Fixing Healthcare Delivery 2.0: Advanced Lean

University of Florida via Coursera

Go to Course: https://www.coursera.org/learn/fixing-healthcare-delivery-advanced-lean

Introduction

**Course Review: Fixing Healthcare Delivery 2.0: Advanced Lean** In an era where efficiency and quality in healthcare are more critical than ever, Coursera's course **“Fixing Healthcare Delivery 2.0: Advanced Lean”** offers an insightful, rigorous exploration of Lean methodologies applied to healthcare settings. As healthcare providers and administrators navigate mounting pressures—both in terms of patient care quality and operational costs—this course presents a timely opportunity to transform how services are delivered. ### Overview Building upon the principles that fueled the Toyota Production System (TPS) in the automotive industry, this course teaches the application of Lean principles specifically tailored for healthcare systems. The core idea is simple yet powerful: by identifying and eliminating waste, healthcare organizations can enhance their service delivery, leading to improved patient outcomes and reduced operational costs. The course is structured for a diverse audience, including healthcare professionals, engineers, administrators, and students. It aims to equip learners with the practical skills needed to implement Lean techniques within their organizations. Through various modules, participants explore waste reduction, process mapping, error proofing, and the creation of a patient-centered healthcare delivery system. ### Detailed Syllabus Breakdown 1. **Introduction to Applying TPS or Lean to Healthcare:** This introductory module lays the groundwork by discussing the origins of Lean and its success in the automotive industry. It highlights the 4 key principles of TPS, demonstrating how they can be adapted for significant improvements in healthcare delivery. The benefits of Lean are clearly articulated, emphasizing enhanced patient care and reduced mortality and costs. 2. **Waste Reduction:** Participants will delve deep into the identification of waste—an ongoing challenge within modern healthcare. The section categorizes eight forms of waste and introduces the 5S methodology, which helps streamline operations. Additionally, the course discusses decision-making strategies, such as Bayes Theorem, to arrive at diagnoses more efficiently and cost-effectively. 3. **Standardized Work and Preparing for Value Stream Mapping:** Here, learners examine the necessity of standardized work protocols to drive improvements effectively. The module addresses common physician resistance to standardization and presents tools to facilitate the design of efficient workflows. By introducing concepts like lead time and cycle time, this section allows participants to better assess production demands. 4. **Value Stream & Process Mapping, RIEs, and Leveling Flow:** An essential component of Lean, value stream mapping reveals bottlenecks and inefficiencies in workflows. Participants learn how to document and analyze processes to improve overall productivity. Rapid Improvement Events (RIEs) are also covered, illustrating how teams can swiftly enact changes to enhance operational efficiency. 5. **Error Proofing and Visual Controls:** This module confronts the critical issue of medical errors, which pose significant risks in healthcare. Through various analytical tools and methods, including the Pareto Chart and Failure Mode and Effects Analysis (FMEA), learners gain strategies for reducing errors and fostering a culture of safety. The introduction of visual controls further aids in monitoring improvements and maintaining accountability. ### Recommendations **Who Should Enroll:** This course is highly recommended for healthcare professionals at all levels, including administrators seeking to optimize operational efficiency, frontline workers wishing to improve patient care delivery, as well as engineering professionals looking to apply Lean principles within healthcare contexts. Medical students will also benefit from different perspectives on systemic issues in healthcare delivery. **Why Take the Course:** The structured approach combining theory with practical application allows learners to not only grasp fundamental concepts of Lean but also to implement them effectively in real-world scenarios. The course is rich in case studies, walking participants through actual transformations in healthcare organizations that successfully applied Lean methodologies. Furthermore, the commitment to a patient-centered approach, culminating in the concept of the Patient-Centered Healthcare Delivery System (PHDS), underscores the relevance and importance of the course content. **Conclusion:** “Fixing Healthcare Delivery 2.0: Advanced Lean” is an indispensable resource for anyone involved in the healthcare sector. By equipping professionals with the tools and frameworks necessary for process improvement, the course holds the potential to significantly enhance the quality of care provided to patients while simultaneously reducing costs. By adopting these Lean methodologies, healthcare providers can champion a culture of continuous improvement and patient-centered care that ultimately benefits everyone involved in the healthcare ecosystem.

