kaizen.com
KAIZENTM / Lean
- Expedient in Health Service? -
Structure, needed Activities,
Resources and Benefit
Carsten Otto
March 24th 2017
© Kaizen Institute
Content
page 2Concept developed from Carsten Otto
© Kaizen Institute
Content
page 3Concept developed from Carsten Otto
© Kaizen Institute 4Concept developed from Carsten Otto
1. Why Kaizen in the Hospitals?
a) Kaizen Institute has experience in hospitals in many countries (e.g. Germany,
Japan, Turkey, Kuwait, Portugal etc.).
b) The hospital-specific workflows are well known.
c) Kaizen Institute has a labour science based structure what we customize on
the specific needs from our client
Natural Science (Medicine) Social Science (Engineering)
a Anamnesis Assessment
b Diagnosis Deep Dive Analysis
c TherapyUsing of defined KAIZENTM Tools like
tablets, treatments, surgery etc.
d Convalescence/Rehabilitation Coaching, Monitoring, Support
e PreventionSustain of the new Standards and
Procedures
© Kaizen Institute
Content
page 5Concept developed from Carsten Otto
© Kaizen InstituteConcept developed from Carsten Otto page 6
2. Guiding Principles – Success Factors
8-Step-Strategy for Improvement of the processes in the Hospitals
© Kaizen Institute
Together with the Management is to define:
1. The concrete Targets, Demands and Expectation from Management of the
hospital
2. All Do’s and Dont’s as Guideline
3. Confirmation of the Members of the “Core Team”
4. Standards and Procedures for optimal Project Organization (Responsibilities,
Sequence and Content of Project meetings, Escalation steps etc.)
Concept developed from Carsten Otto page 7
2. Guiding Principles – Success Factors
8-Step-Strategy for Improvement of the processes in the Hospitals – Step 1
© Kaizen Institute
Following structure to become a “World Class Hospital” with a KAIZEN Award is
recommendable:
a) Start with ED
b) Crossing interface to image procedures
c) Process improvement in the image procedures
d) Crossing interfaces to the different wards (sequence has to be defined)
e) Process improvement into the wards
f) Crossing interfaces to administration and support services
g) Process improvement in administration and support services
Concept developed from Carsten Otto page 8
2. Guiding Principles – Success Factors
8-Step-Strategy for Improvement of the processes in the Hospitals – Step 1
© Kaizen Institute
Kobetsu KAIZENTM Board
5N Analizi
Toolbox
Grafische Darstellung der Ergebnisse
Verilerle konuşun
OEE
4N1K1H Analizi
Ne?
Ne zaman?
Nerede?
Kim?
Hangi?
Nasıl?
3 aySıfır’a yönlenme
S elf influenced
M Ölçülebilir
A Cazip
R Gerçekçi
T Zaman sınırı
Doğru aracı seçin
1. Warum1. Warum 2. Warum2. Warum 3. Warum3. Warum 4. Warum4. Warum 5. Warum5. Warum
Problem
Begründung AktionBegründung Aktion
Begründung AktionBegründung Aktion
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Begründung AktionBegründung Aktion
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Begründung AktionBegründung Aktion
Begründung AktionBegründung Aktion
Begründung AktionBegründung Aktion
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Begründung AktionBegründung Aktion
Begründung AktionBegründung Aktion
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Begründung AktionBegründung Aktion
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Er ist in der Wasserlacheausgerutscht
Er ist traurigRepa-
ratur
1 Point
Lesson
Der Goldfischist tot
Er hat Angst Vater
schimpft
Er isterschrocken
Er hat sicham Eimergestoßen
Er hat
Schmerzen
Er hat sich
verletzt
Der
Junge weint
Er ist
hingefallen
Er hat Wasser
in den Augen
Er wollte den
Fisch fangen
Vaters Gold-
fisch ist tot
Eimer mitGoldfischumgefallen
Er ist gegenden Eimergestolpert
Er wollte denEimer auf dieKiste stellen
Er wolltemit dem Fischspielen
Er istgestolpert
Kennzahl
Analyse
5
10
1520253035
Reparatur Rüsten Wz.Wechsel Ausschuss Kurzstillst.
