1 housestaff lean academy module 1: lean principles for physicians robert martin, psyd performance...
TRANSCRIPT
1
Housestaff Lean Academy
Module 1: Lean Principles for Physicians
Robert Martin, PsyD
Performance Excellence
UCLA Health
2
Module # Module Description
1 Lean for Physicians (Important Concepts)
2 Focusing Improvement Projects/Efforts (Methods Overview)
3 Managing the Improvement Process (PDCA/A3)
4 Understanding the Current State (Process Mapping)
5 Identifying Waste in the Current State (5S, Waste, Standard Work)
6 Analyzing the Current State I (Organizing & Using Data)
7 Analyzing the Current State II (Organizing & Using Data)
8 Identifying Improvements & Actions (A3 Simulation)
9 Working as a Team (Frontline Empowerment & Engagement)
10 Understanding & Leading Change
11 Supporting Infrastructure (ADM, Huddles, A3/A4 Methodology)
Where does this module fit into the curriculum?
Module 1 Agenda…
3
Physician Process
vs. Lean ProcessOrigins Important Concepts Post Questions
Physician Process
vs. Lean ProcessLean Origins Important Concepts Post Questions
Lean should be a familiar process for Physicians…
Scenario – a patient arrives with a problem (clinic, ED, etc.). What is the Physician’s process?
4
Physician Process
Conduct Health & Physical
Develop Initial Diagnosis
Order Tests
Analyze & Understand Data
Develop Treatment Plan
Try, Measure, Adjust It
Lean Process
Understand Scope (Charter)
Develop Problem Statement
Conduct Observations & Collect Data
Analyze & Understand Data
Develop Improvement Plan
Try, Measure, Adjust It
Notes
Neither process jumps to solutions
Both processes involve the patient
Both processes use data
Both processes use the Scientific Method
QI & Lean call “The Scientific Method” PDCA (Plan-
Do-Check Adjust/Act)
Physician Process
vs. Lean ProcessLean Origins Important Concepts Post Questions
Lean is a modern term, but the origins are not…
5
Venetian Arsenal
• 1 Warship/day
• Standardized Parts
• Use of canals to flow galleys to workers
through assembly phases
UCLA Operating System
Established by Amir Rubin
1500s 1780s1908-1926
Scientific Management – Frederick Taylor
• Scientific study of tasks
• Employee development and training
• Managers use principles to plan work and
workers perform tasks
French Army Ordinance
• Concept of interchangeable parts for
muskets (pre-cursor to high-volume
flow production
American Meat Packers
• Conveyor belts to steadily remove
carcasses past workers after meat
removal
1880s 1890s1902- Present
Jidoka (1902)
• Sakichi Toyoda invents device to detect
broken threads in looms autonomously
Just-in-Time (1937)
• Kiichiro Toyoda establishes Toyota, has the
idea for JIT delivery of parts
Henry Ford
• 1908 Model T modular car with truly
interchangeable parts “there are no
files in my factory”
• 1913 Flow Production Moving assembly
line with processing feeder lines
• 1926 Mass Production with product
variety
1930s
Takt Time
• German aircraft industry pioneers use takt
time for synchronizing movement of
aircraft
• Mitsubishi brings idea back to Japan where
Toyota embraces it
1940s
Training Within Industry
• US Dept. of War introduces Job Instruction,
Methods, Relations to teach millions of
workers in war industries. Later
introduced to Japan after the war
1960s
Deming Prize
• Japanese Union of Scientists and
Engineers creates Deming Prize for
statistical quality and PDCA
1980s - 2009
Lean Research
• Toyota Production System (1982, Yasuhiro Monden)
• The Machine that Changed the World (1990, Womack,
Jones, Roo)
• Lean Thinking (1996, Womak, Jones)
• Learning to See (1998, Rother and Shook)
• DNA of the Toyota Production System (1999, Spear and
Bowen)
• The Toyota Way (2003, Liker)
• Shingo Research Award – Lean Hospitals (2009, Mark
Graban)
Toyota > GM (2007)
• Toyota becomes the world’s largest
automaker
Mission, Vision, Values, Commitment
Strategies
Objective Mgt: Goals,
Operating Plans, Dashboards
Performance Improvement
and Management
UCLA Operating
System
Physician Process
vs. Lean ProcessLean Origins Important Concepts Post Questions
Lean is based on a few important concepts…
6
Value
Waste
Scientific
Method
(PDCA)
Empowered
Staff
True North Alignment
Physician Process
vs. Lean ProcessOrigins Important Concepts Post Questions
Lean is more than a collection of tools….
It is about creating a culture based on a few important concepts.
There are more- but these are sufficient for now!