Syllabus

Introduction to Applying TPS or Lean to Healthcare

Toyota Production System (TPS) or Lean has allowed Toyota to become the number one automobile manufacturer in the world by progressively improving the quality and reliability of their products. The System of Profound Knowledge developed by the American, W. Edward Deming is the basis for TPS or Lean. This system has now been adapted to healthcare by Virginia Mason Medical Center and Denver Health with exciting results. You will be introduced to the 4 principles of TPS, as well as the TPS House that illustrates how the various tools of TPS fit together to continually add value to the care of patients. The challenges faced by both health systems will be discussed and their approaches to transforming their delivery systems described. When Lean is applied to healthcare, patient care improves, and both patient mortality and the cost of care decrease. Applying Lean to healthcare systems can revolutionize how healthcare is delivered.

Waste Reduction

Waste is a huge problem in modern health care. It has been estimated that 30-60% of all that we do is wasteful and is not of value. Lean has categorized 8 forms of waste allowing everyone on the front lines to recognize waste and work to remove it. 5S is a very helpful tool that can be used early in the implementation of lean and can remove clutter and quickly improve efficiency. A major form of waste is the excessive use of diagnostic tests, as well as delayed or missed diagnosis. In this session you will be introduced to the 8 forms of waste, the use of 5S, how illness scripts can be used to create a tiered diagnostic list, and how Bayes Theorem can be used to select the highest yield tests. Using this approach diagnosticians can more quickly and cost effectively arrive at diagnoses. Waste is the foundation of Lean and by removing waste we can progressively increase the value of patient care.

Standardized Work and Preparing for Value Stream Mapping

Standardized work is an absolute necessity for improvement. Without standardized work there can be no improvement. This is one of the most difficult concepts to relay to those on the front lines particularly physicians, who call this "cookbook medicine". In this module the philosophy behind creating standardized work is reviewed, and the importance of everyone on the front line participating in creating and continually modifying standardized work emphasized. You will be introduced to tools that will help you to effectively design standardized work: the spaghetti diagram and the Time Observation Sheet. Lead Time, Cycle Time and Takt Time will be defined. You will learn how time the individual steps of a work process. You will also learn how to use a percentage load chart to calculate how many workers are required to meet production demand.

Value Stream & Process Mapping, RIEs, and Leveling Flow

Value stream mapping is at the heart of TPS or Lean. Using the Time Observation Sheets you will learn how to fill out a Value Stream Map, including determining WIP (work in progress) depicting physical movement and process flow along with information flow, and assessing when work is value-added and when it is non-value added. Value stream maps are used to identify bottlenecks and wasteful steps in a work process and then process mapping and rapid improvement events (RIEs) can be used to remove these wasteful processes and impediments to workflow. Finally you will be introduced to the principles of leveling both under elective and emergency treatment conditions. Applying these tools can dramatically improve efficiency and productivity without increasing overall manpower.

Error Proofing and Visual Controls

Preventable medical errors are estimated to kill 100,000 to 440,000 people per year in the U.S. and similar levels of harm due to medical errors have also been observed in other countries. In order to effectively eliminate errors, we must first be able to recognize and report them and different types of error reporting are described. Secondly there must be a culture in place that deals fairly with errors by differentiating systems errors from individual human errors. This can be accomplished by applying a Just Culture. Additional tools for eliminating errors and improving processes are introduced including: the Pareto Chart, Failure Mode and Effects Analysis (FMEA), an expanded Plan, Do, Study, Adjust cycle, and the A3 form. There are 6 levels of error proofing and their effectiveness in preventing errors from reaching patients is assessed using clinical examples. Visual controls can be helpful for reducing errors and for following the progress of work process improvements. In the final video the major topics covered in this course are summarized, and a new name for TPS or Lean adapted to healthcare is proposed: Patient-centered Healthcare Delivery System (PHDS). This name emphasizes the importance of applying the scientific method, like PhDs, to continually improve healthcare delivery while always focusing on the needs of patients.