33 26 16 7 3
Analyse
5
10
1520253035
Reparatur Rüsten Wz.Wechsel Ausschuss Kurzstillst.
33 26 16 7 3
1. Adım:
Problem seçimi
Hangi güçlüğe
odaklanılacak? 16 hasarlı
makine ve fabrika
Set up
stoppages
breaks
Tool-change
Others
Effective
time
0,0%
10,0%
20,0%
30,0%
40,0%
50,0%
60,0%
70,0%
80,0%
90,0%
100,0%
Ø02 Ø03 Jan
04
Feb
04
Mrz
04
Apr
04
Mai
04
Jun
04
Jul
04
Aug
04
Month
O
E
E
Target 2004
OEE ? 2. Adım: Problem tanımlama
Mevcut durumu anlayın
3. Adım: Hedefleri saptayın Sıfır
hata
kusur
kaza
4. Adım: Problemin kök sebebi
Araç
Pro
ble
m içe
riğ
i
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ble
m n
ed
en
i
Pro
ble
m ç
özü
mü
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mü
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on
tro
lü
Hesap cetveli x x
Akış diyagramı x x
Pareto Diyagramı x x x
Süreç diyagramı x x
Litter diagram x x
5N1K x x
Balık kılçığı diyag(Ishikawa)
x
5N x
Beyin fırtınası x x
Matrix diyagram x
mukayesex
5. Adım: Problemin çözümü
Ölçüler
Ne? Kim? Ne zaman?
Visual date designer
Problemin önceki ve şu anki
Durumunun karşılaştırılması
6. Adım: Çözümün
doğrulanması
7. Adım:
Standartlaştırma
SDCA döngüsü
8. Adım:
Diğer aktiviteler
Maliyet
Zaman
Değerlendirme
A P
C D
© Kaizen Institute
Before Start with a Ward, ONE day as Kick-Off is needed.
Content of this “Kick-Off-Day” is:
a) Introduction and Creation of a “common Language”
b) Walk through all medical Department (Gemba)
c) Definition of Core Team from Ward-side
d) Development of the Agendas
e) Clarifying of Organization (Rooms, needed Resources etc.)
Concept developed from Carsten Otto page 10
2. Guiding Principles – Success Factors
8-Step-Strategy for Improvement of the processes in the Hospitals – Step 2
© Kaizen Institute
Following the described Procedure (Assessment-Diagnosis-Using of KAIZEN etc.) we
will start in each Area with an Assessment.
This Assessment will analyze the whole Area (all Layout, Offices, Interfaces, Workplace
Organization, Support Services etc.) and will need two days per area.
Result are clear defined Potentials (in time, resources) and a concrete schedule how
save this Savings (“Sub-Masterplan”) on Ward-Level.
Concept developed from Carsten Otto page 11
2. Guiding Principles – Success Factors
8-Step-Strategy for Improvement of the processes in the Hospitals – Step 3
kaizen.com
Assessment / Health Check in- Ankara Egitim Arastirma Hastanesi
- Dr. Sami Ulus Kadin Dogum ve Arastirma Hastanesi Ankara
- Numune Egitim Arastirma Hastanesi Ankara
Potentials and Proposal for Solutions
15.10.2015
Agenda
© Kaizen Institute
1. Introduction
Who is the Team?
