Patient Safety and as "GUEST"
time to put people – ordinary people – into the health-care process. By working
together in creative new ways, people can change the economics of health care,
improve health outcomes, improve the patient experience, and solve public
amazing advances in medicines and medical technology over the past 50 years,
health care today is in crisis. Costs are skyrocketing, health outcomes are
uneven, and the patient experience is too often unacceptable.
time for a power shift in health care. As a society, we have dramatically
underestimated the power of ordinary people to transform the system, to take
care of their own health, to help develop therapies, and to help solve massive
public health problems.
Hospitals Work on Processes,
Elements of Change Management
Hospitals are sick and need our help. That is the
message process improvement concepts like Lean and Six Sigma hope to address as
they become more commonly used in healthcare.
Like any sick patient, there is a process to help
make hospitals better.
That process is:
The symptoms, like waste and blame, pile on like any
"Blame is like a virus".
are no bad people, only bad processes."
As for waste, people adjust to it and get used to
it. It takes "new eyes"—another common concept to spot waste that
hospitals may have become so used to living with that they no longer even
Without change management lasting change can't
happen. Key elements to change management include:
- Leadership buy-in, active participation, and
- Regular communication with key stakeholders
(via e-mail, reports, and meetings)
- Employee motivation through incentives (such as
recognition, promotion, and burning platform)
- System of checks and balances (e.g., project
reviews and scorecards)
- Action plans at both the project and program
levels that are updated on a regular basis
"Something as simple as an action plan can be
incredibly effective—very simple and very powerful."
Change management can certainly be done wrong,
however. Poor change management can have many variations of negative results:
A major component of making change management work
is meeting management. Leaner processes involve fewer meetings, but meetings
are still necessary—so do them right.
From Lean to Supply Chain Management
The main goal of Lean Approach is to
eliminate activities that don't add value (waste) in the healthcare
When a hospital has
gone through the Lean Improvement Process, waste also has to be eliminated in the
Supply Chain Processes. Supply chain
management is a set of approaches utilized to efficiently integrate patients, suppliers,
services, warehouses, and logistics, so that patients are received, diagnosed,
treated and released in the right numbers, to the right locations, and at the
right time, in order to minimize system wide costs while satisfying patient
2. Wasted Time, Wasted Money, Wasted Effort
Must Have a Vision
In these hard Economic times that we are all facing many healthcare
organisations are turning to Lean Manufacturing in an attempt to save their organisation.
This is a proven method of eliminating wasted time and materials, thereby
improving the bottom line. But, as with anything, there are problems that arise
and can derail your efforts. I would like to address one of those problems:
“There is NO Vision”
To undertake lean approach without having a Vision of where you are going
and what you are attempting to do is a waste of time simply because there will
be no interest, you have to do it, there will be no enthusiasm. Without these
two elements there will be complacency.
The CEO, or President, must have a vision. The Lean approach is a tool
that can assist you in moving your organisation ever forward to your goal, your
vision. More than likely someone that has experience in Lean will be hired or
appointed to take on the leadership of this project. But the job of the
President or CEO has just started.
A vision must be communicated to the people involved in assisting you in
bring it about. Since it is a given fact that no one knows everything you must
surround yourself with people that know the things you don't. But in order for
them to be effective in bringing your vision to reality you must spell it
out in clear and concise terms. While authority may be delegated to others you
are the one in charge of all aspects of the different programs that will be
started. You, the one with the Vision, are responsible.
Lean, Six Sigma and the 5s program are tools that will enable you to
realize your objective, your vision. But they are nothing but tools to be used.
Do not lose sight of your vision.
Meetings that are held with upper and middle management people should
always be held with an agenda in front of them. As president and/or CEO you
must set the tone and direction of all meetings. There are other people that,
while they will assist you in obtaining your vision, they have an agenda of
their own. As president or CEO you must be ever vigilant of this fact.
Problems and projects should be assigned with a timeline for completion
and followed up with progress reports. They report to you, you do not report to
Projects that are started, such as safety tours are continued on a timely
basis not just for the first two weeks.
As President you are ultimately the one that is held accountable. As such
you are the one that directs and sets the tone for ALL employees. Most people
will follow a leader. That is something that works in your favour only if YOU lead.
3. LEAN Approach
3.1. What you need to know about lean approach?
Schellter Lean approach
is an initiative that focuses on cost reduction and increases in turnover by
constantly and methodically eliminating activities that do not add value to the
healthcare process. Basically what lean does is help organisations to achieve
targeted productivity and efficiency, as well as other things, by introducing
tools and techniques that are easy to apply and maintain. What these tools and
techniques are doing is reducing and eliminating waste, things that are not
needed in the healthcare process.
Now that you know
and understand what lean is there are a few important tools and concepts that
you are going to need to know about in order to fully appreciate all aspects of
lean care. One thing that you are going to need to know is visual controls and
how they apply to the lean approach, in fact visual controls are one of the
most important tools that you will be using if you decide to convert to lean healthcare.
One thing that you have to know about visual controls is what they actually are
and luckily visual controls are basically exactly what they sound like. Visual
controls are controls that you put in place that involve looking at things to
see how you can improve them or fix things so that you are not wasting
anything, which basically leads to an improvement in your overall healthcare
One of the reasons
that visual controls are a vital part of the lean approach is because it
provides the organisation with the ability to manage variances in process
conditions and in the caretaking outcomes at the source of where the cure is
being made, not to mention it is used at the same time that the treatment is
being made. Basically visual controls are going to allow you to respond faster
to problems, but they are also going to allow you to develop countermeasures to
problems and by doing this your organisation is going to be able to achieve
numerous additional things.
