The lean doctors workbook : an application guide for transforming outpatient clinic systems

104 Pages·2011·4.43 MB·English

by  Suneja, Aneesh, Carolyn

The Lean Doctors
Workbook
Also available from ASQ Quality Press:
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A Lean Guide to Transforming Healthcare: How to Implement Lean Principles in
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To request a complimentary catalog of ASQ Quality Press publications,
call 800-248-1946, or visit our Web site at http://www.asq.org/quality-press.
The Lean Doctors
Workbook
An Application Guide for
Transforming Outpatient Clinic
Systems with Lean
Aneesh and Carolyn Suneja

ASQ Quality Press
Milwaukee, Wisconsin
American Society for Quality, Quality Press, Milwaukee, WI 53203
© 2011 by ASQ
All rights reserved. Published 2011.
Printed in the United States of America.
17 16 15 14 13 12 11 5 4 3 2 1

Library of Congress Cataloging-in-Publication Data

Suneja, Aneesh, 1968-
The lean doctors workbook: an application guide for transforming outpatient clinic systems
with Lean/by Aneesh and Carolyn Suneja.
p. cm.
Includes bibliographical references and index.
ISBN 978-0-87389-813-3 (alk. paper)
1. Medical offces–Planning–Handbooks, manuals, etc. 2. Lean manufacturing–Handbooks,
manuals, etc. I. Suneja, Carolyn, 1968–II. Title.
R728.S94 2010
610.68–dc22
2010046239
No part of this book may be reproduced in any form or by any means, electronic, mechanical,
photocopying, recording, or otherwise, without the prior written permission of the publisher.
Publisher: William A. Tony
Acquisitions Editor: Matt T. Meinholz
Project Editor: Paul O’Mara
Production Administrator: Randall Benson
ASQ Mission: The American Society for Quality advances individual, organizational, and
community excellence worldwide through learning, quality improvement, and knowledge
exchange.
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To place orders or to request ASQ membership information, call 800-248-1946. Visit our
Web site at www.asq.org/quality-press.
Printed on acid-free paper
Contents
List of Figures and Tables vii
Introduction. . 1
Learning Goals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
How.to.Use.This.Book. . 3
The Six Success Steps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Lean Mapping Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Application Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Your Turn Exercises . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Case.Study.Introduction. . 5
Main Street Orthopedics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Minimize.Patient.Wait.Times. . 7
Low Patient Wait Times Indicate a Healthy System . . . . . . . . . . . . . . . . . . . . . . . . . 8
Application Exercise: Minimize Patient Wait Times . . . . . . . . . . . . . . . . . . . . . . . . . 11
Begin.One.Doctor.at.a.Time. . 13.
Application Exercise: Begin One Doctor at a Time . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Success.Step.1:.Create.Physician.Flow. . 17
Shared Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Changeover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Lean Process Mapping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Application Exercise: Create Physician Flow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
v
vi Contents
Success.Step.2:.Support.Physician.Value-Added.Time. . 29.
Team Leader Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Benefts of the Team Leader Position . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Developing Team Leaders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Application Exercise: Support Physician Value-Added Time . . . . . . . . . . . . . . . . . 40
Success.Step.3:.Communicate.Patient.Stages.Visually. . 41
Visual Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Patient Status Boards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Application Exercise: Communicate Patient Stages Visually . . . . . . . . . . . . . . . . . 48
Success.Step.4:.Standardize.Everyone’s.Work. . 51
Defnition of Standard Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Benefts of Standard Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Application Exercise: Standardize Everyone’s Work . . . . . . . . . . . . . . . . . . . . . . . . 61
Success.Step.5:..Lay.Out.the.Clinic.for.Minimal.Motion. . 65
Spaghetti Mapping and 5S for Individual Workstations . . . . . . . . . . . . . . . . . . . . . 67
Communication Flow Considerations Across the Clinic . . . . . . . . . . . . . . . . . . . . . 72
Application Exercise: Lay Out the Clinic for Minimal Motion . . . . . . . . . . . . . . . . 78
Success.Step.6:.Change.the.Care.Delivery.Model . . 81
Application Exercise: Change the Care Delivery Model . . . . . . . . . . . . . . . . . . . . . 88
Index 91
List of Figures and Tables
Figure 1 Current state at Main Street Orthopedics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Figure 2 Main Street Orthopedics without physician fow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Figure 3 FIFO lane . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Figure 4 Physician Lean process map . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Figure 5 Physician Lean process map with communication fow. . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Figure 6 Physician Lean process map (one patient fow) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Figure 7 Main Street Orthopedics with physician fow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Figure 8 Main Street process with bottlenecks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Figure 9 Main Street Orthopedics process with changeover and a team leader . . . . . . . . . . . . . . . 39
Figure 10 Main Street Orthopedics without visual communication . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Figure 11 A patient status board from an orthopedic clinic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Figure 12 Main Street Orthopedics with visual communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Figure 13 Physician assistant–to–physician handoff without standard work . . . . . . . . . . . . . . . . . . 52
Figure 14 Standard work improvement process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Figure 15 Standard work chart example in a fractures clinic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Figure 16 Standard work chart example for day surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Figure 17 Physician assistant–to–physician handoff with standard work . . . . . . . . . . . . . . . . . . . . . 61
Figure 18 Ineffcient Main Street Orthopedics front desk layout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Figure 19 Spaghetti diagram of the front desk of a busy clinic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Figure 20 Commonly used forms moved to point of use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Figure 21 Cleaned and organized supply closet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Figure 22 Forms pull system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Figure 23 Effcient Main Street Orthopedics front desk layout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Figure 24 Spaghetti diagram of Main Street Orthopedics layout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Figure 25 Hand-offs, delays, and communication barriers caused by ineffcient layout . . . . . . . . . 75
vii
viii List of Figures and Tables
Figure 26 Common staff area redesign . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Figure 27 Improved Main Street Orthopedics layout spaghetti diagram . . . . . . . . . . . . . . . . . . . . . . 77
Figure 28 Main Street Orthopedics casting process spaghetti diagram . . . . . . . . . . . . . . . . . . . . . . . 82
Figure 29 Departmental separation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Figure 30 A cell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Figure 31 Main Street Orthopedics in-room casting process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Introduction
LearnIng goaLs
What do you hope to learn by working through The Lean Doctors Workbook?

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