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NoCVA North Carolina
Preventing Avoidable
Readmissions Collaborative
Prework Webinar 2:
Using Lean Concepts to Identify
Improvement Opportunities
May 31, 2013
Collaborative Goals
• Reduce readmission rates by 20%
• Increase the number of patients in the pilot unit or population who
undergo assessment for risk of readmission to 95%.
• Increase the number of patients in the pilot unit or population who
are assessed to be at high risk of readmission whose primary care
physician is informed of their hospitalization within 48 hours of
admission to 80%.
• Increase number of patients in the pilot unit or population who are
assessed to be at high risk of readmission who are scheduled for a
follow-up physician visit within 7 days of discharge from hospital to
80%.
• 10% improvement or national 25th percentile in scores on four
HCAHPS dimensions
Methods: Prework
• Identify a pilot unit or population
• Develop multidisciplinary project team
• Assess 5 recent readmissions
• Conduct observations of patient admission, education, and
discharge
• Develop Value Stream Map of patient discharge
• Review assessment and observation information
• Submit community zip code form
• Develop data collection plan
Diagnostic Tool
My team has completed the
Diagnostic Assessment of
Readmissions for:
• 5 readmissions
• 3 – 4 readmissions
• 1 – 2 readmissions
• None yet
What did you learn from the
Diagnostic Review?
Bring results of Diagnostic Review
to Learning Session 1, July 11
• Bring your completed forms
• You may use this as your storyboard, on the slides
provided for that
• You will be using this information during the
session
Lean Health Care
Lean Overview
Industrial Extension Service
NC State University
Campus Box 7902
Raleigh, NC 27695-7902
www.ies.ncsu.edu
Industrial Extension Service www.ies.ncsu.edu
Lean Health Care
Lean Healthcare Overview
Define Lean
Value and Non-Value Added
8 Waste
Homework Assignment:
Industrial Extension Service www.ies.ncsu.edu
Lean Health Care
Lean Is…
The essence of Lean Thinking as applied to
healthcare is to:
● Eliminate waste through understanding the value to
the patient using a value stream to deliver that value
● Create an efficient and waste-free continuous flow
system built on a pull approach
● Continually pursue perfection
Industrial Extension Service www.ies.ncsu.edu
Lean Health Care
Lean Culture
● Lean is not merely a set of tools, but rather
a fundamental change in how the people
within an organization think and what they
value, thus transforming how they behave.
Lean Health Care
How Do We Define Value?
● Value added: any activity the patient is willing to pay for or deems necessary (e.g., X-ray, EKG, MRI, etc.)
● Non-value added but necessary: activities that support the patient as necessary today but are not considered of value by the patient (e.g., regulations, JC requirements, etc.)
● Non-value added: activities the patient deem unnecessary or are unwilling to pay for (e.g., waiting, billing errors, etc)
Industrial Extension Service www.ies.ncsu.edu
Lean Health Care
What are Non-Value Added Activities?
Non-Value
Added
Value Added NVA but
Necessary The Eight Wastes…
● Defects
● Overproduction
● Waiting
● Non Value-Added Processing
● Transportation
● Inventory
● Motion
● Employee (Underutilize
Knowledge, Skills, Abilities)
Typically 40-60% of all lead time is non-value added.
Industrial Extension Service www.ies.ncsu.edu
Lean Health Care
Identify and Eliminate Waste
Wastes
Defects
Overproduction
Waiting
Non value-added processing
Transportation
Inventory
Motion
Employee underutilization
Examples
Lean Health Care
Gemba Walk
WASTE WALK Area: _______________________
Date: _______________________
8 WASTES
OBSERVED WASTE
Defe
ct
Ove
rpro
du
ctio
n
Waitin
g
Non
-va
lue
ad
de
d
Pro
ce
ssin
g
Tra
nsp
ort
atio
n
Inve
nto
ry
Mo
tio
n
Em
plo
ye
e
Skill
/Kn
ow
led
ge
IMPROVEMENT IDEA
Industrial Extension Service www.ies.ncsu.edu
Lean Health Care Lean Healthcare
On your walk, focus on…
● Patient first-walk in their steps
● Staff-They are the most valuable resource
● Gemba-Focus on where the work is done
● Goal-Continuous improvement
Lean Health Care Lean Healthcare
Homework
As a team:
● Walk the discharge process from the patient
view and from the staff view
● Note non-value added activities during the
walk
● Come prepared to talk about the waste your
team observed on June 24th
Lean Health Care
Contact Information
● Annah Poteat-Godwin: (704) 266-2404
Industrial Extension Service www.ies.ncsu.edu
Upcoming Activity
Combined Webinar: SSI
and Readmissions
June 13, 2013, 9:00 a.m.
Prework Webinar June 24, 2013, 10:00 a.m.
Open Office Coaching Call
Webinar
July 1, 2013 1:30
Learning Session 1 July 11, 2013, Winston Salem
Orientation Webinar:
Measurement
July 24, 2013, 3:30
Orientation Webinar:
Assessing Risk of
Readmission
July 31, 2013, 1:30
Contacts
For more information, contact:
Laura Maynard, Director of Collaborative Learning at: [email protected] or 919-677-4121
Dean Higgins, Project Manager at [email protected] or 919-677-4212
Erica Preston-Roedder, Director of Quality Measurement, at [email protected] or 919-677-4125