Some things that can
be achieved and that have been achieved in other hospitals are:
90% reduction in materials waste
75% reduction in floor space
90% improvement in healthcare quality
90% reduction in lead time, patient flow
50% reduction in variable costs
Something else that
you need to know about the lean approach and visual controls is that visual
controls can actually be applied in any workplace to a variety of different
departments. So basically what this means is that you can use visual controls
in any kind of working environment, healthcare process, office work, testing
areas, treatments, etc. and the best part is that you can apply the visual
controls to any area of that workforce. So what that means is that if you are
using visual controls for your healthcare process you can place the visual
controls out on the floor where the treatment and cure are taking place or
anywhere else for that matter.
Something else that
is important to know about the lean approach is how you should actually go about
introducing it to your organisation. The reason for this is that different healthcare
techniques require different skills and techniques that you should use when
converting to that style and lean is no different. So before deciding to switch
over to the lean approach you should take a moment to review some of these important
factors. This is what Schellter will expose during the analysis.
The first thing
that you need to be aware of is that unlike other treatment styles with lean
you are not going to want to train your entire workforce at the same time. What
you are going to want to do is to get your upper management on board and then
choose a handful of people from the different departments. And then you are
going to want to choose an area that is small and begin to introduce the lean approach
to that one area. Keep in mind that when choosing an area you are going to also
want to choose an area that will give you results rather quickly so that you
can show your employees the good things that can happen by converting to lean
The Lean Approach is a type of
system that aims to eliminate waste in all of its forms. This waste includes
activities that add no value to the over all healthcare service. By eliminating
these wastes the organisation benefits from having fewer expenses and losses of
time due to a lack of productivity and efficiency. The patient benefits from
the lean approach system by benefiting from the cost savings that the treatment
and cure can pass on to the patient and also by receiving a service that is
free from defect or fault, as is the result of a waste free system.
Where there are other systems that
focus on eliminating waste in certain steps of the process, the Lean Approach
is all about tackling the waste problem from a hospital-wide approach. The
objective of the organisation is to create what is called a "value
stream." A value stream refers to the continuous flow of services and
treatments that is not burdened by the starts, stops and delays of dealing with
Remember that waste can include not only material overflow but also any
activity, step, or process that does not ultimately end in providing the patient
with value. Remember, if the patient is not willing to pay for something that
you spend time on then you want to eliminate that part of the service in order
to maximize your organisation's profitability.
The Lean Approach concepts are
obviously appealing to most healthcare organisations however each hospital has
different levels or degrees at which they commit to running a lean operation. The
Lean healthcare approach is also referred to by a variety of names including
the most popular alternative name; the Toyota Production System (TPS). The TPS
is all about the systematic elimination of waste and was originally developed
by the founder of the Toyota Company.
Types of waste
Naturally in order to eliminate
waste it is useful that there be a method for identifying such waste. Toyota assigned a name to
non-value work that they call "muda." Muda is only discovered in a
manufacturing process once the process has been set in place and put into
action. Then it is dealt with until variation in output can no longer be seen.
The inconsistencies that care found to be the cause of variation are then fed
back into the Lean Manufacturing planning system and re-evaluated for a trial
of the next project and corresponding system of production. The process of
identifying waste or muda is constantly changing due to the fact that the
demands placed on the manufacturing company are ever changing. Whenever demand
is changed supply is then affected in order to balance out these effects,
improvisation is needed. Naturally, this can lead to downtime and mistakes.
However, the process of correction and re-standardizing manufacturing system
movement can be relatively quick if wastes can quickly be identified and plans
made for the elimination of such wastes.
This original concept has been
translated and engineered by Schellter into a healthcare module that can be applied in
any hospital or healthcare organisation.
The seven muda or "deadly
wastes" are defined as follows:
1. Waste from inefficiency - inefficiency occurs when the
healthcare provider produces more than what is required by the patient. In rendering
more than needed treatment, the level of service is exceeding the level of
demand, thereby generating unnecessary time loss and costs.
2. Waste from transportation - In this context, the term
transporting refers to any movement that the patient, or required service,
takes part in as part of the healthcare process. Multiple handling or movement
of patients, or related services, does not add any value to the treatment if
those movements are not required by the standard healthcare process.
3. Waste of motion - Waste of motion refers to the time
that is wasted by staff, equipment, and handling due to the fact that they are
working or moving more than is necessary to perform their assigned step in the healthcare
process path. An example would be searching for utilities or tools due to the
inappropriate location of these items. Time is wasted in the motion of looking
for these tools, when instead the time of the staff should be completely
devoted to accomplishing their assigned portion of the healthcare process.
4. Waiting - Time is wasted whenever there is a
period of waiting in between steps. For example, a patient waiting for a
machine to finish a cycle or staff leaving their station in order to ask their
supervisor a question reflects an interruption to flow, a waiting period of
sorts, and needs to be eliminated.
5. Processing – Services and equipment have a great
deal to do with what type of time is necessary or unnecessary to the steps of treatment
processing. Combining steps or having staff or equipment perform multiple steps
should be done in order to decrease processing time.
6. Inventory - Inventory items are also referred
to as products and items, including equipment spare parts, which represent a
significant percentage of the hospital’s working capital. Inventory
optimalisation, including the pharmacy, are integral parts of the Schellter lean approach
and can save the hospital millions.
