Lean hospitals : improving quality, patient safety, and employee engagement

著者

• Graban, Mark

書誌事項

Lean hospitals : improving quality, patient safety, and employee engagement

Mark Graban

Productivity Press/Taylor & Francis, 2012

2nd ed

• pbk. : alk. paper

注記

Includes bibliographical references and index

Summary: "The new edition of this Shingo Prize-winning international bestseller lays out a framework for defining and understanding Lean hospitals. It starts off by examining the challenges faced by hospitals, including rising costs, falling reimbursement rates, employee retention, and patient safety and satisfaction. Full of examples and case studies, the second edition has been updated to reflect current pressures on hospitals, including the Affordable Care Act, and includes new and updated case studies. New material includes discussions on process audits, performance measures and suggestion management as well as a new chapter on strategy deployment"--Provided by publisher

内容説明・目次

内容説明

Healthcare leaders around the world are facing tough challenges, including the need to deliver better value for patients and payers, which means improving quality while reducing cost. It might seem impossible to do both, but organizations around the world are proving it's possible, through Lean. Health systems are able to enhance all dimensions of patient care, including both safety and service, while creating more engaging and less frustrating workplaces for healthcare professionals and staff... all leading to improved long-term financial performance. Building on the success of the first two editions of this Shingo Prize-Winning book, Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement, Third Edition explains how to use the Lean philosophy and management system to improve safety, quality, access, and morale while reducing costs. Lean healthcare expert Mark Graban examines the challenges facing today's health systems, including rising costs, falling reimbursement rates or budget constraints, employee retention, and harm to patients. The new edition of this international bestseller (translated into eight languages) begins with an overview of Lean methods and mindsets. It explains how engaging staff and leaders in Lean practices such as value stream mapping and process observation can help reduce wasted motion for caregivers, prevent delays for patients, and improve the long-term health of your organization. In addition to a new introduction from John Toussaint, this updated edition includes: New and updated material on identifying waste, A3 problem solving, employee idea management, kanban for materials management, and strategy deployment New case studies and examples-including a new 5S case study (Franciscan St. Francis Health) and other case examples highlighting the challenges and successes of an academic medical center and a small urgent access hospital, featuring quotes and stories from executives New examples and updated data throughout, including revised chapters on patient safety and patient flow challenges and the improvements driven by Lean Detailing the mindsets and methods needed for a successful transition to a Lean culture, the book provides the understanding of Lean practices-including value stream mapping, standardized work, error proofing, root cause problem solving, and daily improvement processes-needed to reduce common hospital errors and improve performance in other dimensions. The balanced approach outlined in this book will guide you through the process of improving the quality of care and service while reducing costs in your hospital. *The Lean Certification and Oversight Appeals committee has approved Lean Hospitals as recommended reading for those in pursuit of Lean Bronze Certification from SME, AME, Shingo Prize, and ASQ

