I N S I D E

Key Take-aways from the VAPExKeynote PresentationDavid Mann, author of Creatinga Lean Culture, on Leading aLean Organization p2

Q&A with David MannAn exclusive follow-up interviewwith our keynote speaker p3

Lean in Healthcare:A Cultural TransformationVAPEx panelists from hospitalsleading with Lean answer questions p8

Highlights from VAPExWorkshops and Presentations

• Getting Out of the Blame Game p5

• Using Visual Controls to EnsureContinuous Improvement p6

• Managing Metrics the Lean Way p6

• Lean-Driven Laboratory Design p7

• Standard Work for Leadership& Managing to Standard Work p12

• The Change Integration Process p13

PEx Puzzler p12

ValuMetrix University Course Offerings• Six Sigma Green BeltCertification

• Lean Training Series p14

Breakthrough LeanExecutive SeminarsPhiladelphia, Sept. 25–26, 2007New York City, Jan. 17–18, 2008 p15

AdvantageS E R V I C E S

A newsletter from ValuMetrix® Services, Ortho-Clinical Diagnostics, Inc. Vol. 3, No. 2 Fall 2007

ProcessExcellence

Process improvement leaders in healthcare convenein Chicago to share knowledge, best practices

“Embrace the miss,” proclaimedDavid Mann, the keynote speaker atValuMetrix VAPEx 2007. Speakingto the gathering of Process Excellenceleaders in Chicago, the author ofCreating a Lean Culture explainedthat every mistake is an opportunityto “smoke out” and eliminate flawsin a process. If staff members arereprimanded for their mistakes, theywill hide them and deprive you ofthat information.

Mr. Mann’s address was part of atwo-day conference that includedworkshops on the finer points ofLean, a panel discussion on applyingLean to a healthcare setting, and a

Lean-themed performance by acomedy improv troupe. “It was greatto network with people who havealready done things we’re planningto do,” said Pam Good, Directorof Laboratory Services at BroMennRegional Medical Center in Normal,Illinois. “Now we’re aware of boththe problems we might encounterand some possible solutions.”

This special edition of PEx Advantagesummarizes some key take-awaysfrom the 3rd Annual VAPEx Forum.We also pose follow-up questionsto our panel of hospital executivesand present an exclusive follow-upinterview with David Mann. �

SPECIALREPORT

on the third annualforum of the

ValuMetrix Associationof Process Excellence

(VAPEx) inHealthcare

A results-oriented executive will bellow, “Doyou need me to help?” As soon as you starthitting the goal, you never see him anymore(which may be an additional incentive tomeet the goal). As soon as you meet a goalset by a Lean manager, he brings otherpeople around to see your process.

Lean management is difficult, not becauseit’s complex, but because it is different. Youhave to change your organization’s cultureand habits. And those habits have had a longhistory of reinforcement. That’s why badhabits are not broken; they are methodicallyextinguished. In a process that is similarto extinguishing a campfire, you have torepeatedly douse, stir, and douse. It’s acumulative process, completely reversibleif you don’t persist.

2

LEADING A LEAN ORGANIZATION

What characterizes a Lean leader? Most organizations look for “results-

oriented” managers who “solve problems and get things done.” But Lean is

a system of ongoing improvement. Lean thinkers search out problems where

none are thought to exist. Then they work to eliminate the causes. In a

Lean manager’s view, negative feedback is the most valuable of all because it

prompts adaptive change. That’s why Lean managers set up their systems to

be very sensitive to problems.

“Lean management isdifficult, not because it’scomplex, but because itis different.”

Key takeawaysfrom DavidMann’s keynoteaddress

3

Q: You have said that processesare often overlooked in anorganization because no oneowns them. Why has the conceptof process ownership not gottentraction?

A: I think the main reason is thatwe’re not organized by process.Fundamentally, a process ishorizontal. It goes across theorganization and is contributed toby the functions through whichit passes. There’s no career pathassociated with a process. They’renot on the org. chart. They’re not inthe budget.

Q: Should we consider appointingprocess managers?

A: We are experimenting withprocess management at Steelcase.There haven’t been any formalannouncements and everybodystill has their day job.

But we’re proceeding with the samestrategy you would use in spreadingLean across an organization. Youimplement it in a place or two and getit working. You measure the differencebefore and after in terms that areimportant to the organization likecapacity, throughput, cost, and qualityof output. Then you show it to otherpeople, and say, “Here’s an area thateveryone knows was tremendouslyfrustrating before. Now it seems to berunning pretty smoothly. Do you thinkthere are other areas where we mightwant to try this kind of thing?”

So rather than appoint processmanagers and risk “nuclear” turfbattles, we’re going to demonstratein a low-key way that this is a way oforganizing and managing that makessense. We want to get some practiceat it and refine what we’re doing aswe bring people around.

Q: Sounds like a fairly low-keyapproach to change management.