7. Defects - Perhaps the most obvious and
detrimental of all the forms of waste is the rendering of defective or
inadequate service. Even if there is a system in place for the inspecting,
scrapping, or repairing of these defective services, their creation is by
definition pure waste according to Lean principles. These clear identifications
or definition of work that adds no value to the healthcare process are
critical. After being identified, they are used to evaluate the current work
process and naturally the next step is to make changes to the operating system
as it is currently organized. Opportunities may lie dormant if the processing
assumptions are left unchallenged.
Just in Time manufacturing
The Just in Time manufacturing
technique is probably the most recognized and widely used of all the Lean
techniques. Just in Time manufacturing gets it name from the process of Lean
Manufacturing that it employs in order to reduce wastes. In short, the Just in
Time manufacturing technique is to have the "right part at the right place
in the right amount at the right time" (this is according to the book
"Running Today's Factory"). Just in Time manufacturing focuses on
shortening the time it takes to produce on product (also known as the product
cycle), decreasing the amount of carried inventory, and streamlining work flow.
Just in Time approach in the
healthcare organisations is a very difficult concept for some hospitals to
implement simply because it forces them to cut back on services even if there
are prospects for more treatments. In the past, the volume of treatments that a
hospital was able to achieve was a sign of efficiency. This is true only if the
volume being treated directly correlates with the immediate demand that the patient
has for that treatment. Finding the balance between the demand of the patient
and the supply of the treatment is the big challenge, especially when positive
occurrences, such as in increase in sales or interest in your hospital, mandate
a change in the healthcare technique to accommodate for the growing demand.
3.3. Lean Approach: JIT services
Just in Time Production (JIT) was
first used by the Ford Motor Company in the early 1920s as an inventory
strategy to reduce inventory. When Toyota
began work on the Toyota Production System, they looked at some of the
methodologies that were implemented by Ford. They found that Ford had a part of
JIT production, but they did not fully implement the entire strategy. Toyota discovered that
Ford had piles of excess inventory lying around their facility and their employees
had uneven work schedules.
JIT services in the healthcare
organisations are considered an inventory strategy that is implemented to
improve the return on investment (ROI) of a hospital by reducing the in-process
inventory and its associated costs. JIT must have different signals about the
process and identify what is happening within the process. Because JIT is
driven by signals, it falls in line with the Kamban methodology.
The Kamban system typically uses
visual signals or tickets to indicate a missing item or designate where a
particular inventory item is stored. JIT can lead to significant improvements
in your quality, efficiency and ROI. The JIT inventory reduction can be the
consumption of old stock which triggers new stock to be ordered. By reducing
JIT, you are saving on warehouse space and costs. Typically stock levels are
determined by historical demand and when a sudden demand rises above the average;
your inventory will quickly diminish faster than usual and may cause patient
service issues. By using the Kamban system, you will be able to flex your
inventory system so these issues won't occur.
There are several components you can
use when you implement JIT. Again, there is the Kamban system, service
treatment leveling, pull systems, Total Quality Control, and several others. So
many people have used the Kamban system with JIT, that the two have become
synonymous with each other. The kan-ban coordinates the overall inflow of services
to the healthcare treatment and minimizes the process.
The benefits for using the JIT
Reduced set up times in the hospital. By cutting down the set up time,
your hospital will be more productive and will be able to improve their bottom
line. This will allow your hospital to look more efficient and you can focus
time on other areas in your healthcare treatment line that need improvement.
The flow of patients is improved. By having your staff focus on
specific areas in the overall system, they will be able to process patients
faster because they won't be fatigued from doing too many jobs at one time.
Employees are utilized more
employees are trained to have multiple skills, they can be utilized more
effectively. By having your employees trained to work on different services in
the healthcare treatment cycle, you will be able to use staff in areas when
they are needed or when there is a shortage of staff on a service in high
Consistent scheduling and employee work
hours. An adequate
scheduling and awareness of idle moments (labour waste) will save your hospital
a lot of money because you won't need to pay staff for a job not completed.
Better supplier relationships. Because you will have more time,
you will be able to work harder on establishing your supplier relationships.
Having a trusted supplier will give you the peace of mint to know when you can
rely on goods to be delivered, how they will be delivered, and if they are
satisfactory to your patients.
Staff is more productive because the
supplies are evenly distributed. Since management is now focused on meeting deadlines, the employees will
work harder to meet the deadlines and a continuous stream of services can help
them stay busy. The employees will see the benefits of their work through job
satisfaction, promotion, or pay incentives, if applicable. One major problem
with JIT operations is the large supply and demand changes. While it is nice to
maintain a consistent inventory level, your patients could face a supply shock.
You will need to use service levelling to help remove the slight variations
that come with inventory holdups. JIT is a proven methodology and will help you
build relationships with your suppliers. By having excellent suppliers, your
margin of error will be improved because you know the exact quality of the
product you will be receiving and you trust who is providing you the product.
3.4. Lean approach benefits
- Reduced Inventory Holding Costs a key lean approach
One of the ways to drive to the
bottom line fast is in the inventory of all departments concerned. Invariably
most organizations are too heavily dependent on high inventory to ensure a
smooth running service. The problem being that the inventory is costly; it gets
in the way, and has obsolete issues. Many will argue some of these points, but
the simple fact is that any more you have in inventory is not helping you
create value for your patient or the organisation. Even if that money is simply
put in an interest bearing account the money gained can be substantial. The key
being that the business will still run as good as, or better than before, if
you implement the lean approach correctly, with significantly less inventory.
