If you make the decision to set about a Lean journey, you’ll need to begin thinking about the magnitude of this change, as it is enormous. Lots of your current practices will change to be focused on patient care (the reasons why you got into healthcare) and not as on the daily aggravations of searching for the things you’ll need to deliver that care. You must have a good framework to measure the progress of one’s lean efforts. First, as you take into account the changes coming, you need to:
Let’s start by defining just what a hospital value stream is: a Value Stream is an accumulation of interconnected processes to deliver value to a customer. A benefit stream example in a hospital describes the care of an individual that arrived to a healthcare facility via the Emergency Department, was admitted to the Telemetry unit, and was discharged home. Another value stream example describes the flow of patients which come to a healthcare facility for outpatient surgeries:
Each process advances the care of the patient. The sum total of these processes delivers value to the patient and is what we call a Value Stream. There are many value streams in a hospital and all of them must mature coming to perfection, as that’s our goal and the goal of any Lean initiative. How can we track the progress of the Lean implementation on a certain value stream? We do that by establishing a five-level framework to measure the progress.
Engagement. By this we mean a advanced level of involvement by the entire staff. Simply improving isn’t sufficient in a Lean Value Stream. With no active involvement by everyone in the task of process improvement, it will soon be difficult to boost fast enough in today’s competitive environment.
Level 1: Identify the Value Stream and assign ownership. The first logical step in improving a benefit stream is to spot and document it. This maturity level involves naming a benefit stream, assigning a benefit stream owner to it, and creating both current and future state value stream maps. We may also desire to establish performance metrics for the value stream: Discharge performance, Medication Administration performance, productivity, quality, and so on.
Level 2: Patient Flow and Pull. The greatest opportunity when moving from the traditional work environment to a Lean environment may be the introduction of flow and pulls methods. Patient wait time in traditional environments can represent as much as 70% of the total patient length of stay. In cases where you flow products, like Sterile Processing of Instrument sets, experience shows that cycle time is related to a long listing of related benefits, including improved productivity, higher quality, less space on the floor, improved flexibility, and higher on-time delivery of the Instrument sets back to the OR Suite.
Level 3: Standardization. Once we’ve harvested the reduced hanging fruit of flow and pull, we ought to continue with the task of training the certifying the staff in Standard Work. We need to involve the entire staff in defining usually the one easiest way to complete work, and to train them to complete the task that way. Understand that standard work doesn’t limit creativity or improvement, but it does determine what sort of work must certanly be done for the present time.
Level 4: Engagement. The stage of engagement is what separates the Lean pros from the amateurs, whenever we are assessing value stream maturity. Until we are able frenchstreaming to involve the entire workforce in the creative work of continuous improvement, our Lean efforts will remain at risk of outside competitors simply copying what we’ve done. Once we are generating hundreds and a large number of small improvement suggestions annually, it will soon be very difficult for the competition to keep up.
Level 5: Sustained Performance. Until we are able to incorporate flow, pull, standard work and employee engagement into our hospital culture, things will inevitably backslide. We can claim that we have reached Level 5 on the value stream maturity scale when we are able to shown that we have maintained continuous improvement for an amount of at least 36 months.
The starting place, obviously, would be to map your primary value streams. Whilst the Value Stream Mapping concept is well-know, the truth is few organizations (hospitals or factories) have actually taken that first step. If you’re willing to maneuver forward with the time and effort, get some expert help from mentoring organizations like Leonardo Group Americas. Getting training and insight from those who have done this before often times is extremely valuable.