Summary:
The monograph makes known the Kaizen method of continuous improvement, in order to consistently and harmoniously improve the levels of quality, productivity, costs, service delivery times and patient satisfaction, in institutions dedicated to health care. To do this, it begins by making known the need for such an improvement system, and the bases of its philosophy. Subsequently, the different tools, methods, instruments and systems designed to achieve the aforementioned objectives are reviewed. It develops the different problems related to the institutions dedicated to health services and how to solve them. Emphasis is placed on various waste and waste (mudas in Japanese), with a lot of emphasis being placed on waste related to bureaucratic-administrative activities and / or processes. A special aspect is related to Kaizen Costs, its objectives, its analysis methodology and the differences with traditional costing systems.At the end of this work, a review is made of the methodology used for the practical application of Kaizen, exposing for this reason ultimately examples of those related to the use of various instruments or methods in the health field.
1. INTRODUCTION
Despite being a non-tradable service (not subject to international competition) and for this reason not directly subject to the effects of globalization, health services are subject to significant pressures as a result of the high costs of supplies, the high financial costs, the excessive or bureaucratic oversaturation product of the demands of the numerous social works, to which must be added the problems of payments by these, and added to all this is the imperative need to provide every day more and best services.
Thus, within this environment, and in the search for adequate levels of profitability, solvency and liquidity, it is imperative to search for tools or methodologies that allow not only a correct evaluation, but also the realization of concrete results.
Among a series of administrative methodologies linked to excellence via continuous improvement in terms of quality, satisfaction levels, productivity and costs, is Kaizen ("ongoing improvement that involves everyone").
The Kaizen philosophy (originally developed in Japan) assumes that our way of life - be it our work life, social life or family life - deserves to be constantly improved.
The message of the Kaizen strategy is that not a day should go by without some kind of improvement being made somewhere in the company.
Improving and exceeding standards is the great goal of Kaizen. Improving standards means setting higher standards. Once this is done, the maintenance work by the administration is to ensure that the new standards are observed. Lasting improvement is only achieved when people work to higher standards.
The Kaizen methodology emphasizes the recognition of the problem and provides clues for its identification and procedures for its resolution. Improvement reaches new heights with each problem that is solved.
Kaizen tries to involve employees through suggestions or alerts. The goal is for workers to use not only their hands but also their brains. Kaizen generates process-oriented thinking, as processes must be improved before better results are obtained. The process-oriented way of thinking fills the gap between process and result, between ends and means, and between goals and measures, and helps people see the whole picture without deviation. Kaizen does not necessarily require a sophisticated technique or advanced technology. To implement Kaizen, only simple, conventional techniques are needed, such as quality control tools.
2. Preparation times and adjustment of the process speed losses 3. Operation at reduced speed
4. Empty time and short downtime Defective products and processes 5. Quality defects and rework
- Start up
All these aspects are not only typical of industrial companies, but also of service providers, call them transport, banks, sanatoriums, energy distributors, among others.
2.4. Policy deployment
Management must set clear goals to guide each person and ensure that they provide leadership for all kaizen activities directed toward achieving the goals. Senior management must devise a long-term strategy, detailed in medium-term strategies and annual strategies. Top management must have a plan to roll out the strategy, running it down through subsequent levels of management until it reaches the production zone.
2.5. The Suggestion System
The suggestion system works as an integral part of individual-oriented kaizen, emphasizing the benefits of elevating mood through positive employee engagement. This is not expected to reap great economic benefits from each suggestion. The primary goal is to develop kaizen-minded and self-disciplined employees.
The workers who develop the work see the defects, errors and failures, lost times and other characteristics that need to be changed, although they tend to keep quiet. Workers can be the source of many improvements if they are encouraged to present their ideas. Some companies that stimulate workers' ideas have found that their costs have been reduced and quality has improved. Top management needs to encourage workers to make suggestions that can continually improve quality.
