESSION OBJECTIVES
 Participants should be able to define LEAN
 Participants should be able to define DMAIC
 Learn how LEAN is applicable to Pharmacy
Purchasing
LEAN GOAL
 Create flow and pull value through the value stream by
eliminating operations that do not add value.
DO YOU ALREADY HAVE THE
WRONG IDEA?
 Common misconceptions about LEAN
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It is a factory thing - started by Toyota
It will not work here, just another program
It is all about 1 piece flow
6S is about cleaning up your office and work area
We are different
It is an excuse to take away our jobs
WHAT IS LEAN?
 A structured method to drive out waste in any process
in the health care environment.
 Focused on adding value in serving the customer.
 Any group of tasks is a process.
 Focuses on reducing waste and adding value to
improve business metrics.
LEAN THINKING
 A methodology focused on eliminating waste in the
processes from the voice of the customer.
 Focus on the rights:
 Right Service
 Right Amount
 Right Place
 Right Time
 Right Condition
ROOM FOR IMPROVEMENT
 “The level of waste in U.S. medicine approaches 50%”

Don Berwick, MD, MPP, FRCP – President and CEO
• Institute for Healthcare Improvement
CAN YOU CHANGE BEHAVIOR?
 LEAN is about a way of thinking
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How we do the job every day
Improving the processes in the work environment
Value added tasks from the customer expectation
Providing the opportunity to work for delighted customers
Reducing MUDA – Japanese term for activity that is wasteful
and does not ad value from the customers perspective
DEFINING VALUE ADDED TASKS
 How do you know?
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KEEP – Value Added Activities
MINIMIZE – Non-value added but necessary to complete the
task or treatment
ELIMINATE – Non-value added MUDA
ALL DEFINITION OF VALUE ADDED TASKS MUST BE FROM
THE VOICE OF THE CUSTOMER.
METHODOLOGY - DMAIC
 DEFINE
 MEASURE
 ANALYZE
 IMPROVE
 CONTROL
METHODOLOGY - DEFINE
 Define who the customers are in the process
 What are the customer’s requirements and
expectations?
 Where is the starting point and ending point of the
project
 Know what the current process is by mapping the
process flow.
METHODOLOGY - MEASURE
 What is the customer demand?
 Develop a data collection plan for the product or
process
 Create a Value Stream Map
METHODOLOGY - ANALYZE
 What is the difference between the current
performance and the goal performance?
 Prioritize improvement opportunities
 Look for MUDA at every turn
 Ask WHY, WHY, WHY, WHY, WHY
METHODOLOGY - IMPROVE
 Create world class solutions
 Develop and implement improvement plans
 6S is a fast way to improve with a KAIZON event.
METHODOLOGY - CONTROL
 Prevent going backward to the way “we have always
done it”
 Develop a monitoring plan
 Make the new process a habit for the institution
 Celebrate your success
DEFINE WITH A CHARTER
 Develop a Charter – an agreement between
management and the team about expectations.
 The Charter is a dynamic document, meant to be
changed.
 Elements of the Charter
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Business Case – Why do this project and expected benefits
Problem & Aim Statements
Project Scope - Set boundaries
Measureable Goal – VOICE OF THE CUSTOMER LINK
Financial Benefits – Soft or Hard Green dollars
CENTRAL SUPPLY CASE STUDY –
Building the Charter
 BUSINESS CASE - Change PARs on the 5th floor in
both supply rooms to meet the demands of the
customer and reduce inventory dollars by 40%.
 PROBLEM STATEMENT - Both supply rooms on 5th
floor have items stocked in abundance of the need of
the customer, thus having excess inventory dollars tied
up in unnecessary stock.
 AIM STATEMENT - Increase/decrease PARs on 5th
floor supply rooms to meet the needs of the Nursing
Staff and reduce inventory stocked in the supply rooms
by 40%.
CASE STUDY – Building the Charter
 PROJECT SCOPE START: Collect data about usage
and current PARs from the Lawson system.
END: Changing of PARs and reducing the inventory on
hand in the supply rooms.
 MEASURABLE GOAL CTQ: Have the supplies in the
supply room when the Nursing Staff needs them.
GOAL: Reduce inventory by 40%
 FINANCIAL BENEFITS - Reduction of inventory.
Increased supply turns
Increased ROI
CASE STUDY – Building the Charter
 PROJECT PLAN - Milestones
Data Analysis of 6th floor supply inventory and data
Compiled 7/14/2009
Recommended PARs reviewed by 6th floor Nursing
Services completed 7/21/2009
Charter review done with Champion 5/18/2009
PARs changed to agreed upon #’s and guns
uploaded for inventory 8/4/2009
 RESOURCES and ROLES - Lawson reports
5th floor Nursing Services and SPD – Lisa Dunn
DEFINE – LEAN DELIVERABLES
 Evaluate the Voice of the Customer (VOC)
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Describe the needs and the perceptions of the product or
service from the customer perspective.
