LEAN Principles - Lab Quality Confab1 HR 2 HRS 1 HR 1 min 1 min 3 min 3 min Large Batches = 1 = 1 = 1 = 3 = 2 CT= 1 min CT= 3 min CT= 3 min 3 HRS Acquisition & Transport 75 min CT=

© 2015 D’Angelo Advantage Consulting LQC- 1

LEAN Principles

http://www.hermanmiller.com/solutions/healthcare/applications/laboratory.html

Rita D’Angelo Lab Quality ConFab November 5, 2015

LEAN LABORATORY


!  Workplace Organization: A structured approach to clean and organize the workplace

!  Bottlenecks: Step in a process line that limits the throughput of the entire process line

!  Pull: Customer order triggers the start of production Underlies Just-‐in-‐Time production and continuous flow

!  Kanban: A visual signal, typically a re-‐order card or container that triggers a Pull manufacturing system

!  Value Stream Mapping: A graphical representation of all tasks and activities needed to transform input materials and information into an output

Definitions


The Learner will be able to:

1) Describe & implement effec9ve process improvements based on manufacturing based produc9on fundamentals

2) Adopt unique measurement tools based on the scien9fic method of data collec9on to iden9fy and analyze defec9ve processes

3) Manage empowered teams of 'expert' workers to con9nuously focus on the system of work

Objective


1.  Create a continuous process flow 2.  Reduce batch sizes 3.  Use the “Pull System” 4.  Level out the workload 5.  Develop Value Stream Maps to identify waste 6.  Standardization of tasks 7.  Visual controls 8.  Observation – Waste Walk 9.  Decide carefully by consensus, Implement

Rapidly 10. Plan, Do, Check, Act (PDCA) problem solving

Principles of Lean


!  Waste elimina9on

!  Quality Methodology -‐ 14 Principles !  (Liker-‐ The Toyota Way)

!  4 Rules of Work Design !  (Spear & Bowen-‐ Decoding the DNA of the

Toyota Produc9on System)

Fundamentals of Lean


Reduce & Eliminate Waste, Continually

!  Overproduction !  Time waiting !  Transportation !  Processing !  Stock on hand !  Movement !  Defective products

The seven wastes

What is Waste?


What is the Philosophy?

Implementation of a Quality Methodology

14 Principles by Jeffrey Liker P.hD


1. Long Term Philosophy-‐ Base your management decisions on a long term philosophy, even at the expense of short-‐term financial goals

2. Create continuous process flow 3. Use the “Pull System” 4. Level out the workload 5. Build a culture of continuous improvement by stopping to fix

problems to get quality right the first time. Every hand-‐off is correct EVERYTIME

6. Standardization of tasks are the foundation for continuous improvements & employee empowerment

7. Use visual controls so no problems are hidden

Liker: The Toyota Way, 2006.

"

"

"

"

" LEAN PROCESSES

"

The 14 Principles


Liker: The Toyota Way, 2004.

" "

PEOPLE & PARTNER RELATIONSHIPS

PROBLEM SOLVING & CONTINUOUS IMPROVEMENT

14 Principles of Lean (Cont.)


Production that is !  Defect Free !  On demand !  Immediate !  One–by-‐one (single piece flow) !  Minimal waste !  Safe

!  Physical, emotional, professional

Delivery of products & services should pursue the Ideal

The Outcome of Quality


Eliminate Waste 1. Value – added 2. Non Value-‐added 3. Non Value Added, but necessary

Identifying the NON -‐Value in our work

What is Lean All about?


Non Value Added Work

!  Missing patient information !  Poor quality !  Redundant paperwork !  Lost samples

Search of containers for MIS-Identified specimen


!  Total waste per hour: 14 min 40 sec !  (11 bags/hour) !  Total waste per shift: 2 hrs 24 min !  Time wasted in a 40 hr week: 9 hrs 36 min !  Time wasted per year: 499 hrs 12 min

Above data is for only 1 shift !!