The following actions are recommended:
- Suggestions must be collected weekly Management must discuss them with workers There must be individual awards for accepted suggestions It must be a continuous program Any accepted suggestion must be implemented immediately
Companies benefit from quality improvement suggestions, companies using this system receive thousands of suggestions each year and greatly reduce costs.
Management must continually advertise, lead and support this policy. Workers should be invited to participate in the system and to submit their proposals. If the attitude is right, workers will come up with hundreds, or thousands, of ideas for improving quality.
2.6. Small Group Activities
A Kaizen strategy includes small group activities that are organized within the company to carry out specific tasks in a work environment. They not only deal with issues related to quality, but also related to costs, productivity, and safety, among others. In any company, leaving aside its size and activity, it is possible and necessary to promote this type of activity aimed at achieving better teamwork and obtaining interaction between its components to improve the organization's standards. It should always be borne in mind that “there is no commitment without participation”.
3. The ultimate goal of the Kaizen strategy
The development of cross-organizational activities aimed at achieving quality, costs and delivery (QCD). Quality refers not only to the quality of finished products or services, but also to the quality of the processes that relate to those products or services. Cost refers to the total cost, which includes designing, producing, selling, and supplying the product or service. Delivery means dispatching the requested volume on time. When all three conditions defined by the term QCD are met, customers are satisfied.
4. Self-discipline, waste elimination and standardization
Everyone in the company must work together to follow three procedural rules that allow Kaizen to be practiced in the workplace:
- Self-discipline Waste Elimination Standardization
Employees without self-discipline make it impossible to supply good quality products or services.
Any activity that does not add value is considered waste or waste. People in the workplace add or don't add value. This is also true for other resources, such as machines and materials.
The third rule of thumb for kaizen practices in the workplace is standardization. Standards can be defined as the best way to get work done. For products or services created as a result of a series of processes, a certain standard must be maintained in each process in order to ensure quality. Maintaining standards is a way to ensure quality in each process and to prevent the reappearance of errors.
5. QUALITY IN SERVICE COMPANIES
Every company, to be successful, depends on a large number of customers. This means that it has to be customer-oriented.
Quality means meeting customer demand. It is based on the prevention of non-quality characteristics. Every service must try to satisfy customer demand by eliminating non-quality characteristics through a process of continuous improvement. Improvement consists of the continuous elimination of non-quality characteristics, such as: errors, delays, downtime, unacceptable behaviors and attitudes, failures, unsafe working conditions and unnecessary services. These characteristics are discovered through the analysis of problems, claims, complaints and suggestions from the client and the workers.
It is necessary to overcome:
- Errors Delays of all kinds Downtime of all kinds Defective services Non-quality behaviors Non-quality attitudes Dangerous methods and actions Failures
For service companies, constancy of purpose aimed at improvement implies the following:
- Long-term plans Expansion to serve more customers Progressive reduction in the number of non-quality features, the goal being zero Continuous training Communication from top to bottom and vice versa
A constancy of purpose requires specific activities in a continuous quality improvement program:
- New ideas New competitive products or services New and improved processes Better trained workers New services to meet customer needs and demands; Improve existing services Improved maintenance of machinery and equipment Improved office maintenance Improved security program Continuous error prevention program Continuous customer study Reduce error rate Reduce downtime Reduced delays Improve quality performance and staff attitude Immediate customer service
Areas that should be examined for service problems include:
- Data collection, sampling, Shopping, Staff, Training, Behavior, and attitudes, Time use of all kinds, Accuracy, Security of operations, Scheduling of all kinds, Customer studies, Service purchase behavior, Customer satisfaction.
