Core Elements of Lean:




◦

Methods, Management System, Mindset




Lean Mindset/Lean Thinking




Lean Methods




Lean Management Systems




Lean Deployment at OHSU ◦

Training, Projects, Change Management

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What is Lean?

Poor Quality

◦ An improvement method adapted from the Toyota Production System ◦ Focuses on enhancing value and eliminating waste or “muda” ◦ Requires a change in thinking and acting ◦ Used for both
breakthrough improvement
continuous improvement

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Provide value for our patients, today and tomorrow




Pillars: ◦ Safety, Quality, Service, Affordability




Foundation: ◦ Innovation, Education, Engagement

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Management System

Mindset

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Methods are the most discussed, but least important part of improvement efforts Examples: ◦ Value stream assessment ◦ Improving flow, reducing waste ◦ Rapid process improvement/Kaizen Events ◦ Plan / Do / Check / Act cycles ◦ 5S (sort, simplify, sweep, standardize, sustain)

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Management system structures strategy deployment and operationalizes the use of methods Strategy: ◦ Focus is on leaders organizing work around critical improvement objectives/metrics Daily Management: ◦ Focus is on supporting learning and the work of front-line staff ◦ Developing standard work and assuring that processes are operating as designed

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Mindset is the most challenging, but most important element; requires long-term effort ◦ Focus is on customer experience/value ◦ Begins with direct observation where the work gets done ◦ Improvements made by eliminating non-value activities/waste ◦ Requires respect for and engagement of front-line ◦ Highlights importance of improvement experiments— including failures

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◦ ◦ ◦ ◦ ◦

Value vs. Waste (muda) The Value Stream Flow Pull Perfection

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Value vs. Waste

Value is what the customer is seeking or is willing to pay for. Examples •Getting a latte? •Healthcare?

Opposite of Value is Waste

1. 2. 3. 4. 5. 6. 7.

Overproduction Waiting Transportation Overprocessing Inventory Motion Poor Quality 12

The Value Stream

A Value Stream is a Process: The process of creating what the customer values. Not everything in the current state value stream creates value. value Recognizing and identifying waste in the current state value stream is essential for making improvement. 13

Flow

Flow is the continual movement through the value stream with no interruption or waiting between steps.

A value stream driven by “batch and queue” methods does not have good flow. 14

Pull

Pull is when something is produced or released into the value stream only when the downstream customer signals the need for it.

Most processes operate in “push” systems and work to optimize the individual process steps in attempt to be more efficient.

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Perfection

Perfection is the complete elimination of waste so that all activities along a value stream create value.

Perfection is an aspiration and a moving target, but we can use it to create the goals and cast the vision of the ideal future state.

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Toyota Production System • A production system focused on the complete elimination of waste and the creation of value from the customer’s perspective. • Every employee is considered a scientist skilled at problem solving. Every employee is expected to think “lean.”

Just In Time What is needed, when it is needed, where it is needed

+

Visual Workplace Quality at the source, immediate problem solving

Standardization and Continuous Improvement 18






Value Stream Mapping Waste Identification Spaghetti Chart

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Value Stream Mapping


Describe/visualize the current state of your process and the ideal future state




A description, visualization, and picture of the resources required to deliver the desired service or product to the customer (what the customer values)

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Example Patient Value Stream Map – Starter RN-Provider-Infusion Room

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Room Service Value Stream – Current State

Pt places order with call center, ticket prints

2.6

1:37 (0:16-4:04)

(0:04-18:43)

Cold Prep

Starter Prep :41

2:35 6:35

1:34

(0:00-5:46)

(0:19-17:52)

1.6

3.9

3.3 Hot Prep

July 27, 2011

(0:10-8:18)

Cart Batch 9:25 (0:00-15:00)

1:22

(0-4:01)

(0:00-6:24)

Delivery Prep (coffee, tea, par stock)

Delivery To Unit RSA

:51

5:10

(0:51-1:45)

Trays are batched into carts, which have a timer set for 15:00. (9:25 is the average amount of time trays waited in carts)

:44

(0:00-6:50)

:47

Checker checks tray, adds beverages, soup :11 :35

:08

(0:04-2:01)

RSA delivers tray to patient Total Wait Time = 19:25

4:15

(0:49-22:56)

Loader loads tray into cart

(0-18:03)

2:02

Total Process Time = 19:10

(0-8:48)

Total Avg Cycle Time = 38:35

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“Day In The Life” Work Analysis Charts

Non-Linear Value Stream Maps – “Day in the Life” charts MA Time

Example

Downtime 11.1%

Patient Care 17.6%

Phone 28.0%

Provider Time

PRR Time Schedule F/U Appts 1.6% Faxes 3.2% Check In Pts 28.3%

Down Time 60.0%

Collecting Supplies/Equipment and Patient Paperwork 2.2%

Desktop 43.4%

Desktop 28.5%

Charts 6.9%

Patient Care 69.2%

MAs – have downtime, 71% on phone/desktop Providers – potential for more patient contact PRRs – high level of downtime, are underutilized 23

Waste is… Anything that consumes resources but creates no value for the customer.

