lean en agile in zorgcentra - zorgondersteuning · ©cimes gcv 2011 - all rights reserved. no part...
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©Cimes gcv 2011 - All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording and/or otherwise without the prior written permission of the author of Cimes gcv.
Tijd voor Zorg? Zorg voor tijd! Performantie in zorgondersteunende diensten
Edegem, 25 maart 2011
Prof. dr. ir. Luc CHALMET
Cimes g.c.v. Universiteit Gent en Universiteit Antwerpen
Lean en Agile in zorgcentra
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Lean’s “Three Steps to Heaven”
1. ‘Verspilling” zichtbaar maken, altijd en overal
2. ‘Verspilling’ voortdurend wegwerken, en op
die manier de doorstroming van de cliënt (patiënt) voortdurend verbeteren
3. Nooit aflaten
25 maart 2011 Zorgondersteuning 2
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Verspilling zichtbaar maken
25 maart 2011 Zorgondersteuning 3
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Enkele voorbeelden 1. Goto Gemba
2. 5S
3. Five-Why
25 maart 2011 Zorgondersteuning 4
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Continuous improvement
Continuous improvement
+ Innovation
= Optimal return from
improvement actions
Continuous improvement
inno
vatio
n
Source : Valéo
Point-Flow-Blitz Kaizen
25 maart 2011 Zorgondersteuning 5
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Perfection: The Deming Cycle
Plan
Do
Check
Act
( what to do; problem solving for improvement)
(Do it, on a trial basis; experiment)
( check if it works; the risks; the variation, LEARN!)
(implement more widely) standardize
“Hold the gains”
25 maart 2011 Zorgondersteuning 6
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“Lean Thinking” de 5 Principes 1. Value 2. Value Stream 3. Flow 4. Pull 5. Perfection
25 maart 2011 Zorgondersteuning 7
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Iedereen op weg naar een ongeziene dynamiek
100 % hectic and dynamic market
static market
1990 2000 2010 2020 1980
Energy and Utilities Government
Telecommunications and Information industry
Consumer Goods
Automotive
old paradigm
new paradigm
Chemical Pharmaceutical
?
25 maart 2011 Zorgondersteuning 8
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Wendbaarheid is absoluut noodzakelijk
1. Obsessie voor waardecreatie voor de klant
2. Kennisgedreven
3. Kunnen samenwerken
4. Adaptieve Processen, Systemen, Structuren, Mensen
5. Inspirerend leiderschap
25 maart 2011 Zorgondersteuning 9
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Agility = Winning in the Dynamic Market
Collaborative Organizations
Knowledge drives the Business
Continuously Adaptive in: • people • organization • processes • systems
Motivating Leadership
Obsession for Added Value to
the Client
management of change
innovative
behaviors and competencies
25 maart 2011 Zorgondersteuning 10
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Lean Agility is het beste van twee werelden
voor ELKE organisatie
25 maart 2011 Zorgondersteuning 11
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Meting van Lean Agility
met het CMI Lean Agility
assessment 25 maart 2011 Zorgondersteuning 12
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13
Om gezond te blijven moet je de CMI(Company Mass Index) in de
gaten houden
BMI = (weight in kg) / (length in m)2
25 maart 2011 Zorgondersteuning
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Scoring via een 5-punt Likert schaal dmv CMI Lean Agility® stellingen die de ‘ideale’ lean /
agility toepassing omschrijven
CMI Lean Agility WebService
25 maart 2011 Zorgondersteuning 14
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1. Hierarchisch
2. Ideale praktijk via stellingen
3. Likert scoringsmechanisme (“helemaal akkoord”, “akkoord”, “neutraal”, “niet akkoord” and “totaal niet akkoord”)
Batterij met CMI Stellingen
25 maart 2011 Zorgondersteuning 15
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• Groep scoort heterogeen, dekt de scope en zijn grenzen, geen hierarchische relaties
• Uitleg: Elke stelling wordt eerst uitgelegd voor eenvormigheid van begrip
• Faciliteren van discussie • Halve Dag: 150 - 200 stellingen • CMI WebService url scoring systeem
De CMI assessment Sessie
25 maart 2011 Zorgondersteuning 16
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CMI Lean Agility® scoring geeft een focus voor verbetering
25 maart 2011 Zorgondersteuning 17
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Interpretation of CMI scores EXCELLENT O - 25
IMPROVEMENTS NEEDED 26 - 50
SUBSTANTIAL EFFORT TO IMPROVE IS NEEDED
51 - 75
START IMPROVING WITH GREAT URGENCY
76 - 100
25 maart 2011 Zorgondersteuning 18
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Interpretation of CMI scores Feedback
-3 2 7
12 Bottom Up Approach Continuous Improvement
Customer Obsession Flow
Lean Finance Focus
Informed Internal Customer
Modularity PDCA Pull
Collaborating Standaardisation
TPM Visualisation
Waste
Renson: 39,5
0
10
20
30
40
50
60
70
80
Zoveel mogelijk doen wat van
waarde is voor de klant
Verkoop oplossingen
Verspillingen vermijden
Lay-‐out
Stroom
Vraag van klant zet keten in gang
Just-‐in-‐Time
Planning
Relaties
Samenwerking
Lange termijn filosofie
Cultuur die streeft naar perfectie
Ondersteuning van werknem
ers
door managem
ent
Reactiesnelheid op onverw
achte
omstandigheden
Ondersteunende functies
CMI
Klantwaarde: 34,4 Stroom + Relaties en samenwerking: 46,5 Cultuur en structuur: 38,1
25 maart 2011 Zorgondersteuning 19
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– Chemical, pharmaceutical, process industries – Manufacturing: Machines, consumer goods, food & beverage,
suppliers to automotive, textile, construction – Retail – Services: ICT service providers, consultants, financial, logistics
service providers, harbour logistics, law & accountancy firms, – Health care (hospitals surgery rooms, elderly care centers) – Education (University departments) – Entertainment (music) – Social economy (“kringloopcentra”& “beschutte werkplaatsen”)
Uitgebreide ervaring met CMI
25 maart 2011 Zorgondersteuning 20
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Combining Lean and Agility as every
organization needs both !