5.1. Conduct a study of the problems
Studying problems is the heart of quality control. You have to find problems to solve such as:
- Check for errors to prevent them Find errors in storage
Save paper and personnel in sampling
Work on a problem that can save time
Work on an issue where security is overlooked
Work on a problem where probability sampling can reduce costs
- Work on improving customer service Do a study on lost customers to find out why they left and how to get them back Study how to improve the learning curve in training and on the job Examine forms for improvements Improve training courses Do a study of programs to discover where it can be improved Use of the root cause analysis system in order to detect the root causes that motivate errors or failures (avoiding acting in this way on the most obvious symptoms or causes), and for preventive planning. Statistical Process Control. Monitoring of the evolution of the different control parameters. Identification of special and natural variations.
5.2. Continually look for areas for improvement
Areas that should be examined for service problems include:
- Data collection, sampling, Shopping, Staff, Training, Behavior and attitudes, Time use of all kinds, Accuracy, Security of operations, Programming of all kinds, Customer studies, Shopping behavior, Customer satisfaction
Among the aspects to be considered in a private sanatorium we have:
- Are residents given adequate nutrition? Is assistance provided at mealtime? Are the correct medications administered, in the correct doses and at the right time? Are the nurses alert?
Are patients receiving correct care?
Have there been cases of theft? What measures have been taken?
Are the residents' rooms safe?
Do patients receive personal assistance: toilets, hair care, clean clothes, clean beds, personal attention?
- What additional facilities and services does the clinic have: religious, books, magazines, radio, television, travel, outings, among others? Does it have fire protection?
5.3. Training workers to achieve quality in job performance There are many ways to train an employee, be it a worker or manager. Examples:
- Set standards for new contracts Semi-annual or annual training program Train new employees Train in any new techniques Offer special training for workers with supervisory skills Train workers to use elementary statistical methods Train in safety measures and how to avoid disasters Teach the worker how to deal with Training in quality behavior and its activities Training in preventing errors Training in better data collection and analysis Training in saving wasted time of all kinds Enter keeping promises
5.4. Institute modern methods of supervision
The supervisor is responsible for maintaining or increasing quality. The new supervisor must ensure the quality improvement actions that have to be taken around the following aspects of the service:
- Safe working methods Computer systems Processing methods Sample design Customer study Better training Clarifying terms in instruction manuals Distinguish between system defects and special cause
Recognize system failures
Emphasize the quality of service characteristics
Insist on high-level action
Listen to employees
5.5. Conduct a worker study
The company must carry out a study of the workers to determine where everyone is in quality matters. Many workers will not have heard the word quality, even fewer will know the true meaning of the word and many will believe that they already do quality work.
This requires several meetings in order to explain the meaning of:
- Error prevention Reduced waiting time Reduced delays Reduced idle time Courtesy and courtesy Polite handling of complaints
5.6. Mistakes
A man suffering from emphysema had a fracture, being transferred from the private sanatorium to the hospital. Oxygen was supplied, dying after 15 minutes. Why? The bottle brought from a dimly lit room contained carbon dioxide. Who was at fault? The individual, the management or the system?
- Was the management to blame for hiring the person or for not having trained him? Should two similar bottles be stored together? Should the bottles bear clear labels? Should the gas supply be carefully monitored? test to verify that the gas was oxygen? Do individuals have any obligation regarding the storage, labeling, identification or supply of gases? Is both the individual and the system or management at fault?
Epilogue: The coroner estimated that the man, who was in his 90s, died of natural causes. As a consequence of this error, a training program was started.
Similar cases include:
- Argon connected to the oxygen pipeline: two dead
Nitrogen mixed with oxygen: one dead
A nurse in the emergency department made a mistake and administered cocaine instead of phenobarbital, causing one death.
Two women, waiting to undergo surgery, were not clearly identified. None died because their operations did not affect vital organs.
- Two anesthesia machines of the same model were used for two consecutive months. They had a faulty oxygen valve, causing two deaths
This last example raises the question of the obligation of medical personnel to check the proper functioning of the machine. In this case, the two machines had been serviced a few months earlier.