- Increase Throughput a key lean approach benefit
By eliminating excess steps and non
value adding activities and by making sure that every accessory to complete a
job is in a known place near the work area you can easily increase your output.
It doesn't seem possible before you get into it, but often times there are a
ton of hidden time wasters that kill productivity and therefore hurt the
service output. If you find legitimate ways to make those issues go away
you will be well on your way to increasing your throughput in a very real
way. More service rendered with the same resources is a huge win for your
More pleasant work atmosphere a key lean approach
This may seem counter intuitive, but
ask anyone who has worked in a lean operation what the difference before and
after a 5S program was installed and you will hear that it is plainly night and
day. Having only the stuff needed and no excess is not only a benefit to
the business through lower inventory costs and therefore more cash on hand, it
also clears up the clutter and allows for people to enjoy the space they work
in. Coming to a clean work environment is a healthy way to work and live
and the benefits are not truly felt until after the cleaning up and placing in
the right place is done. The first time you go to grab an item and it is
exactly where it should be you will be ecstatic and wonder how you ever worked
the other way. A place for everything and everything in its place seems
like an annoying phrase until you have seen the true power that it holds, especially
in a work environment.
- Higher Quality a key lean approach benefit
Better quality and less useless
operations is a key target to the lean approach. Many projects are
focused solely on error proofing and a key component of Overall Equipment
Effectiveness (OEE) is quality. On top of the cost of the waste, one
needs to remember that the rework and overtime also costs money. In
addition to the labour and equipment time to rework the service concerned it
also is lost output. And if it is limiting output, the cost becomes very
large, even greater than the waste cost. The Lean approach is all about
3.5. What causes lean approach failure and how to
Before you can even begin to
understand how the lean approach can fail and the things that you can do to
avoid that kind of failure you should probably know what the lean approach is.
Many people think that they understand lean but when it comes down to it they
are actually rather clueless, which is why their organisation fails when they
try to convert to the lean approach. So before going any further, and this is
to help ensure that your organisation can successfully convert to lean let's
take a few minutes to go over what the Schellter lean approach is.
The Schellter Lean Approach is an
initiative that focuses on cost reduction and increases in turnover by
constantly and methodically eliminating activities that do not add value to the
healthcare service process. Basically what lean does is help hospitals to
achieve targeted productivity, as well as increasing the quality, by
introducing tools and techniques that are easy to apply and maintain. What
these tools and techniques are doing is reducing and eliminating waste, things
that are not needed in the healthcare process. But the most important thing
that you need to know about the lean approach is that if it is not used in the
correct way then it is going to fail, which means your hospital could fail. But
the good news is that there are things you can do to avoid lean approach
Here are some things that you can do
to avoid lean approach failure.
Number one: The first thing that you are going
to have to avoid to prevent lean approach failure is lack of preparation. What
this means is that you are going to have to prepare your organisation to become
a lean champion, you can't just up and decide to switch and then expect it to
happen overnight. If you are going to convert to lean you are going to need to
put forth the time and effort that is going to be needed to make the switch.
You are going to need to figure out what things cost to buy and how you can
save while buying them while cutting out the middle man. You are also going to
need to decide what areas you can cut costs into and where you can't cut any
kind of costs.
Number two: Another thing that can cause lean approach
failure is not having the right kind of training. So basically you are going to
want to avoid improper training which can include management not being trained
right, leadership not getting things done or resolved or not having the right
kind of training tools. This is the strength of the Schellter lean approach.
Number three: Something else that can cause lean approach
failure is not implementing down time. This doesn't mean that you need to give
your employees down time in fact it actually means just the opposite. Many
times during the healthcare service process there is down time when equipment
needs to get moved or something else happens and most of the time people sit
around talking and relaxing which allows your hospital to lose money. So what
you need to do is to give your employees other work to do during those down
times. It will also allow less time spent looking around for things because
everything has a certain place and is organized.
Number four: Another thing that can cause lean approach
failure is if your employees fail you. Basically what this means is that your
employees do not give you their all, they are not trying to get the work done
by not applying themselves. In order to avoid this you are going to want to try
and motivate your employees.
4. Supply Chain Processes
main supply chain
purchasing and procurement
demand planning (forecasting)
When lean strategies
are applied to these processes, hospitals will achieve
lower inventory costs
improved patient care
improved responsiveness to demand
closer integration with suppliers
increased market share
higher levels of customer satisfaction
5. The Seven Wastes, 5 S and Kan-ban
The Chief Engineer for Toyota during the mid-1900
was Taiichi Ohno. Ohno is given credit for creating the Toyota Production
System (TPS) and creating the seven wastes.
Toyota defines waste as being three-form:
· Muri -
· Mura -
· Muda -
Elimination of waste
Muri is a key concept in the Toyota
Production System that relates to being overburdened. Muri generally refers to
the unreasonable work that management places upon their workers and machines.
Carrying heavy weights, performing dangerous tasks, and working at a significantly
faster than normal pace, are all examples of Muri. Muri defines this work as
pushing a person or a machine beyond their normal limits.
Mura focuses on the inconsistency
and unevenness due to human error. Examples of Mura include scheduling
conflicts, assembly line problems, and anything that hurts productivity.
Typically mura can be directly traced back to human error. Mura is a key step
in the Just In Time (JIT) Methodology.
Muda is the final phase in the
Toyota Production System and is the most wide-spread concept of TPS. Management
is in charge of overseeing Muda to ensure that waste is eliminated from the
company. Management should be able to determine if there are deeper causes of
muda that are formed during muri and muda.