Handling Waste Calculator


Using only items that are needed for the next step in production

Create continuous process flow

Principle 2:


Trail of operating room nurses search for blankets

No blankets in the

patient care area

“Bring the work to the man and not the man to the work”

-Henry Ford

Principle 2:


Trail of operating room nurses search for blankets

DEMONSTRATION of

WASTED TIME

Thanks to Angie Williams

Principle 2


One operator works multiple tasks on the inside

of the cell

Task 1

Task 4

Reduce excess travel and motion

DROP-OFF

U-‐Shaped Cell


Work moves along the process path in a smooth and uninterrupted stream

!  Create continuous process flow

•  Leveled •  Balanced •  Cross Trained


Step 1: Create a process map and identify your current process

Step 2: Design work cells for efficient flow Step 3: Rearrange equipment according to your

new process Step 4: Shift to continuous flow, one unit at a time, pull

small batches and determine the need of the customer

Step 5: Measure the result

Steps to Continuous Process Flow


!  Kanban card to signal the next step !  Pull small batches-‐ continuous and managed !  Reduce steps !  Faster & Fewer defects

Principle 3: Use the Pull System


!  Based on forecasting !  No signal when to start of stop !  Wasteful !  Large lots !  High inventories

Push System

http://logistique-pour-tous.fr/flux-pousse-ou-flux-tire/


kanban

Pull one unit of work at a time

!  Respond to customer demand !  Provide customer what they want, when they want it !  Pull is continuous and managed

Custom-ordered F150 show truck


Signaling device that gives instruction 1.  Trigger orders to restock inventory 2.  Next step in production

Red Zone

We’re low on: !  Gloves !  Cassettes !  Stain

Kanban


Surgical Pathology Item

Vendor: Name

(0000000000) Part #:

0000-00 People Soft #:

N/A Cart Count #:

N/A Reorder At:

#, Unit Quantity to Order:

#, Unit Price $0.00

Histology

1st Generation

2nd Generation

Kanban inventory can

be applied anywhere

Kanban Inventory


What Belongs on Kanban Card

!  The material !  A vivid description,

drawing, photo !  Physical location !  The external or internal

supplier !  The order number !  What, when and how

much to make/order


Work Flow

Production Kanban in Color Coded Streams

HF, (2013)


Elimination of Waiting: 1. Create fast track streams to separate cases 2. Redesign staff schedules to more closely follow the work 3. Redesign appointment to distribute patient load

Patients Waiting

Principle 4: Level the Workload


Continuous Flow

“ The Shop Floor is a Reflection of Management” -Mike Rother LEI

http://www.lean.org/library/creating_continuous_flow_introduction.pdf

Continuous flow: A combination of just-in-time inventory production and kanban Production

The goal: A well balance line with minimal waste lowest cost, on time delivery and defect free production

Have just what you need, when you need it.


Case Rework Box

Kaizen

Stop to fix problems to get quality right the first time

Principle 5: Build a Culture of Continuous Improvement

Non-‐Priority defects go into the “Case

Rework” box with the form and

slides.

HF, (2013)


!  QC person of the Day designated in each area

!  Identified by name & photo !  Resolves defects using standard protocol

Defect Driven Continuous Improvement

HF, (2013)


1100 Trucks a day are manufactured

1% are defective

= 11 trucks per day are reworked

Reworking Ford F150 Trucks


!  Every employee is an inspector

!  Inspect, STOP, and FIX at the source

!  It is important to stop the line: !  To prevent defective products

!  To make improvements

!  To develop a line that is strong & rarely needs to be stopped

Develop a culture of not passing defects

Stop the Line


Standardization of tasks

is the foundation for

continuous improvements

& employee empowerment

Method 1? Method 2? Method 3?

Reducing the Variation in Our Work

Principle 6: Standardization of Tasks


Surgical Safety Checklist


Job Aids


Work segregation

Principle 7 :Visual Control


Color Code the Workload


Go where the defect occurs, and ask why? Assume nothing, verify everything.

Don’t rely on other reports.

Principle 12: Go and See

!  Is there a process in place

!  How are defects handled?

!  Who supplies whom?

!  Who is the supplier?

!  Is there wai9ng?

!  Are there defects?


