Walking the Wards

1EXCELLENCE SYSTEMS GROUP

Consultants

Applying Lean to the wards

Michael Ballé

Lean is a system


Consultants

Many have heard about the lean « tools »: 5S, Value Stream mapping, Kaizen events, etc.

Lean veterans insist on applying the tools rigorously

But mostly on the fact that lean is a « system », or a way of « thinking »

What do they mean by that?

Lean as a learning system


Consultants

thinkingthinking

toolstools

systemsystem

What is lean thinking?


Consultants

Visualize performance problems in the ward

Solve problems without « going around » them

In a « lean » way: using ideas rather than investment

By involving all employees

And developing a kaizen mentality in everyone

Lean thinking is guided by a lean system


Consultants

Reactat

firstdefect

Reactat

firstdefect

Flowat

takttime

Flowat

takttime

CUSTOMER SATISFACTIONCUSTOMER SATISFACTION

StandardizationStandardization ContinuousImprovementContinuous

Improvement

EmployeeInvolvement

Lean success needs working at all three levels


Consultants

tool 5S Staff never have to look for parts or equipment

system Standard work

So they can keep to the work standard without being interrupted

thinking Visualize problems

Interruptions can then be recognized right away as problems, and lead to quick response and problem solving

To begin with: walk the wards


Consultants

Go and seeGo and see

Gemba walkGemba walk

CustomersatisfactionCustomer

satisfaction

Gemba walk


Consultants

Gemba walk


Consultants

Gemba walk


Consultants

Customer satisfaction: metrics


Consultants

performancemindset

performancemindset

metricsmetrics

customer satisfactioncustomer

satisfaction

What is a customer incident?


Consultants

TC4 MS3 RF2 Total

Chutes 12 5 5 22

Fugues 5 3 0 8

Infection Urinaire 9 0 0 9

Escarres 0 1 0 1

Réactions médicamenteuses 1 0 0 1

Réclamations 2 2 0 4

Infection pulmonaire 1 0 0 1

Pertes ou vols d'objet 2 2 0 4

Erreurs de médicaments 0 0 0 0

Pansements 2 0 0 2

Accident avec Exposition au Sang 0 0 0 0

Infection s/ Sondes Urinaires 0 1 0 1

Kt périphériques 0 0 0 0

Allergie 0 0 0 0

SUIVI des INDICATEURS

Standardize work areas


Consultants

Involve the teams in visual management and quick response to problems

Involve the teams in visual management and quick response to problems

5S5S

StandardizationStandardization

5S


Consultants

Clear the workspaces, identify locations


Consultants


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Create supermarkets and hunt for out-of-date or missing material

Visualize out of date ormissing material and eliminate

Visualize out of date ormissing material and eliminate

SupermarketsSupermarkets

FlowFlow

supermarkets


Consultants

All the way to housekeeping material


Consultants


Consultants

Make sure material is desinfected after each use

Visualize problem and solve it by involving the team

Visualize problem and solve it by involving the team

Teamproblem-solving

Teamproblem-solving

Standard/kaizenStandard/kaizen

Clear and clean after every use


Consultants

Clear and clean after every use


Consultants


Consultants

Reduce inventory on hand so problems can be seen at one glance

Visual managementAnd quick responseVisual managementAnd quick response

Daily ward walkDaily ward walk

React at first defectReact at

first defect

Bacterial bombs!


Consultants

Visual management for quick response


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From the work environment to care itself


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Involve team in creating their work standards

Involve team in creating their work standards

Work standardsWork standards

StandardizationStandardization

Work standards for care


Consultants

TOILETTE AU LIT

LA TOILETTE IMPORTANT SÉCURITÉ

Repères :

1 – Planification murale à vérifier. 2 – Prendre connaissance de l’ état du patient. 3 – Préparation du matériel. 4 - Installation du patient. 5 – Déroulement de la toilette. 6 – S’assurer d e l’état des téguments. 7 – Réinstallation du patient. 8 – Environnement du patient. 9 – Nettoyage et rangement.

- Doit être à jour, - Plan de Soins actualisé. - Transmissions du jour, - Autonomie du patient - S’enquérir de la douleur. - Vérifier dans la ch ambre si tout le matériel nécessaire est présent et propre (cuvette, gants, serviettes…), - Apporter le matériel adapté aux besoins du patient (changes, produits…), - Vêtements propres - Position ergonomique, respect de la pudeur et de la sécurité, - Commencer par la toilette du siège si le patient est souillé, - Favoriser l’autonomie du patient - Relationnel. - Prévention d’escarres. - Installation au fauteuil, - Réfection du lit, - Nettoyer le dentier et s oins de bouche - Réaménager l’environnement avec tout le nécessaire à proximité. - Proposer de boire. - Désinfecter la cuvette, - Nettoyer et ranger le matériel utilisé, - Mettre de côté le l inge sale personnel au patient.

- Sécurité : - Gestes et postures respect des

capacités à faire du pati ent ; utiliser les a ides techniques (lève malade, drap de transfert) .

- Risque de chute : réinstaller la contention du patient au fauteuil si prescrite ; sonnette à p ortée de main ; déambulateur ou canne à proximité ; dégager le passage dans la chambre ; attention au sol mouillé !!!

- Organiser l’espace : pour l e confort et la sécurité des gestes et postures du patient et du personnel.

- Hygiène : Lavage des mains avant et après la toilette ; Utiliser la solution Hydro alcoolique entre chaque acte, et quand nécessaire ; Mettre tablier et gants vinyle non poudrés ; Respecter les circuits du linge et des déchets :

-Matériel : Linge nécessaire à la réfection du

lit ; Tablier à usage unique ; Gants vinyles non poudrés ; Solution Hydro alcoolique ; Change adapté à la taille du

patient ; Gant de toilette � usag e unique si

patient souillˇ ; Nécessaire de t oilette propre à la

personne ; Utiliser un gant et une serviette

de toilette pour le haut ; un gant et une serviette de toilette pour le bas.

-Auto-contrôle visuel : Vérifier l’installation du patient ; S’assurer de son confort ; Réfection du lit faite ; Vérifier qu’il ait à porté de mains

les affaires personnelles dont il a besoin : (sonnette, téléphone, verre, eau, revues…).

Vérifier le rang ement du mat ériel et des affaires personnelles du patient (linge sale).


Consultants

And more complex problems: preparing patients for physiotherapy

Develop teamwork betweenSpecialisms and solve

Patient problems

Develop teamwork betweenSpecialisms and solve

Patient problems

Value StreamMapping

Value StreamMapping

Patient flowPatient flow

And further challenges


Consultants

Moving to kanban for all supplies (which means convincing hospital logistics)

Tracking the path of BMR through the wards

Improving patient journey and getting involvement from the doctors

What results?


Consultants

Over two years, the rate of incidents per patient halved (that is, the probability each patient admitted has of facing an incident reduced by 45%)

Lean is a learning system


Consultants

The lean environment (visual management, pull system) helps people to see cause and effect

The lean tools are learning opportunities, for people to learn to produce with better, quality, delivery, productivity and flexibility

The tools only highlight problems, resolution with PDCA is the point!

Lean is a management system


Consultants

Using the tools will not transform the culture

The lean culture is about solving all problems rigorously

To understand real priorities

And create another type of relationship with workers

Based on developing abilities

And creating better products, through better thinking

The team!


Consultants

Thank you


Consultants

To the team from Villeneuve, Nord 92

To visitors from Bolton Hospitals

To you, for your attention

Date post:	09-Dec-2014
Category:	Education
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Walking the Wards

Education