1. 2. 3. 4. 5. 6. 7.

Overproduction Waiting Transportation Motion Overprocessing Inventory Poor Quality/Defects 24

Type 1 - Non-Value Add but Essential Incidental Work that does not provide value, but is necessary and cannot be eliminated Minimize

Type 2 – Non-Value Add, non-Essential Provides no value -- Eliminate

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A visual depiction of movement, motion, and transportation, in the current state
Provides a foundation for physical changes to reduce waste and increase value in the future state


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Flow and Pull Constraints Balancing Point-of-Use Storage Standard Work Visual Management/Kanbans 5S ◦ Sort, Simplify, Shine, Standardize, Sustain

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Leaders have two primary responsibilities in a Lean organization: 1. See to it that the processes run as designed 2. Improve the processes









Prioritize and set the direction with explicit metrics Role is NOT to solve the problem Develop the capacity for continuous improvement Be visible in the workplace – go to the gemba through formal Leader Rounding as a coach 30

Need to define and document the standard work Documentation is then used to train/educate the people who do that work As standard work is being implemented, need to develop an audit process to assure the standard is happening as designed








◦


Audit should include a daily observation process and abnormality tracking

Having good standard work helps to surface problems and facilitates the ability to meet the standard by addressing the problems as they occur

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Visual Management

A variety of approaches to make the status of a work process visible at a glance. The status of key processes should be visible to compare actual vs. expected performance. Data should be collected daily and posted. •

Key Performance Indicator Boards/Knowing How We’re Doing Boards

Abnormalities should be tracked and cataloged to detect where improvement is needed and where problem solving should be initiated.

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Training • • • • •

Leaders Point Improvement/Kaizen Events 5S Daily Management Change Acceleration Process (CAP)

Improvement Work • Model Line • Daily Management Systems • Kaizen Events

Strategy Deployment • • • •

True North Metrics Priorities Visual Management Boards Leader Rounding 34

Performance Improvement Consultants • • • •

Project Managers for large, multi-departmental PI Projects Experts in Lean, Change Management, and Project Management Facilitate training classes and coach people learning Lean and doing projects Work collaboratively with PI Consultants in other departments/divisions

Lean Workshops • • • • •

Project-based learning over 3 months, 2 ½ days in classroom Work in pairs/trios to learn Lean in 2 phases: • Assessment and Improvement Coached by a PI consultant Have done 8 cohorts since January 2011 Adding another half-day session on Daily Management

Change Acceleration Process Workshops • •

2 ½ day workshop Pre-requisite for attending Lean Workshop 35










Lean relies on the people who do the work – to help improve the work The people who do the work understand what changes must be made Employees who are empowered to make the changes will support the changes

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Kaizen is a real-time laboratory • The team identifies waste • The team acts to remove the waste • The team tests the solutions

Success is making real, measureable change during the Kaizen event 37

Q x Quality of Solution

3 A Acceptance of Change

Change Acceleration Process

Six Sigma PDSA

=E Results

Effective Results

Lean The Effective Result of the function is equal to the Quality of the solution times the Acceptance of the change. A3 = Acceptance x Accountability x Alignment 38

Leading Change Creating a Shared Need Shaping a Vision Mobilizing Commitment Current State

Transition State

Improved State

Making Change Last Monitoring Progress

Changing Systems & Structures

© General Electric Co. 2008 GE Confidential & Proprietary Information

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Leading Change Changing Systems and Structures

Assessment

Improvement

Creating a Shared Need

Shaping A Vision Mobilizing Commitment Making Change Last Monitoring Progress 40

Model Lines •

Launch a new one each year

Daily Management Systems • •

Identify areas where standard work has been developed and implemented Focus areas: • Quality, Safety, and Organizational Priorities • Areas with Quality, Safety, and Satisfaction Issues

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