A: Yes. My thinking in general is, it’snot the new CEO who comes in andsays, “I have a mandate to changeeverything, so here’s what we’regoing to do.” That’s not necessarilygoing to be effective because it’s byfiat and it goes against what peopleknow and the skills people have andthe way the organization is wiredtogether.

The strategy we’re talking about ismore of a pull strategy. We establisha working model or two. We learnfrom those early experiments, makesome refinements, and get the modelsworking better and better. Then westart saying, “Hey, look what we’vedone over here. What do you thinkabout this?” And give people achance to draw their own conclusions.

Continued next page

A FOLLOW-UP INTERVIEW WITH VAPEx KEYNOTE SPEAKER DAVID MANN

Success measures should reflectthe health of a process

Just as Lean leaders focus on process, yourmeasures of success should reflect not results,but the health of your process. If you reachthe point where you’re achieving your goals95% of the time, you want to stress thesystem and expose sources of failure.Otherwise, you’ll never find ways to getbetter. “I know I’m not perfect,” Mr. Mannexplained. “And if I’m not perfect, I wantto see my problems. Respect the problemand learn everything about it. Who were itsparents and grandparents? Then pull it outby its roots.”

The value of …value stream mapping

Value stream mapping is an especiallyhelpful tool for Lean leaders. Why? Becausea process is often invisible. No one reallyowns it. No one has ever seen it. A valuestream map gives you process measures(e.g., speed, quality, time, labor) that youcan monitor to manage a process.

You can’t sustain a Lean implementationfrom the office or from a computer screen.You need to “Go to the place, talk to thepeople, and look at the process.”

And finally, the only teaching method thatworks well in Lean is the master/apprenticemodel. It’s the philosophy of “Read one,see one, do one, teach one.” You becomea steward of the process perspective bybecoming a student and then a teacherof it. �

David Mann, PhD, is Manager of LeanManagement and Organization at Steelcase,Inc. in Grand Rapids, Michigan. He is theauthor of Creating a Lean Culture.

The follow-up questions from VAPEx attendees led to an extended discussion withkeynote speaker David Mann. The following is an account of this exclusive interview.

4

Q: If Lean doesn’t work well when“dictated” from above, doesthat mean it’s not as necessaryto have the backing of seniormanagement?

A: You always need the backing ofsenior management. I supposethere’s a chance that you can pulloff some spectacular success, getthe attention of those higher in theorganization, and win them overthat way. But that’s the exception.

In the majority of cases, there arepolitical considerations when you’recrossing so many organizationalboundaries. These are legitimateconcerns around, “Do you want me tomeet my functional goals, or do youwant me to meet my process goals?”If the process goals didn’t come fromsomeone in a position of authority,then managers aren’t going to be sointerested in doing both.

People are capable of keeping twosets of goals in mind, but they justhave to know that this new set ofgoals is also important—the onethat isn’t reflected in the organizationchart, the budgeting process, andall the rest. And it’s the seniorsponsorship and frequentengagement that people remember.“Oh, yes, my senior vice presidentand corporate officer were downthe other day looking at how this isgoing.” That makes all the differencein the world.

Q: Could you comment on the need toalign incentives and compensationto process performance?

A: My first impulse is that it not be thatstructured. It should be coveredunder the normal compensationstructures that reward success. Aslong as the senior executive level ofan organization is involved in thedecision of, “Yes, we should do this,”upper middle-level managers shouldknow that if they do well, it’s going tobe good for them. And if they don’tdo well, it’s not going to be so goodfor them. The expectation is thatthey’re going to do what they need todo to make these processexperiments successful.

Q: Would you advocate working withHR to include Lean competenciesin the job descriptions?

A: It’s a very low-leverage place tobegin. Usually, when somethinggets to the point of being in thejob description, the organization ispretty settled on “This is the way weneed to be doing these things.” Butfor most of us, Lean is in the earlyadoption stages. And we’ve alreadydiscussed how imposing Lean by fiatrarely works.

I would rather see the commitmentarise and show itself first in the day-to-day management practices andthen be captured in writing. A jobdescription in an HR file is not reallywhat drives an employee’s behavior.

Q: You wouldn’t add Leanmanagement practices to amanager’s job description?

A: The managers in our newly Leanareas have standard work thatpretty explicitly codifies what they’resupposed to do. They should be“going to the place, looking at theprocess, talking to the people.”They should be maintaining a systemthat captures misses from processesand converts them into actions thatproduce process improvement.

But these are tactical steps forhow you get your job done. Thatkind of detail doesn’t really belongin a job description. Part of thatmay be a matter of taste. In myview, job descriptions and that sortof personnel/administrative functionsdon’t add much value; they’renecessary waste.

Q: Could you comment on theimportance of identifying thepolicies that drive processstructures and designs?

