Lean en Agile in zorgcentra Tijd voor Zorg? Zorg voor tijd! Performantie in zorgondersteunende diensten Edegem, 25 maart 2011 Prof. dr. ir. Luc CHALMET Cimes g.c.v. Universiteit Gent en Universiteit Antwerpen
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Lean’s “Three Steps to Heaven” 1. ‘Verspilling” zichtbaar maken, altijd en overal 2. ‘Verspilling’ voortdurend wegwerken, en op die manier de doorstroming van de cliënt (patiënt) voortdurend verbeteren 3. Nooit aflaten 25 maart 2011
Zorgondersteuning
2
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Verspilling zichtbaar maken
25 maart 2011
Zorgondersteuning
3
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Enkele voorbeelden 1. Goto Gemba 2. 5S 3. Five-Why
25 maart 2011
Zorgondersteuning
4
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innovation
Point-Flow-Blitz Kaizen
e provem m i s u o Continu
nt roveme p m i s u o Continu
25 maart 2011
nt
Source : Valéo
Zorgondersteuning
Continuous improvement + Innovation = Optimal return from improvement actions 5
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Perfection: The Deming Cycle Plan
( what to do; problem solving for improvement)
(implement more widely) standardize Do
Act
“Hold the gains”
Check
(Do it, on a trial basis; experiment)
( check if it works; the risks; the variation, LEARN!)
25 maart 2011
Zorgondersteuning
6
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“Lean Thinking” de 5 Principes 1. 2. 3. 4. 5. 25 maart 2011
Value Value Stream Flow Pull Perfection Zorgondersteuning
7
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Iedereen op weg naar een ongeziene dynamiek 100 % hectic and dynamic market
?
new paradigm
Automotive
Telecommunications and Information industry Consumer Goods
Chemical Pharmaceutical
old paradigm
Energy and Utilities Government
static market
25 maart 2011
1980
1990
2000
2010
2020
Zorgondersteuning
8
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Wendbaarheid is absoluut noodzakelijk 1. Obsessie voor waardecreatie voor de klant 2. Kennisgedreven 3. Kunnen samenwerken 4. Adaptieve Processen, Systemen, Structuren, Mensen 5. Inspirerend leiderschap 25 maart 2011
Zorgondersteuning
9
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Agility
= Winning in the Dynamic Market
Obsession for Added Value to the Client Knowledge drives the Business Collaborative Organizations
innovative management of change 25 maart 2011
Continuously Adaptive in: • people • organization • processes • systems
behaviors and competencies Zorgondersteuning
Motivating Leadership 10
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Lean Agility is het beste van twee werelden voor ELKE organisatie
25 maart 2011
Zorgondersteuning
11
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Meting van Lean Agility met het CMI Lean Agility assessment 25 maart 2011
Zorgondersteuning
12
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Om gezond te blijven moet je de CMI(Company Mass Index) in de gaten houden BMI = (weight in kg) / (length in m)2
25 maart 2011
Zorgondersteuning
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CMI Lean Agility WebService
Scoring via een 5-punt Likert schaal dmv CMI Lean Agility® stellingen die de ‘ideale’ lean / agility toepassing omschrijven 25 maart 2011
Zorgondersteuning
14
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Batterij met CMI Stellingen 1. Hierarchisch 2. Ideale praktijk via stellingen 3. Likert scoringsmechanisme (“helemaal akkoord”, “akkoord”, “neutraal”, “niet akkoord” and “totaal niet akkoord”)
25 maart 2011
Zorgondersteuning
15
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De CMI assessment Sessie • Groep scoort heterogeen, dekt de scope en zijn grenzen, geen hierarchische relaties • Uitleg: Elke stelling wordt eerst uitgelegd voor eenvormigheid van begrip • Faciliteren van discussie • Halve Dag: 150 - 200 stellingen • CMI WebService url scoring systeem
25 maart 2011
Zorgondersteuning
16
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CMI Lean Agility® scoring geeft een focus voor verbetering
25 maart 2011
Zorgondersteuning
17
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Interpretation of CMI scores EXCELLENT
O - 25
IMPROVEMENTS NEEDED
26 - 50
SUBSTANTIAL EFFORT TO IMPROVE IS NEEDED START IMPROVING WITH GREAT URGENCY
51 - 75
25 maart 2011
Zorgondersteuning
76 - 100
18
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Interpretation of CMI scores Feedback Bottom Up Approach Waste 12 Continuous Improvement
Visualisation TPM
7 2
Standaardisation
-3
Collaborating
Customer Obsession Flow Renson: 39,5
Lean Finance Focus
80 70
Pull
Informed PDCA
Internal Customer Modularity