5.7. The knock-on effect of mistakes
Making a mistake can be the beginning of a series of costly consequences: Example:
- A bottle of carbon dioxide is mistaken for an oxygen bottle A man dies A medical examiner declares that he died of natural causes The hospital begins training classes on gas management Son-in-law threatens to sue for negligence The hospital studies the storage of gases.
5.8. Delays
Another kind of mistake is to cause or not to prevent delays. There are many forms of delay. In the ophthalmologist's office, the delays may be as follows:
Waiting for Service
| Waiting in the waiting room | 15 minutes | |
| Sight test | 5 minutes | |
| Waiting | 15 minutes | |
| Glaucoma test | 5 minutes | |
| Waiting | 15 minutes |
Doctor's visit 5 minutes Total 45 minutes 15 minutes
5.9. Lost time
The cost of lost time in service companies can be enormous. It manifests itself in the following ways:
- Idle time Making personal calls Taking excessive time to eat Ignoring customers Not coming to work (no explanations) Delays in receiving important orders Not being able to alphabetize customer names Talking to other workers Keeping customers waiting
5.10. Errors and their prevention
Errors in medical services are frequent. The following examples demonstrate what can be done to prevent them. Mess and confusion are dangerous.
- Carbon dioxide is given to a patient instead of oxygen. You have to clearly identify things; the oxygen must be placed in another room. Cocaine is administered instead of phenobarbital to a patient. Medicines must be stored in separate places and identified very clearly. Two anesthesia machines have faulty oxygen valves. You have to test things before using them. An oxygen bottle is filled with argon. Clear identifications must be made. You have to review the delivery. The Center for Disease Control (USA) tested 3,000 laboratories and found that 14% of the tests contained errors. Requirements: quality control in laboratory work, especially on errors. A graph should be kept on the number of errors made according to the type of test.The financial administration of health estimates that 5% of errors is acceptable. The goal is zero errors. How many have died due to that 5% of errors? A sanatorium confused two people. The person who was alive was sent to the morgue. Identification labels must be entered.
ORGANIZATION AND SIMPLIFICATION OF ADMINISTRATIVE WORK Administrative costs are extremely high; they can represent up to 30% of the total cost of a company or sometimes more. That's considering only the explicit costs. The implicit data can be higher, wrong information or out of date, lack of monitoring and control, lack of information for decision-making are, among others, the cause of headaches for the management levels of an organization.
The office becomes the brain of the company. Most, if not all, managers and professionals control and influence, or are affected by, the way the office operates. Despite this, few companies have a training or support system for the manager who is in charge of the office. Professionals who are experts in engineering, science, accounting, law, or any other field of expertise are not assisted in learning the optimal way to perform office functions.
30% of company costs originate from office functions, which are vital to the company and include planning, control, hiring, purchasing, accounting, financing, legal issues, and many other activities. However, despite the size and cost of these functions, so far they have received little attention.
You have to be immersed in the business world to understand the profound influence of the office and understand how ineffective the systems used in it can sometimes be.
According to a study by Booz, Allen & Hamilton, companies could achieve increased productivity between 13 and 18% by improving the own performance of administrative employees. Almost 80% of office costs are due to managers and professionals, that is, intellectual workers. The study found that these workers only spend 8% of their time performing tests; 30% dedicate it to “less productive” activities; between 40 and 50% to meetings, and 15% to the preparation of documents.
The office is not a physical space; it is, above all, an activity. It is about the training, processing, analysis and use of the administrative work that supports a company, and which is carried out in any place or department where these activities are carried out.
A detailed and exhaustive study of the various tasks, activities and processes will simplify or eliminate all those activities that do not generate added value for the company.
The primary objective is that information systems allow planning and budgeting tasks, but make these serve to identify the reasons or causes of various operating expenses. An example of this would be to use the system to report the number of repairs, the material used (or brand) and the place and date of the same. In this way, it could be concluded that the reason for the continuous repairs are motivated by failures, for example, of an electrical circuit or of the material used. As long as the reason for the damage is not discovered, we will continue to spend huge sums of money to repair symptoms of a more serious problem.