www.lean-agility.com
25 maart 2011 Zorgondersteuning 21
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Zorgondersteuning 25 maart 2011 22
CMI Lean Agility onderzoek in zorgcentra
met medewerking van Lien Van Steenberge
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Zorgondersteuning 25 maart 2011 23
VERGRIJZING (aandeel 65+)
10
15
20
25
30
1990 2000 2010 2020 2030 2040 2050projectiehorizon (op 31 dec)
% o
uder
en (6
5+)
VlaanderenWalloniëBrussel
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Zorgondersteuning 25 maart 2011 24
0100.000200.000300.000400.000500.000600.000700.000800.000900.000
2000 2010 2020 2030 2040 2050tijd
# inwoners
60-‐69jaar
70-‐79jaar
80-‐89jaar
90-‐99jaar
100+
80+
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Zorgondersteuning 25 maart 2011 25
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Zorgondersteuning 25 maart 2011 26
Bestaande woongelegenheden in woonzorgcentrasituatie 01/10/2010
openbaar37%
privaat non-‐profit51%
commer-‐cieel12%
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Zorgondersteuning 25 maart 2011 27
!
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Zorgondersteuning 25 maart 2011 28
!
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Zorgondersteuning 25 maart 2011 29
CULTUUR MENSEN MANAGE-MNT
BEVOOR-RADING
INFRA-STRUCTUUR
ZORG PROCESSEN
ZORG ONTWIK-KELING
LERENDE ORGANISATIE
PERSONEELS ONTWIKKE-
LING
STRATEGIE VISIE
BESTELLING LEVERING
BESCHIK- BAAR
VERSPILLING ZICHTBAAR
KWALITEIT ZORG
PROBLEMEN OPLOSSEN
ZELF STURING
LEIDER- SCHAP
RELATIES LEVERAN-
CIERS
BEHAAGLIJK COMFORT
VERSPILLING ELIMINEREN
MARKT SEGMENTEN
COLLABORATIE
CONTINUE VERBETERING
RELATIES MET BEWONERS
PRESTATIE METINGEN
VOORRAAD MILIEU ENERGIE
STANDAARDISATIE
FLEXIBILITEIT
ONDER-HOUD
HERSTELLEN
INNOVATIE ICT
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Zorgondersteuning 25 maart 2011 30
VZW Zonnehove, Sint-Denijs Westrem VZW Kanunnik Triest, Melle VZW Sint-Jozef, Gent OCMW De Vijvers, Ledeberg OCMW Schelderust, Wetteren Privé Home ‘t Neerhof, Elst
Deelnemende centra
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Zorgondersteuning 25 maart 2011 31
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Zorgondersteuning 25 maart 2011 32
Kritisch, vanuit het standpunt van de oudere, elk proces in kaart brengen en verspillingen identificeren en zichtbaar maken (VSM) Verspillingen wegwerken om meer continue doorstroom van de processen te bekomen (5Why, PDCA verbetercyclus en standaarden) 5S
Processen
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Zorgondersteuning 25 maart 2011 33
Wijzigende omstandigheden vereisten meer multi-functionaliteit en meer samenwerken in zelfsturende teams (in plaats van specialisatie) - Motivatieversterkend - Cross-trainingsprogramma’s - Evolutie naar lerende organisatie - Bottom-up verbeteringen
Mensen
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Zorgondersteuning 25 maart 2011 34
Poka-joke als verbeterproces: zorgen dat het maken van fouten geen kans krijgt Meten in functie van de ouderen Gebruik maken van beschikbare ICT mogelijkheden voor bevoorrading “go to gemba” dagelijks luisteren naar personeel en bewoners en de coach rol invullen
Verbeteren
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Zorgondersteuning 25 maart 2011 35
“Lean thinking is a way of streamlining the patient journey and making it safe, by helping staff to eliminate all kinds of waste and to treat more
patients with existing resources“
D. Jones
CMI onderzoek in hospitalen
met medewerking van Charlotte Van Parys
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Zorgondersteuning 25 maart 2011 36
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Zorgondersteuning 25 maart 2011 37
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Zorgondersteuning 25 maart 2011 38
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Zorgondersteuning 25 maart 2011 39
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Zorgondersteuning 25 maart 2011 40
