Maximize your Lean ROI

Maximize Your Lean ROI
Brittany Hagedorn, CSSBB, US Healthcare Lead at SIMUL8
Claire Cordeaux, SIMUL8 Healthcare Director

SIMUL8 Corporation | SIMUL8.com | info@SIMUL8.com
Presenters
Claire Cordeaux
Executive Director, Healthcare SIMUL8
SIMUL8 Corporation
claire.c@SIMUL8.com
Brittany Hagedorn
Healthcare Lead, North America
SIMUL8 Corporation
brittany.h@SIMUL8.com

Housekeeping
• Audio
• Q and A
• Recording available on SIMUL8healthcare.com

Agenda
• Current State of Lean
• Enhanced Lean Practice
• Practitioner’s Guide to Simulation
• Lessons from Loughborough Workshop

Project: Double Radiology Volumes
Project Background:
Outpatient Radiology for patients with a need for sedation prior to their exam.
Patients were waiting up to 7 weeks for a Radiology test, which was causing
delays in diagnosis and care, poor satisfaction, and lost revenue.
Questions:
• How many bed spaces will be needed to handle additional patients?
• Will the new staffing model actually work as planned?
Controls:
• Number of beds
• Number of nurses
• Nurse assignments
• Appointment schedule
Outputs:
• Staff utilization
• Space utilization
• Patient waiting times
Inputs:
• Patient arrival rates
• Cancellation rate
• Admission durations
• Exam durations
• Recovery durations

Project: Double Radiology Volumes
6
Results:
• 2 Admission beds and 4 Recovery beds
will be sufficient
• Balancing workload among nursing staff
will allow for the handling of the additional
patients without adding staff
• Recommendation – Move on to live trials. Jan Feb March April May
Time to Appointment (days)

Click to edit Master title styleClick to edit Master title style
CURRENT STATE OF LEAN

Widespread Adoption
Lean has been widely adopted as the industry standard
across healthcare delivery systems.

Widespread Adoption
Do Well Need More
Training Implementation……………………..………..
Excitement Culture Change……………………..………..
Strategy Management……………………..………..
Projects ROI…………………..…………..
Tools Measurement…………………..…………..
Within many Lean organizations, there have been a few
key areas that could use additional attention.

Healthcare Challenges
• Sustainment of change.
• Lots of high priorities.
• Adoption/stakeholder engagement.
• Complex process interactions.
• Interdependent changes/projects.
Healthcare faces unique challenges when it comes to
implementing a culture of continuous improvement.

ENHANCED LEAN PRACTICE

Shared Philosophy
• Test before you implement.
• Measure process performance.
• Variability matters to your process.
• Consider everyone’s ideas.

Benefits of Simulation
• Easily visualize complex processes.
• Incorporate variability into process mapping.
• Test over extended periods of time.
• Quickly consider many scenarios.
• Test non-existent processes and unlikely events.
• Engage stakeholders

Models of Integration
Independent
Simulation
Small Model
built during a
Lean Project
Simulation
Integrated into
the Standard
Lean Process
For free downloadable booklet
and models from Warwick
University, visit SimLean.org.

When to use Simulation?
Additional factors may also affect the decision to use simulation:
• High variability in how long activities take.
• Resources constrain the process.
• Need to test a range of time or conditions.
• Have several scenarios to compare.
Great!
Change Already Happened
Consider using
simulation to
understand why
results were not
what you
expected.
It worked. No success.
Use simulation to
uncover unknown
complications,
test scenarios,
and plan for
known risks.
Change is Proposed
Use Lean to
develop process,
test, and
implement.
Complex process. Simple process.
Knowing when simulation will have the greatest impact is critical
to maximizing the return on your time investment.

Example Applications
Examples Lean (Excel) Simulation
Staffing • Managing day-to-day schedules.
• Understanding existing service
levels over time.
• How many do I need to ___?
• Reaching a target service level.
• Shift pattern optimization.
Scheduling • Historical lead time.
• Measuring call drop rates, no-
shows, cancellations, etc.
• Lead time reduction.
• Process bottleneck elimination.
• Block schedule optimization.
Revenue Cycle • Financial projections. • Lead time reduction.
Safety • Tracking performance over time.
• Dashboards & reporting.
• Hand-off elimination.
• Pilot study risk reduction.
Regardless of the type of Lean project, there are opportunities to
utilize simulation. A few examples are included below.

