5hb OGOS 2019

BENGKEL LEAN HEALTHCARE

MINISTRY OF HEALTH MALAYSIA

Lean HealthcareEnhancing Public Service Delivery

Pra-Konvensyen Inovasi dan Kreativiti Farmasi 2019Berjaya Waterfront Hotel, Johor Bahru

Course Objectives:1) Enhance Lean Thinking.

2) Understand Lean principles, tools and methodology.

3) Overview on Lean implementation within MOH.

Enhancing Public ServiceDelivery through

LEANTHINKING

2009

Introduction to MOH’s Lean Journey

2013

HSI-JBOncologyOrthopedic

2014

HTAR-KlangEmergency Dept.Medical Wards

2015

12 State HospitalsED/ Med Wards

2016 2017

HKL TransformationBlok Appt. SystemMedical RecordsOpthal spec. clinicOrtho spec. clinicsFacility Maintenance

2018

Lean Champion

Lean Governance

Lean Sustainability Plan

LEAN Healthcare.. Implementation areas

Patient support Patient registration Medical records

Outpatient

Emergency Department

Outpatient Department

Specialist Clinics

Inpatient

Diagnosticsupport

Neuro DiagnosticsPathology

Radiology

Medical wards

OT / Surgery wards

O&G wards

Orthopedic wards

Ophthalmology wards

Hospital support

HR Management

Finance

Procurement

Facility Management

Food Preparation & Delivery

Patient Safety

Laundry & Linen

Risk Management

Clinical support

Pharmacy

Blood bank

Rehabilitation center

Operating theatres

Pediatrics wards

o Understanding the Process and Values to Customerso Identify Waste & Non value addedo Eliminate the Waste

What is Lean?

o Improvement methodology – adopted from Toyota Production System 5S/ RCA/ ICC/ QA/ BPR/ SS/ BOS

1940’s 1990’s 2000’s

Introduction to Lean ConceptsLean includes principles, methods and

tools used to improve process efficiency by removing wasteful steps

(Defect)

7 Wastes of Manufacturing

8 Knowledge Disconnection

Abbr Type of waste Example Explaination

T Transportation Movement of materials from one location to another Avoid unnecessary steps in between processes

I InventoryEvery piece of product tied up in raw material, work in progress or finished good costs money until its sold

Do not store extra materials

M MotionUnnecessary motions are movements of machines or employees that are not as small or as easy to achieve as possible

Make the motions in between processes easier

W WaitingAny idle time produced when two interdependent processes are not completely synchronized

Connect processes well, so no time is wasted

O Overprocessing Put more into the product than is valued by the customer Do not do more than what customers want

O Overproduction Results from producing more or faster than required Do not produce more than what customers need

D Defects Errors that require time to fix Avoid mistakes or the production of bad quality goods

LEAN is NOT about …Cost Reduction

Typically, non-value added activities

accounts for 95% of the total lead time

12

What 2.5 hours waiting time means to the nation ?

Optimizing Capacity and Resource Utilization

EnhancingLEAN Thinking..

1Oncology HSI

House of LeanGoal of Customer focus:

Highest quality, lowest cost, shortest lead time by continually eliminating muda

Demand & Capacity leveling

Pace of production is synchronized with the rate of sales

Strategic planning in-line with company goal

Automation with human mind

10 Steps on Lean implementation:1) Identify the real issue.2) Create Project Charter.3) Establish Patient Journey, Touch-points and Baseline4) Develop Value Stream Mapping (current state)5) Identify Kaizen (improvement)6) Plan and implement improvements7) Monitor progress and reporting8) Update VSM (future state) 9) Extend Kaizen to connecting areas10) Manage Sustainability

Addressing the ISSUES (cause) Eliminating the NOISE (symptom)

Identifying the “real issue”1

Project Goal

Comparative AssessmentKPIs and challenges to go forward:

Team members:[1] Aspiration: To improve the waiting time of head and neck cancer patient to start radical radiotherapy treatment after first consultation by oncologist at ‘Pusat Rawatan Onkologi’ Hospital sultan Ismail Johor Bahru

Sponsor: Minister of Health - Director General of Health & Deputy Director General of Health (Medical)

Leader: Director Hospital Sultan Ismail.