A: I can give you some examples thatan organization might want to thinkabout. The first is, you decide it’simportant to cross-train your peopleand have them rotate throughdifferent workstations. YourHR policies need to reflect theexpectation for cross training androtation.

Another second policy might involvepeople whose jobs are eliminatedas a result of a Lean initiative. Is thepolicy, “You have 90 days to find anew job, and if you don’t find one,you’re out of the organization?”

LEADING A LEAN ORGANIZATION

“It’s senior sponsorship and frequent engagement that peopleremember. ‘My senior VP and corporate officer were down theother day looking at how this is going.’ That makes all thedifference in the world.”

5

KEY WORKSHOP TAKE-AWAYS

Or are the policies revised to say,“If you’re displaced because ofprocess improvement, we will giveyou opportunities for training or placeyou in areas where we anticipategrowth.” You need a policy likethat because if you don’t guaranteepeople’s jobs, you’re not going toget a lot of cooperation from themin identifying changes that couldbe made.

Finally, when you do eliminatepositions, which ones do youeliminate? Do you want to develop apool of multiskilled people who canoperate as backups or fill-ins forabsent employees? If so, you maychoose to eliminate the most skillfulpeople because they would havethe most value in this sort of multi-talented backup pool. These arepolicy-level things that warrantadvance consideration.

Q: We’ve heard the person you wanton the Lean team is the one youthink your operation could neverlive without. Ironically, that’s theperson you should pull to put onthe team.

A: That is true because what you wantto do with Lean is make the operationmuch more process-dependent andnot so dependent on that smart guyor gal who happens to knoweverything. Because nothing isdocumented and there are nostandard procedures, you call themto say, “Hey the thing’s hiccuping.What do we do now?” In a Leanenvironment, you’ll say, “Hey, thething’s hiccupping. Let’s look up thehiccup procedure and follow thesteps.”

Getting Out of theBlame Game

“Blaming others for our problemsprovides easy answers and seemingly‘neat and tidy’ solutions,” explainedSenior Consultant Mark Graban in aVAPEx breakout session. “We’ll just getrid of Joe and the problem won’t happenagain.” But most errors are not solely anindividual’s fault. We need to focus onsystemic causes and systemic prevention.

To dramatize his point, Mr. Grabanled the group in Deming’s Red BeadGame. “Employees” scooped samplesfrom a premixed bin of beads, while“supervisors” recorded the ratio ofdesired white beads to undesired redbeads. None of the typical measures –be it firing poor performers, a sternvisit from “company headquarters,” ormotivational posters – seemed effectiveat raising quality levels.

Mr. Graban then took the groupthrough an alternative Lean approach.Instead of demanding “Who causedthe problem,” ask, “Why did it happen?What allowed it to occur? And how canit be prevented?”

One helpful technique is to ask Toyota’s“Five Whys.” In one case study, whenLean team members asked, “Why aremed cart batteries often dead?” theimmediate answer was, “The batterycharger isn’t working.”

But when they continued to ask, “Whyisn’t the battery charger working,” itturned out that the outlet was dead.Asking additional “whys” eventually ledto the root problem: High water pressurein a nearby sink caused splashing thatshort-circuited the electrical outlet.

Mr. Graban then showed examples ofmistake-proofing strategies that:

• Make it harder to create the error

• Make it possible to reverse the error

• Make it obvious that an error hasoccurred

• Detect deviations from proceduresor fixed values

In short, make it easy for people to dothe right thing – and hard for them todo the wrong thing. �

Mistake-proofingin action: holes inthis interofficeenvelope helpprevent office workersfrom accidentallydiscarding documents.

Attendees simulate the “effectiveness” oftypical quality control measures in Deming’sRed Bead Game.

6

KEY WORKSHOP TAKE-AWAYS

If each “miss” is an opportunity forimprovement, how can you tell whenyou’ve missed? That’s when you need visualcontrols to alert you at a glance when yourprocess is not where it should be.

It could be a light that flashes whenequipment is malfunctioning, or a red flagthat pops up when your backlog exceeds apre-set limit. The actual form will vary withthe demands of your particular process, asDavid Mann explained in a VAPEx sessionon continuous improvement.

But in general, an ideal visual controlhas the following characteristics:

1. It makes your process status obviousat a glance, e.g., from 10 feet away

2. You can explain how you’ll use the data

3. You can tell if the visual is current,communicating the most recentinformation

4. It is self-documented, telling youthe “who, what, when, and how”of your process

5. Entries are clear, complete, specific

6. It is completed by hand, withoutrequiring computer access

7. It is recorded on paper so it canbe preserved for analysis

After showing examples of visualcontrols, Mr. Mann led an exercise ondeveloping controls based on real-lifescenarios provided by attendees. �Pink rectangles in this visual control

show when production fell behindschedule. Workers record the reasonin the column on the right.