Stroom + Relaties en s amenwerking: 46,5
Klantwaarde: 34,4
Cultuur en s tructuur: 38,1
60 50 40 30 20 10
25 maart 2011
Zorgondersteuning
CMI
Ondersteunende f uncties
Reactiesnelheid op onverwachte omstandigheden
Ondersteuning van werknemers door management
Cultuur die streeft naar perfectie
Lange termijn f ilosofie
Samenwerking
Relaties
Planning
Just-‐in-‐Time
Vraag van klant zet keten in gang
Stroom
Lay-‐out
Verspillingen vermijden
Verkoop oplossingen
Zoveel mogelijk doen wat van waarde is voor de klant
0
19
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Uitgebreide ervaring met CMI – Chemical, pharmaceutical, process industries – Manufacturing: Machines, consumer goods, food & beverage, suppliers to automotive, textile, construction – Retail – Services: ICT service providers, consultants, financial, logistics service providers, harbour logistics, law & accountancy firms, – Health care (hospitals surgery rooms, elderly care centers) – Education (University departments) – Entertainment (music) – Social economy (“kringloopcentra”& “beschutte werkplaatsen”)
25 maart 2011
Zorgondersteuning
20
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www.lean-agility.com Com
25 maart 2011
bini ng L ean org aniz and atio A n ne gility as e eds very both ! Zorgondersteuning
21
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CMI Lean Agility onderzoek in zorgcentra met medewerking van Lien Van Steenberge
25 maart 2011
Zorgondersteuning
22
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VERGRIJZING (aandeel 65+) 30
% ouderen (65+)
25
Vlaanderen Wallonië Brussel
20
15
10 1990
2000
2010
2020
2030
2040
2050
projectiehorizon (op 31 dec)
25 maart 2011
Zorgondersteuning
23
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# inwoners 900.000 800.000 700.000 600.000 500.000 400.000 300.000 200.000 100.000 0
60-‐69ja a r 70-‐79ja a r 80-‐89ja a r 90-‐99ja a r 100+ 80+
2000
2010
2020
2030
2040
2050
tijd
25 maart 2011
Zorgondersteuning
24
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25 maart 2011
Zorgondersteuning
25
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Bestaande woongelegenheden in woonzorgcentra situatie 01/10/2010
commer-‐ cieel 12%
openbaar 37%
privaat non-‐ profit 51%
25 maart 2011
Zorgondersteuning
26
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! 25 maart 2011
Zorgondersteuning
27
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! 25 maart 2011
Zorgondersteuning
28
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CULTUUR
MENSEN
MANAGEMNT
BEVOORRADING
INFRASTRUCTUUR
ZORG PROCESSEN
ZORG ONTWIKKELING
LERENDE ORGANISATIE
PERSONEELS ONTWIKKELING
STRATEGIE VISIE
BESTELLING LEVERING
BESCHIKBAAR
VERSPILLING ZICHTBAAR
KWALITEIT ZORG
PROBLEMEN OPLOSSEN
ZELF STURING
LEIDERSCHAP
RELATIES LEVERANCIERS
BEHAAGLIJK COMFORT
VERSPILLING ELIMINEREN
MARKT SEGMENTEN COLLABORAT IE
CONTINUE VERBETERING
RELATIES MET BEWONERS
PRESTATIE METINGEN
VOORRAAD
MILIEU ENERGIE
STANDAARDI SATIE
FLEXIBILITEIT
ONDERHOUD HERSTELLEN
25 maart 2011
Zorgondersteuning
INNOVATIE ICT
29
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Deelnemende centra VZW Zonnehove, Sint-Denijs Westrem VZW Kanunnik Triest, Melle VZW Sint-Jozef, Gent OCMW De Vijvers, Ledeberg OCMW Schelderust, Wetteren Privé Home ‘t Neerhof, Elst
25 maart 2011
Zorgondersteuning
30
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25 maart 2011
Zorgondersteuning
31
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Processen Kritisch, vanuit het standpunt van de oudere, elk proces in kaart brengen en verspillingen identificeren en zichtbaar maken (VSM) Verspillingen wegwerken om meer continue doorstroom van de processen te bekomen (5Why, PDCA verbetercyclus en standaarden) 5S 25 maart 2011
Zorgondersteuning
32
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Mensen Wijzigende omstandigheden vereisten meer multi-functionaliteit en meer samenwerken in zelfsturende teams (in plaats van specialisatie) - - - -
Motivatieversterkend Cross-trainingsprogramma’s Evolutie naar lerende organisatie Bottom-up verbeteringen
25 maart 2011
Zorgondersteuning
33
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Verbeteren Poka-joke als verbeterproces: zorgen dat het maken van fouten geen kans krijgt Meten in functie van de ouderen Gebruik maken van beschikbare ICT mogelijkheden voor bevoorrading “go to gemba” dagelijks luisteren naar personeel en bewoners en de coach rol invullen 25 maart 2011
Zorgondersteuning
34
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CMI onderzoek in hospitalen met medewerking van Charlotte Van Parys “Lean thinking is a way of streamlining the patient journey and making it safe, by helping staff to eliminate all kinds of waste and to treat more patients with existing resources“ D. Jones 25 maart 2011
