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

Author: Mark Graban
Publisher: Boca Raton, FL : CRC Press, 2012.
Series: Lean / Healthcare process improvement
Edition/Format:   Print book : English : 2nd edView all editions and formats
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  Read more...
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Material Type: Internet resource
Document Type: Book, Internet Resource
All Authors / Contributors: Mark Graban
ISBN: 9781439870433 1439870438
OCLC Number: 796989961
Description: 245 Seiten : Illustrationen.
Contents: The Case for Lean HospitalsWhy Do Hospitals Need Lean?A Renewed Sense of PurposeLean Methods Are Not New to HealthcareToyota's Role in Popularizing LeanOrigins of the Term LeanLean Is Proven to Work Outside Automotive FactoriesLean Is Helping Hospitals ImproveProblems in Healthcare Price Pressures and Cost Challenges Coping with Employee Shortages Poor Quality of CareGood Quality Costs LessA Snapshot of Department Success: Laboratory, Children's Medical Center DallasFrom Departmental to Hospital-Wide SuccessConclusionLean LessonsPoints for Group DiscussionNotesOverview of Lean for HospitalsWhat Is Lean?Ohno's Definition of LeanLean ThinkingThe Toyota Triangle: Tools, Culture, and Management System Human Development Philosophy Technical Tools Managerial MethodsThe "Toyota Way" Philosophy Continuous Improvement Respect for PeopleFour 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 ExperimentalistsConclusionLean LessonsPoints for Group DiscussionNotes Value and WasteWaste Is Not the Same as CostWhat Is Waste?What Is Value? Start with the CustomerHow 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 TimeExamples of Value-Added and Non-Value-Added ActivitiesLearning 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 TalentWhat Non-Value-Added Activities Are Required?Non-Value-Added, Pure WasteConclusionLean LessonsPoints for Group DiscussionNotesObserving the Process and Value StreamsHow Do We Find Waste? Go and SeeWhat Is a Value Stream?Value Stream MappingCreating a Current-State Value Stream MapThe Future-State MapsBreaking Down Silos and Reducing SuboptimizationObserving the ProcessActivity of the Product Activity of the Product-LaboratoryActivity of the Employee Activity of the Employee-Nursing Activity of the Employee-Primary Care Activity of the Employee-Perioperative ServicesConclusionLean LessonsPoints for Group DiscussionNotesStandardized Work as a Foundation of LeanThe Need for Standardized WorkThe Toyota House MetaphorOverview of the Lean FoundationsLean Foundations: Standardized WorkDefinition of Standardized Work Current Proper Outcome and the Highest Quality To Safely Complete One Best Way Fewest Possible ResourcesStandardized, Not IdenticalWritten by Those Who Do the WorkConsidering How Long Tasks TakeStaffing Based on DataTypes of Standardized Work DocumentsStandardizing Daily RoutinesDefining Roles and ResponsibilitiesQuick Changeover as Standardized WorkExplaining Why through Standardized WorkStandardized Work Documents and the Standardized Work SystemMeasuring and Observing for Standardized Work Adherence"Resistance" to Standardized Work?Asking Why When Standardized Work Is Not FollowedStandardized Work Can Apply to PhysiciansLean and ChecklistsStandardized Work Can Apply to ManagersTraining through Standardized WorkConclusionLean LessonsPoints for Group DiscussionNotesLean Methods: Visual Management, 5S, and KanbanLean Is More than Tools, but Tools Can HelpReducing Waste through Visual ManagementExamples of Visual Management for Patient FlowExamples of Visual Management to Prevent Process Problems5S: Sort, Store, Shine, Standardize, and Sustain First S: Sort Second S: Store Third S: Shine Fourth S: Standardize Fifth S: SustainSafety as a Sixth S?Kanban: A Lean Approach to Managing MaterialsProblems with Traditional Materials SystemsTrade-offs with InventoryUsing Kanban to Replenish SuppliesConclusionLean LessonsPoints for Group DiscussionNotesProactive Root Cause Problem SolvingThe Mary McClinton StoryImproving Quality and Patient SafetyCultural Obstacles to Quality ImprovementWhy Do Errors Occur? Violations and Errors, Lapses, and SlipsExamples of Quality ImprovementFinding Root Causes and Preventing ErrorsWorkarounds and the Need for Fixing Root CausesAsking Why Instead of WhoStart at the GembaFind Root Causes Using Simple MethodsA3 Problem SolvingBe Proactive and Use Failure Modes and Effects AnalysisProactive Resolution of Near-Miss ProblemsThe Safety PyramidConclusionLean LessonsPoints for Group DiscussionNotesPreventing Errors and HarmA Problem That Is Not Going AwayMoving Beyond Blaming IndividualsThe Darrie Eason CaseCreating Quality at the Source through Error ProofingBeing Careful Is Not EnoughWhy 100% Inspection Is Not 100% EffectiveTypes 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 ErrorError Proofing, Not Dummy ProofingExamples of Error Proofing in Hospitals Banned Abbreviations as Error Proofing Computer Systems as Error Proofing Preventing Surgery Errors through Error ProofingStopping the Line (Andon)Error Proofing the Error ProofingConclusionLean LessonsPoints for Group DiscussionNotesImproving FlowWaiting: A Worldwide ProblemFocusing on FlowValue Streams Should Flow Like a RiverUneven 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 ProcessAddressing Mura by Matching Staffing to WorkloadsImproving Patient Flow Improving Patient Flow in the Emergency Department Reducing "Door-to-Balloon" Time Improving Patient Flow in Outpatient Cancer TreatmentImproving 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 PharmaciesConclusionLean LessonsPoints for Group DiscussionNotesEngaging and Leading EmployeesChanging How We ManageWhat Is a Manager's Role?Strategy DeploymentCommon Management ProblemsLean as a Management System and PhilosophyA Daily Lean Management System Process Audits or Rounding Standardized Audits of the