Lean is based on a few important concepts…
7
Physician Process
vs. Lean ProcessOrigins Important Concepts Post Questions
Value
Waste
Scientific
Method
(PDCA)
Empowered
Staff
True North Alignment
What is Value?
• What patients are willing to pay for
• Value must be discerned
• Lean systems produce what the patient values
What do Patients Value?
• “Timely” Nursing & Physician Time
• Information to participate in choice
• A safe and effective Treatment Plan to become healthy, alleviate their pain and suffering, or restore function
• To be listened to; Trust and Privacy
Lean is based on a few important concepts…
8
Value
Waste
Scientific
Method
(PDCA)
Empowered
Staff
True North Alignment
Activity (Individual or self-organized)
• Spend a few minutes to discern what your patients value
• Group Discussion
Physician Process
vs. Lean ProcessOrigins Important Concepts Post Questions
Lean is based on a few important concepts…
9
Value
Waste
Scientific
Method
(PDCA)
Empowered
Staff
True North Alignment
Waste is: the opposite of what patients value…
• Waste hides in complex systems, and healthcare is complex!
• Waste must be understood so that it can be discovered and highlighted as abnormal
Focus on minimizing or eliminating waste:
• Waiting for appointments, to be seen, etc
• Waiting for physician’s orders to be written
• Late/Missing callback for test results
• Clinicians who don’t listen, lack of trust, lack of privacy, etc.
• Administrative errors
• Clinical Errors
• Unnecessary documentation protocols & approvals
Physician Process
vs. Lean ProcessOrigins Important Concepts Post Questions
Lean is based on a few important concepts…
10
Value
Waste
Scientific
Method
(PDCA)
Empowered
Staff
True North Alignment
Activity (Individual or self-organized)
• Spend a few minutes to discern
• What your patients do NOT value (i.e. waste)
• Wasteful activities that inhibit your value production
• Group Discussion
Physician Process
vs. Lean ProcessOrigins Important Concepts Post Questions
Lean is based on a few important concepts…
11
Value
Waste
Scientific
Method
(PDCA)
Empowered
Staff
True North Alignment
The Scientific Method (PDCA) …
• Was discussed earlier!
• Is taught to staff so that they can
• Use data to solve problems
• Support value-added activities
• Minimize or eliminate waste
• Continuously improve
• Also known as Plan-Do-Check-Adjust/Act
• (We are going to have a whole class on this)
Physician Process
vs. Lean ProcessOrigins Important Concepts Post Questions
Lean is based on a few important concepts…
12
Value
Waste
Scientific
Method
(PDCA)
Empowered
Staff
True North Alignment
What does Empowered Staff mean? Why is it important?
• The best ideas from the smartest physicians often result in:
• Passive or Active resistance from staff
• Staff who feel disempowered and disengaged
• No change
• Staff must feel that they “Own” changes which will support value-added activities and minimize/eliminate waste
• They are experts in their areas and have great ideas on how to improve
• Leaders (Administration & Physician) must engage, empower, and align staff
• (We are going to have a whole class on this also!)
Physician Process
vs. Lean ProcessOrigins Important Concepts Post Questions
Lean is based on a few important concepts…
13
Value
Waste
Scientific
Method
(PDCA)
Empowered
Staff
True North Alignment
What would happen if all staff was trained in PDCA, engaged and empowered without alignment to the organization’s
goals?
• Some improvement certainly!
• Likely much silo’d improvement which might sub optimize the system (i.e Schegistration might make their job easier and everyone else’s more
difficult!)
• Improvement can occur at all levels, but always in consideration of linked-activities in the organization
What is True North Alignment?
• A vision or ideal from Leadership that can “rally” the case for change (should be aligned or supports the hospital or SoM vision)
• “Minimally sufficient” strategies and initiatives (3 to 5, not 25 to 75) to focus staff effort
• The most ideal strategies include participation from all layers of management and staff (i.e. catchball) to ensure that they are realistic
Physician Process
vs. Lean ProcessOrigins Important Concepts Post Questions
Post Questions & Next Module Preview…
14
Module # Module Description
1 Lean for Physicians (Important Concepts)
2 Focusing Improvement Projects/Efforts (Methods Overview)
3 Managing the Improvement Process (PDCA/A3)
4 Understanding the Current State (Process Mapping)
5 Identifying Waste in the Current State (5S, Waste, Standard Work)
6 Analyzing the Current State I (Organizing & Using Data)
7 Analyzing the Current State II (Organizing & Using Data)
8 Identifying Improvements & Actions (A3 Simulation)
9 Working as a Team (Frontline Empowerment & Engagement)
10 Understanding & Leading Change
11 Supporting Infrastructure (ADM, Huddles, A3/A4 Methodology)
Physician Process
vs. Lean ProcessOrigins Important Concepts Post Questions