Validate the hypothesis of customer need
Listen to the customer by asking open ended questions
•Central Supply Project
•Our customers were as follows: Nurses, Patients, Aides, Family &
Friends of Patient
DEFINE – MAP THE PROCESS
 SIPOC
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Suppliers
Inputs
Process
Outputs
Customer
CENTRAL SUPPLY CASE STUDY SIPOC
SUPPLIER
SPD
INPUT
Master Supply
List
ORDERS
Discovery of need
OUTPUT
Supply item
correct
Phone
Orders
Manufacturer
Computer
Baxter
Supply item
incorrect
SPD
Place Order
Patients
Oral
Respiratory Therapy
Patient Requests
Written
WAIT Apology To Patient
Delivered
Walk In
Right Item Delivered
Physical Therapy
Physcians
Lawson
Delivered
Wholesaler
Nursing Services
Patients
Order
Nursing Services
CUSTOMER
Wrong Item Delivered
Hospital
Clinics
Department - EVS,
RX
DEFINE – PLAN THE PROJECT
 Get an ARMI
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A = Approval of team decisions – the sponsor or champion
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R = Resource to the team
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M = Member of the team
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I = Interested party
DEFINE – WHAT MARKS SUCCESS?
 Do you have a focused project?
 Is it relevant to your business?
 Is your methodology sound?
 Can you execute?
 Do you have the right ARMI?
MEASURE – WHY?
 Without measurement capabilities how do you know
if you improved the process?
 Data allows for us to remember all situations.
Customers tend to remember the extremes.
 Without data, there is no base line
WHAT IS A GOOD MEASURE?
 Measurement is reflective of the VOC.
 Measurement is tied to business goals
 Identified improvement opportunities can be
measured
 Can be measured consistently over time
Data vs. Tribal Knowledge
You don’t need
data. . .I can tell
you what the
problem is!
A customer remembers the extremes – what impacts them (today).
Data allow us to remember all situations,
and presents an objective picture of the process.
VOICE OF THE CUSTOMER
 Do you know who the customer is?
 Do you know what the customer wants? Do you
really know?
 Are you listening?
CENTRAL SUPPLY CASE STUDY
 Identified customers were:
 Nursing Services
 Patients
 Physicians
 SPD
 Other Departments such as Pharmacy, EVS
 Clinics
 Hospital in general
MEASURE – TYPES OF DATA
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Continuous Data
 Measures of time, dollars, etc.
 Cost per test, product utilization per billable unit
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Discrete Data
 Counts of defects
 Number of corrected test reports, number of OSHA
incidents
WHAT IS VARIBLE DATA?
 Time
 Money
 Scaled Measurement (I.e. length, height, weight,
temperature)
 Can have decimals or fractions
 Throughput (volume of work accomplished)
VARIBLE DATA
 Examples of Variables Data:
 Waiting Time
 Cost per case for a DRG
 Daily patient weight
 Monthly accounts receivable
 Volume of prescriptions filled
WHAT IS ATTRIBUTE DATA?
 Discrete-whole numbers-not measures
 (Original data can’t be a fraction or scaled data)
 Two kinds of attributes data:
 Count..1,2,3,4,etc. (Defects)
 Classification..either-or data (good/bad, pass/fail,
yes/no) (Defectives)
ATTRIBUTE DATA
 Examples of Attribute Data:
 # falls per # of patient days this month
 # medication errors per 1000 doses
 proportion of diabetic patients who smoke
 proportion of patients who died (mortality)
CENTRAL SUPPLY PROJECT
ITESTO
CKUOM
current
par
level
ITLLASTISSCOST
current
value
suggest
ed par
ITLLASTISSCOST
suggest
ed
value
QTY
ISSUE
D3
MONT
HS
QTY
ISSUE
D IN5
MONT
HS
ITLITEM
ITM-ITEM-DESCRIPTION
10087
DRESSING ADAPTIC 3X8IN
EA
3
0.684
2.052
3
0.684
2.052
18
45
10114
SYRINGE 30CC ST
EA
10
0.214
2.14
8
0.214
1.712
59
139
10153
SYRINGE 60CC ECC TIP
EA
5
0.4674
2.337
4
0.4674
1.8696
29
37
10496
TOOTHPASTE GEL WHT 0.6OZ TUBE
EA
20
0.1308
2.616
10
0.1308
1.308
273
591
10547
NEEDLE NOVOFINE SAFETY 30GX8MM
EA
200
0.4531
90.62
200
0.4531
90.62
4196
7296
10625
GAUZE ROLL 4IN BULKLEE STER
EA
20
0.548
10.96
8
0.548
4.384
159
405
10628
PACKING IODOFORM 1/2INX5YD
EA
2
2.0759
4.1518
1
2.0759
2.0759
1
4
10629
PACKING IODOFORM 1INX5YD
EA
2
2.51
5.02
1
2.51
2.51
0
1
10630
PACKING PLAIN 1/2INX5YD
EA
2
2.1008
4.2016
1
2.1008
2.1008
1
4
10638
PACKING PLAIN 1/4INX5YD
EA
2
1.7401
3.4802
1
1.7401
1.7401
3
9
10641
PACKING IODOFORM 1/4INX5YD
EA
2
1.8485
3.697
1
1.8485
1.8485
0
1
10643
SPONGE DRN N/WOV 4X4IN STER
EA
50
0.0995
4.975
25
0.0995
2.4875
175
300
10644
PAD ABD 5X9IN STER
EA
25
0.0964
2.41
25
0.0964
2.41
75
300
10648
SPONGE GZE4X4 12-PLY STER 2/PK
EA
100
0.0527
5.27
25
0.0527
1.3175
400
1090
WORST OFFENDERS FOR PHONE
OR WALK IN ORDERS
MARCH APRIL ABNORMAL ORDER PLACEMENT BY DEPARTMENT
14000
92.9%
13469
94.0%
95.0%
95.9%
96.7%
97.4%
98.0%
98.4%
100.0%
90.0%
89.7%
12000
80.0%
70.0%
10000
DEFECTS
60.0%
8000
50.0%
40.0%
6000
30.0%
4000
20.0%
2000
10.0%
469
172
149
141
115
110
87
65
234
Tele
5West
Medical
PCU
Rehab
Peds
ICU
Other
0
0.0%
Surgery
ED
CATEGORIES
ANALYZE – WHERE IS THE WASTE?