Using Visual Controlsto Ensure Continuous Improvement

Managing Metricsthe Lean WayYour average turnaround time is 165 minutestoday. It was 168 minutes three monthsago. Is your process improvement initiativesucceeding? “Two data points do not makea trend,” warned Senior Consultant MarkGraban in a preconference workshop atValuMetrix APEx. To know if your changesare making a difference, you must first:

• Achieve a stable system, one that does notvary excessively on its own

• Calculate the remaining degree of variationso that you can distinguish genuine changesfrom mere “background noise” variation

“If each ‘miss’ is an opportunity for improvement,how can you tell when you’ve missed?”

7

Room for improvement: Some of themost dramatic productivity gains canbe achieved by placing the frequentlyneeded equipment together.

Managers who skip these steps may end uptaking action that makes a stable situationworse. They would be better off heeding W.Edwards Deming, the grandfather of processimprovement, who advised that sometimesthe best course of action is, “Don’t just dosomething. Stand there.”

Mr. Graban gave examples of control chartsthat help differentiate “signal” data frombackground noise. Dotted lines indicate thelimits of natural deviation. A data point thatexceeds those limits suggests that somethingunusual has happened.

That is the manager’s cue to ask, “Is thislikely to happen again? Is it preventable?”

“The key is to identify exceptions andrespond the same day, not at the end of themonth, when everyone has forgotten thedetails,” Mr. Graban said. “By then, it’s toolate to figure out what caused the exception.”

“We’ve been doing a lot of ‘Oh, it’s badtoday. Hurry, let’s do something,’ whenmaybe it’s just that day’s variation,” saidElizabeth Collins, a Lab Manager at NewHanover Regional Medical Center in NorthCarolina. “The math is right there in thehandouts Mark gave us. He included samplecontrol charts. So I do believe we’ll be able todo that when we get back.” �

A Lean operation makes the right products,in the right way, at the right time, at a costthat leaves a profit for the organization. Inmany cases, however, the very layout of alaboratory makes that difficult.

In her preconference workshop on Leanlaboratory design, Six Sigma Black Belt andLean Champion Claudia French explainedthe DMAI2C process for addressing thatproblem:

1.Define the project and what is criticalto quality for your customer

2.Measure the current state, includingactivity of the product and operator

3.Analyze product flow and operatoractivity to identify waste and opportunitiesfor improvement

4. Innovate and Improve, basing a finallayout on information gathered duringanalysis

5.Control the outcome by establishingmetrics that will measure the success ofyour project. Monitor those metrics dailyduring implementation and at least weeklyonce implementation is complete

Ms. French gave an example of how thesesteps were applied at Sacred Heart MedicalCenter in Spokane, Washington. Afterlaboratory services were consolidated fromthree buildings into one Lean space, the labwas able to reassign 5 FTEs, while reducingovertime from 200 hours to roughly 20hours per pay period. No specimen has beenlost internally since implementation. �

Lean-Driven Laboratory Design

Managing a Stable System: This control chartshows the normal range of variation in a process,making it immediately clear when a significantexception has occurred.

“Two data points do not make a trend.”

8

With so many perspectives andexperiences to share, there was simplynot enough time to answer the manyquestions sparked by the VAPEx paneldiscussion. Below, as promised, arethe panelists’ follow-up responses.Our panelists were:

• Shawn NoseworthyAdministrative DirectorFlorida Hospital, Orlando, Florida

• Peter O’Brien, Vice President, KingstonGeneral Hospital, Kingston, Ontario

• David Schlappy, Vice PresidentLe Bonheur Children’s Medical CenterMemphis, Tennessee

• Fred Slunecka, Regional PresidentAvera McKennan HospitalSioux Falls, South Dakota

• Charlotte TaylorAssistant Vice PresidentMedStar Health, Washington, DC

QUESTIONS FORCHARLOTTE TAYLOR

Q: What did your Lean consultantobserve that led to therecommendation to removeyour automated line?

A: Employees wasted a lot of timewalking around the track every timethey had an exception or breakdown.We also couldn’t get the number ofinstruments that we needed on thetrack because it was prohibitivelyexpensive to get them to interface. Italso became apparent that we weresometimes running dual systems.When a STAT order came in, wewould run around the track to get iton the instrument, rather than puttingit on the track and letting the trackdo its job because people were nolonger as comfortable with it as theyhad been in earlier years.

Q: How are you tracking turnaroundtime, real time, every two hours?

A: Every two hours, our LIS spits outreports for four of the top-volumetests in the work cell. We focus onCBC protimes, our basic metabolicprofile, chemistry, and our heartprofile. Those are tests that we knowneed to get out within a very specificperiod of time. It took our LIS team alittle while to figure out how to getthat report. They had to configure it.

Our supervisors take that report andpost how many exceptions did nothit the turnaround time. If they havethree samples that didn’t hit theturnaround time within those twohours, they find out what’s going onwith the instrument and if there areany issues. In fact, they are nowtraining the staff to get their ownreports, post them, and write thereasons why the exceptions occurred.