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Zorgondersteuning 25 maart 2011 41
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Zorgondersteuning 25 maart 2011 42
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Zorgondersteuning 25 maart 2011 43
0
10
20
30
40
50
60
70
CM
I
Virga Jesse
UZA
Heilig-Hart
Sint-Vincentius
Sint-Blasius
Maria Middelares
Jan Yperman
Sint-Augustinus
Sint-Andries
Belanghebbenden
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Zorgondersteuning 25 maart 2011 44
Recente gedwongen samenwerking tussen ziekenhuizen heeft geleid tot meer aandacht voor alle belanghebbenden en transmurale zorg Management moet meer naar de werkvloer
Conclusies
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Zorgondersteuning 25 maart 2011 45
20
30
40
50
60
70
80
PROCESSEN Planning & Uitvoering Processen Procesbeoordeling
CM
I
Virga Jesse
Sint-Vincentius
Maria Middelares
Sint-Augustinus
UZA
Sint-Blasius
Heilig-Hart
Jan Yperman
Sint-Andries
Processen
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Zorgondersteuning 25 maart 2011 46
Dringend E2E processen in kaart brengen en meetcultuur t.a.v. totale proces invoeren Standardisatie is hoognodig (balans tussen chaos en perfecte conformiteit) Betere procesflow realiseren (wachttijden, synchronisaties, verspillingen)
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Zorgondersteuning 25 maart 2011 47
Redundantie en duplicatie van gegevens en documenten – papierbalast, zoeken naar documenten veroorzaken veel verspilling Beter capaciteit afstemmen op vraag, zowel op micro (dokterscabinet) als macro (bedbezettingen) niveau – inplannen van patiënten
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Zorgondersteuning 25 maart 2011 48
25
30
35
40
45
50
55
60
65
ORGANISATIE & CULTUUR Organisatie Cultuur
CM
I
Virga Jesse
Maria Middelares
Sint-Blasius
Sint-Augustinus
Sint-Vincentius
Heilig-Hart
UZA
Jan Yperman
Sint-Andries
Organisatie & Cultuur
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Zorgondersteuning 25 maart 2011 49
Gestructureerde aanpak om problemen op te lossen Sceptisch tegenover ideeën die van buiten komen Ownership van medewerkers over continu verbeteren, bv. Via PDCA verbetercyclus Nood aan matrixstructuur Zichtbaarheid van dagelijkse doelstellingen en realisaties
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Zorgondersteuning 25 maart 2011 50
“Running even the most complicated corporation must sometimes seem like child’s play compared to
trying to manage almost any hospital “
H. Mintzberg
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Zorgondersteuning 25 maart 2011 51
Post Scriptum
“The Productive Ward programme draws upon principles of ‘lean thinking’ to help tackle previously
neglected everyday issues facing frontline NHS staff.
In the case of health care, reducing activities that do not add value could mean releasing more staff time
for work that actually meets patient needs.”
NHS (UK) 2007 - 2011
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Luc Chalmet – Professor at University of Gent and University of Antwerpen
– Managing Owner of Cimes
– 20+ years of Consul?ng experience with PA Consul?ng, Arthur D. LiGle, KPMG Consultants and Unisys Consul?ng, and Cimes
– Recent clients: Atlas Copco, Johnson & Johnson (Janssen Pharmaceu?ca), Philips (Massive), Daikin, Dupont de Nemours, Imperial Tobacco (Rizla), Bekaert, Brady, Etex Group, MicrosoW, Puratos, Siemens, Novar?s, Accenture, United Biscuits, Monsanto (De Ruiter Seeds), Argenta, Tupperware, Unitron, Spraying Systems, Kringwinkel Antwerpen, UCB, Schréder, Crion
– Industrial experience with Alcatel Bell Telephone
– CFPIM (Fellow in Produc?on and Inventory Management), CSCP (Supply Chain Professional) cer?fied by APICS; Master Instructor for CPIM, CSCP and TTT (Train-‐the-‐Trainer)
– Doctor in Applied Sciences, Industrial Management 25 maart 2011 Zorgondersteuning
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Thank You
www.lean-agility.com
25 maart 2011 Zorgondersteuning