introduction to lean and pdsa thinking
TRANSCRIPT
Introduction to Lean and PDSA Thinking
What is Lean Its about principles, thinking and practices Toyota Toyota Production System Lean
management or Lean production Focused on improving the performance of the
business by Maximizing value as defined by the customer Reducing waste in work Collapsing time Decreasing spending Increasing market share Creating new products or service lines
Benefits of Lean Thinking Stability within our work Vitality of our organization Respecting people Creating meaningful work Creating ownership of
your work
How ThedaCare uses LeanTIS 9 Methods to See and Remove
Waste in a Process within a Value Stream
Adjust
Adjust
Adjust
Adjust
Adjust
Sequence and Continuity
50,000 ft
GROUND LEVEL
INCREASING DETAIL
STANDARD WORK
Adjust
5S
SIPOC
TAKT TIME
FLOW DIAGRAM
COMMUNICATION CIRCLE
SPAGHETTI DIAGRAM
TIME OBSERVATION
BAR CHART
STANDARD WORK COMBINATION
5S Visual Management
Adjust
Adjust
Continuous Daily Improvement
Value Stream Analysis
What is the scientific method Penicillin Vaccinations Gravity Electricity Genetics
What is PDSA Lean’s version of the scientific method A document or artifact that represents
your thinking, data collection and problem you are solving
Its your story Used to gain a shared understanding of
an issue to be able to problem solve and get results
Header• Title should be reflective of problem at hand• Owner – Party x (person who is responsible for the
problem / process and accountable to solve the problem)
• Coach – is the supervisor of the owner (sets challenge, insures problem is resolved, and responsible for owners development)
• Start date – date of initial draft• Revision date and number
BackgroundDefinition:• Helps us understand the extent and importance of the
problem, how did we get here today• Why this, why now?
Questions:• What is business context? (True north, challenge)• How did you decide to work on this problem? • What is the compelling story or reason for action?
Tips: We should not be answering why Brief, one or two bullets
Current ConditionDefinition:• What is happening today• Diverge and Converge• Find the patternsQuestions:• What should be happening,
what is actually happening? What is the gap?
• What do you actually know and how do you know it?
• Have you engaged other people?
• Can you quantify the problem?
Current ConditionQuestions, continued…• 4 W’s and 2H’s – Divergent questions
What? (is flowing, happening, is the problem…) Where? (in the flow, in the facility, in the region…) When? (is it occurring – all the time, end of shift, middle of
day, once a year, seasonal, peaks…) Who? (what role, area, process…) How? (Methods…) How many/often? Consequence? (impact)
How will you break down the problem?Tips: We should not be answering why Should be visual (Maps, paretos) Have you gone to see?
Problem StatementDefinition:• Clearly and succinctly defines the actual issue
that is being felt• Quantifiable gapQuestions:• What is the quantifiable problem?Tips: Just the facts Solve just one problem Watch for solution in problem statement
(words like due to, no, isn’t etc)
Example Problem Statements Daily in the TC ICU, at least
2 RN’s/day out of 23 potential staff are assigned as a resource RN due to the lack of a clinical lead structure which creates a lack of consistent process owners, lack of formal frontline leadership role and variability in staffing decisions and problem solving, thus impacting financial metrics, and people engagement per our true north metrics.
Within the TC ICU, when ICU patients meet UWOPO clinical triggers staff is calling statline within one hour 62% of the time from January-Sept 2011, which has resulted in actually missing 1 donation opportunity in 24 months, potentially delaying UWOPO analysis for appropriate candidates, affecting Theda Clark medal of honor recognition, and increased family dissatisfaction with donation process.
Goals and TargetsDefinition:• Know that the work has been successful• Goal is a condition of where we want
something to be, targets tell us how we are progressing
Questions:• Am I using words like reduce, increase,
eliminate, decrease, NOT using words like implement, create or establish?
• Have you validated your targets with your sponsor?
Tips: Make the team uncomfortable with the goals
and targets (should be challenging) Should touch all elements of the triangle (do
not distort it)
Analysis / Root CauseDefinition:• Identify the most significant causes of the
problem stated.• Identify the true underlying source(s) of the
problem.
Questions:• Is there a standard? Is it known and
practiced?• Is the process performing at the designed
quality level? Cost level? Delivery level?• How do you know you are at a root cause?
Analysis / Root CauseTips: Use Fishbone and 5-why’s to root cause if:
There is a standard that isn’t being practiced There is a standard and the quality is poor The problem you are solving is at the step level
Use 9 Methods to see waste if: There is no standard The problem you are solving involves collapsing
time and space at a process level Use Value Stream Analysis if:
The problem you are solving involves collapsing time and space at a value stream level
Verify the root cause/waste by going to see.
CountermeasuresDefinition: Untested actions to remove waste or address root
causes (hypothesis)Questions: Do your countermeasures address the root cause(s)? Is there more than one suggested countermeasure for
each root cause? Have you created a detailed plan for experimentation? Can you show how your proposed countermeasures
will address the waste / root cause? Has your sponsor approved the “Plan” portion of the
PDSA
CountermeasuresTips: Countermeasures should be reductive (do not
add complexity) Creativity over capital Bias for action Countermeasures should be within your
team’s scope of control/influence Plan should include how to deal with change
management
ExperimentsDefinition: Verify the effectiveness of the planned
countermeasures (hypothesis) prior to implementation.
Applying the scientific method to allow the effect of the implementation to be simulated.
Questions: What is the first thing you need to learn? What is the smallest thing you can do to test
this hypothesis? Has the experiment allowed you to reach your
goal? How will you track the experimentation process?
ExperimentsTips: Always state what you believe will happen Have a plan Respect the needs of the people performing
the work Practice change management When experimentation delivers on the
expected results, implement the proven countermeasures.
StudyDefinition: Measurement of the performance over time to
verify that the targets have been achieved. Reflect on the success / failure of the PDSA
process and implemented countermeasures.Questions: Are we able to see if the performance changed
upon implementation? Are the countermeasures sustainable, repeatable
and measureable? How will you continue to support the people doing
the work? How long will I study the countermeasures?
StudyTips: Make performance over time visual Use Pareto’s to track abnormalities in the new
process. Go and see Train to the new standard
Act / AdjustDefinition: Actions required to close the gaps identified in the
study phase. Celebration of the success of the improvement effortQuestions: Are there other areas that can benefit from this work? What is your next challenge? Will you raise the bar or
focus on another problem of consequence? Is the PDSA ready for closure (have we achieved the
target performance)? Has the new practice been standardized?Tips: Establish a target completion date Document your reflections
Do
Study
Adjust
Plan
The Real PDSA Wheel…
Do
Study
Adjust
Plan
Additional Resources Lean Production Simplified by Pascal Dennis Managing to Learn by John Shook Article: Origins of Lean Management in
America Article Link
TIS website Lean.org