Administrative
Lean™
Lean Thinking
is an integrated approach to designing, doing, and improving the
work of groups of people working together to produce and deliver
goods, services, and information. Administrative Lean™
applies concepts and techniques of the Toyota Production System
to office work. Lean Concepts, LLC, applies theory and practice,
based on Lean Manufacturing Systems, to administrative work such
as human resources, sales/marketing, accounting and engineering.
In 2003, Lean Concepts, LLC helped pilot and launch Administrative
Lean™ at a major automotive company.
The
Lean Overview:
The fundamental
objective of Lean Thinking is to create the most value while consuming
the fewest resources. This is done by defining value from the customer's
perspective, and distinguishing process steps that create value
from those that do not. Lean goals are to:
- Reduce lead
time & process time, and improve quality by eliminating waste
- Utilize
employee potential
- Strive for
best practice with standard work and built-in-quality
- Flow and
level the process (Value Stream Perspective)
- Continuously
improve (Kaizen)
How
Administrative Lean™ Works:
Administrative
Lean™ makes use of Value Stream Mapping, a simple, elegant
tool to show how work is done and how to improve that work. This
approach ensures that everyone is aware of the process as it works
today, agrees on current performance of that process, and is involved
in planning its improvement. The Value Stream Map tool:
- Shows flow
of process steps required to complete a product or service from
order to delivery
- Reveals
waste and measures process performance
- Links material
and information flow
- Gets people
involved in planning and deploying a process improvement plan
The work group
(employees who know specific details of the process) first draws
a Current State Value Stream Map to see and understand how work
is presently done. The work group measures the process time
(the amount of work done to complete a task) and lead time (the
total time to provide a product or service from order to delivery).
The work group then draws a Future State Map to improve quality
and reduce lead time and process time by eliminating waste in the
process. Value Stream Mapping shows where to use Lean techniques
such as visual workplace, standard/balanced work, one-piece flow
processing with cross-trained workers, and pull systems.
The process improvement (Kaizen) plan envisioned in Value Stream
Mapping is based on understanding the current state, setting process
improvement goals and making a plan to effectively achieve future
state objectives.
Lean
Techniques:
Workplace organization
and standard work are two Lean tools to achieve
Future State objectives. For example, administrative offices are
stocked and laid out with visual controls to show at a glance where
equipment and supplies belong, with automatic reorder points in
each supply cabinet (i.e. a pull system). Standard work specifies
content, timing, sequence and outcome of tasks using a learning
approach of iterative questioning and problem solving that allows
employees to eliminate variation so that deviation from standards
is obvious, and there is no ambiguity about who provides what to
whom and when and build in quality (error-proof).
Lean
Examples:
Below are summaries
of results from two manufacturing companies applying the theory
and practice of Administrative Lean™. The tables compare Current
and Future State Value Stream metrics, and show results when Lean
Techniques are put to effective use to reduce process time and lead-time
and improve quality.
| 1.
Engineering New Process Value Stream |
| Metric |
Current
State |
Future
State |
Improvement |
| Lead time
(days) |
255 |
256 |
28% |
| Process
time (hours) |
240 |
129 |
46% |
| Number
of meetings |
2 |
0 |
|
| Number
of operations |
155 |
9 |
40% |
| 2.
Vehicle Material Cost Analysis |
| Metric |
Current
State |
Future
State |
Improvement |
| Lead time
(days) |
128 |
49 |
62% |
| Process
time (hours) |
161 |
59 |
63% |
| Number
of meetings |
22 |
2 |
90% |
Conclusion:
The Value Stream Perspective show
process flow from a systems view, and reveals how to measure performance
of that system. The Value Stream Map and the process improvement
plan based on that map are used to put Lean Thinking to effective
use throughout the enterprise.
Healthcare
Lean™ Case Studies by
John
C. Long, MD
Lean Overview
Lean Thinking is an integrated approach to designing, doing, and
improving the work of groups of people working together to produce
and deliver goods, services, and information. Healthcare Lean™,
based on the Toyota Production System, applies concepts and techniques
of Lean Thinking to hospitals and physician practices.
Healthcare Lean™ makes use of Value Stream Mapping, a simple,
elegant tool to show how work is done and how to improve that work.
