Date post: | 21-Jan-2018 |
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Rutger I.F. van der Waal, dermatologist, MD PhD
Tergooi Medical Centre, Hilversum NL
Learning Lean for healthcare
Wheatfield under ThundercloudsVincent van Gogh, 1890
European Lean Educator Conference 2017
Programme in short
• Who am I – how did I become a doctor
• How I came across Lean
• Changing healthcare environment
• Lean in my hospital
• Lean in my department
• Future steps
Lean in healthcare
Lean in healthcare
• Who am I – how did I become a doctor
BSc Medicine: First 3 yearsTheory & knowledge
MSc Medicine: +3 years (T=6y)
Practical training
Next: PhD programme: +4 years (T=10y)
Research & thesis
Medical specialisation: +5 years (T=15y)Hands on practical training
The Anatomy Lesson of Dr Nicolaes TulpRembrandt van Rijn, 1632
• Who am I – how did I become a doctor
• How I came across Lean
• Changing healthcare environment
• Lean in my hospital
• Lean in my department
• Future steps
Lean in healthcare
Sailing aligned towards True North
• Who am I – how did I become a doctor
• How I came across Lean
• Changing healthcare environment
• Lean in my hospital
• Lean in my department
• Future steps
Lean in healthcare
Changing healthcare environment
• Increase in the need of healthcare (‘double aging’)
• Shortage of skilled nursing staff
• Decrease of compensation / price-reduction
Role of Lean
NOT:because Lean is about firing people or depriving them of acquired
benefits
BUT:to improve activities and processes WITHIN the healthcare system
How can Lean be helpful• Centralize activities that matter to the patient
• Hunt down and remove wasteful activities
Benefits of Lean in Healthcare
• Better performance
• Less mistakes and medical errors
• Better information provision for the patient
• Shorter waiting lists for the patient
• Lower hospital- and managementfees
• Greater work satisfaction for nurses and doctors
How Lean can be helpful
• Activities that matter to the patient:
• Skilled staff (i.e. nurses and doctors)
• No waiting list
• Safe and trustworthy environment
• Provision of good patient information
• Hunt down and remove wasteful activities
7 types of waste in healthcare
1. Transport moving patients, materials & equipment/machines
2. Waiting patients waiting for consultation or lab results
3. Overproduction excess diagnostics, and limit liability
4. Inventory medication, tools, referral notifications
5. Motion equipment, materials & medication
6. Mistakes & medical errors wrong patient booked, wrong procedure
planned, wrong diagnosis or medicine, an unsuccessful treatment, re-operate
7. Overprocessing perform diagnostic procedures more than once, filling in
too many lab forms, repeatedly explain procedures, test results or treatments
to the same patient.
• Who am I – how did I become a doctor
• How I came across Lean
• Changing healthcare environment
• Lean in my hospital
• Lean in my department
• Future steps
Lean in healthcare
Toyota Engineering Corporation, Nagoya
Kikuya Cleaning Services, Tokyo
Kanagawa Hospital
St Luke’s International Hospital, Tokyo
Nerima General Hospital, Tokyo
Lean applied in health care
Tergooi’s Lean House: ‘thoughtful & sustainable’
• Who am I – how did I become a doctor
• How I came across Lean
• Changing healthcare environment
• Lean in my hospital
• Lean in my department
• Future steps
Lean in healthcare
Lean for Dermatology: organisation & care
IdentifyValue
Map the Value
Stream
CreateFlow
EstablishPull
CreatePerfection
# 1
# 2
# 3# 4
# 5
The 5 principles of Lean
Lean in Health Care
Customer(a.k.a. patient)
How do we address the activitiesthat matter to the patient
• Activities that matter to the patient:
• Skilled staff
• No or hardly any waiting list, and in case of a
growing waiting list we plan more consultation
hours (in the evening)
• Safe and trustworthy environment (5S)
• Provision of good patient information
• Continuous patient surveys
• Hunt down and remove wasteful activities
We started with 5S
Learning experiences with Lean
Improvement ideas via Kaizen cards
1 2
Weekstarts & Improvement board
Patient satisfaction surveys for CI
improvement kata
coaching kata
Mentee
Mentor
Leading to better, quicker, safer & sustained processes & healthcare
Dermatologic patient care
Medicine: core business = patient care
Customer = patientbut: vulnerable and dependent customer, not (always) by choice
How to adjust patient care through Lean?
Burning platform
Burning platform in terms of dermatology
• Preventive care rather than treatment
• Provision of patient information
• Goal in the healthcare system: to eradicate skin cancer
Skin cancer treatmentthe Lean way
‘5S’ against skin cancer
Building new bridges in dermatologic care
• Who am I – how did I become a doctor
• How I came across Lean
• Changing healthcare environment
• Lean in my hospital
• Lean in my department
• Future steps
Lean in healthcare
Lean in healthcare
• Lean as part of medical education
• Continued Lean philosophy in healthcare
European Lean Educator Conference 2017
Learning Lean for Healthcare
Tulip Fields near The HagueClaude Monet, 1886
Rutger I.F. van der Waal, dermatologist MD PhD