Carsten Otto
Account Director
KAIZENTM Institute Global Operations
page 13Assessment in tree Hospitals in Ankara,
15.10.2015
Fevzi Cem Samli
Senior Consultant
KAIZENTM Institute Turkiye
Umit Guneslik
Senior Cnsultant
KAIZENTM Institute Turkiye
Meryem Findik Celik
Senior Consultant
KAIZENTM Institute Turkiye
Deniz Gursoy
Country Manager
KAIZENTM Institute Turkiye
Gülcan Cakir
Planning and Development Manager
KAIZENTM Institute Turkiye
Yuksel Bayrak
Senior Consultant
KAIZENTM Institute Turkiye
© Kaizen Institute
4. Results in Egitim Arastirma Hastanesi
page 14
Study of Investigation
38 Proposals for 33 Problems
© Kaizen Institute
4. Results in Egitim Arastirma Hastanesi
page 15Assessment in tree Hospitals in Ankara,
15.10.2015
Heijunka Board for
Balancing fromPatient
Proposal for
new Layout
Proposal for
Solutions (1)
Proposal for
Solutions (2)
First Solutions after Investigation
© Kaizen Institute
4. Results in Egitim Arastirma HastanesiThe Hospital gave as all Support and Recourses what we need. “Thank You!” for that.
page 16Assessment in tree Hospitals in Ankara,
15.10.2015
© Kaizen Institute
Recommendation for the next steps
page 17Assessment in tree Hospitals in Ankara,
15.10.2015
For the next Steps in Egitim Arastirma Hastanesi Hospital we propose:
This Hospital should be part of the “Start up Hospitals” (see Page 60)
Start should be KAIZENTM Improvement in the Emergency Department
a) 1st Step: “5S”
b) 2nd Step: “Development of the Heijunka Board for Patient Balancing”
c) 3rd Step: “Improvement and Standardization of the Interface (from Incoming
Patient until final Report)”
d) 4th Step: “Improvement of the Flow from the Patient and of Documentation”
e) 5th Step: “Improvement of Layout and Workplace Design”
f) 6th Step: “Improvement of Logistics (all needed Materials and Information)”
g) 7th Step: “Improvement of the Availability of the Equipment
h) Continuous: Solving of the founded Problems during Assessment
4. Results in Egitim Arastirma Hastanesi
© Kaizen Institute
Based on the Result of the Assessment and the “Sub-Masterplan” of each Area
an “individual Therapy” will be defined.
In that Step we take each Problem/Potential will be solved by Finding and
Elimination of the Root Causes with Kaizen Methods.
Result of this Step are concrete Solutions, clear Action Plan and a Plan of
Implementation.
That Step is related to the specific Problems and for the concrete Area
customized. People from the hospital will be involved.
Concept developed from Carsten Otto page 18
2. Guiding Principles – Success Factors
8-Step-Strategy for Improvement of the processes in the Hospitals – Step 4
© Kaizen Institute
After development of Solutions for Elimination of the Root Causes for Problems
focus’ that Step the concrete Realization and Implementation.
That Step is realized at the Gemba directly in close Cooperation with the involved
People of the Hospital.
That “Therapy” is also related to the specific Problems and for the concrete
Area/Ward customized.
Here are an overview about the Triage-Structure, what’s to do an the example of the
“Canadian Triage and Acuity Scale (CTAS) or “Manchester-Triage-System (MTS)” or
“Emergency Severity Index (ESI)” or “Australasian Triage System” (ATS)
Concept developed from Carsten Otto page 19
2. Guiding Principles – Success Factors
8-Step-Strategy for Improvement of the processes in the Hospitals – Step 5
© Kaizen Institute page 20Presentation name, date
CTAS – Canadian Triage and Acuity Scale
Level II Emergency within 15 minutes
Level III Urgency within 30 minutes
Level IV Less Urgency within 60 minutes
Level I Resuscitiation See patient immediately
Level V Non Urgency within 120 minutes
© Kaizen Institute page 21Presentation name, date
CTAS – Canadian Triage and Acuity Scale
Time to NURSE and PHYSICIAN Assessment
IMMEDIATE
TRIAGE LEVEL 1
RESUSCITATION
© Kaizen Institute
CTAS – Canadian Triage and Acuity Scale
page 22Presentation name, date
Time to NURSE Assessment - IMMEDIATE
Time to PHYSICIAN - 15 MIN
TRIAGE LEVEL II
EMERGENT
© Kaizen Institute
CTAS – Canadian Triage and Acuity Scale
page 23Presentation name, date
Time to NURSE and PHYSICIAN Assessment
30 MIN
TRIAGE LEVEL III
URGENT
© Kaizen Institute
CTAS – Canadian Triage and Acuity Scale
page 24Presentation name, date
Time to NURSE and PHYSICIAN Assessment
60 MIN
TRIAGE LEVEL IV
LESS URGENT
© Kaizen Institute
CTAS – Canadian Triage and Acuity Scale
page 25Presentation name, date
Time to NURSE and PHYSICIAN Assessment
120 MIN
TRIAGE LEVEL V
NON URGENT
© Kaizen Institute
CTAS – Canadian Triage and Acuity Scale
page 26Presentation name, date
Who is involved and „touched“?
