(Muda) Objectives. Determine what is Value added vs. Non-Value added. Identify the eight types of waste. Understand the Barriers to.

Transcription

1 Identifying Waste (Muda) Erika Sundrud, MA AVP Quality, Safety & Performance Improvement 1 Objectives Determine what is Value added vs. Non-Value added Identify the eight types of waste Understand the Barriers to Identifying Waste Understand Waste Walks 2

2 Waste is any task or product that adds cost or time without adding value from the perspective of the customer. 3 Encourages teamwork and staff involvement Improves patient care Improves safety Makes a facility more competitive Improves productivity Eliminating Waste Improves quality Improves the patient experience Reduces physical space required Reduces wait times Reduces costs 4

3 Voice of the Customer Who are our customers? Needs and Wants of customer? What is considered VALUE in their eyes? What are their expectations? 5 Determining Value: Value Added vs. Non Value Added 6

4 Doctor s Office Example: Value Added vs. Non Value Added Check In 3.0 Vitals 2.0 Nurse Exam Prep 4.0 Dr. Exam 9.0 Dr. Consult 4.0 Check Out Wait 35.0 Wait 20.0 Wait 15.0 Wait 10.0 Wait 10.0 Wait 20% Value Added Process VA Time / Total Time 24/119 = 0.20 Time in minutes The Eight Ways We Waste Defects / Errors (Rework) Waiting Inventory Transportation Overproduction Motion Over-processing Not (under) utilizing people 8

5 Defects / Errors (Rework) Making errors producing something that requires rework or is thrown away Waste related to cost for inspections of defects in materials or processes, customer complaints and repairs Incorrect or missing information on forms Illegible handwritten doctor s orders Repeat ED Visits Readmissions Giving wrong medication (type / dosage) Wrong site surgery Retesting due to error, redraws Patient falls Hospital Acquired Condition Sending out bills with incorrect charges Wrong procedure 9 Waiting Time when processes, people or equipment are idle Waiting for people or services to be provided Waiting for a response or call back Delays in receiving patients Waiting on approvals / reviews Waiting to see a doctor Waiting for admission to ER Delays for test results Waiting for transport Waiting on phone to schedule an appointment Delays for a bed assignment Delays in receiving information Waiting on equipment 10

6 Inventory Having more on hand than is needed or used Maintaining excessive amounts of supplies, materials or information for any length of time Stash of supplies just in case (clinical supplies, pens, sticky notes, surgical items, medication) WIP (work in progress) Document waiting for approval Patients in Holding areas Excess supplies / implants that can be ordered JIT (just in time) Multiple boxes of identical gloves Patients in waiting rooms Obsolete equipment Multiple copies or outdated manuals Excess copies of forms 11 Overproduction Producing what is unnecessary, when it is unnecessary, or in unnecessary amounts Making more than the customer requires or the next step in the process can handle Bringing 10 patients into Pre-Op at 7am with only 4 ORs Providing copies of reports to people who never use them Printing, ing, faxing, or sending the same document (or information) multiple times Making extra copies of charts, reports, labs, etc Treatment (meds, dressing changes, etc.) given early to suit staff/equipment schedule Mixing up 10 doses of medication when you need only 7 Making multiple copies of a form that is rarely used 12

7 Over-processing Unnecessary process steps, work elements, and operations traditionally accepted as necessary Ordering more diagnostic tests than the diagnosis warrants Multiple Reviews / Approvals Entering repetitive information on documents or forms (paper or electronic) Writing all information on paper and then going to nurse s station to enter it in the computer Clarifying Orders Compiling a report (form) that used to be required but no longer is required Requesting and processing information that will never be used 13 Transportation Moving or conveying of people or things, multiple handlings, unnecessary handling Moving patients, specimens, supplies or equipment long distances Placing a stretcher in the hall and constantly having to move it Multiple bed assignments moving patients Moving patient charts from one location to another Carrying paper notes to computer station to enter in computer Moving equipment for surgeries in and out of operating rooms Moving patients to multiple locations during course of treatment / visit Moving items early, late or to the wrong location 14

8 Motion Unnecessary action of people or equipment Action of people or equipment that does not add value Searching to find working equipment Replying to All multiple delete actions Staff searching to find supplies or medications Searching to find patients Searching to find charts or orders Physicians walking to their office during an exam to look up online notes Walking to equipment not centrally located Patients walking to multiple locations for treatment Rearranging equipment or instruments 15 Not (under) Utilizing People Unused human potential, talent, skills, ideas, creativity and suggestions of employees Not considering suggestions / ideas of staff Not utilizing a person s skills because it s not their job Little or no cross-training No defined performance management system Not capturing internal best practices and leveraging Utilizing a skill set to do work that does not require that level skill set Not working across silos to utilize capacity of staff Same activities performed in different ways by different people 16

9 Categories of Waste (for those who like acronyms) efects / Errors (Rework) verproduction aiting ot Utilizing People (underutilization) ransportation nventory otion xtra (over) Processing 17 Recognizing Waste Requires: Knowing what your customers want and need Time on the Gemba, observing The ability to see what really is, not what should be 18

10 Barriers to Recognizing Waste Not watching a process enough Inability to put traditionally accepted practices up for analysis Inability to see required non-value added activities as waste Inability to question how we ve always done it and what we believe is required Recognizing that a good portion of one s job is actually wasteful 19 Shifting waste from one department or step in the process to another department or step in the process is NOT LEAN (eliminating the waste) 20

11 Waste Walk Go to the Gemba go to the place the work is done Watch the process, see what it actually is Walk the process - Follow the flow Listen for indications of Waste Identify the Waste you see 21 What to Look for on a Waste Walk Places where the flow Stops Variation in how tasks are completed Complex communications processes or breakdowns in communication Lack of processes to explain how to do things Poor equipment availability and reliability The Voice of the Customer Long travel distances for meds, supplies, and equipment Any and all Waste 22

12 Toast Current State 23 Toast Future State 24

13 Summary Key Points The goal of Lean is to eliminate non-value added activities. Identifying the eight main types of waste in your environment leads to quality improvement. Questioning and systematic observation can overcome barriers to change and improvement. Conducting Waste Walks can help you identify barriers and waste