Table Of ContentHealthcare Management / Healthcare Process Improvement
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“In this book , Dr. Nelson draws on his forty years of medical practice and his experience as an early e
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adopter of Lean for healthcare to identify a crucial piece to aligning healthcare organizations for s
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success: Physician Engagement. … Healthcare executives and clinicians will appreciate and learn n
from Dr. Nelson’s insight.”
—Robert Iversen, Director, Accenture Management Consulting
“… Instead of writing another how-to book, Mike has taken the opportunity to provide insights that
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are sure to help any healthcare organization sustain the impact of its Lean engagement.” U
—Rick Malik, Worldwide Director, ValuMetrix® Services, Ortho Clinical Diagnostics
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“… provides realistic estimates of timelines for projects, expected satisfaction, quality, and A
financial paybacks, as well as the time commitments required for Lean healthcare initiatives to
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become durable successes.” N
—David Mann, PhD, Principal, David Mann Lean Consulting
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“… simplifies and organizes the steps needed to effectively and successfully take advantage of the
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significant contributions Lean management can make … .”
—Edward D. Martin, MD, Co-Founder and Chairman Emeritus, Martin Blanck & Associates, Inc.
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“Lean has become a critical predictor of successful systems going forward. Sustaining Lean in
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Healthcare is the book to get this done.”
—Stephen C. Beeson, MD, Author of Engaging Physicians, A Manual to Physician Partnership N
Among the first books to focus on physician engagement during a Lean effort, Sustaining Lean I
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in Healthcare: Developing and Engaging Physician Leadership explains how to ensure ongoing
physician participation long after the consultant leaves. Dr. Michael Nelson, an early adopter of Lean
in healthcare, explains how to use these synergic tools to achieve consistently high levels of quality and H
clinical care outcomes.
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The book begins with a Lean primer that provides a firm foundation in essential Lean concepts—
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including value stream maps, 6S, Kanban, Heijunka, and Gemba Walks. Next, it examines how to create
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a physician engagement plan and covers the specific responsibilities of physician leadership through
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the Lean transformation. Explaining what to look for when judging success, it provides numerous
examples that demonstrate how to sustain success over the long term. C
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Complete with tips for spotting the danger signs that might indicate your plan is off course, this book
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details time-tested techniques and strategies for reducing waste in healthcare. It supplies a methodology
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for establishing shared expectations of success with your medical team early on in the process, as well
as a proven framework for simultaneous Lean deployment across multiple locations.
K11864
ISBN: 978-1-4398-4027-6
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K11864 cvr mech.indd 1 4/15/11 2:58 PM
Sustaining Lean
in Healthcare
Developing and Engaging Physician Leadership
Sustaining Lean in Healthcare
Mike Nelson
Endorsements:
“Nelson does lean healthcare a service as a physician and lean practitioner focusing on engaging the physi-
cian. In this valuable resource, Nelson stresses and supplies guidance regarding the role of physician cham-
pion and senior management’s responsibilities to the lean initiative. As importantly, he provides realistic
estimates of timelines for projects, expected satisfaction, quality, and financial paybacks, as well as for the
time commitments required for lean healthcare initiatives to become durable successes.”
David Mann, PhD
Principal, David Mann Lean Consulting
“Nelson’s great service in this book is to approach lean healthcare from the practitioner’s perspective and
provide a very valuable and thoughtful approach which simplifies and organizes the steps needed to effectively
and successfully take advantage of the significant contributions lean management can make to their practices
with the minimum expenditure of time and financial resources.”
Edward D. Martin, MD
Co-Founder and Chairman Emeritus
Martin Blanck & Associates, Inc.
“Over the years, I have read a number of books on lean implementation. Dr Nelson’s approach is clear,
practical, easy to read and prescriptive. Efficient use of resources and time are some of the most important
directives for leaders to survive in these reforming times. Lean has become a critical predictor of successful
systems going forward. Sustaining Lean in Healthcare is the book to get this done. Well done, Dr. Nelson.
I learned a ton.”
Stephen C Beeson, MD
Author, Practicing Excellence: A Physician’s Manual to Exceptional Health
Care and Engaging Physicians: A Manual to Physician Partnership
“Of the many books written about Lean journeys, Mike Nelson’s book offers a unique perspective. A physi-
cian himself, Mike focuses on the role he and his colleagues can play in creating and sustaining a Lean envi-
ronment. He speaks from first-hand experience, having taken his own Lean journey and playing a key role in
the quality aspect of a highly successful ValuMetrix• Services Lean engagement. His book clearly illustrates
a fact that is all-too-often often overlooked – physicians must be included in any Lean engagement, since
they are true enablers of change and are critical to sustaining the transformation. Instead of writing another
how-to book, Mike has taken the opportunity to provide insights that are sure to help any healthcare orga-
nization sustain the impact of its Lean engagement.”
Rick Malik
Worldwide Director
ValuMetrix• Services
Over the past two decades Lean Operations has made several significant runs in healthcare. The first attempts,
with a few notable exceptions, lost momentum and were not sustainable because the incentives always seemed
to be misaligned. In this book, Dr. Nelson draws on his forty years of medical practice and his experience as an
early adopter of Lean for healthcare to identify a crucial piece to aligning healthcare organizations for success:
Physician Engagement. It’s my experience that Lean methods work on processes in all industries, but nowhere
is the human element more critical to their success than healthcare, and no one role is more critical than the
Physician. Healthcare executives and clinicians will appreciate and learn from Dr. Nelson’s insight.
Robert Iversen
Director, Accenture Management Consulting
Sustaining Lean
in Healthcare
Developing and Engaging Physician Leadership
Michael Nelson,
M.D.
