Mark Graban - Kaizen Presentation for Spain

The Present and Future of
Lean Healthcare
Mark Graban

Jornadas Lean Healthcare
en a

September 20, 2012

© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved.

Why Lean for Healthcare?

No waiting

No waste

Zero harm
Source: an NHS hospital, UK

Hospital Layoffs & Cost Cutting


“No Layoffs Due to Lean”


Layoffs Aren’t a Long-Term Fix
• "After a year or so, the employee
count is back up and the savings
evaporate.”
• "There has to be a better, longer
lasting and less traumatic way to
deal with such fiscal situations."
Gary J. Passama, CEO NorthBay Healthcare
(Fairfield, CA)


TPS: “Equally Important Pillars”

Continuous Respect
Improvement
For
People


Kaizen is for Everyone!
“… emphasizes morale-
boosting benefits and
positive employee
participation over the
economic and financial
incentives…”
- Masaaki Imai


Dr. Berwick’s
Call for Kaizen (1989)

– Kaizen = “the continuous search for
opportunities for all processes to get better”

• Dr. Donald Berwick
– Founder, Institute for Healthcare Improvement
– Former Administrator, Medicare and Medicaid (CMS)

Citation: Berwick, DM, “Continuous improvement as an ideal in health care,” New
England Journal of Medicine, 1989 May 25;320(21):1424-5.

Easier to Say Than to Do


Early Collaborations


11


5S
A3

Kaizen
VSM
Std Work
Kanban

12

5S A3

Kaizen
Kanban
Std Work VSM

Management System
Philosophy
Culture
Thinking
Mindsets

13

St. Elisabeth Hospital: The Netherlands

Dr. Jacob Caron, Orthopedic Surgeon
Chairman of the medical staff


• 90% reduction in CR-BSI in MICU and Oncology
• Saved $1.7M
• Saved 17 days L.O.S. per case
Source: Dr. Richard Shannon

Improving Radiology
/MRI Access Time
14

12
Weeks Waiting Time

10

8

6

4

2

0


ThedaCare “Door to Balloon” Time
100
90
91
80
70 65
60
50 52
40 37 37 45
30
20
10
0
2005 2006 2007 2008 2009 2010


ThedaCare’s Collaborative Care
Med Rec Errors per Chart Patient Satisfaction
1.2 100%
1 80%
0.8
60%
0.6
40%
0.4
0.2 20% n/a
0 0%
2006 2008 Traditional 2008 Collaborative 2006 2008 Traditional 2008 Collaborative

Pneumonia Bundle Compliance Cost per Case
120% $8,000
$7,000
100%
$6,000
80% $5,000
60% $4,000
$3,000
40%
$2,000
20% $1,000
0% $0
2006 2008 Traditional 2008 Collaborative 2006 2008 Traditional 2008 Collaborative

Source: Health Affairs

Denver Health
• “Denver Health Lean process
has generated more than $135
million in financial benefit since
2006 (as of early 2012)”
• Without those savings, Denver
Health would "absolutely have
had to cut jobs," CEO Patricia
Gabow said.


Kaizen = Change for the Better

• ‘Kai’ means “change.”

• ‘zen’ means “good.”


“What Sets Us Apart?”
“Every Toyota team member is
empowered with the ability to
improve their work environment. This
includes everything from quality and
safety to the environment and
productivity. Improvements and
suggestions by team members are
the cornerstone of Toyota's success.”

Different Levels of Kaizen
Very few
Large issues System
Kaizen

Six
Few Sigma
Medium issues
Lean
Event

Many
Small issues
Daily Kaizen

Adapted from: “The Toyota Way Fieldbook,” Liker and Meier

“Quick and Easy” Kaizen
Find
1. Find
2. Discuss Discuss

3. Implement
Implement
4. Document
5. Share Document

Share


“Bubbles for Babies” Example


Kaizen: Real, Daily, Visual
(Visual Idea Board)

© 2012 Mark Graban and/or Joseph E. Swartz. All Rights Reserved. Children’s Medical Center Dallas (Lab)

Completed “Idea Card”


Kaizen: Real, Daily, Visual
(Electronic - KaiNexus)


Kaizen as a Way of Thinking

Greg Jacobson, MD
CEO & Co-Founder, KaiNexus


Kaizen Principles

• Continually improve, with no
idea being too small

Adapted from: Jacobson, Gregory H. MD, Nicole Streiff McCoin MD, Richard Lescallette, Stephan Russ MD, MPH, and Corey M. Slovis MD, “Kaizen: A
Method of Process Improvement in the Emergency Department,” Academic Emergency Medicine, Volume 16, Issue 12, pages 1341-
1349, December 2009.


Kaizen Principles

• A major source of quality defects
is problems in the process



Kaizen Principles
• Focus change on common
sense, low-cost, and low-risk
improvements, not major
innovations



Kaizen Principles

• All ideas are addressed and
responded to in some way



Kaizen Principles

• Empower the worker to enact
change



Kaizen Principles

• Collect, verify, and analyze data
to enact change



Before / After Data from CMC Lab
Before Lean 12 Months
After Starting
Lean
3. I have the opportunity to do what I do
best every day.
3.11 3.92
8. I feel free to make suggestions for
improvement.
2.84 3.48
10. I feel secure in my job.
2.32 3.42
13. Stress at work is manageable.
2.43 3.23
17. I am satisfied with the lab as a place
to work.
2.51 3.43
18. I would recommend my work area as
a good place to work to others.
2.38 3.46
Grand Average
2.96 3.69

# of Recorded Kaizens
4,500 4,225
3,951
4,000

3,500

3,000 2,822

2,500
2,046
2,000

1,500

1,000

500 281
-
2007 2008 2009 2010 2011


Franciscan Savings Impact
$2,000,000
$1,738,161

EMR
$1,500,000

$1,000,000 $887,491 $925,518

$667,238

$500,000

$190,000

$-
2007 2008 2009 2010 2011


Q&A / Contact Info
• Email: mark@LeanBlog.org
• Blog: www.LeanBlog.org
• Startup: www.KaiNexus.com
• Twitter: www.twitter.com/MarkGraban
• Books:
– www.LeanHospitalsBook.com
– www.HCkaizen.com

www.leanblog.org

Mark Graban - Kaizen Presentation for Spain

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