Process Redesign for Health Care Using Lean Thinking
A Guide for Improving Patient Flow and the Quality and Safety of Care
1st Edition
Published on 17. March 2017
Book
Hardback
222 pages
978-1-138-63086-4 (ISBN)
Description
Process Redesign for Health Care Using Lean Thinking is a response to a simple, but hard to answer, question and is the result of the experiences of a working doctor who was also the chief safety and quality officer of an Australian teaching hospital. At this hospital, he observed that the Emergency Department was staff by talented, well-trained, and respected doctors and nurses. The facilities were modern, and the work load unexceptional, but the department was close to melt down. Bad things were happening to patients, everyone was blaming each other, lots of things had been tried but nothing was getting better and no one could explain why. The problem was not a lack of technical knowledge or expertise, the problem was that no one stood back and said, "what's the best way to move 200 or 300 patients a day through the complicated and varying, sequence of steps needed to sort out the many different problems that bring patients to our department?"
These challenges are faced by hospitals and health services all over the world. There are difficulties with patient flow, congestion, queues, inefficient utilization of resources, problems engaging clinical staff in improvement programs, adverse incidents, and budget constraints.
Lean thinking and value stream analysis gives hospitals and health services struggling with these issues the insights they need to help themselves. This book provides a method that systematically turns those insights into working programs of service and system redesign.
The book is divided into two sections. The first section gives the background to the approach, and systematically works through the Process Redesign methodology, step-by-step. The second section is a series of case studies that show the methodology in action, what worked and what didn't work. The goal of any process redesign is simple: the right care, for the right person, at the right time, in the right place, and right the first time. This book helps the people who work in hospitals and health services realize these goals by working together.
These challenges are faced by hospitals and health services all over the world. There are difficulties with patient flow, congestion, queues, inefficient utilization of resources, problems engaging clinical staff in improvement programs, adverse incidents, and budget constraints.
Lean thinking and value stream analysis gives hospitals and health services struggling with these issues the insights they need to help themselves. This book provides a method that systematically turns those insights into working programs of service and system redesign.
The book is divided into two sections. The first section gives the background to the approach, and systematically works through the Process Redesign methodology, step-by-step. The second section is a series of case studies that show the methodology in action, what worked and what didn't work. The goal of any process redesign is simple: the right care, for the right person, at the right time, in the right place, and right the first time. This book helps the people who work in hospitals and health services realize these goals by working together.
Reviews / Votes
"I loved David's book. He speaks with a distinct personal voice that combines deep personal experience and a framework that places that experience in a universal healthcare context. There is nothing else like it."John Shook, Chairman, Lean Enterprise Institute Inc, Cambridge MA "I loved David's book. He speaks with a distinct personal voice that combines deep personal experience and a framework that places that experience in a universal healthcare context. There is nothing else like it."
John Shook, Chairman, Lean Enterprise Institute Inc, Cambridge MA
More details
Language
English
Place of publication
London
United Kingdom
Publishing group
Taylor & Francis Ltd
Target group
Professional and scholarly
Professional Practice & Development
Illustrations
35 s/w Abbildungen, 43 s/w Zeichnungen, 17 s/w Tabellen
17 Tables, black and white; 43 Line drawings, black and white; 35 Illustrations, black and white
Dimensions
Height: 260 mm
Width: 183 mm
Thickness: 17 mm
Weight
625 gr
ISBN-13
978-1-138-63086-4 (9781138630864)
Copyright in bibliographic data and cover images is held by Nielsen Book Services Limited or by the publishers or by their respective licensors: all rights reserved.
Schweitzer Classification
Other editions
Additional editions
David I. Ben-Tovim
Process Redesign for Health Care Using Lean Thinking
A Guide for Improving Patient Flow and the Quality and Safety of Care
E-Book
03/2017
Productivity Press
€69.99
Available for download
David I. Ben-Tovim
Process Redesign for Health Care Using Lean Thinking
A Guide for Improving Patient Flow and the Quality and Safety of Care
E-Book
03/2017
Productivity Press
€69.99
Available for download
David I. Ben-Tovim
Process Redesign for Health Care Using Lean Thinking
A Guide for Improving Patient Flow and the Quality and Safety of Care
Book
03/2017
1st Edition
CRC Press
€66.00
Article not available at the moment
Person
Dr. David Ben-Tovim is a psychiatrist and Clinical Epidemiologist by background. He trained in medicine and psychiatry in London, at the Middlesex and St Georges University Hospital, and later in Clinical Epidemiology at the Institute of Psychiatry, also in London. He worked for three years in Botswana before migrating to South Australia where he has lived and worked in 1984. In 1998, whilst continuing part-time practice as a psychiatrist, he became the Director of the Clinical Epidemiology Unit at the Flinders Medical Centre, and in 2000, became Director of Clinical Governance. He initiated the Redesigning Care program at Flinders in 2004, and continued as the Director of the Redesigning Care and Clinical Epidemiology Units until 2014.Whilst Director of the Redesigning Care Unit, Dr. Ben-Tovim became involved in teaching, training, and the development of programs of flow improvement, and process redesign, in all the Australian states and territories, in New Zealand, Singapore, the Middle East (including Dubai, Oman and Saudi Arabia) and South Africa, as well as various parts of Europe and occasionally, the U.S.A.
