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There are a lot of misconceptions about what lean is and what it is not. These misconceptions are hard to overcome within industry and become even harder to overcome in heathcare. All of the improvement sciences are based on the scientific method. Understand what is happening today, create a hypothesis, and test the hypothesis. If you can prove the hypothesis is true, then create the work standards to realize the desired result every time.
This cycle of experimentation works as well in healthcare as it does in any industry. There is no magic formula for success. The fundamentals of improvement apply anywhere work is done. Whether we are painting , grinding and assembling or assessing, diagnosing and treating, value is being created for a customer. If we can understand exactly who our customer is and understand the value they expect, then the science of lean improvement applies. Lean is not just for assembly line processes, or transactional processes, or short cycle time processes. If work is being done, either value is being created or time and resources are being wasted. Understanding this is the key to improving processes. This books speaks about how to deliver compelling value in healthcare. Specifically how to achieve high levels of staff and medical staff engagement, how to improve process and clinical quality/safety, how to improve access and reduce lead times for services, and how to reduce cost and improve productivity.
This book is special for the simple reason that it covers the full spectrum of improvement within the healthcare industry in six different parts. First, I discuss in detail the need for change... NOW. There is a perfect storm brewing in healthcare where several forces are coming together to make healthcare unsustainable. These factors include an aging population increasing demand on the system, an aging workforce where it is getting more difficult to fill vacancies, less than optimal quality outcomes in a variety of different services, and escalating costs. There is no industry that warrants improvement more at this time.
Next the book details the fundamentals of improvement. The improvement principles are described both inside and outside healthcare to allow the reader an opportunity to grasp their elementary meaning. The key principles of improvement include flow, pull, defect free, visual management, and continuous improvement. These principles are the DNA of lean improvement.
Once the basic concepts are understood, a detailed explanation of the tools and their application are discussed. Key tools such as value stream mapping and analysis, A3 thinking, and kaizen workshops are explored to bring the improvement principles to life. Other tools covered include takt time, time observation, the loading diagram, spaghetti mapping, communication circle, standard work, and process control.
Case studies follow showing real healthcare examples of how the principles of improvement were applied and how tools were used to see and eliminate wasted time and activity. Areas covered include the emergency department, an orthopedic clinic, diagnostic imaging, patient registration, system collaboration within the community sector, and improvement within an in-patient unit. Each case study provides a background, an understanding of current conditions, a discussion of the improvement plan, a description of the specific tools utilized, and the before and after numbers.
The book discussion then moves toward how to get started with lean improvement. A six step road map is provided on the key steps necessary to foster a culture of continuous improvement. These steps include defining the measurable outcomes, selecting and mapping the key value streams, beginning improvement, sustaining the improvement with visual management, developing the organization through lean training and coaching, and finally spreading the improvement. Each step provides details on the need for these activities and some key tips on how to successfully perform each step.
The book concludes with the most important activity needed to sustain and cultural transformation; leadership involvement and commitment. 10 leadership lessons are discussed to provide insights based on working with over 100 healthcare organizations in improvement work using lean management approaches. These lessons learned are from both at a personal level; leading by example, and at an enterprise level; creating the right structure to be successful.
The combination of addressing all the aspects in lean healthcare make this book truly unique. Summarizing, the book covers, the reason for improvement, the tools and application of the tools, case studies, a road map to get started, and leadership lessons learned. The book is augmented wit over 80 charts, figures, and pictures to illustrate the points and examples contained throughout.
Feel free to add comments on this blog if you have read the book and have any comments you wish to make. Or if you have any questions feel free to leave me a question on the blog comments section.
A second book is being created as of the date of this blog. This book will be on Lean Leadership in Healthcare and will highlight the leadership activities needed to drive a culture of continuous improvement. It will be available in the spring of 2013.
Lean Blessings;
Ron
Ron Bercaw
President, Breakthrough Horizons Ltd
www.breakthroughhorizons.com
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