Buddy: PEMANDU, UniKL MITEC

Team members: Dr Mohd Roslan Haron, Dr Fong Chin Heng,En Mohd Khairee Aripin,En Hassan Ali, Pn Halimaton Saddiah Paiman,Pn Azizah Caronshow, JT Siti Norsiah Ibrahim , KJ Rafi’ah Othman, KJ Zaidah Othman, PPP Kamarul Ariffin Isa

[2] Current Situation: Average waiting time is 4 months from first oncology consultation

[1] Benchmark: WHO standard 3-4 weeks

[2] Comparative assessment: NHS = 31 Days , RANZCR = 28 Days , USORT = 26 Days

[1] KPI: To start 8 weeks after first consultation[2] Challenges:Inadequate Linear Accelerators and other related equipmentsInsufficient manpower such as clinical oncology, radiation physicist, therapy radiographer

Process : Head and Neck Radiotherapy Treatment

Forming Project Charter2

The patients journey.. Touch points for Opthal Clinic

Establish Patient Journey, Touch-points and Baseline3

Develop Value Stream Mapping4

Carta Aliran Di Bilik Rawatan

Process Flow Chart

Based on the given process flowchart:

1) Identify all possible problems exist in the process

2) Plan improvement activities

Kaizen Burst

K1

K2

K3

Identifying Kaizen5

Kaizen (continuous improvement)Kaizen, which in Japanese means good (zen) change (kai) is a philosophy that motivates people to constantly improve their surroundings.While kaizen (at Toyota) usually delivers small improvements.

Reduce waits time from 4 months to 2 months @ 120 Days

Kaizen Burst #1 : To increase Clinac machine capacity --> Goal to reduce treatment waiting time from current 2.5 mths to less than 1 monthKaizen Burst #2 : To reduce patients backlog (inventory) from current 125 files to less than 30 files from Reg. to Before treatment --> Goal to reduce planning work from 1.5 mth to 2 wks

Kaizen Burst #3 : To reduce re-plan works (rework) from 30% to less than 10%

VSM using Swim-lane technique for Oncology Dept, HSI JB

EFFORTvs

IMPACT

Plan and Implement Kaizen 6

Monitor Kaizen progress 7

PDCA

A3 Report

Current State Future

Current State Future State

Current Future

Phase 1

Phase 2

Phase 3

Update VSM (future state) 8

Patient Journey – Key Touch Points at ED Green Zone

o Wardso Pharmacyo Hasil

o KKo District

Hospitalo Ambulanceo Services

o Pathology o Maintenance o Radiology

Extend Kaizen to connecting areas 9

Kaizen Board at HSI

Manage Sustainability10

Project Leader

QualityManager

Lean Champion

LEAN SUSTAINABILITYOPERATIONAL MODEL

the platform

the driver

the competency

2BOR

Heijunka

Scenario planning…levelling discharge

Levelling discharge start as early as 9am

3Discharge

“We have the very best pharmacy sitting right next to the best laboratory, sitting right next to the very best x-ray department, sitting right next to the very best nursing department….and the hospital doesn’t work.” - Dr.Paul Batalden former president of Institute of Healthcare Improvement

PharmacyLaboratory

Radiology Department

Nursing

The challenge to Lean implementation

1. WHO Makes up the Other Department?Start by learning the names and roles of as many people as possible in each department.

Getting to Know Other Departments

2. WHAT Does the Other Department Do?The best way to find out what a department really does is to speak with the people there about their work, and about how it relates to yours.

3. WHY Does Each Department Exist in Your Organization?Learning how each department contributes to the broader vision can "bring home" the importance of working together toward a common goal.

4. WHERE Does Each Department Work?Use this information to plan how and when you will contact these teams, and to schedule virtual meetings , for example. Showing respect for others' working patterns.5. HOW Does the Process Work? H

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ILO

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“What is Lean Healthcare”o Lean Healthcare is not about

turning a hospital into a factory... … not about cost cutting program

o Identify Waste & Non value addedo Understanding the Process and Values to

Customers..Using - Value Stream Mapping (VSM)

“What is Lean Healthcare”

o Philosophy of Continuous Improvement Across Organization…

“Top Management.. Full Commitment”

ALOS issues

“What is Lean Healthcare”

Transforming Malaysian Healthcare Service Delivery through Lean Applications

Thank-you