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Objectives:
Interactive activity to
practice concepts learned
Problem Solving and basic lean concepts
Key components of
a successful lean
transformation
Lean is more than a set of
tools
The application of lean in
Healthcare
• Lean is all about looking at things from the customer’s (or patient’s) perspective to deliver the highest value.
• It focuses on improving culture and processes so that we can deliver the best experience possible to patients.
• Front-line employees are developed and empowered through problem-solving and coaching.
• Leadership is also developed alongside of an effective daily management system.
3
The Lean Management System
5
2000s 1990s 1980s 1950-1970
Toyota Production System is developed at Toyota and shared with domestic suppliers.
Shared with all of Toyota’s suppliers and other automobile OEMs.
Adopted by other assembly and manufacturing industries
Adopted by other industries such as hospitals, healthcare systems, banks, retailers, logistics, hospitality, airlines and the military.
Successful Components of Lean Transformation
Improvement System
Lean Leadership
Mindsets & Capabilities
Performance Management
Voice of Customer
Customers are the actual and potential users of our services
Patients are the primary customers of healthcare organizations • Internal/External customers • Primary/Secondary customers
8
Who is our customer?
3 Lean Categories
Lean divides all work into three categories to determine if they are waste
9
Time Spent Adding Direct
Value to Patients/
Customers
Time Spent on Necessary
Tasks that May Not Add Direct
Value to Patients/
Customers
Time Spent on Unnecessary
Non-Value Activities
8 Wastes
10
Excess
Processing
Waiting
time
Wasted
Intellect
Value Added
Over- Production
Rework
Wasted Motion
Excess Inventory
Wasted Transportation
Capabilities of people
that are not used or
leveraged
Waiting for ANYTHING
Unnecessary
effort to get the
work done
Unnecessary
movement of work
Work that is
waiting to be
processed
Producing unnecessary work
or deliverables
Correcting
error/defects
People moving or working
without producing
Rules:
• One person starts by holding 1 ball. • The ball must pass through each person’s hands once
each cycle. • The ball must start and stop at the same person- This is
one complete cycle. • Not allowed to pass the ball to the people standing
directly next to you • Two people cannot touch the ball at the same time • The team must complete 3 cycles without dropping
the ball. A dropped ball is a quality defect and you must start over
• Form Teams of 7-10 people & Stand in a Circle. • Decide who will be the timer.
Problem-Solving is More Than Tools
15
Improvement Project
Current Condition
Improved Condition
Old vs New Thinking
4-Step Problem-Solving Approach
16
Confirm &
Sustain Describe
the
challenge
Identify root
cause
Develop
Counter-
measures
1
2
3
4
Customers
Patients
Members
Problem A3- [TITLE] Sponsor(s):
Strategic Priority Alignment: Team Lead (s)
1. Describe the Challenge
Problem Statement:
Background / Business Case:
3. Hypothesis Testing / Develop Countermeasures
Metric Baseline Target Benchmark
Team:
Last updated:
2. Identify Root Causes
Understanding Current State: What is currently happening?
Target Condition / Goal: What Should be happening?
4. Confirm & Sustain
What is the problem or gap to be solved?
Why the problem or gap to be solved.
What is currently happening today?
What should be happening?
How will we know we are successful in
solving this problem?
Who is closest to the process that should be involved in problem-solving?
What are the potential root causes of the
identified problem?
What potential solutions are we
trialing and implementing to remove
the root causes?
How will we know we have
sustained the improvement?
Root Cause Analysis Basics
19
SYMPTOM of the problem
Underlying CAUSE below the surface
The word “root”, in root cause analysis refers to many causes, not necessarily just one.
The 5 Whys
Problem
description
Problem
definition
Symptom
Why?
Why?
Why?
Why?
Why?
Symptom
Symptom
Symptom
Root
Cause
5 Whys Saved the Jefferson Memorial The stone on the Jefferson Memorial was crumbling
Solution: Delay the daily lighting to one hour after sunset. Midge population is down 90%, they have broken the food chain and there are less frequent washings.
Example provided by Juran Institute
1. Why was it crumbling?
Too frequent washings were causing the stone to crumble
2. Why was it washed so often?
To remove bird drippings
3. Why were so many birds in the building?
There is an abundant food supply: hundreds of little fat spiders1
4. Why are there so many spiders?
Spiders were attracted to the midges
5. Why were there so many midges? Every evening at dusk they emerge in a mating frenzy. At the same time, the Park Service turns on its powerful spotlights. The midges are then attracted to the lights.
Don’t Jump to Solutions
• Why do we want to break this habit?