Muda divides waste into 7
Besides the 7 waste approach of Toyota, there are other
approaches to lean manufacturing. Many companies have developed
"tools" to assist in the identification and the elimination of waste.
These tools are often called value stream mapping, the 5 S Methodology, and
Kan-ban. The goal of all the approaches is to reduce waste; the only difference
is how you go about achieving the goal and if you can successfully implement it
into your organization.
The 5 S Methodology is widely used
by several companies. The 5 S methodology is another philosophy used as a way
to organize and manage the workspace and work flow in your business to improve
efficiency by eliminating waste, improving flow, and reducing process
The breakdown for the 5 S
Methodology is as follows:
· Seiri -
· Seiton -
Straighten or Set in Order
· Seiso -
Sweep or Shine
· Seiketsu -
· Shitsuke -
The other popular approach is a
Kan-ban system uses visual aids to control the movement of materials between
different work stations. The name Kan-ban referred to a Japanese sign shop that
used a visual image on a sign to communicate the type of products that were
sold. The Toyota Production System implemented Kan-ban into their transport
container. It is a card that is attached to the transport and storage
containers. The purpose of the Kan-ban card is to identify part number and the
There is other information on the card as well that
provides easy, visual, signals to the employees.
Successful implementation will
expose the quality problems which exist within the organisation and you will be
able to identify how to reduce the waste the problems are causing. For some hospitals,
the focus on waste reduction only looks at one small problem at a time instead
of a system-wide approach. Depending upon which type of managers you have, both
approaches can be successful and both will reduce or eliminate waste.
In the end, the Schellter lean approach is
"focused on getting the right things, to the right place, at the right
time, and in the right quantity to achieve perfect work and service flow while
minimizing waste and being flexible and able to change." The concepts of
lean need to be understood, embraced, and appreciated by the employees who render
the services and treatments. If the employees do the concepts, they will pass
them onto the entire process and deliver the value to the healthcare service.
Management is again the biggest factor in the lean approach.
Weak management will not understand
how to implement the tools of lean and it will not benefit anyone. Schellter Lean is
simple to understand and easy to do. It is all about making the work simple,
easy to manage, and understandable for the employees.
If you would like to take an
additional step in the lean process, you can adopt the Toyota mentoring process called Senpai and
Kohai. Senpai and Kohai are essential elements of Japanese age-based status
relationships. They are similar to a family relationship, which is decided upon
age. In western culture, Senpai and Kohai can be compared to the concept of a
This mentoring approach works like
this: an older sibling begins a company and mentors their younger sibling; the
younger sibling will eventually have enough insight to become the mentor to the
older sibling. It is a process of "thinking up and down" the
organizational structure. Employee A affects the steps of Employee B who
affects Employee C and so on. This process has been taken by Toyota and it has helped their suppliers to
improve their production as well.
There is another mentoring approach which is
similar to Senpai and Kohai; it is called "Lean Sensei". Lean Sensei
encourages your company to seek out outside, third-party experts who will
provide coaching, advice, and unbiased opinions to your company.
Implementing the seven wastes into
your lean healthcare process will take some time and a complete mindset change
on your part and on the part of management to become successful.
5. What is value added work and
non-value added work?
What is value added
work and non-value added work? Value added work and non-value added work refers
to the idea that a patient will pay for the healthcare service that adds value.
If there is no value added a patient does not want to, nor will they pay for
the service. This is only a fair way of thinking. However, how does this all
come to play with different management options that are out there.
The application of
programs like Six Sigma or Lean management uses these theories to bring a
higher level of efficiency to the way a business is run.
other businesses are benefiting from the practices that impress upon employers
and employees the importance of value added work.
organisations and other businesses are constantly looking for better ways to
make money, with fewer costs, and have better services and treatment, there are
geniuses coming up with ways that will add value to the work, and eliminate
non-value or waste.
costs are costs that are simply associated with long lead times and quality.
Quality is important, that will not be taken lightly. However, in some cases a
slight quality change can cost tons of money for the hospital. However, there
are some costs for quality that hospitals are willing to accept.
The key difference
is the costs that add no feature or functions to the patient values. These
wasted costs are ones that are like; time wasted or low direct labor
These types of
expenses simply cost the organisation money. There is no real benefit;
therefore it is non-value added work. That is how you will know the difference.
Is there a benefit from the cost that has a value in the end?
You can also look
at things like the cost of obsolesce, excess in capital investments,
transportation expenses, stock rooms, etc. You can include anything that does
not offer direct value to the service or treatment.
In addition to
these types of costs, you will find the non-value added work creeping in when
there is an expansion for a higher volume of productivity. This is because so
much of the time growth includes more resources, and therefore expenses in
training, maintenance, replacement etc.
Lack of knowledge
all too often will be a major contributing factor in the accumulation of a
business having large amounts of non-value added work. Therefore, the best way
to prevent more than necessary non-value-added work, you will need to make sure
to work out each step of a growth, new treatment, or change in order to prevent
the waste that will occur with inaccurate planning.
As with anything
new, there is a new idea that work or don't work. There are more services,
therefore there are more items needed to get those treatments done. There are
also more people needed to render these services. This can all greatly
contribute to the costs involved in non-value added work.
Quality and speed
are also areas that will be figured with the non-value added work. Because a
job that could be completed quickly and with good quality is what the goal is.