In addition, the system must allow to know daily the financial situation in terms of availability of resources. The system must avoid errors in the benefits and also allow the information requested by the different social works to be submitted in a timely manner in order to obtain payment in a timely and proper manner.
All of this is feasible by applying quality management to administrative work, using the various management instruments and tools. Before introducing any type of change, you must know the current system thoroughly.
This is rule number one; it is absolutely imperative. It is essential that the following information is known:
- the philosophy of the system; the standards by which the system operates; the procedures that are followed; the responsibilities and competencies of the individuals involved; the workflow within the system; the forms and forms that are commonly used; the suitability of existing equipment; 8. the sufficiency and quality of the personnel, the reports that are prepared.
Then, and with a solid base of the characteristics of the system in operation, the changes will be made. Both in the case of activities and processes, the following criteria must be followed:
- Delete it (if not necessary) Combine it Modify it Alter the order in which it is carried out
The analysis of methods and tasks is essential in order to reduce the times to perform tasks, simplify them and increase productivity levels. Unnecessary tasks, duplication of work, inaccurate data and information, lack of flexibility in operations constitute high levels of waste and waste.
As well as in the productive area, the great waste or waste went through issues such as quality, supplier service, excess inventories and stock of supplies, products in process and finished, breakdowns, transportation, movements and preparation times, among others. In the case of office work, waste should be traced around: personnel, processes, forms, lists of counts, computing, and work methods. We can thus mention the following types of administrative changes:
- Duplication of tasks, in part due to lack of shared information Excessive movements and transfers, in part as a result of poor physical arrangement Downtime of stationery (procedures that actually last 5 minutes have waiting times at desks or bins of hours to days or weeks.Excessive subdivision of processes and / or activities. Lack of work in groups or work teams. Inadequate internal control, which causes 4 types of problems:
- possible external fraud against the company, possible internal fraud, unreliable or inaccurate information for decision-making purposes, and lack of compliance with regulations of official bodies
- Excessive number of forms, with duplication of information and / or unnecessary Poorly designed forms Excessive inventory / stock of forms Unnecessary tasks, processes and / or activities Complex activities or processes Lack of information and administration by exception Lists of computations: unnecessary and / or poorly designed Information out of time and / or inaccurate over-organizational structure. This may be the result of excessive manual activities, too short control periods, lack of empowerment, lack of clearly defined organizational objectives or over-employment policy. Software: inadequate, not parameterizable, slow execution, not adapted to the characteristics of the company bottlenecks originated in: concentration or centralization of decisions or authorizations,Quantity of scarce critical elements depending on the needs - call them: computers, printers, photocopiers and computing processes. Breakdowns and lack of maintenance in computers, printers, lighting system, telephones. Lack of protection of computer data. Poor supervision Poor training of the personnel. Levels of standardization or internal regulations Excess of internal reports Excess of internal meetings and / or external interruptions Unproductive activities due to excess specialization or division of labor Slowness of printers, photocopiers or computer processesPoor supervision Poor staff training Excessive levels of standardization or internal regulations Excess internal reporting Excess internal meetings and / or external interruptions Unproductive activities due to excess specialization or division of labor Slow printers, photocopiers or computer processesPoor supervision Poor staff training Excessive levels of standardization or internal regulations Excess internal reporting Excess internal meetings and / or external interruptions Unproductive activities due to excess specialization or division of labor Slow printers, photocopiers or computer processes
Given that with the exception of the aforementioned activities of banks, finance companies, stock exchanges, insurance companies and consultancies, in the other activities consumers acquire goods or services not directly related to office tasks, these bureaucratic activities are considered as “non-support activities. added value ”or simply as“ non-value added activities ”; reason why these should be eliminated, simplified or reduced.
