Table Of ContentLean Doctors
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Lean Doctors
A Bold and Practical Guide
to Using Lean Principles to
Transform Healthcare Systems,
One Doctor at a Time
Aneesh Suneja with Carolyn Suneja
ASQ Quality Press
Milwaukee, Wisconsin
American Society for Quality, Quality Press, Milwaukee, WI 53203
© 2010 by ASQ
All rights reserved. Published 2010.
Printed in the United States of America.
16 15 14 13 12 11 10 5 4 3 2 1
Library of Congress Cataloging-in-Publication Data
Suneja, Aneesh, 1968-
Lean doctors: a bold and practical guide to using lean principles to transform
healthcare systems, one doctor at a time/Aneesh Suneja with Carolyn Suneja.
p.; cm.
Includes bibliographical references and index.
ISBN 978-0-87389-785-3 (alk. paper)
1. Medical offces – Planning. 2. Lean manufacturing. I. Suneja, Carolyn, 1968-
II. American Society for Quality. III. Title.
[DNLM: 1. Professional Practice – organization & administration. 2. Delivery of
Health Care – organization & administration. 3. Effciency, Organizational.
4. Physician-Patient Relations. W 87 S958L 2010]
R728.S93 2010
610.68–dc22
2010002393
No part of this book may be reproduced in any form or by any means, electronic,
mechanical, photocopying, recording, or otherwise, without the prior written
permission of the publisher.
Publisher: William A. Tony
Acquisitions Editor: Matt T. Meinholz
Project Editor: Paul O’Mara
Production Administrator: Randall Benson
ASQ Mission: The American Society for Quality advances individual,
organizational, and community excellence worldwide through learning, quality
improvement, and knowledge exchange.
Attention Bookstores, Wholesalers, Schools, and Corporations: ASQ Quality
Press books, video, audio, and software are available at quantity discounts with
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please contact ASQ Quality Press at 800-248-1946, or write to ASQ Quality Press,
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To place orders or to request ASQ membership information, call 800-248-1946.
Visit our Web site at www.asq.org/quality-press.
Printed on acid-free paper
Dedication
This book is dedicated with gratitude to
Ms. Terry Schwartz, Orthopedic Program Administrator
for Children’s Hospital of Wisconsin.
(This page intentionally left blank)
Contents
List of Figures and Tables. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Foreword. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Acknowledgments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
Introduction. 1
What Ineffciency in Healthcare Settings Means for Patients . . . 2
Why Apply Lean to Healthcare Settings?. . . . . . . . . . . . . . . . . . . 3
Strategic Decisions That Made Our Lean
Transformation Work. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
The Importance of Taking a Value Stream Approach. . . . . . . . . 8
SECTION.ONE:.Two.Strategic.Decisions. 13
Chapter.1. Begin.One.Doctor.at.a.Time . 15
Venturing into the Deep Water (One Doctor at a Time) . . . . . . . 16
Lean Works Alongside other Quality Improvement Tools. . . . . 18
Overcoming the ‘Flavor of the Month’ Syndrome. . . . . . . . . . . . 20
Making the Critical Decisions That Will Defne Your Success . . 21
Some Background: Why Pick a Starting Point, or
Model Line? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Moving on, Slowly and Deliberately, as Success Builds. . . . . . . 26
Action Steps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Chapter.2. Focus.on.Patient.Wait.Times. 29
Why Patients Care About Wait Times…and Why
They Don’t. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Wait Times Are the Starting Point, but How Do You Begin?. . . 34
vii
viii Contents
Collect Data About One Physician Practice . . . . . . . . . . . . . . . . . 34
Value Stream Mapping Provides the Overview. . . . . . . . . . . . . . 38
Action Steps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
SECTION.TWO:.The.Six.Success.Steps. 43
Chapter.3. Step.1.–.Create.Physician.Flow. 45
Analyze How the Physician Works as Part of Larger Process . . 47
Creating Flow for the Physician. . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Shared Resources (How the Physician’s Time is Scheduled). . . 50
Changeover. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Lean Process Mapping. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Action Steps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Chapter.4. Step.2.–.Support.Physician.Value-added.Time. 57
The Team Leader is Pivotal to a Lean Transformation. . . . . . . . 59
How the Team Leader ‘Drives the Bus’. . . . . . . . . . . . . . . . . . . . . 62
How to Choose and Develop Effective Lean Team Leaders. . . . 66
Action Steps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Chapter.5. Step.3.–.Visually.Communicate.Patient.Status. . 69
Visual Communication in Healthcare: The Clinic
Status Board. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Why Does Visual Communication Work so Effectively? . . . . . . 74
The Patient Status Board in Action. . . . . . . . . . . . . . . . . . . . . . . . . 74
If Visual Communication Works so Well, Why
Not Start There? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Action Steps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Chapter.6. Step.4.–.Standardize.Everyone’s.Work. . 81
Why Standard Work in Healthcare?. . . . . . . . . . . . . . . . . . . . . . . . 82
The Benefts of Creating Standard Work. . . . . . . . . . . . . . . . . . . . 83
Process for Creating Standard Work . . . . . . . . . . . . . . . . . . . . . . . 86
What Tasks Require Standard Work?. . . . . . . . . . . . . . . . . . . . . . . 89
Standard Work in Action. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
Action Steps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
Contents ix
Chapter.7. Step.5.–.Lay.Out.the.Clinic.for.Minimal.Motion . 93
Defnition of 5S. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Spaghetti Diagrams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Why 5S is Important. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
Pull Systems and Supermarkets for Supplies
Replenishment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
Layout Considerations for the Entire Practice. . . . . . . . . . . . . . . 101
Preconstruction Considerations. . . . . . . . . . . . . . . . . . . . . . . . . . . 102
What to Do When You Cannot Build New Walls. . . . . . . . . . . . . 105
Action Steps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Chapter.8. Step.6.–.Change.the.Care.Delivery.Model. 109
Old Systems, New Systems, Borrowed Systems. . . . . . . . . . . . . 110
A Look Back at Changing the Model in Manufacturing. . . . . . . 110
Cells in the Healthcare Setting. . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Next Steps in Care Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
This Step in Action at the Orthopedic Center. . . . . . . . . . . . . . . . 114
Action Steps. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
SECTION.THREE:.Lean.Leadership. 119
Leadership Competency Model. . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Working with the Team. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Developing Your Leadership Skills. . . . . . . . . . . . . . . . . . . . . . . . 129
Epilogue. Where.We.Are.Now. 133
Appendix.A. Introduction.to.Lean. 137
A Brief and Simple History of Lean. . . . . . . . . . . . . . . . . . . . . . . . 137
Departments or Cells? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Lean Outside of the Manufacturing World. . . . . . . . . . . . . . . . . . 139
Appendix.B. Glossary.and.Explanations.of..
Lean.Principles.and.Terms . 141
Flow, Value, and Waste . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Value-Added Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Waste. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
Glossary of Lean Terms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
x Contents
Appendix.C. O. ther.Resources . 149
Appendix.D. My.Lean.Background. . 151
Appendix.E. A3.Problem.Solving.Form. . 155
Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
