How Effective Lean Management Streamlines Patient Care

Rose Heathcote Lean Institute Africa

Outline

• Sore Heads

• The Reality

• A Preposterous Plan

• Triple Approach

• Leadership Influence

• Possibilities and Probabilities

• Where to next?

• Tipping Point

• Questions

1

2

2003MBA

Students+Prof.Faull

2008FuruhashiWorkshopatGFJoosteHospital

201018-HospitalImprovement

ProjectsNDoH

2010Anova andAurumHealthProjects

2014GDoHCohortofFour

Hospitals 2016PartneredwithCatalysisincoachinglocal

CEO’s

2014GrooteSchuurImprovement

Programme

We’vesupportedaround30facilities

Upto86%reductioninwaitingtime

80%reductioninneo-nataldeaths

35%improvementinthroughput

O u r H e a l t h c a r e E x p e r i m e n t T i m e l i n e

Next?

2012TshwaneOut-PatientDMS

2015TshwaneProcurementLeadTimes

Sore Heads

The Reality

Waiting…waiting…and then some

3

A Preposterous Plan

4

Source:Prof.N.Faull(2014)

• Patient complaints of long waiting times

• Minister and MEC Health prioritise the issue

• Initiate improvement projects

A Preposterous Plan

ARomanCohort:Acohortisagroupofpeoplebandedtogetherforacommoncause.

Cohort1:GautengDepartmentofHealthServiceDeliveryImprovementInitiativeChrisHaniBaragwanathAcademic,Leratong,SebokengandKopanongHospitalsformedaCohort

Mandate: Reducepatientwaitingtimes

Triple Approach

Performance

Time

IncrementalIncremental Improvement

andKataCoachingreferstoday-to-day

continuousimprovement,usuallytriggeredthroughadailymanagementsystemandaddressedatprocess

level

Breakthrough

BreakthroughImprovement andA3

Thinking

referstohighlyfocusedimprovementevents,

usuallytriggeredthroughlongtermtracking,andaddressedatsystemicor

strategiclevel

WinningCombo=breakthroughprojects+dailymanagement+leadershipcoaching

LeadershipCoachingWillingnessHumilityCuriosity

PerseveranceSelf-Discipline

DevelopingtheCurrentCondition Spaghetti

Diagram PhotosofMuda,

Mura,Muri

ValueStreamMap

High-LevelMap

DemandPatterns

Breakthrough!

WorkBalanceChart

Triple Approach

Incremental!

• Short Interval Control

• Structured, Daily Meetings

• Problem Solving

Triple Approach

ExamplesoftheDailyMeasures

drivingincrementalchange

DoctorAvailableCapacity WaitingTime

ClinicStartTime

Doctoronleave

Triple Approach

Leadership Influence

• Visible, consistent support from the CEO is critical- CEO and Execs conduct Gemba Walks and offer support

- CEO and Managers use A3’s to articulate their problem solving

through processes

- CEO commitment is visual and regular – Managers carry this

through to their teams

- CEO enables people the time and space to make change happen

Leadership Influence

• Practices what he preaches

• This is his office

Leadership Influence

• Self-Reflection

• Self-Improvement

• Support

Possibilities and Probabilities

OUT-PATIEN

TJOURN

EY70%Improvementon

baseline72%Improvementon

baseline

After5-dayRapidProcessImprovementWorkshop

DailyManagementImprovement

34%Improvementonbaseline

49%Improvementonbaseline

68%Improvementonbaseline

52%Improvementonbaseline

REGISTRA

TION

CLINIC

PHAR

MCY

• Theatre

• Casualty

• X-Ray

• …

HEALTHCARE FACILITY MODELAREA %IMPROVEMENTAFTER5-DAYS

%IMPROVEMENTATLASTRESULTCAPTURED

Hospital 1Registration 63% 86%

Clinic 13% 45%

Pharmacy 23% 32%

Hospital2Registration 70% 72%

Clinic 34% 49%

Pharmacy 68% 52%

Hospital3Registration 29% 21%

Clinic 26% 22%

Pharmacy 67% 0%(relocated)

Hospital4Registration 37% 73%

Clinic 53% -11%(lesscapacity)

Pharmacy 36% 34%

Possibilities and Probabilities

Richvoicesproclaimed:‘Youjustcallonmebrother,whenyouneedahand.Weallneedsomebodytolean on.Ijustmighthaveaproblemthatyou'llunderstand.Weallneedsomebodytoleanon.’

Everyonegained—bothpersonallyandprofessionally.

Possibilities and Probabilities

Possibilities and Probabilities

Patientspayuscompliments

16complimentsreceivedinMOPD

Wheretonext?

LeanTippingPoint

PleasejoinusattheLeanSummitAfrica2018inCapeTowntohearmore

www.lean.org.za