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Lean for Clinical Redesign is a Professional Collaborative Quality Initiative (CQI) that supports the development of sustainable lean learning programs within Physician Organizations (POs) and Practice Units (PUs) in the State of Michigan. A hunt for waste that is not aligned with a purpose supports nothing.
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Seeing waste from this viewpoint-how it stands in the way of achieving our goals-enables us to focus our energy on what we should be working on. In this case, this is the purpose the teams aligned around and worked to eliminate waste in service of. What matters is the right care, at the right time, at the right place. Sometimes this means shorter appointments, and sometimes it is longer appointments depending on the patient and their needs. The goal isn’t less time spent with patients it’s about having the appropriate time with patients in order to provide the appropriate care. One of the things we have learned with Bronson Healthcare Group is that the real benefits of the experiments aren’t going to show up with time metrics. The waste the clinic staff identifies helps the staff see where they need to improve and what experiments they may want to run.
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The clinics we work with usually map a patient experience from the time they check in until the time they check out using time and percent complete and accurate as metrics. How activities that an individual may perceive as waste support the overall picture can become clear. It can become obvious that redundant work is occurring by multiple people. The conversations that happen through the process can be invaluable for understanding how the system fits together and how each role supports the overall picture.
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Value Stream Mapping can be highly effective for understanding the whole system and how each role supports the overall picture. What problems do we run into when these points are not kept in mind? Do we spend time, resources, and energy on efforts that don’t support our goals or purpose? Do we eliminate waste from our individual perspective that is necessary or valuable for the system? How can we understand how the whole system fits together? Understand how the system fits together and how each role supports the overall picture and analyze it for waste at all levels in service of your purpose.Eliminating waste only makes sense when it is in service of your purpose.Putting them in a different context from cost reduction, they might read: We frequently miss these points when we talk about waste elimination. We have to see each area’s role and function in the overall picture.” No one can understand manufacturing by just walking through the work area and looking at it. Careful inspection of any production area reveals waste and room for improvement. I believe it has a specific meaning – to approach an objective positively and comprehend its nature. Efficiency must be improved at each step and, at the same time, for the plant as a whole. Then look at the operators as a group, and then at the efficiency of the entire plant (all the lines). Look at the efficiency of each operator and of each line.To achieve this, we have to start producing only the things we need using minimum manpower. Improving efficiency makes sense only when it is tied to cost reduction.Ohno says, “When thinking about the absolute elimination of waste, keep the following two points in mind: For example, in the clinics we work with in Lean for Clinical Redesign there is consensus that our purpose is to improve patient care. The goal mattering to the people doing the work is important to get consensus towards the goal. The specific goal doesn’t matter, but having consensus for the goal does, which enables improvement efforts to be aligned towards meeting the goal. The purpose or goal of Lean efforts could be cost reduction, shortened lead time, improve customer satisfaction, removing frustrations, improve quality, etc. It removes frustrations, which improves worker and customer satisfaction. Eliminating waste makes it easier to see and find problems, which is the first step to solving them. The Toyota production system, with its two pillars advocating the absolute elimination of waste, was born in Japan out of necessity.”īut it was also about much more than this. “Cost reduction must be the goal of consumer products manufactures trying to survive in today’s marketplace… A total management system is needed that develops human ability to its fullest capacity to best enhance creativity and fruitfulness, to utilize facilities and machines well, and to eliminate all waste. But what is the purpose of this? Does the purpose matter? If we look at the origins of this principle in Taiichi Ohno’s the Toyota Production System, the goal for Toyota in 1978 was indeed cost reduction: A commonly used definition of Lean is the total elimination of waste (time, resources, energy, etc).