STUDY OF THE APPLICATION OF LEAN MANUFACTURING TECHNIQUES IN THE HEALTHCARE INDUSTRY IN MEDELLIN Emerson Andrés Giraldo Betancur. [email protected] Master Student Universidad EAFIT. Medellín-Colombia Juan Gregorio Arrieta Posada. [email protected] Production Engineering Department. Universidad EAFIT. Medellín-Colombia

Summary Abstract. The objective of this project is to evaluate the level of use of different improvement tools inside of Lean Manufacturing, in the healthcare sector in Medellin. The project presents the state of the art related with Lean Health care applications, and its main tools. A description of the Health sector in Colombia is presented and with the application of a questionnaire in different institutions; the level of implementation of Lean techniques in the health sector in Medellin is evaluated.

Keywords: Lean Health Care, continuous Improvement, benchmark Purpose. The objective of this project is to evaluate the level of use of different improvement tools inside of Lean Manufacturing, in the healthcare sector in Medellin. The project presents the state of the art related with Lean Health care applications, and its main tools. In Figure 1 is presented the number of articles related with lean health care; it is important to notice the increasing interest in this research topic and in Figure 2, the number of papers by country related with this topic, the main research interests in Lean Health Care are in the US and in the UK.

Total Articles Related with Lean Healthcare 16 14 12 10 8 6 4 2 0 Total 2012

Total 2011

Total 2010

Total 2009

Total 2008

Total 2007

Total 2006

Total 2005

Total 2004

Total 2002

Total 1999

Total 1998

Total 1995

Figure 1- Total articles related with Lean Healthcare. Source: Authors.

Total Publications by country 25 20 15 10 5 0

Total

Figure 2- Total publications by country. Source. Authors. Methodology. A questionnaire with 55 questions was used and it was divided in sections according with each Lean improvement tool, in each tool some questions are done, using a likert scale, the questions are about if the Health institution applies the Lean improvement concepts or not, for example; with visual factory a question is the following, The institution has visual charts at glance of all the personnel showing the performance of the different areas in terms of level of service?. The questionnaire is applied based on an interview with the operations manager. The Health institutions, hospitals, (15) were selected according with the information presented in the secretary of Health of the city of Medellin and the ministry of health of Colombia. Findings. In Figure 3, the general results are shown, indicating the best and the lowest qualification of lean tool implementation. In this case 5s and Smed are the best tool implemented, and this is logical, in a hospital and for obvious reasons, the 5s program is a must, and Smed, most of the technology used in surgery rooms has Smed elements and the hospitals have to prepare in advance most of their processes . With the lowest qualification is the herramienta Kanban, hospitals don´t use this technique because is not an assembly line and they do not have implemented visual control for their inventories.

Average qualification by Lean Tool Herramienta Andon Herramienta 5`S 5 Herramienta Kanban 4 3 Herramienta Kaizen Herramienta Jidoka 2 1 0 Herramienta Poka Joke Herramienta Fabrica… Herramienta SMED Herramienta Heijunka

Herramienta VSM Herramienta Hoshin…

Figure 3- Average qualification by Lean Tool. Source: Authors In the project was also developed a matrix composed of four quadrants, (see Figure 4) in each quadrant are located the Health institutions according with a qualification obtained in the questionnaire and a positioning factor, if an institution is located in quadrant one (I), its means, has a good implementation of Lean techniques in their processes, but if it located in quadrant three (III) , has not enough work with Lean and a lot of improvement work has to be done, also is presented, the category of each institution, the category is the level of complexity (complejidad) in the attention they offered to their patients, in Medellin, complexity level three means high complexity attention levels (i.e. specialized surgeries, transplants, special medical training) and level one in complexity, is basic attention.

Positioning Factor

Global positioning of each health Institution according with their complexity (complejidad) level 100,0% 90,0% 80,0% 70,0% 60,0% 50,0% 40,0% 30,0% 20,0% 10,0% 0,0%

