Process Redesign for Health Care Using Lean Thinking : A Guide for Improving Patient Flow and the Quality and Safety of Care

Process Redesign for Health Care Using Lean Thinking is a response to a simple, but hard to answer, question and is the result of the experiences of a working doctor who was also the chief safety and quality officer of an Australian teaching hospital. At this hospital, he observed that the Emergency Department was staff by talented, well-trained, and respected doctors and nurses. The facilities were modern, and the work load unexceptional, but the department was close to melt down. Bad things were happening to patients, everyone was blaming each other, lots of things had been tried but nothing was getting better and no one could explain why. The problem was not a lack of technical knowledge or expertise, the problem was that no one stood back and said, "what’s the best way to move 200 or 300 patients a day through the complicated and varying, sequence of steps needed to sort out the many different problems that bring patients to our department?"

These challenges are faced by hospitals and health services all over the world. There are difficulties with patient flow, congestion, queues, inefficient utilization of resources, problems engaging clinical staff in improvement programs, adverse incidents, and budget constraints.

Lean thinking and value stream analysis gives hospitals and health services struggling with these issues the insights they need to help themselves. This book provides a method that systematically turns those insights into working programs of service and system redesign.

The book is divided into two sections. The first section gives the background to the approach, and systematically works through the Process Redesign methodology, step-by-step. The second section is a series of case studies that show the methodology in action, what worked and what didn’t work. The goal of any process redesign is simple: the right care, for the right person, at the right time, in the right place, and right the first time. This book helps the people who work in hospitals and health services realize these goals by working together.

• Written by an experienced healthcare professional
• Builds on over a decade of direct experience improving health care processes using Lean Thinking and Value Stream analysis
• Integrates theory and practice
• Describes a proven implementation methodology, illustrated with brief clinical examples and extended case studies
• Addresses the human as well as the technical

Preface

Part 1 : Process Redesign - The Complete Method
Chapter 1 : Introduction : An Accidental Redesigner
Chapter 2 : Craft, Flow, Mass
Chapter 3 : Taiichi Ohno and The Birth of Lean
Chapter 4 : The Principles of Lean Thinking
Chapter 5 : Healthcare is not Manufacturing
Chapter 6 : Knowledge Work
Chapter 7 : Redesigning Care : Authorization, Permission, Teams and Governance
Chapter 8 : The Virtuous Circle of Process Redesign and The A3
Chapter 9 : Identifying The Problem
Chapter 10 : Defining The Scope
Chapter 11 : Diagnosis (1) Mapping - The Big Picture
Chapter 12 : Diagnosis (2) Direct Observation
Chapter 13 : The Real Problem (1) : Identifying The Real Problem
Chapter 14 : The Real Problem (2) : Measurement
Chapter 15 : Goals, The Scientific Method and The Future State
Chapter 16 : Value Stream, Batching and Flow Improvement
Chapter 17 : Targeted Interventions - 5S, Visual Management and Visual Systems
Chapter 18 : Queues, Prioritizing, Capacity and Demand
Chapter 19 : Embedding and Sustaining

Part 2 : Case Studies
Chapter 20 : Case Study 1 : Redesigning Emergency Department Flows
Chapter 21 : Case Study 2 : The Care-after-Hours Program
Chapter 22 : Case Study 3 : Visual Management
Chapter 23 : Case Study 4 : Redesigning Podiatry Care
Chapter 24 : Conclusion - Redesigning Process Redesign

Index