International Examples of Lean in Healthcare : Case Studies of Best Practices

Typically entrenched and systemic, healthcare problems require the sort of comprehensive solutions that can only be addressed by a change in culture and a shift in thinking. 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. This book demonstrates how honest appraisal, intelligent planning, and vigilant follow-up have led to dramatic improvements in a variety of healthcare settings across the world. It teaches us how innovative organizations can find sustainable solutions to seemingly intractable problems by following a path guided by Lean Thinking. Lean methods may not solve every healthcare problem, but as these cases prove, changing a culture rather than personnel results in more effective sustainable change. This multi-authored book provides expert descriptions of Lean methods and their application in healthcare, written by the people who developed and tested the methods in healthcare settings. Each chapter brings together a description of the technique or approach, with examples of application in practice from the author’s own practice. Authors use an engaging approach to their narrative, with examples from their personal experience or engagement being described to illustrate the practical application of theoretic approaches. In painting a picture of the environment in which these tools and techniques have been applied, readers will understand the transferability to their own workplace environment. This will be an opportunity to tell real stories of the application of Lean in healthcare and give readers the opportunity to learn from people from across the world, on subjects on which they are acknowledged topic experts, based on day-to-day Lean practice. Cover Half Title Title Page Copyright Page Dedication Table of Contents Foreword Acknowledgements Editors Contributors Chapter 1 Using Lean in Healthcare Aims Introduction History and Principles Lean in Healthcare Evidence of Impact Importance of Context Examples of Lean in Healthcare Conclusions Learning Points Bibliography Chapter 2 Applying 5S in Healthcare Aims Introduction 5S Getting Started Tools for 5S 5S Tags Floor Markings Shadow Boards Signs Labelling Each Step of 5S Sort Sort Tips Set in Order Set in Order Tips Sweep Tips for the Sweep Stage Standardise Standardise Tips Sustain Tips for Sustaining 5S Safety Common Misconceptions about 5S Kanban Conclusion Learning Points Bibliography Chapter 3 The Design and Use of Good Data in Clinical Processes Aims Introduction Using Data for Improvement Outcomes Tracking Systems Outcomes (or Causal) Chains Challenges in Finding the Decision Layer General Principles for Data Design Quality Data Needs to Be Complete, Timely, Accurate, and Transparent Practical Steps for Good Data Design and Good Data Systems Learning Activities Where Does Data Design and Use Fit in an Overall Lean Improvement Effort? Conclusion Tips Learning Points Acknowledgments Bibliography Chapter 4 Hospital Flow Aims Introduction Why Improve Patient Flow? Improving Flow How Can a Hospital Work on Flow Improvement? Case Examples Context: The Dutch Healthcare System and Hospital Characteristics Case Study 1: Clinical Hospital Flow Lessons from This Case Study about Flow Lessons on How to Improve Flow Case Study 2: Outpatient Specialist Care Flow Working with Multiple Teams Conclusions General Reflection Focus of Improvement Work Learning Points Bibliography Chapter 5 Value Management Aims Introduction Development of Value Management Context Value Management Preparing the Service Identify the Existing Quality Improvement Capacity of the Organisation Understand Finance Team Capacity Assess Management Interest Review Strategic Alignment Look for the Right Fit for a First Adopter Preparing a Team Detailed Components of Value Management Box Score Pareto Analysis PDSA Cycles Visual Management Board Weekly Huddle Daily Management Conclusions Learning Points Acknowledgements Bibliography Chapter 6 Building a Model Value Stream for Older People Living with Frailty in Ireland Aims Introduction True North and Adopting Lean for Healthcare Transformation From Getting Started to System-Wide Implementation: Frailty Case Example Example of a Rapid Improvement Event at St Luke’s: ‘First 72 Hours ‒ Frailty Identification’ Preparation Days One to Five Sustain and Standardise Learning and Reflections The Role of Leadership in Transformation Culture, Context, and Insights Pace and Scale Global Pandemic Conclusions Learning Points Acknowledgements Bibliography Chapter 7 Using Lean at Scale in Mental Health Service Provision Aims Introduction Lean in Psychiatry: Is That Possible? Introducing Lean in RCP Value for the Patient Two Ambitious Goals Case Study 1: Reducing the Use of Coercive Measures Trust, Kind Words and Mutual Expectations Competency Development Patient’s Involvement in