The work group (employees who know specific details of the process)
first draws a Current State Value Stream Map to see and understand
how work is presently done. The work group measures the process
time (the amount of work done to complete a task) and lead time
(the total time to provide a product or service from order to delivery).
The work group then draws a Future State Map to improve quality
and reduce lead time and process time by eliminating waste in the
process. Value Stream Mapping shows where to use Lean techniques
such as visual workplace, standard/balanced work, one-piece flow
processing with cross-trained workers, and pull systems. The process
improvement (Kaizen) plan envisioned in Value Stream Mapping is
based on understanding the current state, setting process improvement
goals, and making a plan to achieve future state objectives.
Healthcare Lean™ Case Studies
Below are summaries of four Hospital work groups applying the theory
and practice of Healthcare Lean™. The tables compare Current
and Future State Value Stream metrics of four processes, and show
results when Lean techniques are put to use to improve quality by
reducing process time and lead-time
|
1.
Hospital Billing Process from Receipt of Voucher toTransmitting
Claim or Posting |
| Metric |
Current
State |
Future
State |
Improvement |
| Number
of process steps |
16 |
9 |
42% |
| Process
time (minutes) |
86 |
37 |
57% |
| Lead
time |
5
days |
2
hours |
90% |
| 2.
Endoscopy Procedure Process from Patient Arrival to Discharge |
| Metric |
Current
State |
Future
State |
Improvement |
| Process
time (minutes) |
178 |
131 |
26% |
| Patient
wait time (minutes) |
81 |
11 |
86% |
| Lead time
(minutes) |
260 |
142 |
45% |
| 3.
Physical Medicine Office Visit Process from Patient Arrival
to Completed Report |
| Metric |
Current
State |
Future
State |
Improvement |
| Number
of process steps |
24 |
6 |
75% |
| Process
time (minutes) |
179 |
58 |
68% |
| Lead time
(days) |
34 |
1 |
97% |
| 4.
Procedure Scheduling Process from Physician inquiry to Scheduled
Appointment |
| Metric |
Current
State |
Future
State |
Improvement |
| Number
of process steps |
14 |
8 |
42% |
| Process
time (minutes) |
69 |
18 |
70% |
| Lead time
(days) |
34 |
3 |
90% |
| Percent
Rework (rescheduling appointments) |
25% |
2% |
92% |
Who
is the customer in a Healthcare Value Stream?
The goal of Healthcare Lean™ to improve quality
by reducing cost of non-value added steps, that is, work not reimbursed
by the payer. This is done by reducing process time and lead time,
as shown in the four examples. The intent of Healthcare Lean™
is to improve, not interfere with, the value added process: the
encounter of the patient and the caregiver. Value Stream Mapping
does this by making clear that the output of the process is delivered
to a customer other than the patient. This is shown in the Value
Stream examples in which the customer is not the patient:
| Process |
Output
of process |
Customer |
| Hospital
billing from receipt of voucher to transmitting claim and posting-payment |
Transmitted
claim or posted payment in 2 hours |
Payer and
Accounting Dept. |
| Endoscopy
procedure from patient arrival to discharge |
Increase
throughput of preparation and procedure steps by eliminating
recovery bottleneck |
Physician |
| Physician
medicine from patient arrival to discharge |
Complete
and accurate physical or occupational therapy report in one
day |
Physician |
| Procedure
scheduling from physician inquiry to scheduled appointment |
Scheduled,
authorized appointment for a procedure (e.g., chest roentgenogram,
colonoscopy, cardiac ultrasound) in 3 days |
Resource
that does the procedure (e.g., radiology, endoscopy, cardiovascular
departments) |
Conclusion:
The Value Stream Perspective show process flow from a systems view,
and reveals how to measure performance of that system. Value Stream
Mapping is effective and useful because it makes visible the link
between material flow (e.g., scheduled procedure or physician office
visit, endoscopy or physical medicine report, or claim for a physician
encounter) and information flow (e.g., telephone requests, appointment
scheduling software, on-line transmissions from payers). Healthcare
does not need more queuing algorithms to optimize flow and reduce
labor cost. Healthcare needs Lean Thinking to see processes from
a Value Stream Perspective, to understand the role of the patient
and the customer in that Value Stream, and to put to effective use
improvement plans to build-in-quality eliminating waste in the process.
|
