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Leveling Flow (Part 1)

Course video 20 of 29

Value stream mapping is at the heart of TPS or Lean. Using the Time Observation Sheets you will learn how to fill out a Value Stream Map, including determining WIP (work in progress) depicting physical movement and process flow along with information flow, and assessing when work is value-added and when it is non-value added. Value stream maps are used to identify bottlenecks and wasteful steps in a work process and then process mapping and rapid improvement events (RIEs) can be used to remove these wasteful processes and impediments to workflow. Finally you will be introduced to the principles of leveling both under elective and emergency treatment conditions. Applying these tools can dramatically improve efficiency and productivity without increasing overall manpower.

Lean or Toyota Production System (TPS) is responsible for revolutionizing the auto industry by creating highly reliable and safe cars and trucks. In this course healthcare providers, administrators, engineers, and healthcare professional students will be taught how to apply the principles and tools of Lean to health care. They will learn how to identify and remove of waste, design standardized work, apply 5S, map Value streams, create process maps, conduct rapid improvement events (RIEs), level workflow, use A3 forms and Paredo charts, apply error proofing, and create effective visual controls. The instructional videos minimize Lean technical language, and include patient cases to make the lessons more appealing to students in healthcare. Acknowledging that patients are very different from cars we have carefully adapted Lean to health care and call our system: Patient-centered Healthcare Delivery System (PHDS). The name and abbreviation emphasize two key principles taught in our course: 1. Just like PhDs the scientific method must be continually applied when creating plans to improve our systems of care. 2. All improvements must be made looking through the eyes of patients. Armed with this new knowledge students will be able to design and implement sustainable healthcare delivery system improvements.

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Enseigné par

Frederick S. Southwick, MD
Professor

Transcription

In this session, I will review some ideas and

principles with regards to leveling work in healthcare.

Creating smooth workflow is called heijunka by

the Japanese who employ Toyota production system.

How do we achieve smooth flow?

Using a stream as an analogy, how do we create unobstructed workflow,

shown in the upper image, as compared to flow that has multiple obstructions and

erratic flow, as shown in the lower image?

Why should we aspire to achieve even production or level workflow?

Because wide swings in workload create stress and encourage multi-tasking.

As we discussed in fixing healthcare 1.0,

both of these conditions increase the likelihood of human errors.

Whenever there is sudden extreme increases in work without appropriate adjustments,

this condition endangers our patients.

When it comes to smoothing out work, there are two conditions in healthcare

that require unique approaches, emergency patients and elective patients.

Let's first look at the best practices for leveling workflow for emergency patients.

For this condition, production needs to be designed to match customer demand.

Walk-in clinics and emergency rooms employ these approaches.

These areas need to adjust staffing to patient demand and

this can prove difficult.

Ideally, emergency patients should not have to wait.

To achieve this goal, workflow needs to be more flexible.

And personnel and processes need to increase and

decrease in number and speed to match demand.

When it comes to emergencies, we can't control the number of patients, but

we can match the workers to the workload.

Ideally, health systems should match the number and types of workers and

other resources to deliver value on demand without waste.

Overstaffing can result in low per employee productivity,

while understaffing can lead to stress, multi-tasking and errors.

Unfortunately, staffing is often based on convenience.

And traditional eight and 12 hour staffing patterns

usually do not match demand in the emergency room environment.

Studies of demand over time in emergency rooms and clinics reveal

surprisingly predictable patterns of demand, and once they are understood,

worker numbers and resources can be adjusted to match these patterns' demand.

As an example, let's look at a typical large health system emergency room.

The vertical axis for this set of bar graphs shows the number of

patients waiting in the Every hour of a typical weekday.

As you can see, demand is low early in the morning, and

progressively rises, peaking in the early evening,

maximum demand occurring in the 8 hour period between 3 PM and 11 PM.

How can we level this workload?

I work as an admitting officer of the day approving and

performing second checks, error proofing, for

all patients that the Team wants to admit to the internal medicine service.

My shift is from 7 AM to 7 PM, shown as the number one at the top of this graph.

In the morning hours until about 2 PM, I can easily handle the volume.

But after 2 PM, the workload far exceeds my capacity.

Recognizing this reality, our hospital service assigns a second

physician beginning at 2 PM and going until 12 PM.

And to manage the peak demand, assigns a third physician from 4 PM to 12 PM.

This more flexible approach to physician assignment usually results in

a leveling of work.

To summarise this session, leveling creates even workflow,

reducing stress, multi-tasking and errors.

This approach produces the right number of workers

at the right time to respond to customer demand.

For emergency patients,

the number of workers needs to match the daily demand patterns.

Thank you.

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