目次

The Case for Lean Hospitals Why Do Hospitals Need Lean? A Renewed Sense of Purpose Lean Methods Are Not New to Healthcare Toyota's Role in Popularizing Lean Origins of the Term Lean Lean Is Proven to Work Outside Automotive Factories Lean Is Helping Hospitals Improve Problems in Healthcare Price Pressures and Cost Challenges Coping with Employee Shortages Poor Quality of Care Good Quality Costs Less A Snapshot of Department Success: Laboratory, Children's Medical Center Dallas From Departmental to Hospital-Wide Success Conclusion Lean Lessons Points for Group Discussion Notes Overview of Lean for Hospitals What Is Lean? Ohno's Definition of Lean Lean Thinking The Toyota Triangle: Tools, Culture, and Management System Human Development Philosophy Technical Tools Managerial Methods The "Toyota Way" Philosophy Continuous Improvement Respect for People Four Organizational Capabilities for Lean Capability 1: Work Is Designed as a Series of Ongoing Experiments that Immediately Reveal Problems Capability 2: Problems Are Addressed Immediately through Rapid Experimentation Capability 3: Solutions Are Disseminated Adaptively through Collaborative Experimentation Capability 4: People at All Levels of the Organization Are Taught to Become Experimentalists Conclusion Lean Lessons Points for Group Discussion Notes Value and Waste Waste Is Not the Same as Cost What Is Waste? What Is Value? Start with the Customer How Do We Define Value? Rule 1: The Customer Must Be Willing to Pay for the Activity Rule 2: The Activity Must Transform the Product or Service in Some Way Rule 3: The Activity Must Be Done Correctly the First Time Examples of Value-Added and Non-Value-Added Activities Learning to Identify and Describe Waste Waste of Defects Waste of Overproduction Waste of Transportation Waste of Waiting Patients and Products Waiting Employees Waiting Waste of Inventory Waste of Motion Waste of Nursing Motion Waste of Overprocessing Waste of Talent What Non-Value-Added Activities Are Required? Non-Value-Added, Pure Waste Conclusion Lean Lessons Points for Group Discussion Notes Observing the Process and Value Streams How Do We Find Waste? Go and See What Is a Value Stream? Value Stream Mapping Creating a Current-State Value Stream Map The Future-State Maps Breaking Down Silos and Reducing Suboptimization Observing the Process Activity of the Product Activity of the Product-Laboratory Activity of the Employee Activity of the Employee-Nursing Activity of the Employee-Primary Care Activity of the Employee-Perioperative Services Conclusion Lean Lessons Points for Group Discussion Notes Standardized Work as a Foundation of Lean The Need for Standardized Work The Toyota House Metaphor Overview of the Lean Foundations Lean Foundations: Standardized Work Definition of Standardized Work Current Proper Outcome and the Highest Quality To Safely Complete One Best Way Fewest Possible Resources Standardized, Not Identical Written by Those Who Do the Work Considering How Long Tasks Take Staffing Based on Data Types of Standardized Work Documents Standardizing Daily Routines Defining Roles and Responsibilities Quick Changeover as Standardized Work Explaining Why through Standardized Work Standardized Work Documents and the Standardized Work System Measuring and Observing for Standardized Work Adherence "Resistance" to Standardized Work? Asking Why When Standardized Work Is Not Followed Standardized Work Can Apply to Physicians Lean and Checklists Standardized Work Can Apply to Managers Training through Standardized Work Conclusion Lean Lessons Points for Group Discussion Notes Lean Methods: Visual Management, 5S, and Kanban Lean Is More than Tools, but Tools Can Help Reducing Waste through Visual Management Examples of Visual Management for Patient Flow Examples of Visual Management to Prevent Process Problems 5S: Sort, Store, Shine, Standardize, and Sustain First S: Sort Second S: Store Third S: Shine Fourth S: Standardize Fifth S: Sustain Safety as a Sixth S? Kanban: A Lean Approach to Managing Materials Problems with Traditional Materials Systems Trade-offs with Inventory Using Kanban to Replenish Supplies Conclusion Lean Lessons Points for Group Discussion Notes Proactive Root Cause Problem Solving The Mary McClinton Story Improving Quality and Patient Safety Cultural Obstacles to Quality Improvement Why Do Errors Occur? Violations and Errors, Lapses, and Slips Examples of Quality Improvement Finding Root Causes and Preventing Errors Workarounds and the Need for Fixing Root Causes Asking Why Instead of Who Start at the Gemba Find Root Causes Using Simple Methods A3 Problem Solving Be Proactive and Use Failure Modes and Effects Analysis Proactive Resolution of