Hridoy Ahmed
on April 23, 2021 10 views
0:35 Healthcare and manufacturing are different 3:16 Journey through healthcare 8:32 Root cause analysis 9:05 Key performance indicators 15:15 5 Ss - seiri, seiton, seiso, seiketsu, and shitsuke - sort, shine, set in order, standardize, and sustain 16:43 Visual management & affordances 18:44 Queuing theory 20:12 Buffer slots & FIFO 21:24 Break clinic down into smallest unit 22:19 Booking for future clinics 23:49 Little’s Law 25:30 Erlang Variable and calculating the utilization rate 30:40 Emergency department, likely admitted, likely not admitted and resus Lean Thinking is increasingly migrating from manufacturing to the services sector. The owner of a new car is not present while minerals are mined, smelted, refined, and turned into sheets of metal that are delivered to a car maker. By contrast, the patient is a sentient being who is present, observing and experiencing at every stage of the transformation of his or her raw material, except, in the case of some patients, for a brief period of oblivion during an operation. Authorization nor permission can not be taken for granted in healthcare, both have to be built step by step. Patients make it clear that they want Health Care workers to make a plan and then discuss it with them. It is worth thinking about journeys through healthcare to critically analyse it and attempt to make it more efficient. The more complicated the overall production process, the harder it is for the different groups that are involved to see themselves as part of the whole. If the participants cannot see how their steps link up with processes further down the line, and what impact poor coordination has on the delivery of care, it will be hard to get the whole process working smoothly. Process Mapping and big Picture Mapping are not simply about the engineer or redesigner understanding the process. It is a collective activity in which a map is created by direct and public interaction with the participants, who describe to each other the roles that they play. Therefore for Big Picture Mapping session to be successful, the right people need to be in the room. There is no point trying to map out a process if the senior clinical stakeholders, be they doctors, nurses, or allied health practitioners, are not present. They are key members of the social system involved and need to be involved in the process. Equally the clerical and administrative staff that do the greeting and appointing functions are required to be present. Plan Do Study Act (PDSA) cycle When it comes to planning care typically planned care is scheduled 24 hours or more ahead and can be anticipated versus unplanned care which occurs in less than 24 hours. Work can be divided into short versus longer time scales. Flow: Once a process has been defined, and the series of steps involved are clear, the workgroup involved can turn its attention to improving the flow of work through the process. Improving flow lies at the heart of Lean Thinking and is central to Process Redesign work. ‘5S’ is a translation of a set of Japanese words, seiri, seiton, seiso, seiketsu, and shitsuke (translated as sort, shine, set in order, standardize, and sustain) Sort – take everything out. Sort into things to throw away, things to keep, and things to review Shine – take the opportunity to clean up Set in order – develop a structure for access and storage based on use patterns Standardize – formalize the structure, so that the storage and retrieval solutions become standard practice Sustain – define the “ownership” of the storage area and assign responsibility for its maintenance “Visual management” is the term commonly used to describe the range of strategies that use visual systems to support process management and process control. Some designed objects have “good” (i.e. easily identifiable) affordances, telling you how to hold them and how to use them, while others need further work on their affordances. Partial booking is administratively more demanding than just giving a patient an appointment for a fixed period such as weeks or months in advance. It does however minimise the very complicated shuffling of appointments, because the clinic slots are not taken up months in advance. Partial booking also minimises do not attends, so clinics can run smoothly on the day. In quality improvement ‘wastage’ is time spent looking for things or people. Cut wastage down then allocate tasks to use this time better. If utilization rates are well below 85%, there is every likelihood that driving out the waste will ensure that short-term, and long-term, queues can be reduced or eliminated, allowing the claim for additional resources to be reassessed. For process Redesign widely publicise this to the whole of the trust and relevant stakeholders so they know you aims.
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