minnesota enterprise lean. enterprise lean a coordinated state government initiative for improving...
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Minnesota Enterprise Lean
Enterprise Lean
A coordinated state government initiative for improving organizational performance and results in Minnesota's state government agencies
Approach
Lean/Kaizen events– Six Sigma tools– TQM philosophy
Tools and training to help state government work better for its customers and employees.
What is LEAN?
Maximize customer value
Minimize wasteEmpower workersDerived from Toyota
Production System
Foundational Elements of Lean
7 wastes5SStandard work
7 Wastes
OverproductionWaitingTransportationProcessingInventoryMotionDefects
5s
Method for organizing work space– Sort– Shine– Set in order– Standardize– Sustain
Before 5S
After 5S
Standard Work
A simple written description of the safest, highest quality, and most efficient way known to perform a process or task.
The only acceptable way to do the process it describes.
Expected to be continually improved
Kaizen = change for the better
Identify the current stateDevelop the future stateImplement improvements immediatelyStandardize the processTrain on the new processTrack sustainment
Selecting a Kaizen project
Affects many stakeholders/customersConsumes a lot of resources Is highly visible to stakeholders/ customers Is clearly not working well Is a core business processHas leadership supportHas worker support
A Kaizen team
FacilitatorSponsorTeam leaderMembersNo rank – all
members have equal voice
Kaizen process
Day 1 – current state swim lane mapDay 2 – future state swim lane mapDay 3 – make and document changesDay 4 – document and train on
standard workDay 5 – present results
Swim Lane Map
Swim Lane Map
Define the scope Walk the processDocument the processCharacterize the process
Include time, people, tasks
Swim lane tips
Move chronologically left to rightUse post-it notesHand-offs indicate a lane changeHand-off usually indicates wait timeAssign average times to tasks and
waits
Sustain Improvement
Overall improvement planVisible and engaged managementClear roles and responsibilitiesAccountability for workCommunication about improvementA system to support standard work
Newborn Screening Kaizen Event
Ensure that infants who screen positive for metabolic, genetic, or hearing disorders are referred for diagnostic confirmationreceive appropriate intervention andreceive long-term follow-up services.
It will start at the point that the lab provides a presumptive positive.
Current state Dried Blood Spot Process
Current Future
Qty Time Qty Time
Tasks 61 12.75 hrs
Waits 21 51 days
Handoffs 36
Decisions 11
File/stores 26
Total time 52.5 days
Early hearing detection and intervention process
Current Future
Qty Time Qty Time
Tasks 85 14.5 hrs
Waits 22 56.5 days
Handoffs 35
Decisions 12
File/stores 32
Total time 58.3 days
Observations of Current State
Lots of handoffs Lots of double storage Lots of re-entry of data Redundancy – some good, some bad We are contacting the same people There are necessary waits in the process We are waiting on people outside our agency It is hard to completely map these processes There is a lack of trust in the data systems
Recommendations
Set up tools (Quickplace, sharefolders, case conferences) to promote better communication
Redesign the process, train staff in LIMS, and document standard work
Develop Access database. Long-term create a functional, child-based, interoperable system for MDH and its stakeholders.