LEAN IN HEALTHCARE: A CULTURAL TRANSFORMATION

Our esteemed panelists (l. to r.) Charlotte Taylor, David Schlappy, Peter O’Brien, Fred Slunecka, and Shawn Noseworthy. Moderator: Jamie Miles (standing, right)

Panel DiscussionFollow-up

9

Q: Is your understanding of Leandifferent than when you firststarted?

A: Oh, yes. If it wasn’t different, Iwouldn’t have grown, the companywouldn’t have grown, and we wouldn’thave taken advantage of all of thedifferent workshops that are availableout there. It truly is a journey ofgrowth. When you first start on thispath, you think you’re going tocomplete a project and that’s going tobe the end of it. And it’s not. Itbecomes a way of life.

QUESTIONS FORDAVID SCHLAPPY

Q: When making your commitment tono layoffs due to Lean, did youallow for changing shift or workhours? If yes, how did you addressstaff concerns that the changesdon’t fit their personal needs?

A: Honestly, that never came up asan issue. There are cases where wehad to adjust the schedule to meetdemand, but in our case we neverencountered that as a problem,particularly in the lab, becauseeverything we eliminated wasovertime and PRN status.

Q: Did your FTE reductions turn intoactual savings?

A: Oh, yes. When we reduced our staffby 5.5 FTEs, we figured out howmuch that would cost and rolled thatinto the lab’s budget for the followingyear. We’ve required the savings to bebudgeted in, so that they will be inreal dollars.

Q: Your Lean project called forestablishing a complete backupwork cell. Can you expand on whatyou meant by this deliverable?

A: We had enough space savings fromour Lean design project to create asecond redundant cell that servesthree purposes. One is, when ourvolume gets high enough, we justfire up the second cell. The second is,if any piece of equipment in the firstwork cell breaks down, everybodyjust switches over to the secondcore cell, and we have zero downtime.And the third use is to keep thingsmoving during regular preventivemaintenance. You don’t have to shutdown our process to get that done.

Once we implement this in our newbuilding, we will run one work cell fora month and then move to the otherone for a month so that they’re bothbeing tested and worked in.

Q: You talk about ROI for Leanprojects, but what about turnaroundtime, patient satisfaction, and othermeasures that are hard to expressin short-term dollars?

A: I emphasize financial return becausewe took a gamble on implementingLean in our hospital. We had to havesome way to show that we were atleast going to break even.

That said, every one of these projectshad other metrics as well. For example,when we did our laboratory project,we showed a reduction in turnaroundtimes for most specimens of between30% and 50%. And we did thatduring a period of increased volume,with fewer people.

In our OR project, we reduced thetime it took to build a case cart from12 minutes to six minutes, just byhaving our inventory managed better.

In some cases, I think we couldhave done a better job of gatheringbaseline measures. So going forward,on all the projects we roll out, we’regoing to have a very well-definedset of balanced measures in thebeginning that says, “Here’s the ROIwe’ve got to achieve. Here are theturnaround targets we’ve got toachieve. Here are the error rates we’retrying to reduce, and so on.” Thesemeasurements are very important fordemonstrating success and gettingsupport for future projects.

Q: So is your advice to measure asmany of these metrics as possible?

A: I wouldn’t say as many as possible. Iwould say pick the few that make thebiggest difference. You want to haveprocess metrics, such as turnaroundtimes and throughput. You might alsohave patient satisfaction and someclinical or safety metrics. And thenyou’ll have the financial piece. And allthose together give you a balancedset of measures to say, “This projectwas a success as defined in five orsix different terms.”

Continued next page

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QUESTION FORPETER O’BRIEN

Q: What productivity benchmarksdo you use for your laboratory?

A: We use benchmarks establishedby the Canadian Institute for HealthInformation. They are based onworkload units, where one unit ofwork equals one minute of work.The following numbers are forteaching hospitals across Canada.

KingstonGeneral(Pre-Lean) Mean Median

Lab costper inpatientweighted case $178CD $180CD $172CD

Workloadunits perweighted case 157 136 136

Cost per unit $1.11CD $1.26CD $1.24CD

$CD = Canadian dollars

QUESTION FORSHAWN NOSEWORTHY

Q: Is there any ongoing Leantraining for your people?

A: We have provided one-day trainingsessions. When a project begins,we assign people from that areato work with our full-time LeanProcess Improvement Specialiston the videotaping, analysis, andpiloting. We originally learnedthese techniques during the five-daytraining and original project withour ValuMetrix consultants.

LEAN IN HEALTHCARE: A CULTURAL TRANSFORMATION

QUESTIONS TOMULTIPLE PANELISTS

Q: Do you have FTE/financial savingstargets per kaizen (single quickimprovement) or one general targetfor an entire Lean project?

