Lean Forward

In November 2008, the California Health Care Safety Net Institute (SNI) launched its Lean Core Measures Improvement Initiative.The program introduced the use of Lean/ Toyota Management System (TMS) as a strategy to streamline processes and create a more patient-focused environment that supports timely delivery of treatment and other healthcare services with optimum quality at the least cost. Over the last two years we have been working with deliberate focus and speed to integrate Lean/TMS as our leadership system. Many of you have participated in improvement events (rapid/kaizen), and/or had the opportunity to learn of the ongoing efforts at one of our many monthly “report-outs.”

As a next step CCRMC was selected as one of five public hospitals to participate in the Embedding Lean initiative. This ambitious two-year initiative aims to support system-wide Lean transformation by increasing the number of staff who are trained in performance improvement, and the Toyota Management System (TMS).



What's happening here?



Mike Rona and Patti Crome from Rona Consulting provided the first of a series of Lean Intensive workshops for partners (users and providers) across our county involved in the delivery of health care. You may have seen some of the teams out in the medical center and clinics participating in an exercise called a waste walk. This was an eye opening experience for those of us who went. We went out to CCRMC in search of waste. We wrote down our examples on sticky notes and placed them on a wheel based on what type of waste they were. At times it was almost laughable, until we began to see the waste literally falling off our waste wheel. Some of us did what is called a spaghetti diagram. We followed the path of workers to see where they go to get their work done. The movement was phenomenal to watch. In summary, although it was a fun and very easy exercise, it was also quite sobering.





What is Lean?


Lean manufacturing or lean production, which is often known simply as "Lean", is a production practice that considers the expenditure of resources for any goal other than the creation of value for the end customer to be wasteful, and thus a target for elimination. Working from the perspective of the customer, who consumes a product or service, "value" is defined as any action or process that a customer would be willing to pay for. Value is always defined by the external customer and in our case it's always the patient. Lean is centered on creating more value with less work. Lean manufacturing is a generic process management philosophy derived by and large from the Toyota Management System (TMS). It focuses on reduction of the original Toyota seven wastes in order to improve overall customer value. 




Why Lean/ TMS and why now? 


"The future is already here…it’s just not evenly distributed yet." *



Currently health care makes up about 17% of the GDP and is climbing at a steady and very unsustainable rate. Although the solutions are still in the development phase it is clear we must change course nationally and it is just as clear we must do the same here at the local level. Lean/ TMS offer a systematic way of improving efficiency, while improving- not compromising- quality. 



What's Next?


On October 24, 2011, a team of key stakeholders will perform an exercise called value stream mapping focused on the Patient Centered Medical/Health Home (PCMH). The team will examine steps in our processes and assign value to them from a patient’s perspective. We will then follow this up with a series of rapid improvement events or kaizen events (also known as kaizen blitz).

I know this seems like a foreign language, that's because it is. 

It feels like so much to learn, but we will learn together. We will take one step at a time. If we fall down seven times, we will get up eight. Please ask questions and keep an eye out for updates. If you have questions so please don't hesitate to ask.



More very soon...

Anna