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LEAN GUIDE to TRANSFORMING HEALTHCARE H1295 Zidel 00Front.Qxd 8/15/06 11:52 AM Page 2 H1295_Zidel_00Front.qxd 8/15/06 11:52 AM Page 1 A LEAN GUIDE TO TRANSFORMING HEALTHCARE H1295_Zidel_00Front.qxd 8/15/06 11:52 AM Page 2 Also available from ASQ Quality Press: Lean-Six Sigma for Healthcare: A Senior Leader Guide to Improving Cost and Throughput Chip Caldwell, Jim Brexler, and Tom Gillem Improving Healthcare with Control Charts: Basic and Advanced SPC Methods and Case Studies Raymond G. Carey The Manager's Guide to Six Sigma in Healthcare: Practical Tips and Tools for Improvement Robert Barry and Amy C. Smith Stop Rising Healthcare Costs Using Toyota Lean Production Methods: 38 Steps for Improvement Robert Chalice The Six Sigma Book for Healthcare: Improving Outcomes by Reducing Errors Robert Barry, Amy Murcko, and Clifford Brubaker Lean Kaizen: A Simplified Approach to Process Improvements George Alukal and Anthony Manos 5S for Service Organizations and Offices: A Lean Look at Improvements Debashis Sarkar Root Cause Analysis: Simplified Tools and Techniques, Second Edition Bjørn Andersen and Tom Fagerhaug The Quality Toolbox, Second Edition Nancy R. Tague Making Change Work: Practical Tools for Overcoming Human Resistance to Change Brien Palmer The Path to Profitable Measures: 10 Steps to Feedback That Fuels Performance Mark W. Morgan To request a complimentary catalog of ASQ Quality Press publications, call 800-248-1946, or visit our Web site at http://qualitypress.asq.org. H1295_Zidel_00Front.qxd 8/15/06 11:52 AM Page 3 A LEAN GUIDE TO TRANSFORMING HEALTHCARE How to Implement Lean Principles in Hospitals, Medical Offices, Clinics, and Other Healthcare Organizations THOMAS G. ZIDEL ASQ Quality Press Milwaukee, Wisconsin H1295_Zidel_00Front.qxd 8/15/06 11:52 AM Page 4 American Society for Quality, Quality Press, Milwaukee, WI 53203 © 2006 by ASQ All rights reserved. Published 2006. Printed in the United States of America. 12111009080706 54321 Library of Congress Cataloging-in-Publication Data Zidel, Tom, 1949- A lean guide to transforming healthcare : how to implement lean principles in hospitals, medical offices, clinics, and other healthcare organizations / Tom Zidel. p.; cm. Includes bibliographical references and index. ISBN-13: 978-0-87389-701-3 (alk. paper) ISBN-10: 0-87389-701-3 (alk. paper) 1. Health services administration. 2. Industrial efficiency. 3. Just-in-time systems. I. Title. [DNLM: 1. Delivery of Health Care--organization & administration. 2. Efficiency, Organizational. 3. Health Care Reform--methods. W 84.1 Z64L 2006] RA971.Z53 2006 362.11068--dc22 2006022782 No part of this book may be reproduced in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher. Publisher: William A. Tony Acquisitions Editor: Matt T. Meinholz Project Editor: Paul O’Mara Production Administrator: Randall Benson ASQ Mission: The American Society for Quality advances individual, organizational, and community excellence worldwide through learning, quality improvement, and knowledge exchange. Attention Bookstores, Wholesalers, Schools, and Corporations: ASQ Quality Press books, videotapes, audiotapes, and software are available at quantity discounts with bulk purchases for business, educational, or instructional use. For information, please contact ASQ Quality Press at 800-248-1946, or write to ASQ Quality Press, P.O. Box 3005, Milwaukee, WI 53201-3005. To place orders or to request a free copy of the ASQ Quality Press Publications Catalog, including ASQ membership information, call 800-248-1946. Visit our Web site at www.asq.org or http://qualitypress.asq.org. Printed on acid-free paper H1295_Zidel_00Front.qxd 8/15/06 11:52 AM Page 5 To my wife Liz. God only knows what I’d be without you. H1295_Zidel_00Front.qxd 8/15/06 11:52 AM Page 6 H1295_Zidel_00Front.qxd 8/15/06 11:52 AM Page 7 CONTENTS List of Illustrations . xi Foreword . xiii Preface . xv Acknowledgements . xvii Introduction . xix Chapter 1 Lean Principles . 1 A History of Lean and the Toyota Production System . 2 Categorizing Operations . 3 Working vs. Adding Value . 4 Becoming Lean . 5 Prerequisite to Launching the Lean Initiative . 6 Chapter 2 Time for Action . 9 The Need for Change . 9 Preparing for the Lean Transformation . 10 Project Selection . 13 The Decision to Hire a Consultant . 15 The Transformation Process . 17 Chapter 3 A Lean Road Map . 19 Know Your Destination . 19 Strategy Deployment . 20 The Value Stream . 20 Develop a Work Plan . 21 Create Flow . 22 Standard Work . 22 User-Friendliness . 22 Unobstructed Throughput . 23 Proceed with Caution . 24 Lean Organizational Roles . 25 vii H1295_Zidel_00Front.qxd 8/15/06 11:52 AM Page 8 viii CONTENTS Chapter 4 Value Stream Mapping . 27 Value Stream Mapping Defined . 28 Definitions . 28 Takt Time . 29 Cycle Time . 30 Flow . 31 Push . 31 Pull . 31 Changeover Time . 32 VSM Symbols . 32 Drawing a Map of the Current State . 34 Drawing the Future State Map . 40 The Value Stream Work Plan . 42 Conclusion . 42 Chapter 5 Standard Work . 45 Definitions . 46 Work Sequence . 46 SWIP . 47 Curtain . 48 Step 1. Evaluating the Current Situation . 49 Standard Work Sheet . 49 Time Observation Sheet . 51 Combination Sheet . 57 Percent Load Chart . 60 Step 2. Identifying Areas of Opportunity . 64 Step 3. Modifying the Existing Process . 67 Brainstorming . 67 Andon . 68 Five Whys . 68 Leveling . 69 Step 4. Substantiating and Enumerating Improvements . 70 Step 5. Implement New Standard Work . 70 Conclusion . 71 Chapter 6 5S . 73 The First S – Seiri – Organize – Sort . 74 Red Tag Strategy . 75 The Second S – Seiton – Orderliness – Straighten . 77 Kanban . 79 Visual Controls . 82 H1295_Zidel_00Front.qxd 8/15/06 11:52 AM Page 9 CONTENTS ix The Third S – Seiso – Cleanliness – Scrub . 84 The Fourth S – Seiketsu – Standardize – Stabilize . 84 The Fifth S – Shitsuki – Discipline – Sustain . 86 Keys to Success with 5S . 86 Chapter 7 Mistake Proofing . 87 Define the Mistake or Defect . 88 Red Flags . 89 Root Cause Analysis . 90 Cause-and-Effect Diagram . 90 Generating Ideas . 92 Affinity Diagram . 92 Prioritization Matrix . 93 Developing the Device or Method . 95 Mistake-Proofing Work Sheet . 95 Chapter 8 Quick Changeover . 99 Changeover Time . 100.
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