lean is not just something to talk about… it’s something...
TRANSCRIPT
+
Improving the Continuum of Care
through Lean Thinking
Lean is not just something to talk
about… It’s something to do!
+ Today’s Objectives…
Discuss the five elements that are basic building blocks to effective QAPI
Duplicate Process improvement Projects utilizing Lean methods
Describe the power and utility of Lean and explain how it can be used to improve client satisfaction and the continuum of care
Recognize the eight types of waste typically found in healthcare and help your organization “learn to see” waste
Describe A3 thinking and explain how A3’s are used to solve problems and improve workflow
+ Design and Scope
New QAPI at a Glance was reviewed and we made changes
Broadened our steering committee to include all departments
Conducted a “Self-Assessment” to identify gaps
Discussed how we could address all systems of care and
management practices
Completed “Guiding Principles”
+ Governance and Leadership
We provided education to our Board
Gained “Buy-in” and support for projects and education
+ Feedback, Data systems and
Monitoring
We have broadened our idea of feedback beyond clinical
quality measures and incidents
We utilize customer service survey data from the post-acute
care area that is collected at discharge
We analyze readmission root cause from “INTERACT”
We utilize consultant reports to ancillary departments such
as the business office
We have work to do in this area to better utilize the systems
we have from EHR, CareWatch, etc.
+ Performance Improvement
Projects (PIP’s)
We identified the need to improve our skills in conducting
Improvement Projects
We want to Improve our Processes to make systemic changes
We want to Sustain the improvements we make
We want to gain greater teamwork skills across disciplines
We chose LEAN methodology as a starting point
We chose PIP’s, identified teams, and started training
The expectation is, Learn, Lead, Teach, Participate…
+ Systematic Analysis and Systemic
Action
LEAN’s approach is a starting point to taking a
comprehensive look at all systems to sustain improvement
and also to prevent future events.
We are learning through utilization of the A3
We are on a journey toward Operational Excellence
+ Continuous Improvement
Why do we need it?
Why is it easier said than done?
+ Lean History…
1885
Craft Production - Machine then harden
- Fit on assembly
- Customization
- Highly skilled workforce
- Low production rates
- High Cost
1955 - 1990
Toyota Production
System - Worker as problem
solver
- Worker as process
owner enabled by:
-- Training
-- Upstream quality
-- Minimal inventory
-- Just-in-time
- Eliminate waste
- Responsive to change
- Low cost
- Improving productivity
- High quality product
1993 -
Lean Enterprise - "Lean" applied to all
functions in enterprise
value stream
- Optimization of value
delivered to all
stakeholders and
enterprises in value chain
- Lower cost
- Improving efficiency
- High quality service
- Greater value for
stakeholders
1913
Mass Production - Part inter-changeability
- Moving production line
- Production engineering
- "Workers don't like to
think"
- Unskilled labor
- High production rates
- Low cost
- Persistent quality
problems
- Inflexible models
+ Goals of a
Lean Enterprise…
Improve Quality
Eliminate Waste
Reduce Lead Time
Reduce Total Costs
+ What are we really trying to do
with Lean…
For any regularly performed activity…
Reduce the lead time
Improve the flow
Match demand to capacity
Workflow Optimization versus Process Optimization
+ The Value Equation
Quality / Cost = Value
Quality / Cost = Value
50% / $100 = .5
90% / $100 = .9
90% / $75 = 1.2
Does higher quality mean higher cost? Not necessarily!
+ As it relates to Lean, where are we
now?
At your table…
Take a few minutes to assess your company with
the six keys to operational excellence…
With a possible score of 30, where do you see your
company right now?
+ Keeping a constant eye on the
ideal state…
Defect-free delivery: Exactly what the client needs
No waste in the system: None of the eight types of waste exist
Individual attention to clients: One-on-one care that is
customized to each client
On-demand care: Care that is exactly as requested, when
requested
Immediate response to problems: A safer environment for
clients and workers, with no replication of recognized problems
+ We ask three questions…
What is your purpose?
What processes achieve your purpose and how
lean are they?
How do you engage your people to agree on your
purpose and create lean processes, with fulfilling
work, to achieve your purpose?
* James Womack - Lean Enterprise Institute
+ Purpose
“To enhance the quality of life for all of our
clients!”
Successful organizations solve client problems by
providing what clients want, when they want, where
they want, cost effectively.
