Lean at OUH A Targeted Commitment to Quality and Efficiency The Lean Staff OUH Odense University Hospital Svendborg Hospital
OUH in brief OUH the joint designation for both Odense University Hospital and Svendborg Hospital is one of the three largest hospital centres in Denmark operating in the fields of treatment, research and education. Highly specialised OUH - Odense University Hospital and Svendborg Hospital - is a general hospital, primarily for patients from Funen. Furthermore, Odense University Hospital is a highly specialised referral hospital for the Region of Southern Denmark and treats patients from the rest of Denmark and abroad. OUH comprises 10% of Denmarks healthcare services. Odense University Hospital s peak competencies are in the areas of cardiovascular disease, cancer and replantation of fing - ers, hands, etc. But also in the areas of allergies, sores that are difficult to treat, diabetes, paediatrics, oesophageal disorders, infectious diseases, as well as arthritis and connective-tissue diseases. Research and education Research activities at Odense University Hospital are growing rapidly both within Denmark and with foreign partners. Resarch is conducted in close cooperation with the Faculty of Health Sciences at the University of Southern Denmark, situated in Odense. Research activities with - in diabetes, immunology, inflammation, ageing and degenerative disorders, as well as health-service research are extremely well established. OUH has 1,600 study spaces dispersed over 18 different study programmes. OUH is more productive than any other major Danish hospital. Joint management Both hospitals in OUH are managed by a joint management board and have a total joint budget of DKK 4.5 billion. Together, the hospitals have 1,300 beds and 10,000 employees. The hospitals process 650,000 outpatients and 100,000 hospitalisations a year. Published by OUH, March 2008 Editorial staff: Lean Staff at OUH Texts and planning: OUH and arkitekst kommunikation Graphic design: Inge Karrebæk Translation: Interpen Translation A/S Printed by: one2one 2
Initiated by management carried through by employees In the years ahead, we intend to implement Lean throughout OUH Odense University Hospital and Svendborg Hospital. In so doing, OUH will become the first hospital centre in Denmark to implement Lean methods full-scale throughout not only in minor, temporary projects. Quality in focus Lean s basic concept goes hand in glove with OUH s own intentions of continuing to develop for the benefit of patients and employees alike. Lean is initiated by the management but is carried through by the ideas and dedication of our employees. Our employees insight into the strengths and weaknesses of our processes results in suggestions, improvements and tangible initiatives in our daily work, with the help of the Lean techniques. This makes big demands on managerial staff to risk committing themselves, loosening the reigns and letting things occur in new ways. At OUH, no one will be made redundant in the wake of Lean we still need every employee! Instead, Lean will be used for obtaining more resources for treatment and examinations, for higher quality and for more research, training and education. OUH has decided that 55% of the gains achieved will accrue to the department itself in the form of resources and more time for research, training and development, while 45% will be prioritised by the hospital management together with the department's management. This very same quality and professionalism are the watchwords that encourage employees to take part in the project and make a gigantic effort thus ensuring Lean s success at OUH. With this close interaction of theory and practice, ideas and action, Lean methods are eminently suitable for becom - ing incorporated throughout OUH s change culture. Getting the entire hospital on board This pamphlet presents the first lessons learned from applying Lean methods in three departments Diagnostic Radiology, Cardiology and Orthopaedics in an eighteen-month pilot project. Based on these lessons learned, we adopted a roll-out plan in the early summer of 2007, which will eventually encompass the entire hospital. Six additional departments are being introduced to the Lean method in 2008, assisted by OUH s own Lean Staff. At the same time, we ve made great strides in charting out and coordinating the hospital's purchases, with a view to streamlining our purchasing processes and optimising our stock management system. A total of 2,500 employees are now involved in Lean processes. On the following pages, we briefly describe how we apply the Lean methods at Odense University Hospital and the results we have achieved so far. Jens-Otto S. Jeppesen Managing Director 3
Small steps towards big improvements All sections work with kaizen boards in the Department of Cardiology. Staff expertise, constructive criticism and every little bit helps Lean is a tool for encouraging daily growth and development. Every hospital procedure involves some sort of waste, which has no direct or indirect value to the patient. Putting the patient first The Lean approach puts the patient first. We chart out what creates value for the patient. Each procedure is analysed and any waste is identified includ - ing by following a patient or group of patients as they are treated at a department of the hospital. Waste can include the time spent by an employee looking for a specific piece of equipment or time spent waiting to receive overdue information from another hospital department. Systematisation and visibility, work scheduling, modified procedures, better use of equipment and employees. The overall effect of making many small changes increases our ability to treat more patients who are, in turn, more satisfied with their treatment. Ongoing improvements Changes occur when employees come up with their own suggestions for improving procedures. The suggestions are gathered and posted on kaizen boards (a type of notice board). Once a week, the staff meet to discuss the suggestions and agree how to implement them. This is actually a crucial aspect of the Lean process: trying things out quickly and taking small steps towards big improvements. In the Lean approach, the task of improving the work is never done, but involves a constant striving for perfection. Lean: a tool for development Lean at OUH is also a tool for growth and development. Employee know-how empowers the employees in their own work, so each staff group finds solutions together. In so doing, Lean improves the working environment, frees up time and enables professional growth and development at the same time. 4