Zorgondersteuning
35
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25 maart 2011
Zorgondersteuning
36
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25 maart 2011
Zorgondersteuning
37
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25 maart 2011
Zorgondersteuning
38
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25 maart 2011
Zorgondersteuning
39
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25 maart 2011
Zorgondersteuning
40
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25 maart 2011
Zorgondersteuning
41
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25 maart 2011
Zorgondersteuning
42
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70
Belanghebbenden
60
50 Virga Jesse 40 CMI
UZA Heilig-Hart Sint-Vincentius
30
Sint-Blasius Maria Middelares
20
Jan Yperman Sint-Augustinus
10
Sint-Andries
0
25 maart 2011
Zorgondersteuning
43
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Conclusies Recente gedwongen samenwerking tussen ziekenhuizen heeft geleid tot meer aandacht voor alle belanghebbenden en transmurale zorg Management moet meer naar de werkvloer
25 maart 2011
Zorgondersteuning
44
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Processen
80
70 Virga Jesse Sint-Vincentius
60
CMI
Maria Middelares Sint-Augustinus 50
UZA Sint-Blasius Heilig-Hart
40
Jan Yperman Sint-Andries 30
20 PROCESSEN
25 maart 2011
Planning & Uitvoering
Processen
Zorgondersteuning
Procesbeoordeling
45
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Dringend E2E processen in kaart brengen en meetcultuur t.a.v. totale proces invoeren Standardisatie is hoognodig (balans tussen chaos en perfecte conformiteit) Betere procesflow realiseren (wachttijden, synchronisaties, verspillingen)
25 maart 2011
Zorgondersteuning
46
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Redundantie en duplicatie van gegevens en documenten – papierbalast, zoeken naar documenten veroorzaken veel verspilling Beter capaciteit afstemmen op vraag, zowel op micro (dokterscabinet) als macro (bedbezettingen) niveau – inplannen van patiënten
25 maart 2011
Zorgondersteuning
47
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65
Organisatie & Cultuur
60
55 Virga Jesse Maria Middelares
CMI
50
Sint-Blasius Sint-Augustinus
45
Sint-Vincentius Heilig-Hart
40
UZA Jan Yperman Sint-Andries
35
30
25 ORGANISATIE & CULTUUR
25 maart 2011
Organisatie
Zorgondersteuning
Cultuur
48
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Gestructureerde aanpak om problemen op te lossen Sceptisch tegenover ideeën die van buiten komen Ownership van medewerkers over continu verbeteren, bv. Via PDCA verbetercyclus Nood aan matrixstructuur Zichtbaarheid van dagelijkse doelstellingen en realisaties 25 maart 2011
Zorgondersteuning
49
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“Running even the most complicated corporation must sometimes seem like child’s play compared to trying to manage almost any hospital “ H. Mintzberg
25 maart 2011
Zorgondersteuning
50
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Post Scriptum “The Productive Ward programme draws upon principles of ‘lean thinking’ to help tackle previously neglected everyday issues facing frontline NHS staff. In the case of health care, reducing activities that do not add value could mean releasing more staff time for work that actually meets patient needs.” NHS (UK) 2007 - 2011 25 maart 2011
Zorgondersteuning
51
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Luc Chalmet
25 maart 2011
–
Professor at University of Gent and University of Antwerpen
–
Managing Owner of Cimes
–
20+ years of Consul?ng experience with PA Consul?ng, Arthur D. LiGle, KPMG Consultants and Unisys Consul?ng, and Cimes
–
Recent clients: Atlas Copco, Johnson & Johnson (Janssen Pharmaceu?ca), Philips (Massive), Daikin, Dupont de Nemours, Imperial Tobacco (Rizla), Bekaert, Brady, Etex Group, MicrosoW, Puratos, Siemens, Novar?s, Accenture, United Biscuits, Monsanto (De Ruiter Seeds), Argenta, Tupperware, Unitron, Spraying Systems, Kringwinkel Antwerpen, UCB, Schréder, Crion
–
Industrial experience with Alcatel Bell Telephone
–
CFPIM (Fellow in Produc?on and Inventory Management), CSCP (Supply Chain Professional) cer?fied by APICS; Master Instructor for CPIM, CSCP and TTT (Train-‐the-‐Trainer)
–
Doctor in Applied Sciences, Industrial Management Zorgondersteuning
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Thank You
www.lean-agility.com
25 maart 2011
Zorgondersteuning
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