28-10-2016, 04:04 PM
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Abstract
Lean manufacturing is a production strategy for continuous improvement by focusing on waste reduction and increase productivity.With healthcare costs rising continuously and various improvement techniques have been proposed to address reported inefficiencies in the healthcare systemThe main aim of this study is to identify the effective lean tools to be implemented in healthcare industry to improve quality, reduce total costs and improve the productivity of the organization thereby, making the system more lean and agile.
1. Introduction
The evolution of production systems is linked to the story of Toyota Motor Company(TMC) which has its roots around 1918. Despite many rigorous process thinking in manufacturing, Henry Ford was the first person to truly integrate an entire production process. He consistently combined interchangeable parts with standard work and moving conveyors to create what he called “Flow Production”.
Later Ford faced problems with longer throughput times and longer wait times due to their implementation of variety of body styles in their production line. Eventually this lead to continuous increase in the throughput times and larger inventories. As Kiichiro Toyoda, Taiichi Ohno and others at Toyota looked at this situation in the 1930s more intensely especially as Japan was left with very limited resources after World War II they came up with a series of simple innovations to provide continuous flow processes and also a wide variety of products. Mr. Eiji Toyoda then visited Ford Plant inspired by the Assembly Line flow returned to Japan to develop Toyota Production System(TPS) along with Mr. Kiichiro Toyoda and Taiichi Ohno in 1950.
The term “Lean” was coined in 1990 after the exploration of Toyota model which led to the transferencein sustaining the concept that manufacturing relapted problems and techniques are universal problems faced by various other industries and that these concepts can be emulated in non-Japanese organizations. In 1988 Mr. John Krafcik under the mentorship of Mr. James Womack coined in the term “Lean” during their analysis on the TPS, which these days is popularly known as Lean Manufacturing. Later, as the term” Lean” suggest the production world was invested with smart processes including high productivity with less human capital, les waste, less costs, less defects, less inventories and less throughput times. There are two man pillars of Lean Continuous Improvement(Kaizen) and Respect for People are to be a followed at all times for the successful implementation of Lean in any field.
It was the same Joseph Juran who linked manufacturing and the healthcare industry and he wrote: “as the health industry undertakes change, it is well advised to take into account the exoerience of other industries in order to understand what worked for them and what has not…..In the minds of many the health industry is different and it is certainly true as to its history, technology and culture. However, the decisive factors in what works and what does not are the managerial processes, which are alike for all industries”.
The following is a list of wasteful activities commonly taking place in healthcare industries (Also called as the 7 wastes in Lean):
• Inventory
• Motion
• Transportation
• Over-Processing
• Waiting
• Under Utilizing Staff
The main objective here is to reduce the wastes and the Lean tools that can be implemented to reduce the wastes in a healthcare industry are:
5S
Pull system(Kanban)
Kaizen(Continuous Improvement)
Total Productive Maintenance (TPM)
Jidoka (Autonomation)
Value stream Mapping
2. Literature Review
2.1 5S
5S is one of the fundamental tools also called as the “First Lean tool” to be followed before implementing a lean process. 5S is one of the methods to determine the company’s approach to evaluate its workplace organization capability and visual management standards. 5S helps in improving both efficiency and effectiveness of a system.
5S stands for
• Seiri (Sort) –Sort out and separate what is needed and not needed in that area.
• Seiton(Set In Order) – Arrange items that are needed so that they are ready and easy to use. Clearly identify all the locations for all items so that anyone can find them and return them once the task is completed.
• Seisou(Shine) – Clean the workplace and equipment regularly to maintain and identify defects.
• Seiketsu(Standardize)- Repeat the first three of 5S frequently
• Shitsuke(Sustain) – Follow the above rules to sustain and continue to improve everyday.
2.2 Pull System (Kanban)
Pull system(Kanban) is a method of controlling the flow of resources only replacing only what has been consumed. The main objective of the Pull system is to eliminate waste of handling, excess inventory(WIP and finished goods), repair, rework, storage, expediting. It also provides visual control of all the resources. It uses Kanban cards to place order of the items that have been consumed and needs replenishment. Benefits of Pull system is reduce floor-space, and increases cash-in-hand.
