|
07/25/2011 03:39 PM
|
|
|
Other than number of events and savings, what are some other measurable annual goals for a lean manager in a hospital just starting a lean initiative?
Any help would be graeatly appreciated.
Thanks,
Chris
|
|
|
|
|
07/26/2011 10:14 AM
|
|
|
If you can document these well, what about:
1) Value Added Time with a patient; i.e. number of hours/shift or percent of time that a clinical person (physician, nurse, tech) spends in direct contact with a patient.
2) Measuring a reduction in time spent charting?
3) Measuring savings in time/steps hunting and gathering supplies/equipment/information.
4) etc.
Consider the major waste buckets, and think of creative ways to quantify time/$/Effort that goes into each bucket; then improve on them.
|
|
|
|
|
07/28/2011 04:59 PM
|
|
|
Thanks for your input.
Chris
|
|
|
|
|
07/29/2011 04:03 PM
|
|
|
Think in 2 big categories: process measures (or inputs) vs. outcome measures.
Metrics like number of events may be useful process measures, but they rely on an assumption that those things ultimately add value. That is often a reasonable assumption, but can not be taken for granted and must be validated with other measures. Similar process measures might include number of people that have been trained (possibly at various levels: awareness, facilitator, etc.) or audit/assessment scoring systems.
However, the real measure of success has nothing to do with number of events or people trained or how you ranked on an audit, but with true change to the business. Outcomes are notoriously difficult to measure, and truth is that there will always be many soft or indirect benefits that you just won't have the time or ability to fully capture, but failing to capture direct business impact is a primary way that Lean managers and practitioners end up out of a job (and frankly, end up wasting good time and energy). Outcome measures include: financial (both savings and avoidance), quality (I tend to put a lot under this category - both delivery metrics such as TAT and more traditional quality metrics related to defects), safety, and satisfaction (patient, staff, physician). Not every improvement will have a direct impact on each of those, and at any given time some of those metrics will be more important to the organization than others, which should be high on your mind in determing where you spend your limited time and resource.
One place you should absolutely look when establishing your goals is to your hospital's strategy plan. Hopefully there are 3-5 clear strategic goals for the organization (and they will change over time, which is fine) - your goals as a Lean manager had better be directly tied to the ultimate goals of the organization or else you, your team, and your good intentions to bring improvement are all at high risk. If you can't identify a specific goal(s) tied to each of the strategic objectives, try harder or get some help - please do not fall back on the easy to measure but high risk process measures as your only goals.
I help organizations build their internal improvement infrastructure (as well as other things). If you want to talk more, please shoot me an email: lewislefteroff@hotmail.com
-Lewis
|
|
|
|
|
08/01/2011 04:17 PM
|
|
|
Before we get too wrapped up on "waste" let's not forget basic quality of care delivery.
- Medication errors (and near-misses)
- Instances of infection
Overall morbidity / mortality results.
|
|
|
|
|
08/02/2011 10:16 AM
|
|
|
These are both "classic" examples of waste.
Medication errors and near misses fall into the Defects/Mistakes "bucket"
Infection falls into the both the defects/mistakes bucket - we didn't do something properly to prevent the infection - and the "excessive processing" bucket - we have to do more treatment than was necessary to correct the original problem with the patient.
The 8 classic waste "buckets" are
Defects/Mistakes
Overproduction
Waiting (there's none of this in healthcare, right?)
Non efficient use of talent/ideas
Transportation
Inventory
Motion
Excessive processing (how many times do we enter the same patient information in multiple places?)
Waste is not an indictment of what a person is doing; waste is an indictment of the processes/system in which that that the person is working.
|
|
|
|
|
08/02/2011 02:56 PM
|
|
|
In the opinion of an observer of medical performance over a six year period, medical process and procedures are siloed. There are successful "lean" projects in one area of a medical institution that may show exceptional results but by the nature of the change they brought have sub-optimized patient care in other areas. Why? Because this "industry" has not yet learned that the focus of an over-arching process is the well being of the patient. Many optimized processes that are uncoordinated and do not account for the effect of the end result of the improved processes on adjacent (upstream and down stream) processeses can be dangerous, maybe even fatal in an extreme case.