Note: Cost reduction is the wrong end of the
telescope; value maximization by solving problems
is the real client desire.
+ What is a Lean Process?
Every step is:
Valuable – as judged by the client
Capable – a good result every time
Available – ready whenever needed
Note: Capability x availability = stability
Adequate – just enough capacity
Flexible – able to switch quickly at low cost from
one task to the next
+ People
How do you engage people at every level?
Teach them to see the process
Give them problem-solving PDSA skills
Push responsibility to the level of action
Introduce end-to-end metrics
Create frequent problem-solving loops
Make the abnormal immediately visible
+ Lean Leadership
Not charisma (or heroic fire fighting)
Not bureaucracy
Not “do it my way”
Not “do it your way” (but be sure to make your
numbers)”.
But instead…
“Let’s get agreement on our purpose and the
processes that achieve our purpose”
“Let’s transform the processes together”
+ Lean Leadership
Three attributes of lean leaders at every level
Go see: Visit the point where value is actually
being created; verify the situation.
Ask why: What is the problem? What are the
possible countermeasures? Why is one
countermeasure the best?
Show respect: Assign clear responsibility for
every process & problem; ask questions about
people’s work.
+ Lean Leadership Checklist
Do you:
Ask five whys or one who?
Show respect by asking questions rather than
giving answers?
Make sure every leader is a teacher
manufacturing new leaders?
Dig into details (“go see”) to a point that the root
cause of the problem/gap is clear? (turn
hunches and data into facts)
+ Lean Leadership in Action
Once someone takes responsibility, you will
need a method for:
Clearly determining the problem
Identifying and evaluating alternative
countermeasures
Implementing the chosen countermeasure
Evaluating the results, adjusting, and sustaining
A3 is an excellent tool if used properly
+ A3 Thinking…
What is an A3?
The A3 document comprises a format for structured problem solving,
created with a pencil on a piece of 11” X 17” paper: Outside the United
States, this paper size is called “A3”, thus the name
What is A3 thinking?
“A3 as a process embodies a way of thinking that captures the heart of lean
management. In this context, an A3 document structures effective and
efficient dialogue that fosters understanding followed by the opportunity for
deep agreement. It’s a tool that engenders communication and dialogue in
a manner that leads to good decisions, where the proposed countermeasures
have a better chance of being effective because they are based on facts and
data gathered at the place where the work is performed, from the people
who perform it.“
John Shook author of Managing to Learn.
+ A3 Problem Solving
+ Principles of Operational
Excellence
Cultural Enablers
Lead with humility
Respect for every individual
Continuous Improvement Process
Focus on process
Embrace scientific thinking
Flow and pull value
Assure quality at the source
Seek perfection
Enterprise Alignment
Create constancy of
purpose
Think systemically
Results
Create value for the
customer
+ Four Rules…
Rule 1: Clearly specify all activities of work
Rule 2: All steps in a request for a product or services are simple and direct
Rule 3: The flow of steps required to deliver a request is simple and direct
Rule 4: All problems are addressed directly and in a timely way, under the guidance of a coach
Decoding the DNA of the Toyota Production System – Bowen & Spear
+ Lean Certification
Lean Bronze Certification
Five (5) tactical projects: events, projects and/or activities to which specific lean principles and tools were applied*
Lean Silver Certification
Three (3) tactical projects and Two (2) Integrative (Value Stream) projects: events, projects and/or activities to which specific lean principles and tools were applied
Mentoring/Coaching*
Lean Gold Certification
One (1) tactical project, Two (2) Integrative (Value Stream) projects and Two(2) Strategic (Enterprise) Projects: events, projects and/or activities to which specific lean principles and tools were applied*
Mentoring/Coaching
+ Teacher versus Teller
“So far Toyota has only been successful because of their
managers willingness to facilitate learning by asking
questions…”
Decoding the DNA of the Toyota Production System – Bowen & Spear
+ In Summary… How do we get
there?
Follow a Roadmap…
The “Ideal State”
Use of Mentors
“Workflow Optimization” versus “Process Optimization”
Certifications: definitely a win-win situation…
Lots and lots of A3’s
Teaching versus Telling!
+ Facilitated by…
Michael Gilreath – Lean Six Sigma Solutions, LLC
517-712-3186
+ Facilitated by
Barbara J. Smith-Burcham Hills Strategic Initiatives and
Quality
517-349-4803