The Lean Healthcare Handbook: A Complete Guide to Creating Healthcare Workplaces

Introduction
Contents
List of Figures
Part I: Lean Tools and Techniques
	1: Introduction to Lean and Muda (Waste)
		1.1 What Is Lean?
			Value Stream
			Thinking Lean
			How to ``Think Lean´´
				Summary of Thinking Lean
			Value
				Example
			Value Added and Non-value Added
				Value Stream Maps
				Takt Time
				Spaghetti Diagrams
				Creative Thinking Is Important
				Value Flow
				5S
				Constraint (Bottleneck) Management
				Level Loading
				Push and Pull Systems
				Pull System Example (Supermarkets)
				Flexible Processes
				Batch Size Reduction
				Summary of Value Flow
			Perfection
				Kaizen
			Deploying Lean at the Value Stream Level
				Elements of Lean Production
				Six Sigma
				Six Sigma Infrastructure and ``Belts´´
	2: Product Family Matrices
		2.1 What Is a Product Family
			Example of a PFM
		2.2 Creating Product Family Matrices
			Emergency Department Example
			Services Example
		2.3 What Makes a PFM Unique?
		2.4 Creating and Using a PFM
	3: Spaghetti Diagrams
		3.1 What Is a Spaghetti Diagram?
		3.2 Creating Spaghetti Diagrams
		3.3 Summary
	4: Value Stream Maps
		4.1 Push Systems and Pull Systems
		4.2 Why Value Stream Maps Are Important
		4.3 Value Stream Symbols
		4.4 Example: Emergency Department VSM
		4.5 What Makes VSMs Unique
		4.6 How Value Stream Maps Are Used
		4.7 Creating the Value Stream Map Phase I
			Go to the Gemba
			Identify the Customer and Their Needs
				Preliminary Sketch of the Value Stream
		4.8 Creating the Value Stream Map Phase II
			Process Data
			Workers
			Inventory
			Electronic Information
			Manual Information
			Material Data
			Timeline
			Value-Added and Non-Value-Added Time
			Step-by-Step Process for Creating Value Stream Maps
	5: Lean Value Stream Design
		5.1 Overview
		5.2 Continuous Flow
		5.3 Reasons for Discontinuous Flow
		5.4 Steps Toward Continuous Flow
			Takt Time
		5.5 Supermarkets and Kanbans
		5.6 Pacemaker Process
		5.7 Production Mix
		5.8 Production Volume
		5.9 Load-Leveling Box (Heijunka Box)
		5.10 Every Part Every Day
		5.11 Surgical Procedures Scheduling Case Study
			Demand Forecasting
			Surgical Procedures
			Heijunka
			Changeovers
			Adjusting the Schedule
			Takt Time
			Flexibility
		5.12 Future State Value Stream Map Case Study
			Current State
			Process Information
		5.13 Future State Plan
			Takt Time
				Where Should Finished Sets Go?
				Continuous Flow
				Kaizen and Continuous Improvement
	6: Standardized Work Design
		6.1 Selecting Subprojects
		6.2 Elements of Work
			Principles of Motion Economy
				Use of the Human Body
				Arrangement of the Workplace
				Design of Tools and Equipment
			What Do We Need to Produce? How Many and When?
				Takt Time
			What Are the Requirements for Materials, Machines, and Manpower?
				Can the Processes that We have to Meet this Demand? Identifying Work Elements
				What Are the Specific Tasks Required to Complete the Work?
				Example of Calculating Production Capacity
				Bottlenecks
			What Materials Do We Need to Have on Hand in Order to Produce the Items? (Standard Stock)
			What Equipment Do We Need in Order to Produce the Needed Items?
				Small, Flexible/Mobile, ``Fast-Enough´´ Machines
			Autonomation (Jidoka)
		6.3 What Methods Should Be Used to Accomplish the Goal Using the Resources that We Have?
			Standard Operations Routine Sheet
				Are There Any ``Tips´´ that People Should Know About Doing the Work?
			Manual of Work Directions
			Which Non-Value-Added Activities Can Be Eliminated Immediately?
		6.4 How Should the Workplace Be Arranged?
			How Should We Layout the Equipment so Movement of People and Materials Is Efficient?
			Where Will WIP Be Stored?
			How Can We Rearrange the Workplace Quickly When We Need to Make a Different Item?
		6.5 How Many People Are Needed?
			What Skills Do the People Need?
			How Can We Keep Track of Cross-Training?
			How Can We Arrange the Workplace and Assign Workers so Those Working in it Can Easily Help One Another?
	7: 5S
		7.1 Sort
			Red-Tagging
				Aren´t You Ashamed?
		7.2 Set in Order
			Locations (5S Map)
		7.3 Shine
			Shine Steps
		7.4 Standardized Cleanup
			Determine Responsibilities
			Integrate Sort, Set in Order, and Shine with the Work Routine
		7.5 Sustain
		7.6 Safety: The Real First S
		7.7 How Can We Continue to Reduce Waste? (Kaizen, Lean)
	8: Fast Work Changeover
		8.1 History
		8.2 SMED for Healthcare
			Implementation
				Separate Internal from External Setup Operations
				Convert Internal to External Setup
				Standardize Equipment
				Quick Fasten and Release Mechanism
				Adjustments
				Parallel Activities
				Non-parallel and Non-sequential Activities
				Fast Patient Transfer
				Pre-prepared Workers
			Key Elements to Observe
			Parallel Operations Using Multiple Operators
				Automating
Part II: Continuous Improvement and Kaizen
	9: Introduction to Continuous Improvement
		9.1 Kaizen
			Responsibility for Kaizen
			Process Owner Responsibilities
			PDCA
			Benefits of Kaizen
			Kaizen Events
			Training for Kaizen Teams
			Transfer Ownership
	10: Process Mapping
		10.1 Activity Maps
			What Is a Process?