Therefore if you are working to get this overall goal, then you will need to
work a process that allows for those growths to happen.
technologies of today increase the speed and quality of service and treatment;
in addition to lower the non-value added work. This is the difference between
value added work, and non-value added work. The work that adds value, and the
work that is an expense that does not.
What does the word "Kaizen"
This Japanese word
has been associated with many Lean Manufacturing techniques and more
specifically the Toyota Production System.
Japanese this word is pronounced 'kaizen'. KAI means 'change' or 'the action to
correct' while ZEN means 'good'. So quite literally Kaizen means a change for
good or an action to correct something to make it better. The Chinese
translation is extremely similar. The only addition is that the Chinese
translation adds a component of "benefit" to the definition of the
word. In this regard the term Kaizen refers to good changes that not only
benefits the business but also the society. In the Chinese translation it is
assumed that one of these two parties cannot possibly benefit at the other
party's expense. Therefore the Kaizen changes are to be mutually beneficial to
all or they are not true to the Kaizen methodology.
The Kaizen strategy
In English the term
Kaizen and the workplace strategy referred to as Continuous Process Improvement
are often used interchangeably. Like many of its complementary partners, Kaizen
aims to improve productivity in the work place by minimizing and eliminating
waste. Waste in the workplace is defined as activities that add cost but do not
add value. More specifically Kaizen tries to eliminate this waste not simply by
picking it out and ridding the production line of individual components, but
rather by creating a standardized "better way" of operating.
way" of operating involves many elements, five of which are mentioned
specifically. They are: teamwork, personal discipline, improved morale, quality
circles, and suggestions for improvement. These founding principles demonstrate
well just how different Kaizen strategies are from other less personal lean
manufacturing methods. When executed correctly, Kaizen not only improves
productivity, but it also humanizes the workplace, eliminates overly hard work
(both mental and physical), and teaches employees of all positions how to
identify and create solutions for everyday problems or inefficiencies that they
may encounter. Small changes made by individuals are meant to build a long term
needs to be order as far as what types of changes are implemented on a large
scale, and therefore brainstorming groups are often guided through the Kaizen
process by a supervisor of some sort. Nurturing such a culture where continuous
improvement is a way of life will lead to innovations yielded from a pool of
contributors much larger than any room of board room executives or management
team. In this atmosphere of small changes and experimentation, employees are
not discouraged by other more common managerial strategies that involve a type
of "command and control" mentality. Every member of the company has a
voice through which they can express their ideas not only for how their own job
can be improved, but also for how the company as a whole can make improvements
to eliminate those procedures that are not needed.
It is sometimes
difficult to implement a new method, especially one that may be as drastically
different as Kaizen may be for some organizations. So it may be simpler to
start the implementation process by first following these three steps:
Re-align the focus of managerial techniques - In Kaizen, the
worker is attributed with much of the credit as far as contribution for
continual improvement methods are concerned. The idea is that when Kaizen
methods are implemented correctly, the worker see that benefits of having a job
that is more productive, less physically demanding (and ultimately safe) and
more efficient. The worker is an actively contributing member of a support
group that is working towards making the work day more pleasant and rewarding.
Improve equipment - Your next focus, after your employees,
should be on your equipment and how you can improve it. Changing machine layout
and installing devices to improve their function are just a few suggestions.
Create a plan - Continuous improvement doesn't just
happen, you have to have a plan. It is unlikely that improving procedures will
have a long term effect if there is no plan by which they can be measured and
The Kaizen way of thinking/managing
The Kaizen way of
thinking is not something that comes naturally to all managers. Kaizen is
unique in that it focuses on both maintenance and improvement at the same time,
two concepts that some would assume are contradictory in ways. What Kaizen
methods suggest that may help to clear up this misunderstanding is that the
maintenance aspect of the thinking style pertains to the standards that are
currently being upheld by management and the maintenance of technological and
Obviously, if there are no policies or rules for these
sorts of standards, they will need to be established before they can be
maintained. The term standard operating procedures (SOP) is one that is
frequently used when Kaizen methods are being explained so it is important to
understand what exactly these SOP's are for your company or production line.
is also central to the Kaizen way of thinking and managing. Once standard
operating procedures are in place, it is management's job to work towards the
revising and improvement of those standard practices. Very gradually, higher
and higher standards are set for the company (obviously at a pace that does not
deplete the company of its resources or its employees of their energy and
Improvement and innovation go hand in hand.
Innovative ideas are
constantly needed if the company is to achieve levels of productivity, quality
and efficiency on a continually improving basis. Kaizen is unique in that
improvement and innovation are recognized as features that are gradual and will
not necessarily yield drastic improvements, nor are such drastic improvements a
benefit to the company. It is the coordinated and continuous efforts of all the
employees in an organization that can truly change that organization for the
better. Managerial attitudes towards this coordinated effort of all employees
can be either instrumental or detrimental in the overall result of the of the
Kaizen methods. How an organization meets and masters change, or in other
words, their attitude towards this new way of thinking will quickly reveal
whether or not Kaizen is right for your company.
"gemba" is a word that you may find associated with the term
"Kaizen" and the process of continuous improvement. Gemba, as you may
have guessed, is a Japanese word. When translated into English this word means
"real place" or "where real action takes place." In a
business setting the gemba is the place where the actions that add value to the
customer are taking place. In a production or assembly line type of a business
the gemba is typically going to refer to the shop floor or place where most of
the work is taking place. The value in recognizing gemba is that in doing so
less emphasis can be placed in the more popular customer attraction practices
such as marketing, sales, and financial management, and re-assigning the
emphasis where it is most important, on the production line floor. When you
have the gemba as the centre of your operation you are putting all of your
effort into where the real action takes place or where your customers are
ultimately going to receive what is of value to them from. The customers are
not paying for add campaigns or marketing techniques, so the emphasis of the
company's efforts and funds ought not to be centralized in these areas.