David Schlappy:We neverreally followed a kaizenapproach. We had a targetthat we aimed to hit for the

whole project. We’d say, “Our ROIshould be this much over this manyyears, and it should take us this manymonths to get to break-even.”

Fred Slunecka:We had arule of thumb that we oughtto save twice as muchmoney as we put into a

Lean project. And we’ve done thaton most projects, but not all. Wehad one project in the EmergencyDepartment where we actually addedFTEs because that’s what it would taketo improve throughput. The savingsin that case came through reducedconstruction costs. So the shortanswer is every project has savedmore than the cost of the project,but not every project saves FTEs.

Q: Does “cost avoidance” translate intoactual savings?

David Schlappy: That’s real moneythere. We had been funded for aconstruction project and were trying touse Lean to get us back within budget.But the facility we planned would havehad 3,600 square feet of space wedidn’t need. We’d be paying peopleto walk around between multiplecollection points, interfering with laboperations by walking around andtrying to find supplies. We would havehad to hire at least three more FTEsto cover that wasteful layout.

We would have built the facility thatway, so that’s where the real savingscome in. We saved 3,500 square feetat a cost of roughly $250 per squarefoot. Interestingly, we just finished witha first-pass review of our ED, and it’sastounding how much waste we hadbuilt into it. We see an opportunityfor a 5,400 sq. ft. reduction. We’regoing to build a smaller, more efficienthospital at $250 per square foot. Thecost avoidance is real.

Shawn Noseworthy: Thedesign of our expandedcampus kitchen was 25%over budget. By the middle

of the Lean project, however, werealized that a better Lean flow wouldreduce our need for expansion spaceand allow us to renovate existingspace instead. I pulled the plug onthe expanded kitchen design.

Changing our processes has alsoallowed us to forego a plannedexpansion of our Food ProductionCenter’s cook-chill facility. Thisrepresents a $5 million capital costavoidance.

Q: What type of change managementstrategy did you follow?

Charlotte Taylor: It takesa lot of communication.People don’t always hearyou in the same way. So

you just have to keep at it in smallincrements. We try to spend a lot oftime with the staff and speak aboutLean. In some cases, the managershave changed their hours. They comein earlier in the morning to be therewith the staff and start the day bysetting the right tone.

11

We bought David Mann’s book(Creating a Lean Culture) for everysingle team leader. And now severalof our sites are doing a book club.Every week they read one chapter andtry to adopt some of the things they’veread in the book.

I also think that as laboratorians, weoften fail to show upper managementthe good things that we’re doingand the positive results that comeout of these efforts. So we are nowpresenting more of our information toupper management.

David Schlappy:We decided whatwould need to be communicated towhom, how we would want to dothat, and how we would mitigatefears and frustration. Then we did alot of communication. We conducttraining at all levels — everythingfrom 30-minute discussions and staffmeetings to a letter, a newsletter, andnotes. We hold bigger celebrationswhere we bring people togetherand say, “Hey, this is what we did.Congratulations.” We thank everybodyand recognize the team.

There were also a few caseswhere we had to have one-on-oneconversations with somebody whowasn’t really seeing that this wasgoing to require them to change theirjob. We wanted to make them awarethat “Yes, we want to hear yoursuggestions and input. But this is thedirection we’re taking and we’re notturning back.” That was a message wehad to convey consistently.

Q: Have you worked with humanresources to incorporate Leanrequirements into your jobdescriptions?

Peter O’Brien: Yes. Wehaven’t changed all thejob descriptions yet, butwe have rewritten job

descriptions for senior technologistsand for charts technologists thatoutline their duties and what theyneed to do at the supervisory levelsand beyond. And those descriptionsinclude Lean duties.

Fred Slunecka: To some degree.The job descriptions in the laboratoryhave certainly changed. We’re justnow in the process of trying to createindividual accountabilities as it relatesto both service and processes. It’s awork in progress.

Q: After investing and culturallytransforming your staff into Leanleaders, how do you keep themfrom leaving the organization?

Fred Slunecka:We haven’t had anyproblems with people leaving, partlybecause they’re so excited aboutwhat we’re doing. I think it’s energizedthem to where they can’t imagineworking now in an organization thatisn’t using Lean principles.

David Schlappy: The biggest thingwe can do is to create an environmentwhere they feel successful and thatthey are making a difference – not justin the lives of our patients, but in ouroperation. We have not done anyspecial work to retain them, other thancreate a good work environment, givethem the tools they need, supportthem, and pay them a fair salary.

But on the other hand if you’ve builtyour process well, it shouldn’t dependon your Lean leaders to keep running.They are there to assist in holdingthe gains, but also to identify and fixnew things. So having a Lean teammember leave might slow yourprogram down, but the processitself should continue to run well.

Q: How has Lean changed you as aleader?