He is the chairman and co-founder of the Australasian Lean Healthcare Network . Since 2005 the Network has put on annual Redesigning Care Summits in conjunction with Lean Enterprise Australia. The Summits draw participation from across the region.
Dr. Ben-Tovim has a PhD as well as medical qualifications. He has been an active clinical researcher throughout his career. He is currently Professor, Clinical Epidemiology and Process Redesign, Flinders University Centre for Epidemiology and Biostatistics and the Department of Primary Care. Currently, he concentrates on training and research in Redesign and Process Improvement, and on measurement and evaluation of indicators of healthcare safety and quality.
Dr. Ben-Tovim has published on a range of topics in the peer reviewed literature, including a series of frequently quoted articles on Lean Thinking and Redesign in Healthcare. He has also co-authored a textbook of psychiatry for developing countries, and a book about his work in Botswana, published by Tavistock /Routledge.
He is the chairman and co-founder of the Australasian Lean Healthcare Network . Since 2005 the Network has put on annual Redesigning Care Summits in conjunction with Lean Enterprise Australia. The Summits draw participation from across the region.
Dr. Ben-Tovim has a PhD as well as medical qualifications. He has been an active clinical researcher throughout his career. He is currently Professor, Clinical Epidemiology and Process Redesign, Flinders University Centre for Epidemiology and Biostatistics and the Department of Primary Care. Currently, he concentrates on training and research in Redesign and Process Improvement, and on measurement and evaluation of indicators of healthcare safety and quality.
Dr. Ben-Tovim has published on a range of topics in the peer reviewed literature, including a series of frequently quoted articles on Lean Thinking and Redesign in Healthcare. He has also co-authored a textbook of psychiatry for developing countries, and a book about his work in Botswana, published by Tavistock /Routledge.
Content
Part 1: Process Redesign - the complete method
Chapter 1: Introduction: An accidental redesigner
Why redesign?
Learning about Lean
A decade later
Chapter 2: Craft, Flow, Mass
British manufacturing: the extension of the craft work system
The American method of production
Moving to mass
Chapter 3: Taiichi Ohno and the Birth of Lean
Toyota and Taiichi Ohno
Waste and flow
Push and pull
Workers as problem solvers: the challenge for managers
Chapter 4: The Principles of Lean Thinking
The process viewpoint: the golden thread of Lean
The Lean principles
Principle 1: specify value from the standpoint of the end-customer
Principle 2: identify the value stream for each product family
Principle 3: eliminate waste and make the product flow
Principle 4: so that the customer can pull
Principle 5: as you manage towards perfection
Chapter 5: Healthcare is not manufacturing
The Lean principles are very important - but
Placing an order: customers and raw materials
Redesign double vision
Complicated: or complex and adaptive?
Chapter 6: Knowledge work
Knowledge work
Knowledge workers own their knowledge capital
Design
Or Redesign
Chapter 7: Redesigning care: authorization, permission, teams and governance
Authorization and permission
The redesign team
Governance
The workgroup and the improvement event
Chapter 8: The virtuous circle of Process Redesign and the A3
Chapter 9: Identifying the problem
Primary purpose, problems and concerns
Problem statements
What kind of problem, and where to start?
Chapter 10: Defining the scope
The benefits of starting with scope
Scope and scoping: an evolving task
Chapter 11: Diagnosis (1) Mapping - the Big Picture
The process of Big Picture Mapping: a social intervention
Setting up and undertaking a Big Picture Mapping
Chapter 12: Diagnosis (2) Direct observation
External or internal redesign capacity?
