Description
Book SynopsisProcess Redesign for Health Care Using Lean Thinking is a response to a simple, but hard to answer, question and is the result of the experiences of a working doctor who was also the chief safety and quality officer of an Australian teaching hospital. At this hospital, he observed that the Emergency Department was staff by talented, well-trained, and respected doctors and nurses. The facilities were modern, and the work load unexceptional, but the department was close to melt down. Bad things were happening to patients, everyone was blaming each other, lots of things had been tried but nothing was getting better and no one could explain why. The problem was not a lack of technical knowledge or expertise, the problem was that no one stood back and said, what's the best way to move 200 or 300 patients a day through the complicated and varying, sequence of steps needed to sort out the many different problems that bring patients to our department?
These challenges are face
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"I loved David’s book. He speaks with a distinct personal voice that combines deep personal experience and a framework that places that experience in a universal healthcare context. There is nothing else like it."
John Shook, Chairman, Lean Enterprise Institute Inc, Cambridge MA
"I loved David’s book. He speaks with a distinct personal voice that combines deep personal experience and a framework that places that experience in a universal healthcare context. There is nothing else like it."
John Shook, Chairman, Lean Enterprise Institute Inc, Cambridge MA
Table of ContentsPart 1: Process Redesign – the complete method
Chapter 1: Introduction: An accidental redesigner
- Why redesign?
- Learning about Lean
- A decade later
Chapter 2: Craft, Flow, Mass
- British manufacturing: the extension of the craft work system
- The American method of production
- Moving to mass
Chapter 3: Taiichi Ohno and the Birth of Lean
- Toyota and Taiichi Ohno
- Waste and flow
- Push and pull
- Workers as problem solvers: the challenge for managers
Chapter 4: The Principles of Lean Thinking
- The process viewpoint: the golden thread of Lean
- The Lean principles
- Principle 1: specify value from the standpoint of the end-customer
- Principle 2: identify the value stream for each product family
- Principle 3: eliminate waste and make the product flow
- Principle 4: so that the customer can pull
- Principle 5: as you manage towards perfection
Chapter 5: Healthcare is not manufacturing
- The Lean principles are very important – but
- Placing an order: customers and raw materials
- Redesign double vision
- Complicated: or complex and adaptive?
Chapter 6: Knowledge work
- Knowledge work
- Knowledge workers own their knowledge capital
- Design
- Or Redesign
Chapter 7: Redesigning care: authorization, permission, teams and governance
- Authorization and permission
- The redesign team
- Governance
- The workgroup and the improvement event
Chapter 8: The virtuous circle of Process Redesign and the A3
Chapter 9: Identifying the problem
- Primary purpose, problems and concerns
- Problem statements
- What kind of problem, and where to start?
Chapter 10: Defining the scope
- The benefits of starting with scope
- Scope and scoping: an evolving task
Chapter 11: Diagnosis (1) Mapping – the Big Picture
- The process of Big Picture Mapping: a social intervention
- Setting up and undertaking a Big Picture Mapping
Chapter 12: Diagnosis (2) Direct observation
- External or internal redesign capacity?
- The structure of the learning to see phase
- Tracking patients or tracking specific process steps
- Analysis
Chapter 13: The real problem (1): Identifying the real problem
- Root cause analysis, the five whys and effect-and-cause analysis
Chapter 14: The real problem (2): Measurement
- Measurement for redesign-types of measurement
- The basic triad of analysis design
- Measurement focus: releasing time or improving outcomes (or both)
- Measuring processes or outcomes
Chapter 15: Goals, the scientific method and the future state
- Experiments and the Plan-Do-Study-Act cycle
- Goals
Chapter 16: Value stream, batching and flow improvement
- Making the process viable
- Splitting into value streams
- Flow
- Takt time
- Batching
- Improving flow: eliminate, combine, reduce, simplify
Chapter 17: Targeted interventions – 5s, visual management and visual systems
- 5s
- Visual management
- The ideal visual management system
Chapter 18: Queues, prioritizing, capacity and demand
- Acknowledging Erlang – the Calling population
- Queue discipline – First in, first out
- Queue discipline: planned work, short term queue, shortest service time
- Capacity lost, demand moves forward
- Queues and priorities
- Analysis of capacity and demand
- Exponential growth in queue length
- Impossible jobs
Chapter 19: Embedding and sustaining
- Measure, monitor, evaluate
- A formal decision to adopt the new way
- The front-line manager
- A culture of continuous improvement
Part 2: Case Studies
Chapter 20: Case Study 1: Redesigning Emergency Department flows
- The problem
- Scoping
- Diagnosis
- The real problem
- Intervention
- ED works
- Evaluation
- Embedding and sustaining
Chapter 21: Case Study 2: The Care-After-Hours Program
- The problem
- Authorization and permission
- Scoping
- Diagnosis
- Four major-work streams
- The real problem
- Intervention
- The Electronic Medical Task Board
- Evaluation
- Embedding and sustaining
- Continuity of information
Chapter 22: Case Study 3: Visual Management
- The Patient Journey Boards
- Scoping
- Diagnosis-tracking
- The real problem
- Intervention
- Evaluation
- Discharge traffic lights and blue dots
Chapter 23: Case Study 4: Redesigning podiatry care
- The problem
- Diagnosis
- The real problem
- Interventions
- Evaluations
Chapter 24: Conclusion – Redesigning Process Redesign
