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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
OW
TO
BRE
AK S
ILO
S4W1H
“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