Using Lean Thinking to Drive HIT Efficiency and Hospital Performance

Transcription

1 Using Lean Thinking to Drive HIT Efficiency and Hospital Performance Rural Hospital Performance Improvement August 10, 2012 Melissa P. Lin, MS, LSSBB, CPHQ Learning Objectives Discuss the five principles of Lean Outline a major Lean principle the seven types of waste Verbalize how the Lean principles could be used when designing or updating an EMR system 2

2 HIT Adoption across the Nation Organizations are adopting different EMR and HIT platforms in an effort to meet Meaningful Use Guidelines A belief that HIT will help streamline operations and reduce costs FALSE "Every system is perfectly designed to get the results it gets. Paul Batalden, MD Unless it is supported by well-conceived, standardized, safe processes, an investment in complicated and expensive technologies will only create more waste and inefficiency 3 Two Bad Scenarios Your HIT software traces your existing badly designed, inefficient processes, creating another layer of waste and non-value OR Your HIT software dictates your flow, regardless of your local culture, patient needs, etc. 4

3 What is Lean? Lean thinking coined by Massachusetts Institute of Technology Originated from Toyota A philosophy that is focused on: Defining value in the eyes of the patients Eliminating wasteful steps that add no value to the organization Creating flexibility and agility to meet the changing needs of the patient and the industry Empowering frontline by incorporating easy problemsolving tools to use daily Do more with less 5 How can Lean improve your hospital? Best Safety Highest Employee Morale LEAN Highest Quality Lowest Cost Shortest Lead Time 6

4 Five Principles of Lean Value Value Stream Map Eliminate Waste Flow Strive for Perfection 7 Waste, Value, and Process Steps Process Series of actions or steps that define the flow of an activity Beginning and ending Outcomes Value-Added Steps Directly adds value to the care or service we provide as determined by the customer/patient Non-Value-Added Steps Waste: steps that add no value and can be eliminated Non-Value-Added-But-Necessary Steps Required to provide care or service but adds no value 8

5 Seven Types of Waste 1. Transportation 2. Inventory 3. Motion 4. Waiting 5. Overproduction 6. Overprocessing 7. Defects 9 Transportation Movement of product or service that does not add value Highly observable waste Transporting patients, equipment, or products Retrieval or storage of files Increases production time and poor communication Higher potential for damage or injury to product/service Examples: Walking a patient chart down from billing to ED in order to get a missing physician signature; number of mouse clicks to get from one module to another 10

6 Inventory More materials, parts, products on hand than the customer needs right now A direct result of overproduction/excessive downtime Adds costs and resources that don t meet demand Examples: a hospital ordering 4 years worth of a patient information booklet that become obsolete 6 months later; 4 separate diabetes worksheets in HIT that ask the same information 11 Motion Unnecessary movement of people or equipment Think ergonomics: Searching, reaching, stacking, clearing, and walking Examples: Walking over to a decentralized printer at the nurse s station; needing to open 4-5 different interfaces sorted by discipline just to find appropriate discharge planning info 12

7 Waiting Idle time created because of unnecessary waiting for people, equipment, beds or information May be seen as a bottleneck, downtime, lack of continuity Examples: Lag time for test results or obtaining medical records; patients waiting in ED because paper charts aren t available over weekend; patients waiting to schedule an appointment due to bad scheduler software 13 Overproduction Producing more than the customer needs right now Producing sooner to get ahead of the game Just in Case vs. Just in Time (JIT) Can lead to other types of waste Costs money and consumes resources Hides problems/defects Examples: Excessively stocking supplies on the floor before they are needed, which results in inventory expiration or loss; Swing bed assessments that ported over too many acute care questions unrelated to swing bed 14

8 Overprocessing Extra effort that adds no value from the customer s view Providing/processing products above the patient s standards Consumes additional resources and increases production time Examples: Ordering CT when x-ray will suffice Ordering CBC with/without differential when you only needed to monitor a hemoglobin (cost of care consciousness) Not being able to transfer over previous basic information to a new assessment, resulting in retyping of data 15 Defects When work results in errors, rework, rescheduling and re-inspecting, or when work lacks something necessary Defects interrupt flow and result in loss of time, increased effort and waiting, and patient safety issues Examples: Medication errors Wrong patient; wrong side Missing documentation Missing equipment Medication reconciliation 16

9 Final Tips to HIT Implementation Before implementing, identify and understand the current workflows that satisfy patient needs Is there waste to be eliminated? With HIT overlaid, will it create more harm than benefit? Identify how can HIT become an enabler, promoting and enforcing new processes instead of dictating them Determine how information will flow in an organized manner to prevent variation Guarantee that the infrastructure can be altered/redesigned as failures arise or new pieces of information are required Work with your vendor: consulting/maintenance time allotted? 17 Any Questions? Melissa P. Lin, MS, LSSBB, CPHQ Consultant (O) 18