Schellter applies this
method successfully in healthcare organisations as patients are central.
Other terms that
are commonly associated with Kaizen are: SMED, Total Productive Maintenance
(TPM), Zero defect, Fool proof Poka-Yoke and Just in Time. All of these are
methods by which a method of production can be improved and are therefore
related at least in some extent to Kaizen and the continuous process of
Examples of Kaizen
Examples of Kaizen
are often times the most effective ways of showing just how this method can be
used in the workplace. Kaizen, Continuous Process
Improvement and many other
techniques in Lean Manufacturing involve a great deal of thinking outside of
the box, a task that can be quite difficult to do when you have been running
with the same operation system and managerial tactics for the life of your
business. Thinking differently is much harder than many people think. These
examples of how other companies use Kaizen may help to spark some creative
ideas of how you can apply similar innovation in your own service system.
- Changing equipment layout - Something
as simple as changing the layout on the service line floor can make a big
difference in eliminating wasted resources. For example, arranging equipment
so that they are in a `U' shape design can eliminate the need for an
operator as the layout of the equipment make them more assessable to a
fewer number of staff.
- Making pieces of equipment your own with small
modifications - Many times a home remedy or simple adjustment to standard tools or
equipment can make a huge difference to the overall efficiency of the work
that is being done. For example, a chef who attaches a paper towel rack to
the side of an island prep area can save himself a lot of time by not
having to move around to different areas of the kitchen in order to keep
his workstation and himself clean.
- Use what you have working for you to your advantage - You can use
forces that occur naturally to make your service job that much easier to
perform. For example, you can let gravity work for you by creating shoots
or holes where products can simply fall through to get re-routed to their
appropriate positions in the recycling bins or at different points in the service
line. Using this free energy saves time, money, and frustration.
7. Six sigma and lean manufacturing criticisms
focuses entirely on solving the problem of waste through a constant process of
analysis, production and mistake-proofing. Lean
Manufacturing is a holistic,
comprehensive, enterprise-wide program designed to be integrated into your company's
core strategy. Many experts believe Lean Manufacturing strategy is the most
effective way to launch and sustain lean activities. A second process of Lean
Manufacturing is improving the `flow' or the smoothness of the work. Toyota developed this
added process to improve the flow instead of focusing on waste reduction. The
Flow is designed to produce goods at a constant rate and allow further
processing to be carried out at a constant and predictable rate.
is focused on "the right" that is; getting the right things to the
right place at the right time in the right quantity. During this
"right" process the Lean Manufacturing system also strives to achieve
perfect work flow while minimizing waste and being flexible to change.
does lead to the overall reduction of costs in your organisation, but it also
teaches that most of the "extra" costs are assigned when the product
is first designed. Many times it has been noted that employees will specify
familiar, safe materials and processes rather than search for a new one. This
tends to lead to expensive and inefficient programs and/or processes.
When you implement
lean manufacturing, you should start by setting up a checklist and review it
often. Product design can be cut in half with a few brainstorming sessions that
improve overall company cost and performance. Lean Manufacturing also requires
the use of an effective, efficient leader. Lean Manufacturing focuses on a
complete cultural change to your business. Toyota has used a system of coaching and
guiding series to help the less experienced companies become proficient in
Many companies have
had outstanding results from implementing Lean Manufacturing. Cefla Group
published they have accelerated business process by 87%. General Motors has
implemented Lean Manufacturing to cut down administration costs. They reported
a $200 million dollar savings for halting the printing of catalogues for
dealers. Chrysler also reported savings upward of $2 million by implementing
Lean Manufacturing. Many other companies have reported cutting costs by 10% to
40% and increased productivity by 12% to 52%.
Criticisms of lean manufacturing
with lean manufacturing tend to remove around the key principles and if they
make sense. For a rational thinker, very few of the principles will make sense
because when properly applied, lean manufacturing will lead to a sense of
urgency, stress and discomfort. This problem lies because people do not have
the proper mindset that is required for lean manufacturing.
with lean manufacturing is the immediate patient needs that need to be
responded to. This again will create a sense of urgency and that will lead to
misunderstandings and discomfort. Employees tend to cover a problem if they are
rushed instead of focus on fixing the problem. If you have buffers in the
system, it is seen as weak and should be eliminated.
Many people feel
that the lean approach forces people to change instead of allowing them to do
it on their own. It is a necessary part in lean to push people beyond their
comfort zone in order to obtain results.
Six Sigma to identify and remove defects in the manufacturing process. The Six
Sigma methodology uses a series of quality management methods that are based on
statistics. Six Sigma creates a unique infrastructure within your organization,
assigning certain individuals to have different roles and responsibilities. The
methodology follows a karate belt method calling these roles "black belt,
green belt, etc."
Each step in the Six Sigma project will be assigned to a
different group and will be carried out following a defined sequence of steps.
The entire process is focused on statistics and your overall goal will be
financially set, meaning the end result will include cost reduction or an
increase in revenue.
encompasses a wide range of topics. Originally it was designed to improve the
manufacturing processes and eliminate defects, but it now defines anything that
leads to customer dissatisfaction.
