GEMBA. Walk the Process. Part of History for Infection Prevention
Professionals. Benefits: See current state. Removal of potential barrier.
Become ...
Lean Six Sigma “The Lean process is a management philosophy
focusing on reduction of eight common wastes to improve overall value, as seen through the eyes of the customer. The elimination of waste and bottle-necks greatly increases productivity, reduces costs and improves profits.”* Taiichi Ohno Inventor of Toyota Production System
Toyota Production System (TPS) Eliminate Waste Management Decisions
Long-term Philosophy – 50 and 100 year plans Right Process
Right Results Plan-Do-Check-Act (PDCA)
Why Lean for Infection Prevention Demands are increasing • External – Mandatory Reporting • State level • Federal level
• Internal – Facility Administration • Utilization of Data • Resources for IP • Manual data review and entry – Increased data to be reviewed/reported • Staffing for IP departments
Lean Philosophy Healthcare Patient First Most valuable resource People Continuous Improvement Focus on where the work is performed
Eliminate inefficiency Long Term Plans
Key Points Transformation is a Journey Starting Point with Destination With No End Different ways to arrive at destination
Common Terminology Muda – Waste Types of Muda Defect
Work that contains errors, rework, mistakes or missing something necessary
Waiting
Idle time from material, information, people, equipment not ready
Common Terminology Continued Non-Value Added Processing (NVA) Efforts that create no value to the product or service from the customer’s perspective Examples in Healthcare Multiple transfer of patients within a unit Re-draw of blood due to hemolyzed specimens Re-entering of data
Example of Tools • PDCA • P = Plan • D = Do • C = Check • A = Act • Value Stream Mapping – Analyze process flow • Spaghetti Diagram – Unnecessary Motion • 5S – Unnecessary Searching
Example of MRSA/VRE Alert List IP Worklist
Add to Excel List
MRSA/VRE Positive
Review Pt. Record
Add to Staff Alert - Star
HA or Com
Back to the MRSA/VRE List Example How many hours allotted to surveillance of
MRSA/VRE per day? What is the volume of the positive cultures to be addressed per day? Spending time to perform Takt time may assist in
allocation of resources
Creation of Process Map • Level of Detail • Too much • Too little • Review Process being studied • Define Boundaries of the Project
• Identify type of Chart to be used • Arrange steps in order • Use sticky notes
Creation of Process Map cont. Eliminate duplicates Combine similarities
Maintain level of detail Move in one direction Left
Right
Fishbone Diagram Materials
Process/Methods Why?
Why?
To copy all f ishbone "objects" Use Cntl-Shif t-A
Why?
Why?
Why?
Why?
Problem Statement
Why?
Why?
Why?
Why?
Why?
Why?
Why?
Why?
Why?
Why?
People
Machine Ishikawa Fishbone Diagram Cause Effect Analysis
During (time), Pareto accounted f or 50% of problem which was 3X higher than desired and caused customer dissatisf action.
5S Sort Store
Shine Standardize Sustain
Benefit of 5S Increase control Increase efficiency
Sorting Store frequently used items in work area Remove items seldom used in work area
Storage Locate permanent place for needed items Mark the permanent location
Benefits • Reduces need to “hunt” for items • Reduces need to replace items unnecessarily • Brings items to where they are needed Reduces risk of presence of expired items Example: Storage of sutures
Shine Continuous basis for keeping area clean Benefits Helps identify areas for improvement/repair Becomes part of the “norm”
Reduces need to “panic” when TJC arrives
Standardize Benefits Stable and repeatable process Facilitates training of staff Basis for continuous improvement Example:
Placement of waterless hand gel dispensers Placement of supplies for central line insertion
Sustain Repetition Same Way – Always
Benefit Creates culture of safety Reduces need for re-education of staff
Can be the BIGGEST Challenge of all 5S
Example of Office Space 5S
PDCA
Facilitates movement from Reactive State to Proactive State
Plan-Do-Check-Act Plan Identify and Collect Data Do Brainstorm Check Pilot Program Act Sustain the gain
Kaizen • Benefits – Rapid Process Improvement – Scope/boundaries are narrow – Prevention of additional issues – Short-term commitment of time for staff
Examples: Improper use of equipment Outbreak Investigation
Brainstorming Component of All projects All members need to be heard
Benefits Can produce many ideas/solutions in short time Creative thinking
Brainstorming cont. Do Allow quantity of ideas Time for thoughts Be brief on ideas All need to be heard Use “sticky notes” for creation of diagrams later
Do not Criticize ideas Make early judgments Paraphrase when writing ideas Allow domination
How will I know what to change if I do not know what is happening?
GEMBA Walk the Process Part of History for Infection Prevention Professionals
Benefits: See current state Removal of potential barrier Become engaged with staff Improved patient outcomes
Use of GEMBA Preparation for Accreditation Environmental Rounds
Baseline Data Collection Evaluation of Interventions Implemented Evaluation of Compliance with Current Departmental
Policy Opportunity to bring Evidence-based literature to bedside
Benefit of GEMBA Walk Learner as well as teacher Observe
Monitor Audit New ideas are formed for Process Improvement
GEMBA Walk Go to the place
Look at the process Talk with the people
Lessons Learned from GEMBA Just because Infection Prevention “said so” does not
equal “is so” Elimination of assumptions – “not at my hospital” Monitor for sustainability (last step of 5S) Return to Basics for Infection Prevention Put the evidence reported from literature into action
Key Traits Needed for GEMBA Ask Questions Delay formation of opinions
Dedicate Time for the GEMBA Keep commitments when appointments are made Speak to variety of staff members from all positions
Summary Utilization of Lean Six Sigma Tools for Infection Prevention • Identify issues • Prevent re-occurrence • Facilitate collaboration between IP and staff • Identify potential resources for IP • Lead to improved outcomes for patients • Reduce Healthcare-associated infections
