Process Redesign for Health Care Using Lean Thinking

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