SIMUL8 Workshop - Process Improvement Innovation: Lean and Simulation

Process Improvement

Innovation:

Lean and Simulation

Dr. John Boulton: IHI Fellow and Rheumatologist

Claire Cordeaux & Brittany Hagedorn: SIMUL8

SIMUL8 Corporation | SIMUL8.com | [email protected]


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http://www.simul8healthcare.com/

Process Improvement

Innovation:

Lean and Simulation

Dr. John Boulton: IHI Fellow and Rheumatologist

Claire Cordeaux & Brittany Hagedorn: SIMUL8


Messages from Research

“Simulation and lean are approaches that

are rarely discussed together, particularly in

the healthcare context. This is surprising

given that they have a similar motivation:

improvement of processes and service

delivery”

Warwick University – Simlean/SLIM simlean.org


What does Simulation add to Lean?

Reflections from SimLean research

participants:

• Dynamic process maps

• What if? scenario tool

• Accelerates understanding


Testing, testing…Live from IHI

Agenda

• Simulations of Lean concepts

• IHI participants’ feedback

• Implications for Simulation

• Reflections from Dr. John Boulton


Lean and Simulation Communities

Why don’t they work together more?

Both improvement methodologies are

powerful change agents – surely we need all

the help we can get to improve healthcare?


Our Hypothesis

• Experts in both domains are passionate

about their own methodology and don’t

look to combine approaches

• We believe that if Simulation is used to

explain Lean concepts, we can bridge this

gap.

• The LeanSIM Toolkit:

– Demonstrates Lean principles

– Allows users to experiment with parameters

and quickly see results


LeanSim – Using Simulation


LeanSim – Demand Smoothing


LeanSim – Batching vs.

Single Piece Flow


What does the IHI community think?

• Pictures of people at stand and quotations

“As a teacher of Lean, I often find it difficult to get buy-in on Lean concepts since they are counter-intuitive until you actually live them. This brings them to life.” “I’ve often struggled to use simulations to explain Lean concepts as they are all manufacturing examples. Having healthcare scenarios is so powerful!”

Click to edit Master title style Click to edit Master title style


“Why isn’t every hospital using this?” - Sara Dalo


What we heard at IHI...

• Lean simulations are a really powerful

communication tool.

• Passion of clinicians to continually improve

is alive and well.

• People are busy with day-to-day tasks and

struggle to find time to use the techniques.

• Evidence-based solutions are still needed to

complement cultural change management.


Implications for Lean and Simulation

1. Simulation is a powerful means of engaging

stakeholders and enabling collaboration in

change programs.

2. Educational models are needed to bring Lean

concepts to life.

3. Simulation will help with the IHI challenge for

new patient-centered service models by

demonstrating the impact on resources,

outcomes and costs.


Value Stream Mapping

Identify Improvement Opportunities

Prioritize Projects

Develop Charters

Map Current State

Design Future State

Pilot Future State

Implement Sustain

• Conduct observations.

• Collect data. • Document

value stream statistics.

• Document all barriers, rework, and wait times.

• Estimate the impact and effort for each improvement.

• Combine for prioritization.

• Define process and outcome metrics.

• Establish target (%) for improvement.

• Create a detailed process map.

• Identify potential interventions.

• Develop and document a future state process map.

• Implement the proposed future state on a small scale.

• Identify issues & unexpected effects.

• Modify the future state as needed.

• Conduct training.

• Go live.

• Document standard work and policies & procedures.

• Monitor and sustain improvements.

Simulation and Lean –

Improving Process Improvement

Incorporate variability into VSM.

Understand dependencies.

Set evidence-based targets.

Validate your current state.

Reduce risk.

Gain buy-in.

Visualize improvement

results.

Simulation is a powerful tool, which is even most effective when integrated with the Lean Six Sigma approach. By doing so, we can maximize the impact of our improvement efforts.


About me

• Rheumatologist

• Clinical lead for Quality Improvement

• 2012-13 IHI QI Fellow

– High reliability principles

– System wide flow

• An interest in simulation and modelling

• Twitter: @the_Rheum_doc


What does the IHI community think?

• Pictures of people at stand and quotations

“As a teacher of Lean, I often find it difficult to get buy-in on Lean concepts since they are counter-intuitive until you actually live them. This brings them to life.” “I’ve often struggled to use simulations to explain Lean concepts as they are all manufacturing examples. Having healthcare scenarios is so powerful!”


Click to edit Master title style “Why isn’t every hospital using this?” - Sara Dalo


Hospital Physiology First Edition


The challenge

Processing (T) Utilization (U) Variability (V)

What is acceptable waiting?

0

200

400

600

800

1000

1200

1400

1600

1800

2000

0.50 0.55 0.60 0.65 0.70 0.75 0.80 0.85 0.90 0.95

Wai

tin

g ti

me

in m

inu

tes

Utilization

acceptable wait

High variability

Medium Variability

Low variability


Simple models


Deming’s System of Profound knowledge

• System

• Variation

• Knowledge

• Psychology

Simulation


System


“If I had to reduce my message for management to just a few words, I’d say it all had to do with reducing variation.” W. Edwards Deming


Variation


Knowledge

• Early Arthritis Clinic


knowledge

• 10 medical follow-up

slots

• 12 nurse follow-up slots

• Simple model

– Insufficient capacity

within 6 months

• Clinic abandoned after

9 months


Psychology


Psychology

SIMUL8 Corporation | SIMUL8.com | [email protected] Associates in Process Improvement


Simulation and Quality Improvement

• A useful tool

– Enables deeper understanding of systems

– Translates difficult and counterintuitive

concepts

– Virtual PDSA cycles

• Models do not need to be complex

– Simple are often more effective


LeanSim Toolkit

We’d love you to try these models

yourselves and give us your feedback.

To download your own copy link to:

SIMUL8healthcare.com/LeanSIMToolkit


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Technology

SIMUL8 Workshop - Process Improvement Innovation: Lean and Simulation