Value Stream
Mapping
Identify
Improvement
Opportunities
Prioritize
Projects
Develop
Charters
Map Current
State
Design Future
State
Pilot
Future State
Implement Sustain
• Conduct
observations.
• Collect data.
• Document
value stream
statistics.
• Document all
barriers,
rework, and
wait times.
• Estimate the
impact and
effort for each
improvement.
• Combine for
prioritization.
• Define
process and
outcome
metrics.
• Establish
target (%) for
improvement.
• Create a
detailed
process map.
• Identify
potential
interventions.
• Develop and
document a
future state
process map.
• Implement
the proposed
future state
on a small
scale.
• Identify issues
& unexpected
effects.
• Modify the
future state as
needed.
• Conduct
training.
• Go live.
• Document
standard work
and policies &
procedures.
• Monitor and
sustain
improvements
.
Many Opportunities
Incorporate
& visualize
variability.
Understand
dependencies.
Set evidence-
based targets.
Validate your
current state.
Reduce risk.
Gain buy-in.
By integrating with the Lean Six Sigma approach, we can maximize the impact
of our improvement efforts.

VSM in SIMUL8
• During Event:
– Document the VSM in SIMUL8.
– Validate the process by checking
that wait times and inventory levels
match observations.
– Quantify the impact of potential
project ideas in real time.
• After Event:
– Set the right performance target
level for each step / resource in
order to achieve desired outcomes.
– Organize events (order, resources)
based on their expected impact and
interdependencies.
Integrating simulation provides quick insight and a validated VSM process map.
Modified VSM
Team deepens understanding of how process
times and wait times/inventory are related.
Validate that observations are not outliers.
Idea testing in real time lets you select those that
will have the most impact in an objective way.
Set improvement goals for each action item based
on evidence.
Prioritize improvement efforts to maximize
limited resources.

VSM in SIMUL8

Project Prioritization
With a simulation-based VSM, the leadership team is able to quantify the
operational, financial, and strategic impact of proposed Lean projects.
Step Standard Practice With Simulation Deliverable(s)
List Opportunities Examine VSM to
identify bottlenecks,
inventory, etc.
Visualize how variability
affects key process
measures.
List of potential
projects.
Estimate Impact of
Individual Projects
Use Excel to
extrapolate based on
historical data.
Simulate each change
to quantify strategic,
financial, and
operational outcomes.
Project ROI.
Examine
Interdependencies
Difficult. Simulate each
combination to identify
augmented outcomes.
Program Impacts.
Prioritize Pick the project(s) with
the highest ROI.
Select the program
with the best combined
outcomes.
Action Plan.

Setting The Right Target
What is the right target for improvement?
How do your operations impact the key outcome?
Improve
throughput
by 50%.
Reduce
cost by
30%.
Eliminate
overtime.
Increase
revenue
by $1 M.

Setting the Right Target
By simulating potential targets, you ensure that projects have achievable goals,
that the target is high (or low) enough to impact the outcome metric, and that you
do not waste effort improving a process more than necessary.
Current performance
Necessary performance
Target unnecessarily high
Target too low
Target unrealistic
Process Measure
OutcomeMeasure

Post-Kaizen Risk Reduction
Answer questions such as:
• Do I have enough resources to handle the increased
throughput?
• Is the new process robust enough to handle unusual or
unexpected situations?
• What downstream effects have we forgotten to plan for?
After a Kaizen event, there is always some uncertainty about how the
new process will work after “go live”. For processes that are critical to
the business, simulation can help mitigate implementation risk.

Stakeholder Engagement
Results in
Real Time
With simulation, you can visualize everyone’s suggestions and their
impact on key outcome measures – for minimal time or cost.

PRACTITIONER’S GUIDE
TO SIMULATION

Ideal Phases of Integration
Time
Adoption – Initial use of
simulation as part of
the Lean improvement
process (ex. VSM).
Engagement – A critical
component of the Lean
process is to simulate
potential new scenarios.
Integration – Simulation is
fully integrated into the
Lean improvement toolbox
and used when appropriate.
Moving too fast through integration can confuse and overwhelm stakeholders.

PDCA Approach to Simulation Building
Using a PDCA-style approach to simulation has many benefits and helps the team
address / avoid the typical barriers that can be found in simulation projects.
Design
(Plan)
Create
(Do)
Validate &
Evaluate
(Check)
Revise
(Act)
ADDRESS BARRIERS:
• Create stakeholder buy-in along the way as
the model generates insights during every
cycle.
• Identify gaps in data availability early on.
AVOID MISTAKES:
• Mitigate the tendency to make the model
unnecessarily complex.
• Escape “analysis paralysis” by developing
models that are representative, rather than
perfect.
• Revise the model with additional detail only
where necessary.