Near-Miss Problems The Safety Pyramid Conclusion Lean Lessons Points for Group Discussion Notes Preventing Errors and Harm A Problem That Is Not Going Away Moving Beyond Blaming Individuals The Darrie Eason Case Creating Quality at the Source through Error Proofing Being Careful Is Not Enough Why 100% Inspection Is Not 100% Effective Types of Error Proofing Make It Impossible to Create the Error Make It Harder to Create the Error Make It Obvious the Error Has Occurred Make the System Robust So It Tolerates the Error Error Proofing, Not Dummy Proofing Examples of Error Proofing in Hospitals Banned Abbreviations as Error Proofing Computer Systems as Error Proofing Preventing Surgery Errors through Error Proofing Stopping the Line (Andon) Error Proofing the Error Proofing Conclusion Lean Lessons Points for Group Discussion Notes Improving Flow Waiting: A Worldwide Problem Focusing on Flow Value Streams Should Flow Like a River Uneven Workloads as a Barrier to Flow Naturally Occurring Unevenness Mura Caused by Morning Rounds Mura Caused by Suboptimizing Courier Routes Mura Created by Clinic Scheduling Mura in the Patient Discharge Process Addressing Mura by Matching Staffing to Workloads Improving Patient Flow Improving Patient Flow in the Emergency Department Reducing "Door-to-Balloon" Time Improving Patient Flow in Outpatient Cancer Treatment Improving Flow for Ancillary Support Departments Improving Flow in Clinical Laboratories Reducing Delays in Specimen Collection Reducing Delays in the Receiving Areas of the Lab Improving Flow Also Improves Quality and Teamwork Reducing Delays Inside the Testing Areas of the Lab Improving Flow in Anatomic Pathology Improving Flow in Pharmacies Conclusion Lean Lessons Points for Group Discussion Notes Engaging and Leading Employees Changing How We Manage What Is a Manager's Role? Strategy Deployment Common Management Problems Lean as a Management System and Philosophy A Daily Lean Management System Process Audits or Rounding Standardized Audits of the Standardized Work A Hierarchy of Rounding Performance Measures Timely Measures Drive Timely Improvement A Balanced Scorecard Focuses on All Stakeholders Metrics Should Be Visible, Visual, and Statistically Meaningful Daily Stand-up Team Meetings Kaizen and Suggestion Management Problems with Suggestion Boxes The Role of Supervisors in Kaizen Finding a Better Method for Managing Kaizen Visual Tracking of Suggestions Communicating Kaizen Changes Conclusion Lean Lessons Points for Group Discussion Notes Getting Started with Lean How Do We Start? Where Do We Start? What Do We Call It? Types of Kaizen Kaizen Events Pitfalls of Kaizen Events Lean Transformation Executive Sponsorship and Leadership Starting from the Middle Establishing a Model Line and a Road Map Chartering a Project Dedicating Internal Resources: The Lean Team The Importance of Change Management A Snapshot of Hospital Success: Avera McKennan Hospital Conclusion Lean Lessons Points for Group Discussion Notes A Vision for a Lean Hospital Introduction When Is a Hospital Lean? What Would a Lean Hospital Look Like? What Would a Patient Experience in a Lean Hospital? What Would It Be Like to Work in a Lean Hospital? How Would We Describe a Lean Hospital? Strategy and Management System Patients Employees Waste and Kaizen Technology and Infrastructure Points for Group Discussion Notes Glossary of Terms Index Chapter-by-Chapter Breakdown of What's New in this Edition: General "Points to Ponder" at the end of each chapter are now called "Points for Group Discussion," with some new questions added. Chapter 1 Updated initial introduction (talking about "starting from need" in terms of why we use Lean methods and principles) Added callout talking about Toyota's reputation and quality Updated Lean history to reference Joan Wellman and Seattle Children's early Lean work Updated/new metrics that show Lean improvement examples in healthcare Updated data on cost pressures, staff shortages, quality problems in healthcare New departmental case study (Children's Medical Center Dallas - lab) 1st edition case example moved to later chapter on improving flow The bulk of the Avera McKennan case study (from 1st edition) moved to later chapter on getting started with Lean Chapter 2 Various updates, including some references to ThedaCare's Lean management system Updated "Toyota Way" framework to change first pillar wording from "elimination of waste" to "continuous improvement" - the main idea is the same, but this is more consistent with Toyota wording New callout on "respect for people" pillar Added the "four rules in use" as a Lean definition framework Chapter 3 New introduction, "Waste is Not the Same as Cost" New data