Standardized Work A Hierarchy of RoundingPerformance Measures Timely Measures Drive Timely Improvement A Balanced Scorecard Focuses on All Stakeholders Metrics Should Be Visible, Visual, and Statistically MeaningfulDaily Stand-up Team MeetingsKaizen 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 ChangesConclusionLean LessonsPoints for Group DiscussionNotesGetting Started with LeanHow Do We Start?Where Do We Start?What Do We Call It?Types of KaizenKaizen Events Pitfalls of Kaizen EventsLean TransformationExecutive Sponsorship and LeadershipStarting from the MiddleEstablishing a Model Line and a Road MapChartering a ProjectDedicating Internal Resources: The Lean TeamThe Importance of Change ManagementA Snapshot of Hospital Success: Avera McKennan HospitalConclusionLean LessonsPoints for Group DiscussionNotesA Vision for a Lean HospitalIntroductionWhen 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 InfrastructurePoints for Group DiscussionNotesGlossary of TermsIndexChapter-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 1Updated 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 qualityUpdated Lean history to reference Joan Wellman and Seattle Children's early Lean workUpdated/new metrics that show Lean improvement examples in healthcareUpdated data on cost pressures, staff shortages, quality problems in healthcareNew departmental case study (Children's Medical Center Dallas - lab)1st edition case example moved to later chapter on improving flowThe bulk of the Avera McKennan case study (from 1st edition) moved to later chapter on getting started with LeanChapter 2Various updates, including some references to ThedaCare's Lean management systemUpdated "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 wordingNew callout on "respect for people" pillarAdded the "four rules in use" as a Lean definition frameworkChapter 3New introduction, "Waste is Not the Same as Cost"New data from Virginia Mason about reducing waste to free up RN time at the bedsideRefined description of "pull" in healthcare, why pull should be about patients pulling on resources, not a unit "pulling" the patient when a room is availableImprovements in the section on defining value, incorporating insights from Dr. Don BerwickEdits and, in some cases new examples, about the types of waste in healthcareFuller discussion of "Required Waste"Chapter 4Edits and some new examples in intro to value streamsNew callout on electronic VSM - downplaying the need for that software and technologyNew "activity of the employee" example for primary care physician, with new figureChapter 5New figure showing the "Park Nicollet System of Care" version of the "Lean House" diagramEdits and refined section on standardized work for healthcareNew callout on looking at the communication process and standardized work instead of just blaming parents for not following NPO instructions properlyNew callout on standardized work in a radiology departmentNew section on determining staffing levels based on dataNew 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 problemsNew material on Lean, standardized work, and checklistsNew material on standardized work for managersNew callout on standardized work and Training Within Industry (success story example)Chapter 6New examples of visual management used to help manage patient flowNew 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 HHCNew material on Kanban vs. par levelsNew material on Kanban vs. automated inventory cabinetsNew culminating case study about the use of standardized work, 5S, Kanban, and visual management to prevent patient harmChapter 7New intro case study of the Mary McClinton case and lessons learned (Virginia Mason)New quality improvement data and examples from ThedaCare and othersNew examples and discussion about workaroundsNew section on A3 problem solving, with exampleNew 5 Whys problem solving examplesChapter 8New introduction and case example of patient harm and lessons learned (Darrie Eason case) - blame vs systemsNew examples about quality at the source and not blaming individualsNew error proofing and quality improvement data and case examplesNew material about Lean and "Crew Resource Management"New material on Virginia Mason "patient safety alert" systemNew figures and photosChapter 9:New intro - "Waiting: A Worldwide Problem" with data from many countries and waiting times and improvementsNew material on the "Seven Flows of Healthcare"New examples and data on flow improvementsNew material on matching staffing to demand in emergency departmentsNew examples of E.D. flow improvementNew case example (ThedaCare) on reducing door to balloon timeChapter 10New quotes and callouts on Lean leadership, including John Toussaint's comparison of "white coat leadership" and "Lean leadership."New section on strategy deploymentNew material on goals versus hard targets and a warning about dysfunctionsAdditional material on daily standup meetingsUpdates on managing kaizen and continuous improvement Updated format for an "idea card" to be used on visual idea boardsChapter 11New callouts about organizations getting started with LeanNew material on "what do we call it?" - giving a name to a formal Lean programUpdates on kaizen events - different formats and success/failure data updatedReplaced LeBonheur Children's Hospital "getting started" Lean transformation case with updated/expanded version of Avera McKennan caseChapter 12Updated and expanded "Vision for a Lean hospital."
Series Title: Lean / Healthcare process improvement
Responsibility: Mark Graban.

Abstract:

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.

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Praise for the New Edition of this Shingo Prize Winner:"Whether it is the ThedaCare story ... Seattle Children's ... or Virginia Mason, the answer is in: Lean works. The question now for all of you Read more...

 
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