Most Specimens arrived at night Highest number of specimens batched between 4-8:00 PM

Extensive data collection to know source of problems

Principle 13: Decide Carefully, Implement Rapidly

HF Pathology, ( 2013)


Accession Gross

1 HR 2 HRS 1 HR

3 min 3 min 1 min 1 min

Large Batches

= 1 = 1 = 1 = 3 = 2

CT= 1 min CT= 3 min CT= 3 min

3 HRS

Acquisition &

Transport

75 min

CT= 1 min

VA= 83 min

NVA = 1020 min 10 HRS

VA = 8.13 % NVA

Multiple Specimen Handling

To Processor

Redundancy

= 1

CT= 75 min

Receive In

Pathology

Sort into Buckets Accession Gross

Current State Value Stream Map


Added: 10:30 1:30

Completed Goals: 1. Redesign courier pick up schedules to more closely follow the work 2.  Added more runs

Specimens Collected & Prepared for Pickup



Leveling the load

= 1 = 3

CT= 1 min CT= 3 min

75 min

Waiting

1.  Customer/Supplier meetings with clinics to expedite specimens to the lab

2.  Standardize clinic specimen pick up to every hour with sign off

3.  Installed lab pickup boxes in the clinic walls

Acquisition &

Transport

= 1

CT= 75 min

3 HRS

UNCHANGED

75 min 3 HRS



Hourly specimen pick up

Expediting Specimen Movement to Lab

NEW Process: Visual specimen drop-off boxes at each clinic entrance doorway, recessed into the wall. Easy to see & collect. OLD Process: Buckets throughout internally located clinics, non-standard


Added 2nd Accession Shift til 11PM

10 sec

35 MIN

1 min

= 1 = 1

Acquisition &

Transport

CT= 1 min

10 HRS

= 1

CT= 75 min

Receive In

Pathology

9.5 Hours REDUCED TIME

Waiting

IMPROVED



Large Batches

= 1 = 1 = 1

CT= 1 min

Acquisition &

Transport

CT= 1 min

Multiple Specimen Handling

= 1

CT= 75 min

Receive In

Pathology

Sort into Buckets

2 HRS

Waiting

1 min

Leveling the load

1.  Redesigned specimen handling

2.  Removed multiple handoffs

3.  Created Specialty Streams

5 min

30 sec

1.9 Hours REDUCED TIME

IMPROVED



Batching the Work Load



Standardization of Work

8 min Trays contain variable number containers to produce 20 slides

Leveling the Work Load



Accession

1 HR

3 min

= 1 = 1 = 1 = 3

CT= 1 min CT= 3 min

Acquisition &

Transport

CT= 1 min

= 1

CT= 75 min

Receive In

Pathology

Sort into Buckets Accession

Smaller Batches

5 min

2 min

1. Redesigned work into trays 2. Removed redundant steps 3. Redesigned & revised part types 4. Barcoded Specified &

Standardized Work Processes IMPROVED

56 Min REDUCED TIME



Reduce Steps = FASTER & Fewer Defects

60% time reduction

Pull Smaller Batches


Current State Value Stream Map Pathway to Processing

Accession

= 1 = 1 = 1 = 3

CT= 1 min CT= 3 min

Acquisition &

Transport

CT= 1 min

= 1

CT= 75 min

Receive In

Pathology

Sort into Buckets Accession

unchanged

= 2

CT= 3 min

Gross

3 min

1.  Created a macro to eliminate gross dictation 2.  Standard protocols & cassettes via LIS 3.  Prioritized specimens by specialty 4.  Timer to PULL cassettes to processor

3 min

Implement PULL


Use Only Reliable Thoroughly Tested Technology

Barcode Specified Work Processes

All barcodes generated at Accession & Microtome

Requisition

Specimen container

Tissue cassette

Glass slide HF, (2013)


Work Simplification Redesign

HF, (2013)


Receive in Pathology

Sort into Buckets Accession Gross

5 min 5 min 28 min

3 min 2 min 30 sec 10 sec

= 1 = 1 = 1 = 2 = 1

CT= 30 sec CT= 2 min CT= 3 min CT= 60 min

Acquisition & Transport

CT= 10 sec

VA =80.6 min

NVA =253 min 35 min

VA/NVA = 32 %

180 min

75 min

To Processor



Focusing on elimina.ng waste is the best leverage for an improvement effort

WASTE 32% Value Added 68%

Lead Time Cycle Time

WASTE 32% Value Added 68%


WASTE 8.13% Value Added 91.87%


Before

After

Non Value Added Work


Pick reasonable defects to eliminate

How Do I Get Started?


