Neurosurgical Science Centre Tilburg

used Makigami to reduce treatment of lumbosacral radicular syndrome

(LRS, ‘Hernia’) from an average 107 days to 14 days!

Makigami Process Improvement in Hospitals and Healthcare

It is often asked whether a makigami in a hospital gives similar results as in other environments.

Two multi disciplinary teams of each 6 people from the Dutch St Elisabeth hospital went December 11 and 12, 2006 through a Makigami analysis of the treatment of ‘a hernia’ (LRS). It was one of the first makigami’s made in a hospital ever.

The St Elisabeth Hospital in Tilburg – Netherlands

The LRS Process

For the patient, the process starts with the visit at a neurologist and ends when the patient is correctly being treated. Both teams came up with more than 10 meters of analysis each!

Although involved in the process at a daily basis, they where flabbergasted about the complexity of such a ‘regular, standard treatment’.

On average a patient is ‘on the way’ for 107 days, with fluctuations between 37 and 270 days.

    Makigami Teams

    In the teams participated:

    • hospital manager,
    • manager neurosurgery,
    • floor manager,
    • nurses,
    • secretaries,
    • department assistants,
    • and neurosurgeons.

    None of them had knowledge of the whole process, most where even not aware of parts of the process.

    How long did this makigami take?

    It took the teams about 1,5 days to fully understand and describe the current process. During this phase many ideas where raised and discussed. Valuable issues where parked for further investigation. Sharing different perspectives is a crucial goal in this ‘exercise’. Many ideas for the future state of the process are born in this phase.

    At the end of the second day, both teams presented the results at each other and invited guests. They all firmly believed it should be possible to go through the whole process in between 4 to 14 days, depending the route it would take.The future state of the process could be described at 1,5 Makigami sheets, compared to 9 sheets in the current situation. Lots of complexity is eliminated!

    The implementation of the future state makigami

    The implementation was realized within 3 months, which may well be called a record pace!

    A “hernia street” was set up, in which team members from all the necessary disciplines worked together according to the defined makigami future state process.

    From the new process, naturally emerged a multidisciplinary team that, without much ado, could together provide the flow of hernia patients with rapid- and above all strongly patient centered care.

    Not only the patients, but also the employees reacted with enthusiasm; the clear agreements and tight cooperation resulted in a high flow of work, but reduced work stress and the previously usual friction to integrate this patient flow into the other flows.

    The project was so successful, that the hospital was flooded with patients from all over the country, causing an unexpected new challenge to the team!

    What was done after this Makigami?

    After this first pilot in 2006, the makigami methodology was soon being used by one of the team members (a nurse) to improve other processes.

    Oil Spot

    The first team learned the -relatively simple- method and saw how quickly great results could be achieved.

    Because management gave room for this, one of the participants was able to start a new team and transform a new problem process.

    As time went on, new methods were introduced for other types of problems.

    There was an increasing willingness to change in the organization, which was supported from below and facilitated from above.

    The first improvement could thus spread through the organization like an oil slick.

    The Elisabeth Hospital thus became one of the first hospitals to embrace large-scale improvement methods from the manufacturing industry.

    Radboud university medical center

    ER team redesigning process with Makigami

    Redesigning ER Process

    A similar situation happened in the Radboud University Medical Centre. After a first makigami performed in the ER of the University Hospital (in Nijmegen, the Netherlands), one of the staff members used it in other departments and later in other hospitals.

    Today it has also successfully been implemented in other medical disciplines.

    Where expensive equipment is being used -like MRI scanners, gamma knives or other radio-therapy equipment- the combination of makigami and OEE (see OEE Academy) will show spectacular results!

    In Honour to Dr. Cees de Nie, a briliant Neurosurgeon who passionately promoted Lean and Makigami in the medical world.

    Cees left us far too early, but thanks to his promotion of Lean, many hospitals now have changed, leading to far less mistakes and losses.

    Cees has saved numerous lives and inspired many- and certainly me.


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