When you make the decision to attempt a Lean journey, you’ll need to begin thinking about the magnitude of this change, since it is enormous. A lot of your present practices will change to be much more dedicated to patient care (the reasons why you found myself in healthcare) and much less on the daily aggravations of searching for the things you’ll need to provide that care. You must have a great framework to measure the progress of your lean efforts. First, as you think about the changes coming, you have to:
Let’s start by defining what a hospital value stream is: a Value Stream is a collection of interconnected processes to provide value to a customer. french-stream A price stream example in a hospital describes the care of an individual that arrived to a healthcare facility via the Emergency Department, was admitted to the Telemetry unit, and was discharged home. Another value stream example describes the flow of patients which come to a healthcare facility for outpatient surgeries:
Each process advances the care of the patient. The sum total of the processes delivers value to the individual and is what we call a Value Stream. There are many value streams in a hospital and all of them must mature returning to perfection, as that’s our goal and the goal of any Lean initiative. How can we track the progress of the Lean implementation on a particular value stream? We do that by establishing a five-level framework to gauge the progress.
Engagement. By this we mean a advanced of involvement by the whole staff. Simply improving isn’t sufficient in a Lean Value Stream. With no active involvement by everyone in the task of process improvement, it is likely to be difficult to improve fast enough in today’s competitive environment.
Level 1: Identify the Value Stream and assign ownership. The very first logical step in improving a value stream is to recognize and document it. This maturity level involves naming a value stream, assigning a value stream owner to it, and creating both current and future state value stream maps. We will even want to establish performance metrics for the value stream: Discharge performance, Medication Administration performance, productivity, quality, and so on.
Level 2: Patient Flow and Pull. The biggest opportunity when moving from the traditional work environment to a Lean environment may be the introduction of flow and pulls methods. Patient wait time in traditional environments can represent around 70% of the sum total patient length of stay. In cases where you flow products, like Sterile Processing of Instrument sets, experience indicates that cycle time is related to an extended set of related benefits, including improved productivity, better quality, less floor space, improved flexibility, and higher on-time delivery of the Instrument sets back once again to the OR Suite.
Level 3: Standardization. Once we’ve harvested the reduced hanging fruit of flow and pull, we ought to continue with the task of training the certifying the staff in Standard Work. We need to involve the whole staff in defining the one easiest way to complete work, and to train them to complete the work that way. Remember that standard work does not limit creativity or improvement, but it does determine what sort of work ought to be done for the current time.
Level 4: Engagement. The stage of engagement is what separates the Lean pros from the amateurs, whenever we are assessing value stream maturity. Until we have the ability to involve the whole workforce in the creative work of continuous improvement, our Lean efforts will continue being at risk of outside competitors simply copying what we’ve done. Once we are generating hundreds and a large number of small improvement suggestions annually, it is likely to be very difficult for your competition to help keep up.
Level 5: Sustained Performance. Until we have the ability to incorporate flow, pull, standard work and employee engagement into our hospital culture, things will inevitably backslide. We are able to claim that we have reached Level 5 on the value stream maturity scale if we have the ability to shown that we have maintained continuous improvement for a period of at the least 36 months.
The starting point, obviously, would be to map most of your value streams. As the Value Stream Mapping concept is well-know, in fact few organizations (hospitals or factories) have actually taken that first step. If you’re willing to go forward with your time and effort, acquire some expert help from mentoring organizations like Leonardo Group Americas. Getting training and insight from people who have done this before often is extremely valuable.