• How do we change this mindset?
Before I state the problem are there any solutions?
Improve the process, remove root causes and eliminate waste.
23
Error-
proofing
Process
Redesign
Visual
Management
Standard
work
28
Reduce the time it takes to
complete a given step
Reduce the number of
steps
Complete steps in parallel
Reduce time in between
steps
3 Methods for Standardizing Operations
32
1. Make timing consistent
2. Make roles and responsibilities consistent
3. Make materials and information consistent
How can these basic lean concepts be applied to remove waste in Round 2 of the Tennis Ball Activity?
35
Error-
proofing
Standard
Work
Visual
Management
Process
Redesign
Rules:
• One person starts by holding 1 ball. • The ball must pass through each person’s hands once
each cycle. • The ball must start and stop at the same person- This is
one complete cycle. • Not allowed to pass the ball to the people standing
directly next to you • Two people cannot touch the ball at the same time • The team must complete 3 cycles without dropping
the ball. A dropped ball is a quality defect and you must start over
• Stay with same team as you were in for round 1 • Decide who will be the timer.
What is Lean Leadership •Definition: Leadership’s presence in their staff’s work environment, preparing them for change and helping them manage through it.
39
Show respect
• Connect with staff. Show interest in teams’ efforts, individual suggestions and help people with obstacles
Always think of the customer first
• Focus front line and all leadership levels to address patients’ needs first
Be present
• Check the visual management, participate in problem-solving and observe front line
Ask questions
• Develop problem-solving skills through thought provoking questions
• What do you consider to be Lean Leadership?
• What do you do now (or have done in the past) that you might consider Lean Leadership?
40
Successful Transformations
41
Successful transformations require leaders to lead the change journey. Lasting impact is hard to achieve.
Results of transformations1
~70% of transformations fail because management behavior undermines the
transformation and employees are often not empowered
SOURCE: 1 Beer and Nohria (2000); Cameron and Quinn (1997); CSC Index; Caldwell (1994); Gross, et al. (1993); Kotter and Heskett (1992); Hickings (1988); Conference Board report (Fortune 500 interviews); press analysis; team analysis
Program fulfils objectives Employee resistance
Management behavior does not support change
Other obstacles
Insufficient resources
Successful Transformations Successful transformations require leaders to lead the change journey…and leadership behavior is crucial
42
1
Leadership is critical to inspire the
transformation – role of the
sponsor creating a movement
2
Leadership matters to role model and drive the transformation – role of
the managers during the transformation
to ‘go and see’
3
Leadership is the backbone of
sustainability and continuous
improvement
Stages of Change As individuals move through stages of change, they experience a variety of responses
44
Concern
Will I
be
able to
do it?
Something
is finally
going to
change Change?
What
Change?
What
impact will
it have?
How will it
affect me?
It is more
than I
expected!
Who
am I?
I'm going!!
This is not
for me!
I see a
future for
myself
It works and
is effective!
Relief
Denial
Fear
Threat Dejection
I'll prove that
it is
unnecessary!
Disappoint
ment
Hope
Confidence
Animosity
What can you do to stay motivated and to
motivate others?
• Shares Best Practices
• Encourages Learning & Reflection
• Drives key behaviors
• Role models collaboration
• Allows staff time to do problem-solving
• Creates a safe space
• Allows the team to fail forward fast
46
Continuous Improvement
47
Time! Calendars! Meetings! … “Oh my!”
Workload variability
Lack of feedback loops to support the development of ideal behaviors
Dependent on lagging indicators to determine success
Geisinger is geographically dispersed
Firefighting
Other non-value added work
•Lean Leadership is a responsibility for each level of leadership from executive leaders to front line managers
48
Map your standard work
Role Model Lean Leadership–
including good change
management
Support your direct reports - including accountability for
change and improvement
Lean Leadership & the 4 Key Areas that Need to be Implemented Into Your Week in the Life of (WILO)
49
Action
Gemba - understanding
the frontline
Engaging in problem-
solving sessions
▪ Conduct in-person floor visits to understand
state of operations, confirm processes and
identify issues before they arise
▪ Actively lead your management team in
problem-solving sessions on their most
challenging priorities
Conducting regular
discussions about
performance
▪ Have group-based performance
management discussions with direct
reports and connect performance to vision
Coaching
▪ Actively provide coaching and feedback to
all staff in an informal or formal manner
Week in
Life of
a Lean
Leader
(WILO)
Description
Bringing it all together
Improvement System
Lean Leadership
Mindsets & Capabilities
Performance Management
Voice of Customer