The aforementioned inefficiency is the reason why organizations related to education or health lose a large part of their resources, if not most, in administrative expenses apart from the illicit ones that are usually carried out through these activities.
7. ENERGY MANAGEMENT
As energy costs grow and as energy supply and use require a medium-term planning effort, the need to establish energy management mechanisms is understood. In other words, it is necessary to know the consumption and uses of the different energy sources, not only at the level of global values, but also in a particular way applied to the different internal processes and consumption. From here it is possible to predict the increases in energy used that will occur when increasing industrial production capacity, or it is possible to set cost containment measures through an intelligent savings program. It is interesting to know that immediate corrective measures can be applied without investment costs that allow energy savings.
8. Kaizen costs
The objective is not to reduce total costs, but to reduce costs per monetary unit of sale. This can be achieved by increasing sales in a greater proportion than costs, increasing sales without increasing costs, or increasing sales with lower costs. Any of these options implies an increase in profits, but the objective is always to achieve higher returns.
Kaizen companies use more physical than financial measures to direct and control daily operations. Inventories, productivity levels, operational efficiency, downtime, and quality levels, among others, are closely controlled. For all this, the Statistical Process Control graphics are extremely important. The Kaizen cost system is the “continuous improvement applied to the reduction of costs in the manufacturing phase of a product or provision of services”.
This system aims to determine where managers detect the greatest possibility of cost reduction. For this system to be effective, detailed cost information is provided to work teams on an ongoing basis.
When used in the context of Kaizen, the word cost refers more to cost management than cost cutting. Cost management has to do with the proper management of various resources, and the elimination of all types of waste, in such a way that the total cost goes down.
There are three types of activities or processes:
- Those that provide added value Support those without added value, and Those without added value
All those activities that do not add value should be eliminated, while support activities should be simplified and / or reduced.
New costing systems linked to Kaizen:
- Objective Costing Just in Time Costing Activity Based Costing Value Engineering and Value Analysis Cost Modeling
Cost modeling deserves special attention due to the importance it has in decisions for the acquisition of goods and services. Among the 5 key principles for its achievement we have:
- Identify cost drivers, not just cost elements Build specific models for each product or service to highlight key cost drivers Consider the impact of total cost of ownership Start simpler and more complex based on the need Consider collected data to improve accuracy and confidence
8.1 The cost of poor quality
Quality is only possible with effectiveness and efficiency, because effectiveness and efficiency refer to the use made of resources. When the use is appropriate, lower costs and higher productivity are obtained, so, in a pure economic sense, it is not possible to speak of a “good product” (that is, of “quality”) if there is not a good process. productive, and "good process" is only the one that, in addition to being efficient, is cheaper. Therefore, since to improve the product it is necessary to improve the production process, it turns out that "good quality" is no longer "good use of resources" or "avoid waste" (among which is the poor quality of products or services).
Quality does not require higher costs. This is a totally wrong approach and without much foundation, it still circulates wrongly among those who believe that quality is synonymous with more expensive, difficult and complicated production processes.
Now, the reality in which it is necessary to move inevitably causes the appearance of costs caused by poor quality, a cost whose definition is “the expense incurred to help the employee to do the job well every time, expense incurred in determining if the production is acceptable, and any other expenses that the company and the client may incur due to the production not meeting the necessary specifications and / or the client's expectations ”. From this definition it is possible to identify the elements that make up the cost of poor quality, being present in all areas and departments of the company (both production and administration). In the administrative areas it takes between 20 and 35% of the total expenses of these areas.
9. WORK METHODOLOGY
9.1. Diagnosis and evaluation
Strategic planning. Organizational values, missions and objectives. Vision of the organization. Of fundamental importance to define from there where you want to go and in what way.
Measurement of costs, quality, productivity, delivery times, safety and satisfaction levels. Verify that it is currently being measured. What should be measured. How, where, who and when.
Survey of information and internal control systems. In order to confirm the validity of the data reported in terms of quality, costs, and productivity, among others.