 8 Types of waste
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Defects
Overproduction
Transportation
Waiting
Inventory
Motion
Processing
Intellect
ANALYZE – STANDARD WORK
 Standard work allows the process to be high quality on
a reliable and sustained basis.
 The objective is to clearly communicate exactly how
the job should be performed.
 It optimizes the work flow in the best known sequence
and utilizes the most effective combination of
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People
Materials
Methods
Machines
5 Whys
 Focused Problem
 Customers complain about
waiting too long to get
connected to staff during
lunch hours.
WHY does this problem happen?
Backup operators take longer to
connect callers.
WHY does it take backup operators longer?
Backup operators don’t know the job as well as
the regular operators do.
WHY don’t the backup operators know the job as
well?
There is no special training, no job aids to
make up for the gap in experience, or on-thejob learning for the backup operators.
WHY don’t they have special training or job
aids?
In the past, the organization has not
recognized this need.
WHY hasn’t the organization
recognized this need?
The organization has no system
to identify training needs.
CONSISTENCY
UNNECESSARY
INVENTORY
COMMUNICATION
Communication
of MFG
backorders
Incorrect
Item
EMERGENT
NEED
EDUCATION
ORDERING
DELIVERY
QUICK HITS – A PHARMCY
FAVORITE
 Quick hits are rapid Improvement Opportunities
 If there is any doubt about doing it validate before
proceeding.
PHARMACY OPPORTUNITY
PAID FOR VISIPAQUE
MONTH
08
Ap
ri l
08
Ju
ne
08
Au
g
ct
08
O
D
ec
08
09
IF BOUGHTON CONTRACT
COST
Fe
b
09
$4,500.00
$4,000.00
$3,500.00
$3,000.00
$2,500.00
$2,000.00
$1,500.00
$1,000.00
$500.00
$0.00
Ap
ri l
DOLLARS
CHANGING FROM VISIPAQUE TO ISOVUE 100ML
IMPROVE – BRAINSTORMING
 Generating solutions – ask the people who do the job
 Brainstorming to be successful
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Do not judge ideas, let them flow out
Encourage “far-out” ideas
Hitchhiking on others ideas is encouraged
CENTRAL SUPPLY CASE STUDY IMPROVE
 After brainstorming, it was decided that the PAR
reduction would be a quick hit.
 An additional Charter was written to define, analyze,
measure, improve and control the ordering process
 Templates were built for each nursing unit with their
specific needs on the template
 Training on using Lawson to order was conducted.
 Expectations were set for ordering all items through
Lawson versus call ins and walk-ins.
IMPROVE – 6S
 SORT – Keep only what is required
 STORE – Arrange and identify for ease of use
 SHINE – Clean
 STANDARDIZE – Eliminate causes to reduce variation
 SUSTAIN – Discipline, a plan, a schedule – stick to it!!
 SAFETY
IMPROVE – 6S BENEFITS
 Opportunity for creative input.
 Pleasing work area.
 Increased job satisfaction.
 Removes obstacles and frustrations in a constructive
setting.
 Organizes work load.
 Clearer communication
CONTROL – IT IS EASY TO REVERT
 Provides a method to continue to monitor the
improvement.
 Effectively maintaining means:
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Verify the results for at least 12 months
Document the new methods in a way that people will
understand and use.
Make regular course corrections.
Share the information learned with co-workers.
Think about what is the next improvement.
CONTROL – REPORT THE RESULTS
 Keep it simple!
 Document the learning's from the project.
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Results
Work process
Team’s process
Share with the organization
OTHER LEAN PHARMACY
PROJECTS
 Vaccines for Children implementation
 IV Waste project
 Revenue Charging Changes for the Health Center
 Revenue Charging Changes for the clinics
 Hazardous Pharmaceutical Waste
 Dietary Procurement
 Cancer Medication treatment cost tables
CELEBRATE!!