The structure of the learning to see phase
Tracking patients or tracking specific process steps
Analysis
Chapter 13: The real problem (1): Identifying the real problem
Root cause analysis, the five whys and effect-and-cause analysis
Chapter 14: The real problem (2): Measurement
Measurement for redesign-types of measurement
The basic triad of analysis design
Measurement focus: releasing time or improving outcomes (or both)
Measuring processes or outcomes
Chapter 15: Goals, the scientific method and the future state
Experiments and the Plan-Do-Study-Act cycle
Goals
Chapter 16: Value stream, batching and flow improvement
Making the process viable
Splitting into value streams
Flow
Takt time
Batching
Improving flow: eliminate, combine, reduce, simplify
Chapter 17: Targeted interventions - 5s, visual management and visual systems
5s
Visual management
The ideal visual management system
Chapter 18: Queues, prioritizing, capacity and demand
Acknowledging Erlang - the Calling population
Queue discipline - First in, first out
Queue discipline: planned work, short term queue, shortest service time
Capacity lost, demand moves forward
Queues and priorities
Analysis of capacity and demand
Exponential growth in queue length
Impossible jobs
Chapter 19: Embedding and sustaining
Measure, monitor, evaluate
A formal decision to adopt the new way
The front-line manager
A culture of continuous improvement
Part 2: Case Studies
Chapter 20: Case Study 1: Redesigning Emergency Department flows
The problem
Scoping
Diagnosis
The real problem
Intervention
ED works
Evaluation
Embedding and sustaining
Chapter 21: Case Study 2: The Care-After-Hours Program
The problem
Authorization and permission
Scoping
Diagnosis
Four major-work streams
The real problem
Intervention
The Electronic Medical Task Board
Evaluation
Embedding and sustaining
Continuity of information
Chapter 22: Case Study 3: Visual Management
The Patient Journey Boards
Scoping
Diagnosis-tracking
The real problem
Intervention
Evaluation
Discharge traffic lights and blue dots
Chapter 23: Case Study 4: Redesigning podiatry care
The problem
Diagnosis
The real problem
Interventions
Evaluations
Chapter 24: Conclusion - Redesigning Process Redesign
Chapter 1: Introduction: An accidental redesigner
Why redesign?
Learning about Lean
A decade later
Chapter 2: Craft, Flow, Mass
British manufacturing: the extension of the craft work system
The American method of production
Moving to mass
Chapter 3: Taiichi Ohno and the Birth of Lean
Toyota and Taiichi Ohno
Waste and flow
Push and pull
Workers as problem solvers: the challenge for managers
Chapter 4: The Principles of Lean Thinking
The process viewpoint: the golden thread of Lean
The Lean principles
Principle 1: specify value from the standpoint of the end-customer
Principle 2: identify the value stream for each product family
Principle 3: eliminate waste and make the product flow
Principle 4: so that the customer can pull
Principle 5: as you manage towards perfection
Chapter 5: Healthcare is not manufacturing
The Lean principles are very important - but
Placing an order: customers and raw materials
Redesign double vision
Complicated: or complex and adaptive?
Chapter 6: Knowledge work
Knowledge work
Knowledge workers own their knowledge capital
Design
Or Redesign
Chapter 7: Redesigning care: authorization, permission, teams and governance
Authorization and permission
The redesign team
Governance
The workgroup and the improvement event
Chapter 8: The virtuous circle of Process Redesign and the A3
Chapter 9: Identifying the problem
Primary purpose, problems and concerns
Problem statements
What kind of problem, and where to start?
Chapter 10: Defining the scope
The benefits of starting with scope
Scope and scoping: an evolving task
Chapter 11: Diagnosis (1) Mapping - the Big Picture
The process of Big Picture Mapping: a social intervention
Setting up and undertaking a Big Picture Mapping
Chapter 12: Diagnosis (2) Direct observation
External or internal redesign capacity?
The structure of the learning to see phase
Tracking patients or tracking specific process steps
Analysis
Chapter 13: The real problem (1): Identifying the real problem
Root cause analysis, the five whys and effect-and-cause analysis
Chapter 14: The real problem (2): Measurement
Measurement for redesign-types of measurement
The basic triad of analysis design
Measurement focus: releasing time or improving outcomes (or both)
Measuring processes or outcomes
Chapter 15: Goals, the scientific method and the future state
Experiments and the Plan-Do-Study-Act cycle
Goals
Chapter 16: Value stream, batching and flow improvement
Making the process viable
Splitting into value streams
Flow
Takt time
Batching
Improving flow: eliminate, combine, reduce, simplify
Chapter 17: Targeted interventions - 5s, visual management and visual systems
5s
Visual management
The ideal visual management system
Chapter 18: Queues, prioritizing, capacity and demand
Acknowledging Erlang - the Calling population
Queue discipline - First in, first out
Queue discipline: planned work, short term queue, shortest service time
Capacity lost, demand moves forward
Queues and priorities
Analysis of capacity and demand
Exponential growth in queue length
Impossible jobs
Chapter 19: Embedding and sustaining
Measure, monitor, evaluate
A formal decision to adopt the new way
The front-line manager
A culture of continuous improvement
Part 2: Case Studies
Chapter 20: Case Study 1: Redesigning Emergency Department flows
The problem
Scoping
Diagnosis
The real problem
Intervention
ED works
Evaluation
Embedding and sustaining
Chapter 21: Case Study 2: The Care-After-Hours Program
The problem
Authorization and permission
Scoping
Diagnosis
Four major-work streams
The real problem
Intervention
The Electronic Medical Task Board
Evaluation
Embedding and sustaining
Continuity of information
Chapter 22: Case Study 3: Visual Management
The Patient Journey Boards
Scoping
Diagnosis-tracking
The real problem
Intervention
Evaluation
Discharge traffic lights and blue dots
Chapter 23: Case Study 4: Redesigning podiatry care
The problem
Diagnosis
The real problem
Interventions
Evaluations
Chapter 24: Conclusion - Redesigning Process Redesign