Benchmarking. Comparison of the levels of: quality, productivity, costs, preparation times, delivery or service times, among others, with the best levels in the market and the averages.
Survey and evaluation of: Verification of resource leaks (waste, waste and losses). Survey and evaluation of internal control (to avoid losses due to internal or external fraud, commission of formal or regulatory errors); verification of security levels; application of the 5 "S" (existence of unnecessary elements, lack of order, lack of cleanliness, personal hygiene and use of work elements, labor discipline); use of Statistical Process Control; standardization and improvement of processes; dumps (waste in Japanese) due to: movements, transportation, lay-out, breakdowns, lack of quality of services and products purchased, lack of quality of services provided, preparation times, excess stock of supplies; existence of participatory systems (suggestion and quality circles, quantity of suggestions); energy consumption;administrative unproductivities; existence of management and budgetary control; cash flow behavior; financial waste; personnel hiring system; training systems; level (rate) of work versatility; behavior of the various cost levels by: service, activity, cost center or departments, their historical evolution; possibilities of outsourcing services. Tools or instruments used: Seven statistical quality management tools (Ishikawa Diagram, Pareto Diagram, Scatter Diagram, Histogram, Stratification, Statistical Control Chart and Data Collection); the Seven new management tools (Flowchart, Matrix Diagram, Tree Diagram, Affinity Diagram, Relationship Diagram, Critical Path and Contingency Diagram); PERT,Gant Chart, Survey of Tasks, Activities and Processes, Analysis of Time and Tasks, Analysis of Added Value by Activity or Process; Linear Programming, Kaizen Questionnaire, Cost Analysis - Marginal Contribution, Balance Point, Financial Modeling, Quality Function Deployment, Cosso Report Questionnaire, Value Analysis, among many other systems, tools and instruments linked to or belonging to:
Operations Administration, Industrial Engineering, Cost Management, Operational Research, Problem Solving and Decision Making, Audits: Operational, Internal, Financial, Administrative, Social, Cultural, Informatics, Quality and Productivity. Treasury Management, Resource Allocation, Task Design among others.
9.2. Training of managers and staff in Kaizen matters: Includes Kaizen philosophy, discipline, use and interpretation of Management Tools and Statistical Process Control, Total Quality Management, Standardization, concept of waste and waste, the 5 "S", Poor Quality Costs.
9.3. Application of the 5 "S". Practicing the 5 "s" has become almost indispensable for any company involved in manufacturing or services. Quickly, the capacity of a company can be determined based on the state of the gemba (place where the production process or service provision is carried out) Activities include: a) Separating everything unnecessary and eliminating it, b) Putting the essential elements in order, so that they have easy access, c) Clean everything –tools and workplaces-, removing stains, dirt, waste and eradicating sources of dirt, d) Carry out a cleaning and verification routine, and e) Standardize the four steps above to build a never-ending process that can be improved.
9.4. Establishment of Statistical Control of Processes and Management. Training for its use and interpretation. Selection of control points for quality and productivity control. Design and selection of various indexes to use.
- Implementation of measures conducive to the improvement of Quality - Productivity - Delivery - Costs - Safety (Elimination of Waste) Opportunities for cost reduction can be expressed in terms of change (waste). The best way to reduce costsin the gemba (place of production) is to eliminate the excessive use of resources. To reduce costs, the following seven activities must be carried out simultaneously, with quality improvement being the most important. The other six important cost-cutting activities can be seen as part of process quality, in a broader sense: Improve quality Improve productivity Reduce inventory Shorten production line Reduce machine idle time Reduce space Reduce total cycle time
These efforts to eliminate waste will reduce the overall cost of operations. Quality improvement lays the groundwork and begins cost reduction. In this case, quality refers to the quality of the work process of managers and employees. Improving the quality of the work process results in fewer errors, defective products and rework, shortens the total cycle time and reduces the use of resources, thereby lowering the overall cost of operations. Improving quality is also synonymous with better yields.