I

II

Complejidad 1 Complejidad 2

1,00

Complejidad 3

IV

III

2,00

3,00

4,00

Complejidad 4

5,00

Average evaluation in each Lean Tool

Figure 4- Global positioning of each Health Institution. Source: Authors

Relevance. This kind of studies allows the companies, in the manufacturing sector and in the services area, know what improvement processes they have and what are the tendencies worldwide and with this information and diagnosis, they could decide if move towards a culture of improvement or if they don´t move, they could find process or tasks that could be improved in a short period of time. In addition make the interviews and apply the questionnaire allows the operation manager of this companies to have a quick look of the challenges facing their companies. Conclusions. In the results of the project, is shown the relationship between the level of complexity Healthcare institutions and the Lean manufacturing tools implemented, and some conclusions are done related with the kind of improvement tool found implemented in the hospitals and its complexity attention level, and how could and hospital could move for one quadrant to another. It was found in the project, as presented previously most of the health institutions, have a good qualification in the application of 5s and Hoshin Kanri, this is due, 5s, are related with housekeeping and cleaning, something that for obvious reasons have to be implemented in the hospitals, and Hoshin Kanri is related with management by policies and this sector works with a lot of policies and standards, one example could be medical procedures and vaccination plans. Lean techniques like Kanban and visual factory are the ones with the lowest average qualification, this is due hospitals do not use, just in time systems to replenish different warehouses in the facilities, and the visual control to manage, procedures and to present to all the personnel the different key performance indexes used in the institutions. In conclusion the institutions has a relative good performance and implementation of Lean techniques in their processes and Facilities. In Figure 5, is presented the grade of application of Lean tools in all the health institutions evaluated, in this case the hospitals are located in quadrant I, and has a grade of 3.62 and a positioning factor of 72.5% which means the healthcare industry in Medellin reaches a good level of implementation of Lean Tools and it has very good improvement opportunities.

Positioning Factor

Accomplish level of Lean tools implementation in the health care industry 100,0% 80,0% 60,0% 40,0% 20,0% 0,0% 1

2

3

4

Average grade for Lean Tool

Figure 5 – Accomplish level of lean tools implementation. Source: Authors

5

Acknowledgments. All the participant institutions, the Hospitals and their Operations Managers and personal involve in the areas of continues improvement and quality. References Alukal, G., & Manos, A. (2006). Lean kaizen: a simplified approach to processAmedee, R. G., Maronge, G. F., & Pinsky, W. W. (2012). Improving the transition of care in patients transferred through the ochsner medical center transfer center. The Ochsner journal, 12(4), 318–22. Arrieta, J. (2012). Las 5s pilares de la fábrica visual. Revista Universidad EAFIT, 35(114), 35–48. Ballé, M., & Régnier, A. (2007). Lean as a learning system in a hospital ward. Leadership in health services (Bradford, England), 20(1), 33–41. Cudney, E. A. (2011). Using hoshin kanri to improve the value stream (p. 88). New York: Productivity Press. Holden, R. J. (2011). Lean Thinking in emergency departments: a critical review. Annals of emergency medicine, 57(3), 265–78. doi:10.1016/j.annemergmed.2010.08.001 Holweg, M. (2007). The genealogy of lean production. Journal of Operations Management, 25(2), 420–437. doi:10.1016/j.jom.2006.04.001 Kumar, S., & Steinebach, M. (2008). Eliminating US hospital medical errors. International Journal of Health Care Quality Assurance, 21(5), 444–471. Doi: 10.1108/09526860810890431 Radnor, Z. J., Holweg, M., & Waring, J. (2012). Lean in healthcare: the unfilled promise? Social science & medicine (1982), 74(3), 364–71. doi:10.1016/j.socscimed.2011.02.011 Restrepo, J. E. T. (Ed.). (2003). Gerencia de los procesos de atención. In Hospital y empresa (pp. 171–208). Medellin: Hospital universitario San Vicente de Paul. Snyder, K. D., & McDermott, M. (2009). A rural hospital takes on Lean. Journal for healthcare quality: official publication of the National Association for Healthcare Quality, 31(3), 23–8. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19522344 Souza, L. B. De. (2009). Trends and approaches in lean healthcare. Leadership in Health Services, 22(2), 121–139. Doi: 10.1108/17511870910953788 Stankovid, A. (2008). Developing a Lean Consciousness for the Clinical Laboratory. Journal of Medical Biochemistry, 27(3), 354–359. Doi: 10.2478/v10011-008-0015-2 Stonemetz, J., Pham, J. C., Necochea, A. J., McGready, J., Hody, R. E., & Martinez, E. a. (2011). Reduction of regulated medical waste using lean sigma results in financial Zidel, T. (2006). A lean guide to transforming healthcare: How to implement lean principles in hospitals, medical offices, clinics, and other healthcare organizations. (A. quality Press, Ed)