from Virginia Mason about reducing waste to free up RN time at the bedside Refined description of "pull" in healthcare, why pull should be about patients pulling on resources, not a unit "pulling" the patient when a room is available Improvements in the section on defining value, incorporating insights from Dr. Don Berwick Edits and, in some cases new examples, about the types of waste in healthcare Fuller discussion of "Required Waste" Chapter 4 Edits and some new examples in intro to value streams New callout on electronic VSM - downplaying the need for that software and technology New "activity of the employee" example for primary care physician, with new figure Chapter 5 New figure showing the "Park Nicollet System of Care" version of the "Lean House" diagram Edits and refined section on standardized work for healthcare New callout on looking at the communication process and standardized work instead of just blaming parents for not following NPO instructions properly New callout on standardized work in a radiology department New section on determining staffing levels based on data New section on quick changeover as a form of standardized work (O.R. turnover, etc.) New material on managers coaching on standardized work, rather than being punitive when they see problems New material on Lean, standardized work, and checklists New material on standardized work for managers New callout on standardized work and Training Within Industry (success story example) Chapter 6 New examples of visual management used to help manage patient flow New 5S callouts and small case examples New Kanban examples and new case study from Northampton General Hospital (UK), Seattle Children's, Park Nicollet, Henry Ford Health System, New York HHC New material on Kanban vs. par levels New material on Kanban vs. automated inventory cabinets New culminating case study about the use of standardized work, 5S, Kanban, and visual management to prevent patient harm Chapter 7 New intro case study of the Mary McClinton case and lessons learned (Virginia Mason) New quality improvement data and examples from ThedaCare and others New examples and discussion about workarounds New section on A3 problem solving, with example New 5 Whys problem solving examples Chapter 8 New introduction and case example of patient harm and lessons learned (Darrie Eason case) - blame vs systems New examples about quality at the source and not blaming individuals New error proofing and quality improvement data and case examples New material about Lean and "Crew Resource Management" New material on Virginia Mason "patient safety alert" system New figures and photos Chapter 9: New intro - "Waiting: A Worldwide Problem" with data from many countries and waiting times and improvements New material on the "Seven Flows of Healthcare" New examples and data on flow improvements New material on matching staffing to demand in emergency departments New examples of E.D. flow improvement New case example (ThedaCare) on reducing door to balloon time Chapter 10 New quotes and callouts on Lean leadership, including John Toussaint's comparison of "white coat leadership" and "Lean leadership." New section on strategy deployment New material on goals versus hard targets and a warning about dysfunctions Additional material on daily standup meetings Updates on managing kaizen and continuous improvement Updated format for an "idea card" to be used on visual idea boards Chapter 11 New callouts about organizations getting started with Lean New material on "what do we call it?" - giving a name to a formal Lean program Updates on kaizen events - different formats and success/failure data updated Replaced LeBonheur Children's Hospital "getting started" Lean transformation case with updated/expanded version of Avera McKennan case Chapter 12 Updated and expanded "Vision for a Lean hospital."

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詳細情報

• NII書誌ID(NCID): BB12660879
• ISBN:
  • 9781439870433
• LCCN: 2011020421
• 出版国コード: us
• タイトル言語コード: eng
• 本文言語コード: eng
• 出版地: New York
• ページ数/冊数: 16, 245p
• 大きさ: cm
• 分類:
  • LCC : RA971
  • NLM : WX 157.1
  • DC23 : 362.11068
• 件名:
  • LCSH : Hospitals -- United States -- Administration
  • LCSH : Hospital care -- United States -- Quality control
  • LCSH : Hospital care -- United States -- Cost effectiveness
  • LCSH : Patients -- United States -- Safety measures
  • LCSH : Just-in-time systems
  • LCSH : Total quality management
  • MESH : Hospital Administration -- economics
  • MESH : Hospital Administration -- methods
  • MESH : Efficiency, Organizational
  • MESH : Total Quality Management -- methods
  • MESH : Total Quality Management -- organization & administration