Clarify roles in the process and share key information
Institute case conferences
Future State Dried Blood Screening Process
Current Future
Qty Time Qty Time
Tasks 61 12.75 hrs 25 5.60 hrs
Waits 21 51 days 7 23 days
Handoffs 36 15
Decisions 11 2
File/stores 26 8
Total time 52.5 days 23.65 days
Improvements from new process
59% reduction in tasks66% reduction in waits58% reduction in handoffs81% reduction in decisions69% reduction in file/stores56% reduction in cycle time
Future state hearing detection/intervention
Current Future
Qty Time Qty Time
Tasks 85 14.5 hrs 43 8.60 hrs
Waits 22 56.5 days 10 21.5 days
Handoffs 35 23
Decisions 12 6
File/stores 32 11
Total time 58.3 days 22.7 days
Improvements from new process
49% reduction in tasks54% reduction in waits34% reduction in handoffs50% reduction in decisions65% reduction in file/stores61% reduction in cycle time
Benefits of Future State
Save some trees and staff sanityFamilies are better and more efficiently
servedWill be able to move forward with more
initiativesWill have more time to be proactive
instead of reactiveLaid the groundwork for future changesStaff will be used more effectively, and
less frustrated
30 - 60 day Action PlanAction who when Complete
Provide LTFU access to Update Registry
Chris 3-12-09
X
Training in LIMS for LTFU Amy 3-19-09
X
Assure LTFU staff have access to LIMS
Barb 3-22-09
X
Update and/or create audio-related forms
Kirsten 3-23-09
X
Create LTFU Access database Maggie
5-6-09 X – Aug 09
Create standards for data items Allison 3-31-09
X
Determine if GCs can track in Registry Amy 3-26-09
X
30 - 60 day Action Plan, ContinuedAction who when completeCreate Work Space rooms for blood spot transfers/hearing QA /H & V
Amy 3-13-09 X – hearing not possible
Write a SOP for the HPRs for Blood Spot
Julie 3-23-09 X
Update SOP for the HPRs for Hearing
Chris 3-23-09 X
Write script for HPRs to find PCP Amy 3-12-09 X
Finish SOP for LTFU hearing Nicole
Yaoli
3-24-09 X
Standardize availability/location of procedures
Chris/Barb
5-1-09 X
Case conference/set up schedule for future
Amy 3-13-09 X -ongoing
Implement new process Chris/Barb
5-18-09 X - ongoing
What must we and the agency do to implement and sustain this effort?
We need to have follow-up meetings of this group through implementation and evaluation of the new process
Maintain respectful and open communications at all levels
We need management and staff support We need some IT resources to implement new
process
For more information…
http://www.lean.state.mn.us/
Kim McCoyOffice of Public Health Practice
Minnesota Dept of [email protected]
651-201-3877
Service Contracting Kaizen Event
Erin BarkemaIowa Department of Public Health
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Quality Improvement in Iowa
Why a Kaizen event?
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Customer concerns about the service contracting processGrant application process Issuance of contracts Reimbursement of expenses
Pre-event activities
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Identified a facilitator
Identified participants
Developed a charterScopeObjectives Goals
Gathered data
The Event - November 2-6, 2009
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AgendaOverview of KaizenFlow chartingBrainstormingIdentifying a new processResultsAssigning homeworkGaining buy-in from leadership
Flowcharting
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Brainstorming
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7 ideas for improvement
7 different ways to implement main idea
Brainstorming
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Small groupsDiscuss optionsIdentify solutionsPrioritize solutions
I III
II IV
IMPACT
DIFFICULTY
New Process
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Homework
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Twenty-three steps identified on a variety of topics Training curriculumPolicies and proceduresStandardized formsUse of technologyCommunication planMeasures to determine change or
improvementAssigned to members of the teamDue dates established
Buy-in
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Report outs to Deputy Director throughout the week.
Presented the results of the week to the IDPH Executive Team.
Developed a newsletter to keep people informed of the progress.
Post-event activities
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HOMEWORK, HOMEWORK, HOMEWORK!!! Follow-up meetings
30 day*60 day*90 day*120 day 150 day6 month*
CommunicationCELEBRATION!
Accomplishments & Lessons Learned
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AccomplishmentsImplemented an electronic document libraryProvided training to over 101 IDPH staff on the
new service contracting processCompleted 90% of homework assignments to
date
Lessons learned Kaizen was a great team building experience.Large scale quality improvement work takes time.Improved processes and increased satisfaction
will be worth all of the hard work!
Questions
45
Information
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Service Contracting Processhttp://www.idph.state.ia.us/mphi/quality_impr
ovement.asp
Contact Information:Erin BarkemaIowa Department of Public [email protected] (515) 242-5524