David Schlappy: Lean has givenme a different perspective on howI manage. It encourages me tothink more about processes. It hasalso allowed me to set up somespecific operational controls that tieaccountability to the things that makea difference. So definitely yes, Leanhas expanded my skills as a leader.

Shawn Noseworthy: It has totallychanged my thinking and under-standing of what we can do with aprocess to improve our space, flow,quality, and output. Once I becamesensitized to the waste in ourprocesses, I felt compelled by mysense of stewardship to eliminate itwherever possible. �

12

KEY TAKE-AWAYS

“You have 40 seconds to drawa pig,” announced SeniorConsultant Lewis Lefteroff.

The participants in his breakout sessiongenerated a wide variety of porkers. A few wereunable to finish within the allotted time.

Mr. Lefteroff then taught the group “standardwork” for drawing a pig, with such steps as “drawa letter M at the top-left intersection of the gridon the paper, then draw a W at the bottom-leftintersection.” The results of the second attemptwere much more uniform, and the number oftimely completions rose dramatically.

Having demonstrated the value of standard work,Mr. Lefteroff explained the steps for developing it(yup, those are standardized, too). He introducedtools for communicating standard work toemployees and monitoring their adherence. Andhe described specific steps leaders can take tomake standard work part of an organization’sculture. Without discipline and standardization,any system will backslide. Leaders need to coachand continuously reinforce. �

Standard Workfor Leadership& Managing toStandard Work

A standardized 13-step process led to faster,more consistent “pig production.”

“Whenever there is fear,you will getw r o n g f i g u r e s .”1 2 3 4 5 6 7 5 8 2 9 10

—W. Edwards Deming

Activity that changes the fit, form, orfunction of a product adds …

Activity that does NOT change the fit,form, or function of a product is …

A flaw or a failure to meet an intendedrequirement is a …

Instead of end results, a Lean managerfocuses on the …

This level of quality results in no morethan 3.4 defects per million opportunities

A systematic methodology for eliminatingwaste

Fax or mail the solution (one per person, please) to receive a FREEcopy of The Lean Toolbox, plus a $50 certificate that can be applied toregistration for a Lean seminar or Green Belt Training!

Name (please print)

Title

Company

Street Address

City/State/Zip

Telephone

E-mail address

The above quote serves as a reminderthat we must “embrace the miss.” Usethe clues below to complete the puzzle.

Mail your completed puzzle by September 15, 2007, to:Audrey KnableValuMetrix Services, Ortho-Clinical Diagnostics1001 Route 202, Raritan, NJ 08869

8

1 10

9

9

2 3 9 10 10

9

9 4

6

9

7 57

Or fax it to:

908-218-8024

?PEx PUZZLER

13

“People don’t mind change, theyjust don’t like being changed,”said Training Specialist Michele Long in aspecial postconference workshop.

She explained how an organization’s membersmust be led up a “commitment curve,” whichbegins with initial contact with the proposedchange through awareness, understanding,and ultimately internalization. Managing thisprocess correctly can lead to a faster return oninvestment, reduced productivity losses, andlower project costs. A recommended five-stepprocess calls for change managers to:

1. Develop a vision of the future that will berealized through the change

2. Communicate the future state and organizesupport for the change

3. Ensure success by establishing systems,structure, processes, and capabilities forchange

4. Implement the changes, make coursecorrections, and continuously improve

5. Preserve the gains and improve theorganization’s capacity to change

“Just because a stakeholder lets you finish yourpresentation doesn’t mean they’re on boardwith your project,” warned Ms. Long. Sheled the group in an exercise of identifying keystakeholders in their own organizations anddetermining what levers could be used to bringthem on board. Some additional practical tips:

• You will always have nay-sayers. Seek earlywins to help win them over. Then build onthose early successes.

• Get people actively involved early on. Peoplesupport what they helped create.

• Protect yourself from the person who sitssilently through a presentation and challengesyou later with, “I never said it was okay.”Clearly announce during the meeting that,“This is your one chance to disagree. Therewill be no ‘meeting after the meeting.’” �

The Change Integration Process

A communication plan is essential for makingpeople ready, willing, and able to work in new ways.

SAVETHEDATE!Mark your calendarfor ValuMetrixAPEx 2008April 15–17, 2008in Philadelphia

Joe Teddy, a Lean team member

from Saint Michael’s Hospital, is one

attendee who would be happy to come

back. “I know that next year, ValuMetrix

will have new ideas and approaches to

show us, practices we haven’t thought

of, or haven’t come across yet,” he

says. “And we’ll be further along in our

own projects and have more to share

with other people.”

ValuMetrix UniversitySuccessful ChangeManagementOctober 9–10, 2007

For details and

registration, visit

ValuMetrixServices.com

2008

ValuMetrixUniversity

Your organizationgains a championwho can lead processimprovement projects

This two-week seriesmethodically takesyou from the basicsto the finer points ofLean. Take individualcourses – or enjoy areduced rate on theentire series.