Determine Need for Complexity
Once you have determined the type of question you need to answer, you can
set stakeholder expectations and design in only the necessary details.
Time and Effort Investment
ModelComplexity
I need to test
scenarios around
my key
constraint.
I need to
understand how
the complexities
in my system
interact.
I need a
directional
answer on how a
change will affect
the system.

Choosing the Necessary Details
It is easy to add many details to a model in order to achieve “perfect” results,
which leads to extensive data collection, complex models, and long lead times.
Consider the following:
1. Is this something that my stakeholders frequently complain about?
2. Does this consume my attention and time every day?
3. Do changes affect how my process flows?
4. If there is maintenance/downtime/time off, would it
disrupt normal operations?

Data Accuracy Requirements
How much data do you need in order to build a reasonable simulation?
Approximation is often beneficial
for the first phase of a project:
• Minimal need for data
collection and analysis.
• Can be provided by
stakeholders.
• Easy to understand and
communicate.
• Represents a typical
day/patient/event, rather
than uncommon events.

LESSONS FROM LOUGHBOROUGH

Improving Process Improvement:
Utilizing both Lean and Simulation
Workshop at Loughborough University
June 6th, 2014
“Having demonstrated … the opportunities and benefits of
using lean and simulation together for healthcare
(www.simlean.org), the purpose of this workshop is to
further open up the debate on why Lean and Simulation are
not being used or researched together more.”

Improving Process Improvement:
Utilizing both Lean and Simulation
Special thanks to the many participants for the
inspiration for the following ideas, especially:
• Professor Zoe Radnor
• Professor Stewart Robinson
• Mark Palmer, Managing Director of OEE
• Center for Service Management at
Loughborough University

Efficiency vs. Effectiveness
Lean’s principles combine both:
– Eliminate waste – efficiency
– Create value – effectiveness
– Increase flow – efficiency
• Is there too much focus on efficiency?
• To create truly patient-centered care, do we need to
spend more energy on creating value?
• How does “lower utilization” provide better access,
outcomes, and costs?

How simple is too simple?
Simple Complex
Validation
VisualsTrustUnderstanding
Time to Build
Engagement
There are a multitude of factors that determine how many simplifying
assumptions can be made. How do you strike the right balance?

Who holds the power?
Many stakeholders are needed in order to make a Lean project
successful. The challenge is to make sure that each voice is
heard, including the person who…
– Is “paying for” the time.
– Decides what to include.
– Is building the model.
– Has the information/data.
– Interprets the results.
– Makes the decision.
– Implements the change.
– Receives the service (customer).
Should the project
facilitator and
model builder be
the same person?

How are visuals useful?
Useful for validating :
• Work is moving
through the system
correctly.
• Queues are building up
where you expect
them.
Useful for communicating:
• With a wider, non-
technical audience.
• Demonstrating that the
model mimics reality.
• With leadership who
want to see the big
picture.
• Faster to review than a
table of numbers.
Validation Interpretation Communication
Useful for interpreting:
• How the system works.
• Why one change is
better than another.
• How complex process
flows interact.
• Putting results into
context.

Key Takeaways
1. Lean and Simulation share a common philosophy.
2. There are many opportunities to incorporate Simulation
into standard Lean practice.
3. Lean ROI can be enhanced by integrating Simulation.
4. Careful deployment and strong advocacy will be
required in order to fully integrate Lean and Simulation.

References
If you are working in Lean, you may also find the following to be useful
for your work as well:
• Webinar by John Boulton, IHI Fellow
– Process Improvement Innovation: Lean and Simulation
– December 2013
• Webinar by Todd Robert, Memorial Health System
– Improving Planning in the O.R.
– May 2013
• LeanSim Toolkit
– Free downloadable Lean models
– www.SIMUL8healthcare.com/LeanSimToolkit

QUESTIONS
The scientist is not a person who gives the right
answers, he's one who asks the right questions.
Claude Lévi-Strauss

QUESTIONS
• Please forward any topics you would like
to see covered to brittany.h@simul8.com
• Continue the discussion on SIMUL8 in
Health – LinkedIn Group

NEXT WORKSHOP
Simulating Care Outside of Hospital
Tuesday July 22, 11am (Eastern)
Further details & booking info will be emailed to
attendees – watch this space!

Maximize your Lean ROI

Recommended

Recommended

More Related Content

What's hot

What's hot (19)

Similar to Maximize your Lean ROI

Similar to Maximize your Lean ROI (20)

More from SIMUL8 Corporation

More from SIMUL8 Corporation (20)

Recently uploaded

Recently uploaded (20)

Maximize your Lean ROI

Editor's Notes