When Bill Smith at
Motorola formulated Six Sigma, he was inspired by the Toyota Production System
and Lean Manufacturing.
Six Sigma and Lean Manufacturing both
believe a business can become successful with the following:
- Reduce process variation through
continuous effort to achieve stable and predictable results.
- The manufacturing process has
characteristics that can be measured, analyzed, improved and controlled.
- To achieve results, management
must believe in the concept and implement a complete cultural change in
Six Sigma not only implements the
above, but it also believes in the following:
- Increasing the emphasis on
leadership. Management must be strong and passionate about the program in
order to obtain success.
- Having a clear focus will help
to measure and achieve quantifiable financial returns.
- The infrastructure of
"Champions", "Master Black Belts", "Black
Belts", "Green Belts" and "Yellow Belts" will
lead, implement, and obtain results from the Six Sigma approach.
- Assumptions and guesswork lead
to poor results. By following Six Sigma, a clear commitment to making
decisions will come from verifiable data.
Six Sigma came from
a field of statistics that is known as process capability studies. These
studies are designed to produce defect levels below 3.4 defects per million
The different belts in the Six Sigma
methodology are as follows:
- Black Belts - they are able to devote all
their time to the process.
- Champions - Middle or senior-level executive who sponsors
the Six Sigma project and is responsible for the implementation of Six
Sigma throughout the company.
- Green belts - these individuals can devote
some of their time to Six Sigma.
- Yellow belts - these individuals have been
trained in the process, but have not completed a Six Sigma project.
Criticisms Six Sigma
Although Six Sigma
is a proven method, it still has critics who disagree that it is successful.
Many people will tell you that Six Sigma is simply a marketing ploy.
Sigma does draw on tools from other measures, it also represents a modern
quality in the context of defects per million opportunities.
Some people will
argue that Six Sigma doesn't take enough of a preventative approach to
problems. They state that it is more of an appraisal system or a corrective
action system. Six Sigma is much more than an appraisal system; it involves
extensive training and education to the entire workforce and creates an
infrastructure of experts who are involved in numerous projects focusing on
quality, timeliness and cost.
Other people have
argued that the success of the program depend more on the establishment of the
right organizational culture rather than on the program. Unlike other programs,
Six Sigma's training takes a look at the importance of a company-wide program
mindset instead of individual buy-ins. The methodology must be internalized if
it is going to be successful.
Another area where
Six Sigma is criticized is for its leadership. Leadership is the key to the
success of the complete Six Sigma program. Without the support of leadership at
every level, the program will fail. Many critics claim that Six Sigma is simple
a "flavour of the month" program and relies heavily on individual
support instead of a group implementation.
A few other
criticisms of Six Sigma get into the technical aspects like distribution and
short-term variability. For each critic of Six Sigma, there are always
proponents of the process who can find factual evidence to support their defence.
Lean Manufacturing and Six Sigma
Despite all the
critics that are looking for ways to pick apart the 2 methodologies, both
systems have been effective and useful for several companies. Because the 2
methodologies go hand-in-hand, many companies have actually combined certain
aspect of each method and call it "Lean Six Sigma." Like lean
manufacturing and Six Sigma, Lean Six Sigma focuses on creating a
"cultural change" within your organisation.
The results you should see from Lean
Six Sigma include:
Improved product quality
Increased customer satisfaction
Increase in revenue
Higher volumes of business
10 Facts on Patient Safety from the World Health Organization (WHO):
Patient safety is a serious global public health issue. In recent years, countries have increasingly recognized the importance of improving patient safety. In 2002, WHO Member States agreed on a World Health Assembly resolution on patient safety.
Estimates show that in developed countries as many as one in 10 patients is harmed while receiving hospital care. The harm can be caused by a range of errors or adverse events.
In developing countries, the probability of patients being harmed in hospitals is higher than in industrialized nations. The risk of health care-associated infection in some developing countries is as much as 20 times higher than in developed countries.
At any given time, 1.4 million people worldwide suffer from infections acquired in hospitals. Hand hygiene is the most essential measure for reducing health care-associated infection and the development of antimicrobial resistance.
At least 50% of medical equipment in developing countries is unusable or only partly usable. Often the equipment is not used due to lack of skills or commodities. As a result, diagnostic procedures or treatments cannot be performed. This leads to substandard or hazardous diagnosis or treatment that can pose a threat to the safety of patients and may result in serious injury or death.
In some countries, the proportion of injections given with syringes or needles reused without sterilization is as high as 70%. This exposes millions of people to infections. Each year, unsafe injections cause 1.3 million deaths, primarily due to transmission of blood-borne pathogens such as hepatitis B virus, hepatitis C virus and HIV.
Surgery is one of the most complex health interventions to deliver. More than 100 million people require surgical treatment every year for different medical reasons. Problems associated with surgical safety in developed countries account for half of the avoidable adverse events that result in death or disability.
The economic benefits of improving patient safety are compelling. Studies show that additional hospitalization, litigation costs, infections acquired in hospitals, lost income, disability and medical expenses have cost some countries between US$6 billion and US$29 billion a year.
Industries with a perceived higher risk such as aviation and nuclear plants have a much better safety record than health care. There is a one in 1,000,000 chance of a traveller being harmed while in an aircraft. In comparison, there is a one in 300 chance of a patient being harmed during health care.
Patients’ experience and their health are at the heart of the patient safety movement. The World Alliance for Patient Safety is working with 40 champions – who have in the past suffered due to lack of patient safety measures – to help make health care safer worldwide.