Physicians
Nurses
Med. – techn. Staff
(Imaging procedures, Laboratories etc.)
Pharmacy
Service Staff (Maintenance etc.)
Logistics
Administration
© Kaizen Institute
CTAS – Canadian Triage and Acuity Scale
page 27Presentation name, date
…but what can we see very often?
Physicians
Med-tech
Staff
Admin
Nurses
Pharmacy
Service
Staff
Logistics
…different „black boxes“
…each box in an „other colour“
…not defined, not intelligent interfaces (BSI)
© Kaizen Institute
CTAS – Canadian Triage and Acuity Scale
page 28Presentation name, date
How to do?
Team
„ER Physicians/Nurses“
Med-tech
Staff
Admin
Pharmacy
Service
Staff Logistics
Order
Service
Order
Service
Ord
er
Se
rvic
e
Ord
er
Se
rvic
e
Ord
er
Se
rvic
e
1. One ER „Client“ with a clear defined
„colour“
2. Different „Supporter“ in the same common
colour
3. Clear defined Interfaces with clear defined
„Customer-Supplier-Relationship“ with
using of the 5W1H-methodology
- who?
- what?
- when?
- where?
- which?
- how
© Kaizen Institute
CTAS – Canadian Triage and Acuity Scale
page 29Presentation name, date
How to do?
1. All procedures were related on medical art and nursing
competence has to be defined from the team
„Physicians & Nurses“ and is part of natural science
2. All procedures were related on functional services has to be defined
from the teams „All functional services” and is part of natural science
3. All definitions how this special procedures must be connected comes
from the team „Engineering“ and is part of labour science
4. The guideline to define and connect all procedures defined in
pt. 1-3 is defined in CTAS
© Kaizen Institute
CTAS – Canadian Triage and Acuity Scale
page 30Presentation name, date
How to do?
…But…
ONLY as interdisciplinary team can all involved persons succeed
…the certification is a result of that, not more…
© Kaizen InstituteConcept developed from Carsten Otto page 31
2. Guiding Principles – Success Factors
8-Step-Strategy for Improvement of the processes in the Hospitals – Step 5
“Emergency Severity Index" defined a
Structure and a Procedure for a
failure-free Initial-Indication
© Kaizen Institute
How works Manchester-Triage-System (MTS)”? (1)
Manchester-Triage-System (MTS) is a standardized Procedure for initial
Investigation in an Emergency, developed in Manchester/GB 1995.
Target of MTS is to build a Consensus between Emergency Doctor and Nursing
Staff as additional Standard to the existing Standards of clinical Triage (e.g.
Emergency Severity Index).
Focus of MTS are Kinds of Discomfort and Main Indication.
Main Indications are „Danger to Life“, „Degree of Pain“, „Quantity of Blood
Loss“, „State of Consciousness“, „State of Temperature“ and „Length of
Sickness“.
Concept developed from Carsten Otto page 32
2. Guiding Principles – Success Factors
8-Step-Strategy for Improvement of the processes in the Hospitals – Step 5
© Kaizen Institute
How works Manchester-Triage-System (MTS)”? (2)
MTS define maximum Waiting Times in five Categories.