Example: A hospital needs additional complex diagnostic equipment. Purchasing can buy the additional equipment for less than it can buy the existing equipment brand. Good for purchasing. They save the institution $$. Bad for the staff. Staff needs training (time is $$) staff hads two different kinds of equiopment (could degrade performance), have to maintain two sets of spare parts(wasted $$). And on and on. Is this equipment replacement/addition a "balanced" decision? Did Purchasing consult the medical staff?
This is a common example of "Blunt End" / "Sharp End" behavior. I would be glad to continue an exchange of opinions onthe application of lean in the medical industry.
Andy Masson
|
|
|
|
|
08/03/2011 09:56 AM
|
|
|
Andy:
This issue is common across many industries, not just healthcare. This is where the need for a value stream understanding is so important. When we work with companies - including healthcare organizations - we stress the need for value stream managers that have full responsibility for the flow of care throughput their value stream. Of course there are messy issues like the imaging or other diagnostic "monuments" and there are issues where patients require care in more than one value stream, etc.. But these are common problems and small in comparison to the harm done by departmentalism. Value streams are fundamental to lean success.
Brian
|
|
|
|
|
08/03/2011 09:56 AM
|
|
|
Andy:
You example of purchasing is significant. If you have a purchasing department they will frequently be measured to reduce the amount paid for equipment, supplies, etc.. But this is very anti-lean because the lowest prices are rarely the lowest cost from the value stream. Cost should be addressed through the value stream not the departments.
Brian
|
|
|
|
|
08/03/2011 09:56 AM
|
|
|
Chris,
I'd suggest that "number of events" is not a very good measure of success for what really counts - your customers. "Counting Kaizens" has been brought up many times here and every single time, it gets shot down as a good measure of success. The reason is that the number of Kaizens one runs has little to do with the effectiveness of those same Kaizens. Unfortunately, management that hasn't yet fully understood Lean keeps demanding this measure. Be careful here.
Tom
|
|
|
|
|
08/04/2011 01:09 PM
|
|
|
The problem of buying the lowest price on the contract and not the lowest cost solution usually comes from the metrics that are used for performance. If I am the buyer and my performance is measured on purchase price I will focus on that.
To work toward lowest total cost the functional silos must be broken and everyone works toward the same vision. Also, most purchasing personnel have little experience in operations, logistics and materials management.
Advancing Supply Chain Management and value stream management in an organization is difficult but represents a Gold MIne of cost reduction and profit improvement.
Ron Turkett
|
|
|
|
|
08/04/2011 01:09 PM
|
|
|
Original question is about hospitals..but I might comment on other types of institutions in my universe.. assisted living facilities. A key measureable metric may be length of stay while not getting worse..or while satisfied with stay. This steady state metric seems would be enhanced with preventive measures which avoid dequalifying the resident for services as she or he 'gets worse'. That keeps the census up and the costs for the resident down. The per unit evaluation of the facility depends a great deal on the net return per unit of the facility. Improving satisfaction, daily health and outlook for ALF residents improves the value of the facility while encurring more medical service coordination costs can reduce the value.
a novice,
David
|
|
|
|
|
08/17/2011 09:21 AM
|
|
|
A lot of great ideas on measurable goals, but here is some thoughts on annual goals that tie to the program level.
Value Delivery: $ identitied Savings target, Realized Savings Target (year 2), % of portfolio that is data driven intiatives (assuming if you have an approach that will mature the organization from low hanging fruit - just do it, to more data driven initiatives that happen when the program is more mature, % of projects that are assess to ensure value creation & realization of results
Sustainability
- % of leadership engagement, % of people leaders trained in lean basics, # of practitioner training courses, % of certified practitioners (assuming you have a % of overall population you would train in these skills)
Engagement / Program Marketing
- # of enterprise communications (1 a quarter might suffice) that would include testimonials from business owners / champions on actual work
- # of staff meeting overviews of service offering
Methodology, Practice, Team development
- x% of project adhere to a gating process
- x% of project adhere to a financial peer review
- x% proficiency in lean methodology
-x% proficiency in change management (facilitation, change adoption, stakeholder analysis etc...)
Just some program level ideas
|
|
|
>
Community >
Forums
Send to a Friend