			Why Activity Maps Are Important
			Activity Map Symbols
			How to Create an Activity Map
			How to Use Activity Maps
		10.2 Opportunity Maps
			Why Opportunity Maps Are Important
			What Makes Opportunity Maps Unique
			How to Create Opportunity Maps
			Opportunity Map Example
		10.3 Deployment Maps (Swimlane Maps)
			Differences Between Deployment Maps and Activity Maps
			Variations of Deployment Maps
			What Makes Deployment Maps Unique?
			How to Create a Deployment Map
			How to Use Deployment Maps
	11: Statistical Thinking
		11.1 Enumerative Studies (Classical Statistics)
			Enumerative Study Example
		11.2 Analytic Studies
			Statistical Control
			Distributions
			Process Control Versus Quality Control
			Special and Common Cause Variation
			Using Process Knowledge to Make Improvements
				Making Matters Worse When Variation Is from Common Causes
				Superstitious Learning
				Making Matters Worse When Variation Is from Special Causes
				Reacting Properly to Special and Common Cause Variation
		11.3 Operational Definitions
			Dark Blue Carpet
			Examples of Operational Definitions
				Intelligence
			Administer the Stanford-Binet IQ Test to a Person and Score the Result. The Person´s Intelligence Is the Score on the Test
				Acceptable Waiting Time
			A Support Call´s Waiting Time Will Be Deemed Acceptable if a Customer Agrees Or Strongly Agrees with the Survey Item ``The Wai...
				Control Charts
	12: Descriptive Statistics
		12.1 Properties of Distributions
			Statistics to Measure the Central Tendency
			Statistics to Measure the Spread of a Distribution
		12.2 What Does s Mean?
	13: X-Charts
		13.1 Sampling for Process Control
		13.2 Control Charts for Process Metrics
			X-Chart Example
		13.3 Equations for X-Charts (Optional Material)
	14: Pareto Analysis
		14.1 How to Perform Pareto Analysis
			Principles of Good Charts
		14.2 The Graphical Story of Me
			How to Create a Pareto Chart
			Example
			Discussion
	15: Graphical Data Analysis
		15.1 Correlation Analysis Using Scatter Plots
			Linear Models
			Curvilinear Relationship
			How to Create Scatter Plots
			Tips for Using Scatter Plots
			Scatter Plot Interpretation Guide
		15.2 Histograms
			Histogram Structure
		15.3 Example of a Histogram
			Creating Histograms by Hand
				Example of Creating Histogram by Hand
			Pointers for Using Histograms
	16: Problem Solving Tools
		16.1 Cause and Effect Diagrams
			How to Create Cause and Effect Diagrams
			Example of Cause and Effect Diagram
			Narrowing the Focus
			Enhanced Cause and Effect Diagram
	17: Project Management
		17.1 True North Projects
			Transfer Function
			Linking Lean Projects to Leadership Goals
			The Effect  Cause  Effect  Root Cause Cascade
		17.2 Project Assessment
		17.3 Project Charter
			Charter Form Completion Instructions
		17.4 Project Planning and Scheduling
			Work Breakdown Structure (WBS)
			Project schedule charts (Gantt charts)
		17.5 Failure Mode and Effects Analysis (FMEA)
			Purpose of FMEA
			FMEA and Project Risks
			How to Perform FMEA
			SEV, OCC, and DET Category Descriptions and Ratings
			FMEA Workbook
		17.6 Risk Assessment and Contingency Planning
			Process Decision Program Chart (PDPC)
	18: Kaizen Events
		18.1 Scheduling
		18.2 Two Months Before The Event
			Finish Your Charter
			Pick Your Team Members
			Schedule the Event
			Collect Data
		18.3 Event Planning
			Day 1 What Is the Problem?
			Day 2 Map the Process
			Day 3 Root Cause Analysis and Brainstorm Solutions
				Brainstorming
				Affinity Analysis
			Day 4 Build the New Process
			Day 5 Launch
				Feedback
		18.4 Sustain
	19: A3 Thinking
		19.1 What Is the A3 and A3 Thinking?
			Types of A3
				Properties of Good A3s
				Standardized Problem Solving
				Develop Scientific Method
				Objective Decision-Making
				Visual Communication
				Deep Understanding of Problems
				Alignment Between Key Process Indicators (KPIs) and Projects
				Collaboration
				Coaching
		19.2 A3 Content and the A3 Thinking Process
			Creating an A3
			Example
				Document Identification
				Problem Background
				Current Conditions
				Target Condition (Future State)
				Root-Cause Analysis
				Develop Countermeasures
				Implementation Plan
				Effect Confirmation
				Follow-Up Actions
				Tips for Coaches
					Tip 1: Listen More Than You Ask Questions
					Tip 2: Do Not Try to Have all the Answers, Use Better Questions
					Tip 3: Avoid Answering the ``What Do You Think?´´ Question
					Tip 4: Mistakes Are Learning Moments
					Tip 5: Make Time for Short but Frequent Coaching Interactions
					Tip 6: Begin with Questions and Selectively Shift to Mentoring When Required
Appendix
	Lean Six Sigma Lexicon
Index