Lean hospitals improving quality, patient safety, and employee engagement Mark Graban

Includes bibliographical references and index

The Need for Lean Hospitals Better Results with Lean 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 Good Quality Costs Less Interconnected Benefits A Snapshot of Department Success: Laboratory, Children's Health Dallas From Departmental to Hospital- and System-Wide Success Conclusion Lean Lessons Points for Group Discussion Notes Overview of Lean for Hospitals and Health Systems What Is Lean? Ohno's Definition of Lean Lean Thinking The Toyota Triangle: Tools, Culture, and Management System The "Toyota Way" Philosophy Four Organizational Capabilities for Lean Lean and Other Methodologies What Lean Is Not Conclusion Lean Lessons Points for Group Discussion Notes Value and Waste Waste: A Global Problem with Local Solutions Reducing Waste Is a Better Goal Than Reducing Cost What Is Waste? What Is Value? Start with the Customer How Do We Define Value in a Broad Sense? How Does Lean Define "Value?" Examples of Value-Added and Non-Value-Added Activities Learning to Identify and Describe Waste There's Not Always an Easy Answer 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 Learning to See 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 Employee Conclusion Lean Lessons Points for Group Discussion Notes Standardized Work as a Foundation of Lean Helpful Standardization: From 171 Forms to Just Six The Need for Standardized Work The Toyota House Metaphor Overview of the Lean Foundations Lean Foundations: Standardized Work Definition of Standardized Work 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 for Raising Concerns Standardized Work Can Apply to Leaders 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 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 Tragic and Preventable Mary McClinton Story Improving Quality and Patient Safety Cultural Obstacles to Quality Improvement Why Do Errors Occur? 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 Toyota's Practical Problem Solving Be Proactive and Use Failure Modes and Effects Analysis Proactive Resolution of Near-Miss Problems The Heinrich Safety Pyramid Conclusion Lean Lessons Points for Group Discussion Notes Preventing Errors and Harm A Serious Problem with Large, Unknowable Numbers 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 Error Proofing, Not Dummy Proofing Examples of Error Proofing in Hospitals Stopping the Line (Andon) Error Proofing the Error Proofing Conclusion Lean Lessons Points for Group Discussion Notes Improving Flow Lean Is Both Quality and Flow Waiting: A Worldwide Problem Targets without a Means for Improvement Might Lead to Improvement or Dysfunction Focusing on Flow Value Streams Should Flow Like a River Uneven Workloads as a Barrier to Flow Addressing Mura by Matching Staffing to Workloads Improving Patient Flow Improving Flow for Ancillary Support Departments Conclusion Lean Lessons Points for Group Discussion Notes Lean Design Better, Faster, and Cheaper Understanding the Current State before Designing the Future Lean Design at East Tennessee Children's Hospital Integrated Lean Project Delivery at Akron Children's Hospital Conclusion Lean Lessons Points for Group Discussion Notes Engaging and Leading Employees Improving the Way 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 Performance Measures Conclusion Lean Lessons Points for Group Discussion Notes Getting Started with Lean How Do We Start? The LEI Lean Transformation Model Where Do We Start? What Do We Call It? Getting Started with Kaizen Kaizen Events Lean Transformation Projects The Lean Project Team Executive Sponsorship and Leadership Starting from the Middle Establishing a Model Line and a Road Map Dedicating People to Lean Beyond Projects The Lean Department The Importance of Change Management A Snapshot of Hospital Success: Avera McKennan Hospital & University Health Center Conclusion Lean Lessons Points for Group Discussion Notes A Vision for a Lean Hospital and Health System Introduction When Is a Health System Lean? What Would a Lean Health System Look Like? What Would a Patient Experience in a Lean Health System? What Would It Be Like to Work in a Lean Health System? How Would We Describe a Lean Health System? In Conclusion Points for Group Discussion Notes Glossary Index

The new edition of this Shingo Prize-winning international bestseller lays out a framework for defining and understanding Lean hospitals.