Lean Fundamentals 3 days Oct. 2–4

Breakthrough Thinking 1 day Oct. 5

Successful Change Management 2 days Oct. 9–10

Managing in a Lean Environment 2 days Oct. 11–12

Two 41⁄2-day training sessionscombined with an actual on-site project

Week 1: Sept. 10–14

Week 2: Oct. 29–Nov. 2

ValuMetrix Universityprovides essentialtraining programs inprocess improvementfor healthcareorganizations.

The more trained your peopleare at process improvement,the better they become atmoving your organization forward.

ValuMetrix University, brought to

you by Ortho-Clinical Diagnostics,

has trained thousands of healthcare

professionals in the advanced

techniques of process improvement.

Each course takes a pragmatic

approach, teaching attendees to

apply the skills and tools to real-life

challenges at their workplace.

ENROLL TODAY!

Fall 2007 Course Offerings

For details on courses,registration, and groupdiscounts:

• Call: 800-523-6911, ext. 8316

• E-mail: VMU@ocdus.jnj.com

• Visit: ValuMetrixServices.com

More Highersavings. quality.

14

Six Sigma Green Belt Certification

ValuMetrix Lean Training Series

Course Location:

New Brunswick, New Jersey

15

EXECUTIVE SEMINARS

“You’re not reading

about a project that

someone else did.

You’re taking the tools

and applying them in

your own environment.

To me that’s more

meaningful because as

you’re going through

that process, you’re

thinking, ‘I know

where I could use this,’

or ‘I know what my

next project is going

to be.’”

Carol Hill, MT (ASCP), CLSEd/Quality/Compliance CoordinatorFairview Laboratory ServicesMinneapolis, Minnesota

Betterpatient care.

Breakthrough

LeanWhy settle forincremental improvement?

Throughout the U.S. and Canada, healthcare organizationsare using Lean to achieve breakthrough results.

» Children’s hospital improves testing turnaround time by 27-56%,realizes more than $290,000 in savings.*

» Hospital OR department cuts patient preparation time by 40%,saves $182,000 in inventory costs.*

» Hospital Emergency Department shortens patient turnaround time by 29%,saves $0.25 million in avoided construction costs.*

You toocan achievedramatic,sustainablegains.

Join us for two intensive, information-packeddays and see how!

September 25–26 Philadelphia, PA

FEATUR ING

Jane Crosby, RT, MBALaboratory Service DirectorProvidence Health CareVancouver, BC, Canada

Debra RodahlSystem DirectorHealthEast Laboratory ServicesSt. Paul, Minnesota

Michael F. Powell, MS, FASHPExecutive DirectorPharmacy/Pathology ServicesThe Nebraska Medical CenterOmaha, Nebraska

For complete detailsCall: 800-523-6911, ext. 8316Email: AKnable@ocdus.jnj.comVisit: ValuMetrixServices.com

Can’t attendthis fall?Next BreakthroughLean session:January 17–18, 2008New York City

And Two In-depth Workshops

*Data on file

Process Excellence is the proven

way to reduce error rates, cut costs,

raise productivity, increase capacity,

and improve customer satisfaction. It

combines the tools and methodologies of:

• Six Sigma – measuring and reducing

your error and defect rate.

• Lean – eliminating waste to

speed your workflow and deliver

better value.

• Design Excellence – structuring a

process from the outset so that it flows

efficiently with minimal opportunities

for waste or error.

ValuMetrix Services, from Ortho-Clinical

Diagnostics, helps you harness the power

of Process Excellence. We provide hands-

on assistance throughout your first effort,

while giving you the tools and training to

handle subsequent projects on your own.

Process Excellence:the systematic approach to processand quality improvement

Answer to puzzle on page 12:

1001 Route 202Raritan, NJ 08869800-523-6911, ext. 3821www.ValuMetrixServices.com

S E R V I C E S R EAD E R S E RV I C E FORM

� Yes, I would like you to call me to discuss how I can improve mylaboratory’s performance.

� Yes, I would like to receive news and updates from ValuMetrix Services viae-mail, including valuable Process Excellence case histories. I understand Imay unsubscribe anytime.

P L E A S E P R I N T

Name

Title

Company/Affiliation

Address

City State Zip

Phone Number E-mail Address

Do you have colleagues who would benefit from receiving this newsletter?We will be happy to add them to our mailing list:

Your Colleague’s Name

Your Colleague’s Department

Your Colleague’s Organization

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FAX TH IS FORM TO: 908-218-8024

ValuMetrix is a registered trademark of Ortho-ClinicalDiagnostics. All other trademarks and service marks arethe property of their respective owners.

Printed in USA.©Ortho-Clinical Diagnostics, Inc. 2007 OC10107

“Wheneverthereisfear,youwillgetwrongfigures.”