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The Application of Industrial Production Techniques to Health

Care Delivery

Summary of notesPittsburgh Regional Healthcare Initiative: Perfecting

Patient CareNovember 11-18, 2005

Unless otherwise stated, all slides adapted from course by Pittsburgh Regional Healthcare Initiative: Perfecting Patient Care November 11-18, 2005

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Overview

• Application of industrial thinking to the delivery of health care services

• Not doctoring/nursing

• Why study Toyota?

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What TPS is not

• Simple procedures

• Quick Fix

• Pick and choose (dabble)

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WHAT THE TPS IS

• A Philosophy of Doing Business

• Achieving the idealOn demandDefect freeImmediatelySafeNo waste

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The Toyota Way

People

Process: Lean Production

PhilosophyAdapted from: Liker, JK. The Toyota Way. New York: McGraw Hill, 2004. Page 13

Problem Solving

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PHILOSOPHY Long term thinking

Top down commitment

Base management decisions on long-term goals even at the expense of short term goals

• Customers

• Profitability

• Employees

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PROCESS: OUTCOMES

• Eliminate waste

• Build in quality

• Build in continuous improvement

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PROCESSTypes of Waste

• Overproduction• Excess inventory• Unnecessary transport• Unnecessary movement • Waiting • Over processing and Incorrect processing• Defects• Unused employee creativityAdapted from Liker, JK. The Toyota Way. New York: McGraw Hill, 2004. Pages 28-29.

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PROCESSCommon Reactions to Excesses

• Increase capacity• Increase size of plant• Increase warehouse• Increase overhead• Increase labor force• Increase overtime

Rather than concentrating on eliminating waste

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Traditional ProcessBatch and Queue: Individual Silos

Push Orders

Finished Products Out to Truck

Assembly Line

Warehouse raw materials and supplies P I

CDEFECTS

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TPS Process One piece flow: Teams

Pull Raw materials and supplies

Finished Product Out to Truck

PULL

Assembly Line

HELP!

Quick responseStabilize processCountermeasure

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Andon Board

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Process: Value FlowEliminating Waste: How much time do you spend looking for

information?

Waiting

Time

Casting Transport Staging Set-

up

Machining Inspection Assembly Staging

Raw Materials Finished Product

From: Liker, JK. The Toyota Way. New York: McGraw Hill, 2004. Page 30.

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CRAFTING THE PROCESSSpecifications

• Activity: Specific

• Connection : Binary, direct

• Pathway: continuous, straight

• Improvement: Scientific method

Then, test each specification to see whether or not they’re meeting expectations

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PEOPLE AND PARTNERSDeveloping Trust

• Highly selective

• Culture for TPS and quality

• Grow leaders from within

• Job safety

• Technology to support not replace people

• Align interests of suppliers

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PROBLEM SOLVINGScientific Method at the Bench Level

• On site inspection

• Consider all options

• Blame free

• Countermeasures, not solutions

• Sustain the organization

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Applications to Health Care

• Work: cycle, periodic, and fluctuation

• Takt time

• Standardization with contingencies

• Communication

• Problem solving

• Continuous improvement as policy

• NEXT STEP?