!  Sensing the pulse of the “machine”

!  If you can’t measure it, you can’t fix it

!  Develop indicators cri9cal to quality

!  Adap9ng data collec9on & analysis !  Real-‐9me, visual, publicly displayed

!  Captured at point of worker detec9on

!  Create measurement tools, Andon-‐like

Measuring the Current State


Real-time production information

Andon Boards


KEEP IT SIMPLE

Data Collection

Defect Type Number of occurrences


!  Start Simple

!  Define start and stop times

!  Continue over all shifts

!  Ensure blameless data capture

!  Tabulate results

Design Improvement


Four Rules of Work Design


!  Rule 1: Activities !  Highly specified work-‐ content, sequence, timing, location, &

expected outcome

!  Rule 2: Connections !  Every customer-‐supplier connection (roles not individuals)-‐ highly

specified, direct, unambiguous yes-‐or-‐no way to send requests & receive responses

!  Rule 3: Pathways !  For every product/service-‐ predefined, highly specified, simple &

direct w/ no loops or forking

!  Rule 4: Improvement !  Made in accordance w/ scientific method, under guidance of a

teacher, at place work is done, toward the ideals, using data

Bowen & Spear: Decoding the DNA of the Toyota Production System. Harvard Business Review, Sept-Oct, 1999.

Four Rules of Work Design


!  Work must be highly specified as to

! Content,

! Sequence,

! Timing,

!  Loca9on,

! and Expected Outcome

Rule 1: Activities


!  How do you do the work?

! Who is your customer?

!  How do you know if you are

doing the work correctly?

Activities of Standard Work

h^ps://www.behance.net/gallery/18566529/Standard-‐Work-‐Poster-‐

Building-‐Lean-‐Series


Ford F-150 Truck Factory

Standard Work Critical to Quality Wiring harness assembly

Get It Right the First Time


!  Between customers & suppliers must be: !  Highly specified !  Direct !  With an unambiguous yes-‐or-‐no way to send

requests & receive responses (NO assumptions)

Rule 2: Connections


!  Who are your customers?

!  What is the expected 9me frame?

3 4

How Do People Connect?

Histologist Pathologist

Clinician Specimen Receipt

Meet with your customers to identify requirements


!  The pathway for every product & service must be-‐

!  Predefined

!  Highly specified, Simple

!  Direct with no loops or forks

histology pathologist

pathologist molecular

histology molecular pathologist pathologist

fork

loop

Rule 3: Pathways


!  Any improvement must be made in accordance with-‐the scientific method (data driven)

Rule 4. Improvement is Highly Specified

!  Under guidance of a teacher (Team or Group Leader, Quality Facilitator)

!  At place where work is done !  Moving incrementally toward the ideal


Improvement discussions held for 20 minutes, a few days a week

Team Meetings Where the Work is Done


Iden.fy Defect

Ongoing PDCA

Resolu.on

Process of Improvement

Daily Resolu.on

A3 PDCA Resolu.on

Customer-‐Supplier Communica.on at level of work

Team Leader Facilita.on

Share the Gain Learnings

Rapid Fix


Take Home Messages

1.  Understand the philosophy, create a strategy and apply tools and principles to the system of work

2.  Empower the worker 3.  Identify the focus of the value stream mapping 4.  Conduct weekly meetings 5.  Implement and track improvements


Questions & Answers

Documents

LEAN Principles - Lab Quality Confab1 HR 2 HRS 1 HR 1 min 1 min 3 min 3 min Large Batches = 1 = 1 = 1 = 3 = 2 CT= 1 min CT= 3 min CT= 3 min 3 HRS Acquisition & Transport 75 min CT=