Total Productive Maintenance (TPM)
TPM (Total Productive Maintenance is a holistic approach to equipment maintenance that strives to achieve perfect production which includes zero breakdowns, No small stops, no defects. It also accounts for a safe working environment- No accidents. TPM can also be defined as the process to achieve maximum equipment effectiveness through active involvement of all the employees. There are 7 pillars of TPM:
Jishu Hozen (Autonomous Maintenance)
Kobetsu Kaizen
Planned Maintenance
Office TPM
Quality Maintenance
Training
Safety, Health and Environment
2.5 Value Stream Mapping (VSM)
Value stream Mapping is a special type of flow chart that uses symbols and Lean terms to depict and improve the flow of information and inventory. VSM is very essential in every company as it helps in identifying the factors to be improved and also provides a better method to be improved for better overall results. There are two types of value stream mapping: Current state Value Stream Mapping (CVSM); Future state value Stream Mapping (FVSM).
CVSM depicts the current state of the company and also shows the need for improvement for better results. FVSM depicts the possible improved VSM that could bring the new changes to get better results for the system. This is a cycle process where the a future state map is created with respect to the current state map and the future state becomes the current state map when a new innovation or improvement arises for better results and another future state map is made accordingly and the cycle goes on.
. Lean Implementation
3.1 Implementing 5S
Sort – Removing unnecessary items from surgery ward, making the path short for emergencies instead of taking the usual long route.
Set In Order – Arranging required items in the surgery ward, emergency wards in a hospital can help save time and provide better treatment for the patients.
Shine – Keeping the premises and every room in the hospital clean and tidy prevents from acquiring diseases and also helps maintain the system even better.
Standardize – A standardized list is to be made informing the staff about things in its place so that in the absence a regular staff the substitute staff should be able to find things easily. Example- Error in giving the lab test results, reports, etc to patients.
Sustain - All the above processes must be followed on a daily basis and continuously monitoring the implementation of 5S can improve the system from unnecessary motion and over-processing in this case.
3.4 Implementing TPM (Total Productive Maintenance)
• Autonomous maintenance can be implemented as the nurses, ambulance drivers, other employees can take care of their day-to day equipment and small repairs so that the waiting time for patients is reduced.
• Kobetsu Kaizen can be implemented where the employees can make small improvements in their control to avoid any breakdown of the machines, replacing the medical equipment after use,etc
• Planned Maintenance is implemented where in the current status/condition of the medical equipment/machines are checked and measures are taken to avoid it form deteriorating. Also predictive maintenance plans, time-data plans are made so that maintenance can be carried out ahead of the equipment life cycle.
• Quality maintenance is implemented where the quality of the medicines, equipment, etc are taken into consideration and made sure that high quality is maintained and also focusses on achieving zero defect conditions.
• Training Maintenance is implemented do that all the staff and employee are trained to maintain a certain level of knowledge to perform their jobs. It mainly helps in their personal development and also the successful implementation of TPM in the system. In this pillar of maintenance it is ensured that all the employees are trained and skilled enough to perform their work without any chance of error.
• Office Maintenance is implemented so that all the staff in the administrative sector of the hospital are skilled to maintain the records and other documents in a properly organized manner. They are also trained to have good communications skills, attend to patient complaints and be able to attend to emergency situations.
• Safety, Health and Environment Pillar is implemented where all the employees are trained and given proper safety and health instructions to avoid accidents at the workplace.
3.5 Value Stream Mapping (VSM)
Value stream mapping is implemented to resolve the problem of transporting the medical equipment, medicines and other items to far distances and making frequent trips leading to more costs. By implementing VSM a plan can be made to organize and schedule the number of trips to be made in a week and trying to minimize the costs.
Conclusion
As mentioned I believe the five Lean tools will help in achieving the desired goal.
• Implementing 5S would reduce the need for unnecessary motion and prevents over-processing in the hospital by standardizing the procedure to avoid confusion.
• Implementing Pull system helps to avoid excess inventory in the hospital and reduces unnecessary costs.
• Implementing Kaizen eliminates under-utilization of staff talent. All the employees have equal opportunity to give suggestion for improvement of the system.
• Implementing TPM reduces the waiting time and improves customer satisfaction.
• Implementing Value stream mapping to compare the current state of the system especially for transportation and making a improved future state map to resolve the problems.