Intradepartmental effort Each department at OUH is an independent workplace with its own tasks, responsibilities and procedures. Each department has to involve Lean in its work, but it is impossible to involve every area all at once. Lean takes time and requires thoroughness and a strategic approach. For this reason, OUH started out by implementing pilot projects in three departments and decided that the other sixty-some departments should be gradually introduced to Lean methods in the years ahead. It is crucial for the departments to have direct access to optimal support during the initial period. This support is provided by the hospital s own consultants from the Lean staff. The management board decides which departments should begin simultaneously, a decision based on factors such as how the departments are mutually interrelated. OUH also intends that Lean will gradually affect the many working relationships across the departments. Lean at a department level Each department starts out its Lean process with a project period lasting almost one year. During this time, the department is supported by OUH s Lean consultants, and a high priority is given to aspects such as information and training. The department is also guided towards setting its own tangible goals for its Lean efforts. During the project, the department's own employees learn their initial Lean lessons and, one year later, the department is ready to use Lean as a permanent tool for development in its daily work. Post-project knowledgesharing and Lean Lean ensures effective knowledge-sharing across the departments after the project period, too. Inspiration is also obtained from external sources, such as by sharing lessons learned with other enterprises and other hospitals in Denmark and abroad. Using Lean in purchasing departments Concurrent with the departments Lean efforts, the hospital s purchasing processes are charted and coordinated. This is done to streamline the purchasing processes and, in the long term, to optimise stock management in relation to hospital operations. 5
Simple methods large-scale changes Lean has strikingly altered the working processes in the Department of Orthopaedics. We use Lean to get to the heart of the matter. We ask each other difficult questions or else the Lean consultant does, says Søren Larsen, Consultant Physician and project manager. Why do we do this and not that? By asking these questions, we challenge habitual thinking and routines and jump headlong into the changes. Among the many results that ease our daily work are stand ard journals that eliminate time wasted on looking for information. Now, virtually every journal is written during the course of one day at the secretariat, thus avoiding journal backlogs and disruptive reminders. At the outpatient clinic, a complete reorganisation of the appointment-notification principles, in the form of a drop-in system, has drastically reduced patients waiting time. Close to practice We ve learned that Lean should preferably be amusing and motivating, says Marianne Lundegaard, Head Nurse. In the outpatient clinic, we ve worked with patient satisfaction by surveying our patients using a plastic tube with red and green balls. The patients deposit a red or a green ball in the tube to tell us whether they are satisfied. They can also add explanatory comments on sticky notes. The employees discuss the input at 'survey evaluation meetings' which have inspired many fine initiatives. Obviously we ll be continuing our Lean efforts after the project period is over, says Niels Dieter Röck, Head Consultant Physician. We ve obtained many ideas and have a lot of problems to keep working on, because in theory our efforts in this area are never done. 6
Surprising results The Department of Diag - nostic Radiology is pleased with visible improvements that are noticeable to patients and staff alike. The waiting time for ultrasound scanning has been reduced from 22 weeks to 8 and been cut in half for CT scanning. These are just two of the tangible results of the Lean project in the Department of Diagnostic Radiology. In a way, I m surprised at what we ve achieved, admits Jens Karstoft, Head Consultant Physician. Lean seems a little mysterious at first, but it s actually just common sense. Lean is about taking a critical look at what you do and constantly considering ways of doing things better. Lean gives us the space for considering such aspects of our work and it obviously yields good results. Motivating The department head is convinced that much of the employees motivation is due to the fact that the gains of the Lean project had to be analysed in terms of increasing the amount of time earmarked for things like supplementary and further education and training. The CT scanner project is a good example of this, Jens Karstoft says. Half of what we ve achieved through the project has been spent on reducing patient waiting times, while the rest has been converted into enhancing the technical skills of our employees working with computerised tomography. Efficiency engineering and much more besides The Department of Cardiology gladly embraced the Lean project because it streamlined their efforts for the sake of quality. To Anders Junker, Consultant Physician, Lean is obviously better than many other efficiency engineering tools. It s a question of quality! One of Lean s big advantages is the short distance from idea to action. The ideas can be tried out right away, and the employees make the decisions. This broad employee involvement has been a notable and important aspect of the project. That s why we ve worked on using common tools in every department and sharpened our focus on special projects when - ever we felt this was necessary. Treating more patients and better learning Lean has generated fine results in our echo examinations where we ve drastically reduced the waiting time and increased our capacity by 450 examinations a year. At the same time, we ve established a better learning process for young doctors by putting them in charge of all echo examinations as part of a team effort with an experienced physician. The process from referral to examination, and possibly treatment, of patients suffering from a hardening of the coronary arteries has been reduced to three days for all patients. At the same time, we ve increased our capacity by 35% and improved our quality by using standardised journals and procedures thus freeing up work - ing time in all staff categories. 7
OUH and Lean The first Danish Hospital to use Lean full scale We intend to disseminate Lean throughout OUH Odense University Hospital and Svend - borg Hospital to ensure mutual continuity among the departments. In the years ahead, more than sixty departments will be implementing Lean, thereby making OUH the first hospital in Denmark to use Lean full scale throughout the hospital for the benefit of patients and employees alike. The first step of the dissemination process involved Lean pilot projects in three departments in 2006 and 2007: l Department of Diagnostic Radiology l Department of Cardiology l Department of Orthopaedics This is where OUH learned its first Lean lessons. The pilot projects generated many positive results and, on the basis of this, we now develop our own OUHversion targeted to hospital practice. Six additional departments are being introduced to Lean methods in 2008 with the assistance of OUH s own Lean Staff: l Department of Oncology l Department of Neurosurgery l Department of Dermatology and Venereology l Department of Gynaecology and Obstetrics l Department of Biochemistry, Pharmacology and Genetics l Department of Rehabilitation Lean methods have also been used in: l purchasing departments