- Kaizen in activities or processes. Examples.
Preparation times: The preparation times in the operating rooms are essential to make a higher use of scarce resources, reducing these times is feasible a greater number of daily operations.
Relations with suppliers: Achieve supply taking into account the total cost, with lower income from drugs and other supplies that allow reducing the financial cost due to the high value that these inventories have.
Just in Time: Applying this concept to the entire subject of forms by issuing these at the time of use avoids the cost of printing, stationery stock and the high level of waste that this causes.
Preventive maintenance: Fundamental in any activity and even more so in sanatoriums or hospitals due to the dangers of loss of life that can cause the malfunction of various medical equipment such as artificial respirators.
Administrative waste: Caused by the lack of a thorough study aimed at avoiding duplication of procedures, duplication of cargo or dumping of internal information, incorrect information and / or out of time. A solution to these wastage of resources can be solved through a redesign of administrative tasks, which include both internal and customer service tasks.
Statistical Control of Processes and Management applied to: the quality of services, controls in productivity levels and costs, and in the measurement and monitoring of customer / patient satisfaction.
The 5 "S": Fundamental for the cleanliness of the facilities, the neatness of the workers and the correct location of the different elements, tools or equipment. Poka-yoke: Fundamental to avoid errors such as giving drugs to the wrong patients, forgetting pieces of surgery in the body, operating on the wrong people, among others. The functions performed by Poka-yoke systems and devices are:
- Avoid forgetting and human errors and with it the origins of the causes of defects Detect defects Guarantee a level of quality of 100% Report the presence of oversights, errors and also defects, when their purpose is informative.
Alarm reports: It requires that every time an employee witnesses a potentially dangerous situation, he must present an alarm report, which is later used as a basis to correct the conditions that allowed the situation to arise. The purpose of the report is to ensure the safety of patients, and not to blame colleagues for making mistakes. The main goal is to achieve quality assurance. It is of fundamental importance to understand Heinrich's Law in its practical application, which states that of every 330 accidents, 300 are accidents that do not cause damage, 29 cause minor damage and one had serious consequences. In order to avoid such a serious accident, both the total number of minor accidents and the total number of non-damaging accidents must be reduced.For this reason, reports are classified according to the Law. Alarm reports must be submitted every day, and this tool has largely fostered a safety awareness among nurses and paramedical personnel alike. Reports are prepared at each nurse's station and presented daily to administration. On a monthly basis, the administration compiles the reports and sends a summary to the staff. Each department must implement the correct preventive measures immediately and report on them. If the solution is more complex and requires a greater amount of time, the quality circles of the hospital or sanatorium should approach the problem as a joint effort.And this tool has largely fostered a safety awareness, in both nurses and paramedics. Reports are prepared at each nurse's station and presented daily to administration. On a monthly basis, the administration compiles the reports and sends a summary to the staff. Each department must implement the correct preventive measures immediately and report on them. If the solution is more complex and requires a greater amount of time, the quality circles of the hospital or sanatorium should approach the problem as a joint effort.And this tool has largely fostered a safety awareness, in both nurses and paramedics. Reports are prepared at each nurse's station and presented daily to administration. On a monthly basis, the administration compiles the reports and sends a summary to the staff. Each department must implement the correct preventive measures immediately and report on them. If the solution is more complex and requires a greater amount of time, the quality circles of the hospital or sanatorium should approach the problem as a joint effort.management compiles the reports and sends a summary to staff. Each department must implement the correct preventive measures immediately and report on them. If the solution is more complex and requires a greater amount of time, the quality circles of the hospital or sanatorium should approach the problem as a joint effort.management compiles the reports and sends a summary to staff. Each department must implement the correct preventive measures immediately and report on them. If the solution is more complex and requires a greater amount of time, the quality circles of the hospital or sanatorium should approach the problem as a joint effort.
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