Foreword by Quint Studer,
Founder & CEO, Studer Group
CRC Press
Taylor & Francis Group
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Boca Raton, FL 33487-2742
© 2011 by Taylor & Francis Group, LLC
CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
Version Date: 20110831
International Standard Book Number-13: 978-1-4398-4028-3 (eBook - PDF)
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To Patsy, my wonderful wife of 43 years. Not only did she read,
edit, and comment on the book, but took numerous chores and
duties off my hands in order to give me time to write.
Contents
Acknowledgments ................................................................................................................xi
Introduction ......................................................................................................................xiii
Foreword ...........................................................................................................................xvii
1 The Basics of Lean ........................................................................................................1
Implementation Phase ........................................................................................................3
Lean Tools for Product and Process Approaches .......................................................3
Value Stream Maps (VSM) ..............................................................................3
6S ......................................................................................................................................6
Kanban ..............................................................................................................................8
Single Piece Flow ...............................................................................................................8
A Simple Exercise ...............................................................................................................9
Level Loading (Heijunka)..................................................................................................10
Product Process Flow ........................................................................................................11
Lean Tools for Operator-Focused Approaches .........................................................11
Full Work Analysis .........................................................................................11
Standard Work ..............................................................................................12
Sustainment Phase ...........................................................................................................12
Visual Controls .......................................................................................................12
Huddles ............................................................................................................................15
Assessment (Audits) ..........................................................................................................15
Gemba Walks ....................................................................................................................16
Culture Change ................................................................................................................18
Improvement Model ........................................................................................................20
What Are We Trying to Accomplish? ......................................................................21
How Will We Know That a Change Is an Improvement? ........................................21
What Changes Can We Make That Will Result in an Improvement? ......................21
Plan .................................................................................................................................22
Do ...................................................................................................................................22
Study ...............................................................................................................................22
Act ...................................................................................................................................23
Kaizen .............................................................................................................................23
References ........................................................................................................................24
vii
viii ◾ Contents
2 Lean and Physician Culture .......................................................................................25
Clinical Decision Making and the PDSA Cycle ...............................................................28
Reference .........................................................................................................................30
3 Creating a Physician Engagement Plan ......................................................................31
A Bit of History ................................................................................................................31
Elements of a Physician Engagement Plan .......................................................................32
Vision and Goals .....................................................................................................33
Selection and Development of Physician Champions..............................................34
Reward and Recognition Plan ................................................................................36
Approach to and Engagement with Frontline Physicians (Chapter 4) .....................36
The Physicians’ Role in Sustaining Improvements and
Maintaining the Lean Culture ................................................................................37
References ........................................................................................................................38
4 The Senior Leader’s Role ............................................................................................39
Success Starts at the Top ..................................................................................................39
Leadership Is More Important Than Tools.......................................................................40
The Senior Leader’s Role ..................................................................................................40
Important Duties of a Leader .................................................................................40
Create the Vision—Determine the Right Destination
before You Start the Journey ..........................................................................40
Selecting the Right People ...............................................................................41
Provide Resources and Invest in Infrastructure ...............................................41
Executive and Champion Role Definition and Training .................................41
Frequent and Clear Communication .............................................................42
Strategic Alignment .......................................................................................42
Deployment Plan ...........................................................................................42
Establish Measures for Success ......................................................................43
Project Spread and Sustainability ..................................................................43
Summary—Active Leadership Is Essential to Effective Deployment ...............................44
Reference .........................................................................................................................44
5 Analysis and Preparation ...........................................................................................45
Business Needs Assessment and Operational Impact ........................................................45
Lean Resources .......................................................................................................46
Likelihood of Financial, Quality, or Satisfaction Improvements .............................46
Resources .................................................................................................................47
Leadership ......................................................................................................47
Desire to Improve ..........................................................................................48
Architecture ...................................................................................................48
Readiness .......................................................................................................48
Preparation Phase .............................................................................................................53
Stakeholder Analysis ........................................................................................................54
References ........................................................................................................................56
Contents ◾ ix
6 Setting Expectations ...................................................................................................57
Criteria for Intervention ....................................................................................................61
Who ........................................................................................................................61
How.........................................................................................................................61
Reference .........................................................................................................................62
7 Physician Case Studies ...............................................................................................63
Discussion........................................................................................................................66
Scenario #1 .............................................................................................................66
Scenario #2 ..............................................................................................................67
Scenario #3 ..............................................................................................................67
Scenario #4 ..............................................................................................................67
Scenario #5 ..............................................................................................................67
Scenario #6 .............................................................................................................68
Scenario #7 .............................................................................................................68
Scenario #8 .............................................................................................................68
8 Keys to Sustaining Lean—A Physician Guide ...........................................................69
References .........................................................................................................................76
9 Judging Lean Success The Process ..............................................................................77
Financial Success .............................................................................................................78
A Balanced Approach ......................................................................................................80
Tollgates...........................................................................................................................80
In-Person Monitoring ......................................................................................................80
Scorecards .........................................................................................................................81
References ........................................................................................................................83
10 A Case Study ...............................................................................................................85
11 Sustaining...................................................................................................................97
Lean Work .......................................................................................................................98
Improvement Work ..........................................................................................................99
Monitoring .....................................................................................................................101
Communications ............................................................................................................102
Standardization ...............................................................................................................103
Summary ........................................................................................................................106
References .......................................................................................................................106
12 PreImplementation Tools and Approaches ...............................................................107
Site Lean Team Selection: Roles and Responsibilities ......................................................107
The Site Team ........................................................................................................107
Purpose of Site Team .............................................................................................107
Characteristics of Site Team Leaders and Members ...............................................108
Identifying Site Team Leaders ...............................................................................108
PreImplementation Checklist..........................................................................................109