Group Indication Color Max. Waiting Time
1 Immediately Red 0 min
2 Very urgent Orange 10 min
3 Urgent Yellow 30 min
4 Normal Green 90 min
5 Not urgent Blue 120 min
Concept developed from Carsten Otto page 33
2. Guiding Principles – Success Factors
8-Step-Strategy for Improvement of the processes in the Hospitals – Step 5
© Kaizen Institute
How works Manchester-Triage-System (MTS)”? (3)
Mackway-Jones & Marsden & Windle (2011)
Red
Orange
Yellow
Green
Blue
yes• Andangered Airway?
• Inadequate Breathing?
• Shock?
yes• Acute neurological deficit?
• Striking Mechanism of Injury?
• Child with high Temperature?
• Adauld with very high Temperature?
• Abdominal Pain?
• Strongest Pain?
no
yes• Fresh neurological Deficit?
• Direct Back Trauma?
• Unable to walk?
• Adauld with high Temperature?
• Colicky Pains?
• Mismatching History?
• Moderate Pain?
yes• Younger Problem?
• Younger slight Pain
no
Immediately
Very urgent
Urgent
Normal
Not urgent
Concept developed from Carsten Otto page 34
2. Guiding Principles – Success Factors
8-Step-Strategy for Improvement of the processes in the Hospitals – Step 5
© Kaizen Institute
How works Manchester-Triage-System (MTS)”? (4)
MTS is used in Australia, Brasil, Germany, Irland, Italy, Japan, Canada, Mexiko,
New Zealand, Nederland, Norway, Austria, Portugal, Sweden, Swiss, Spain,
Tansania.
I recommend a special, customized „KOC-Triage-System“ with best points from
a) ESI (Emergency Severity Index)
b) MTS (Manchester Triage System)
c) CTAS (Canadian Triage and Acuity Scale)
d) ATS (Australasian Triage Scale)
Concept developed from Carsten Otto page 35
2. Guiding Principles – Success Factors
8-Step-Strategy for Improvement of the processes in the Hospitals – Step 5
© Kaizen Institute
Once a Month should be a “Follow up Workshop”.
Content will be:
1. Status Check
2. Degree of Realization of defined Actions
3. Adjustment
4. Additional support
5. Audit after three Month
Concept developed from Carsten Otto page 36
2. Guiding Principles – Success Factors
8-Step-Strategy for Improvement of the processes in the Hospitals – Step 6
© Kaizen Institute
To guarantee a stable Sustainment is it necessary to educate OWN Employees in
the KAIZENTM Methodology. This Step create an own KAIZENTM Way and make
the Hospital independent from external Consultants.
KPI are:
1. for 250 Employees a Hospital need 1 full Time “KAIZENTM Manager”
2. For 25 Employees a Hospital need 1 “Process Facilitator”.
This Person spends 10%-20% from his/her Time for Continuous Improvement.
Concept developed from Carsten Otto page 37
2. Guiding Principles – Success Factors
8-Step-Strategy for Improvement of the processes in the Hospitals – Step 7
© Kaizen Institute
In that Step the Hospital is able to manage, to control and to monitor the own
KAIZENTM Process with own educated Employees.
If support of KAIZEN Institute is needed for further Steps, must be defined at
that time.
Concept developed from Carsten Otto page 38
2. Guiding Principles – Success Factors
8-Step-Strategy for Improvement of the processes in the Hospitals – Step 8
© Kaizen InstituteConcept developed from Carsten Otto page 39
Possible Results
Done in World Class Companies
© Kaizen InstituteConcept developed from Carsten Otto page 40
İlginiz için teşekkür ederim
Kaizen Institute Consulting Group, Ltd.
Bahnhofplatz
6300 Zug
Switzerland
www.kaizen.com
Phone +41 (0) 41 725 42 80
Fax +41 (0) 41 725 42 89
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