Improvement Work Changing the Physical Surroundings Meaningful Activities Providing Sensory Integration Ongoing Lessons Learned from Coercion Episodes and In-Depth Data Analyses Results Conclusions Case Study 2: Reducing Waiting Times Examples of Flow Improvements Standard Work for Assessment and Treatment New Management Tasks and Competency Development Data-Driven Management Results Conclusions Shared Features from the Two Case Studies Meaningful Goals as a True North Managerial Focus and Willpower Continuous Systematic Improvement Works Locally and across the Organisation Management Decisions Driven by Data, Facts and Knowledge The Importance of Courage and PDSA Thinking Let Someone Pave the Way: Model Cell Thinking Copy Kaizen and Gemba Creating a Sense of Purpose: Patient Experienced Value and ‘What Is in It for Me’ Conclusion Learning Points Additional Resource Acknowledgements Bibliography Chapter 8 Organisation-Wide Implementation of Lean in Iceland Aims Introduction Context Our Strategic Priorities The Improvement School Our Lean Journey Case Studies Initial Project-Based Work Kaizen Events Daily Huddles Production and Improvement Boards Gemba The Communication Compact Using Social Media to Influence Patient Flow Communicating with Patients and the Public 3P: Production Preparation Process Rapid Process Improvement Workshop on a Medication Process Conclusion Learning Points Acknowledgements Bibliography Chapter 9 Improving Learning Disabilities Services with Lean Design: A Case Application of the 3P Method Aims Introduction Case Example Background Design Space Experience of Lean Intervention (Lean 3P) Scoping and Planning Time-Out Design Workshop Follow-Up Outcomes Proposed Servicescape Project Brief Construction and Post-Build Lessons Learned Lean Principles Participation Prototyping Pathway Modelling Summary and Implications Learning Points Acknowledgements Bibliography Chapter 10 Co-Producing an Organisation’s Quality Improvement Method: No Decision about Me, without Me Aims Introduction Setting the Scene for Co-Production Initial Projects Building Confidence and the Role of the Expert by Experience Coordinator Involving Patients and Users of Service in QI Training Coming along for the Whole Journey: Tailored Patient and Carer QI Training Building in Involvement at the Beginning, During, and on Evaluation of a QI Project Building the Will Communication Plan Feedback from Participants Carer A Patient A Carer B Patient B Carer C Further Development Conclusions Learning Points and Tips Learning Activities Acknowledgements Bibliography Chapter 11 Applying Kata in Healthcare Aims Introduction Context What Is Kata? The Improvement Kata The Coaching Kata Kata and Lean Applying Scientific Thinking Case Study: Practising Kata in an Organisation Getting Started Kata as a Modifier of Culture Developing a Cohort of Learners Establishing Coaching Capacity and Capability Scaling Kata across an Organisation Success Factors for Applying Kata Risks and Barriers to Success Top Tips for Getting Started Conclusion Learning Points Acknowledgements Bibliography Chapter 12 Executive Leadership in Sustaining Lean Transformation Aims Introduction Providing Organizational Leadership Tools and Much More Core Element Number One: Lean Methods and Systems Start at the Top and Are Rooted in Values, Principles, and Behaviors Core Element Number Two: Effective Leadership, Lean Principles, and Tools Combined with a Lean Management System Become the Foundation for This Transformation Core Element Number Three: Leaders Set Expectations of Behavior Change at Every Level of the Organization to Support and Sustain the Operating Improvements Core Element Number Four: Educate the Board of Directors to Generate Long-Term Support for Organizational Change Getting Results with a Lean Management System The Results King’s County Hospital Behavioral Health, Brooklyn, New York, USA St. Mary’s Hospital, Kitchener, Ontario, Canada Western Sussex Hospitals NHS Foundations Trust, England Hospital for Sick Children, Ontario, Canada Providence Little Company of Mary, Torrance, California, USA Would You Recommend This Hospital to Friends and Family? Would You Recommend This Organization as a Good Place to Work? Lean at Zuckerberg San Francisco General Hospital – A Case Study Goals, Strategies, and Personal Growth Leveraging a Crisis Quality Improvement Results Conclusions for the Case Study Learning Activities Activity 1: Silent Observation Activity 2: Gemba Walk Conclusion Learning Points Acknowledgments Bibliography Chapter 13 Learning How to Apply Lean Aims Introduction The Foundations of Lean Application in Healthcare Agreeing on the Need for Change Developing Support for Lean in Healthcare A Sense of Place in Lean Spreading Improvement Across an Organisation Engaging Strategic Partners in Lean Implementation Conclusions Learning Points Bibliography Index