Lean hospitals: improving quality, patient safety, and employee engagement

Content: The Need for Lean HospitalsBetter Results with LeanWhy Do Hospitals Need Lean?A Renewed Sense of PurposeLean Methods Are Not New to HealthcareToyota's Role in Popularizing LeanOrigins of the Term LeanLean Is Proven to Work outside Automotive FactoriesLean Is Helping Hospitals ImproveProblems in HealthcareGood Quality Costs LessInterconnected BenefitsA Snapshot of Department Success: Laboratory, Children's Health DallasFrom Departmental to Hospital- and System-Wide SuccessConclusionLean LessonsPoints for Group DiscussionNotesOverview of Lean for Hospitals and Health SystemsWhat Is Lean?Ohno's Definition of LeanLean ThinkingThe Toyota Triangle: Tools, Culture, and Management SystemThe "Toyota Way" PhilosophyFour Organizational Capabilities for LeanLean and Other MethodologiesWhat Lean Is NotConclusionLean LessonsPoints for Group DiscussionNotesValue and WasteWaste: A Global Problem with Local SolutionsReducing Waste Is a Better Goal Than Reducing CostWhat Is Waste?What Is Value? Start with the CustomerHow Do We Define Value in a Broad Sense?How Does Lean Define "Value?"Examples of Value-Added and Non-Value-Added ActivitiesLearning to Identify and Describe WasteThere's Not Always an Easy AnswerWhat Non-Value-Added Activities Are Required?Non-Value-Added, Pure WasteConclusionLean LessonsPoints for Group DiscussionNotesObserving the Process and Value StreamsLearning to SeeHow Do We Find Waste? Go and SeeWhat Is a Value Stream?Value Stream MappingCreating a Current-State Value Stream MapThe Future-State MapsBreaking Down Silos and Reducing SuboptimizationObserving the ProcessActivity of the ProductActivity of the EmployeeConclusionLean LessonsPoints for Group DiscussionNotesStandardized Work as a Foundation of LeanHelpful Standardization: From 171 Forms to Just SixThe Need for Standardized WorkThe Toyota House MetaphorOverview of the Lean FoundationsLean Foundations: Standardized WorkDefinition of Standardized WorkStandardized, Not IdenticalWritten by Those Who Do the WorkConsidering How Long Tasks TakeStaffing Based on DataTypes of Standardized Work DocumentsStandardizing Daily RoutinesDefining Roles and ResponsibilitiesQuick Changeover as Standardized WorkExplaining Why through Standardized WorkStandardized Work Documents and the Standardized Work SystemMeasuring and Observing for Standardized Work Adherence"Resistance" to Standardized Work?Asking Why When Standardized Work Is Not FollowedStandardized Work Can Apply to PhysiciansLean and ChecklistsStandardized Work for Raising ConcernsStandardized Work Can Apply to LeadersTraining through Standardized WorkConclusionLean LessonsPoints for Group DiscussionNotesLean Methods: Visual Management, 5S, and KanbanLean Is More Than Tools, but Tools Can HelpReducing Waste through Visual ManagementExamples of Visual Management for Patient FlowExamples of Visual Management to Prevent Process Problems5S: Sort, Store, Shine, Standardize, and SustainSafety as a Sixth S?Kanban: A Lean Approach to Managing MaterialsProblems with Traditional Materials SystemsTrade-Offs with InventoryUsing Kanban to Replenish SuppliesConclusionLean LessonsPoints for Group DiscussionNotesProactive Root Cause Problem SolvingThe Tragic and Preventable Mary McClinton StoryImproving Quality and Patient SafetyCultural Obstacles to Quality ImprovementWhy Do Errors Occur?Examples of Quality ImprovementFinding Root Causes and Preventing ErrorsWorkarounds and the Need for Fixing Root CausesAsking Why Instead of WhoStart at the GembaFind Root Causes Using Simple MethodsA3 Problem SolvingToyota's Practical Problem SolvingBe Proactive and Use Failure Modes and Effects AnalysisProactive Resolution of Near-Miss ProblemsThe Heinrich Safety PyramidConclusionLean LessonsPoints for Group DiscussionNotesPreventing Errors and HarmA Serious Problem with Large, Unknowable NumbersMoving beyond Blaming IndividualsThe Darrie Eason CaseCreating Quality at the Source through Error ProofingBeing Careful Is Not EnoughWhy 100% Inspection Is Not 100% EffectiveTypes of Error ProofingError Proofing, Not Dummy ProofingExamples of Error Proofing in HospitalsStopping the Line (Andon)Error Proofing the Error ProofingConclusionLean LessonsPoints for Group DiscussionNotesImproving FlowLean Is Both Quality and FlowWaiting: A Worldwide ProblemTargets without a Means for Improvement Might Lead to Improvement or DysfunctionFocusing on FlowValue Streams Should Flow Like a RiverUneven Workloads as a Barrier to FlowAddressing Mura by Matching Staffing to WorkloadsImproving Patient FlowImproving Flow for Ancillary Support DepartmentsConclusionLean LessonsPoints for Group DiscussionNotesLean DesignBetter, Faster, and CheaperUnderstanding the Current State before Designing the FutureLean Design at East Tennessee Children's HospitalIntegrated Lean Project Delivery at Akron Children's HospitalConclusionLean LessonsPoints for Group DiscussionNotesEngaging and Leading EmployeesImproving the Way We ManageWhat Is a Manager's Role?Strategy DeploymentCommon Management ProblemsLean as a Management System and PhilosophyA Daily Lean Management SystemPerformance MeasuresConclusionLean LessonsPoints for Group DiscussionNotesGetting Started with LeanHow Do We Start?The LEI Lean Transformation ModelWhere Do We Start?What Do We Call It?Getting Started with KaizenKaizen EventsLean Transformation ProjectsThe Lean Project TeamExecutive Sponsorship and LeadershipStarting from the MiddleEstablishing a Model Line and a Road MapDedicating People to Lean Beyond ProjectsThe Lean DepartmentThe Importance of Change ManagementA Snapshot of Hospital Success: Avera McKennan Hospital & University Health CenterConclusionLean LessonsPoints for Group DiscussionNotesA Vision for a Lean Hospital and Health SystemIntroductionWhen Is a Health System Lean?What Would a Lean Health System Look Like?What Would a Patient Experience in a Lean Health System?What Would It Be Like to Work in a Lean Health System?How Would We Describe a Lean Health System?In ConclusionPoints for Group DiscussionNotesGlossaryIndex