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Introduction to Lean
Principles
Planning of your work processes to improve flow
Productive Endoscopy Workshop
Tuesday 15th...
Simulation exercise
“The current state”
Simulation Exercise
• Practical simulation designed to introduce
Lean principles
• 2 teams - all team members with a role
...
Simulation Exercise
1. Simulate the process within healthcare from end
to end
2. Observe the process and capture key metri...
Teams
1. Operator #1 (at step 1)

9. Metrics/Time Keeper

2. Operator #2 (at step 2)

10. Finance Manager

3. Operator #3 ...
Simulation One
Objective:
• Produce 40 Endoscopy reports for scoped
patients
Simulation Rules
Each Operator:
• Collect lego pieces from stock room
• First operator ONLY - place sticky 1 on piece
1, s...
Simulation Rules
QA Inspector:
• Check report by report – confirm pass / fail
• Inform Metrics/Time keeper
• when 1st, 10t...
Simulation Rules
Process Observers - closely observe for the
following:
• How the piece moves from step to step
• How many...
Simulation Rules
Leadership Observers - closely observe for the
following:
• What do you observe about leadership in this
...
Simulation Rules
Porter:
• When called by operators 1-5, collect pieces
and transport to next operator or to the QA
Inspec...
Simulation Rules
Metrics / Time keeper:
• Start the process (start the stopwatch)
• Do not stop stopwatch until end of gam...
Simulation Rules
Finance Manager:
• Calculate profit and loss results and unit cost
per report
Correct Final Report

£25

...
On your marks…..
Results
What are the
principles of Lean?
What is Lean?
• Perfected by Toyota – from 1928 (Deming & Ford)
• ‘Lean’ coined by Jones & Womack in 1990s
• Lean is about...
Lean Thinking…
It is –
• A way of thinking
• A philosophy
• A mind set
• An approach
• A new culture

It is not –
• A mana...
NHS Change
Model
Lean principles
support the
capability to
deliver the new
NHS Change
Model
The 4Ps of Lean
Problem
Solving

Solve problems using Root Cause Analysis,
‘Go See’ and data

People &
Partners

Respect, ...
Lean Principles
Define value from the
customers perspective
and express value in
terms of specific
requirements/measures

...
Lean “Tools”
• Voice of the customer

•
•
•
•
• Work Combination
Sheets
• Total Productive
Maintenance
• Mistake Proofing
...
Lean Principles
Define value from the
customers perspective
and express value in
terms of specific
requirements/measures

...
The Customer defines Value Added
A visit to the Doctors

Where is the added value?
• Making the appointment
• Registration...
Lean Principles
Define value from the
customers perspective
and express value in
terms of specific
requirements/measures

...
Understanding Value & Waste
Value Added Activity
Any activity that changes the
form, fit, or function of a
product/transac...
Types of Waste - Simple Mnemonic
• Doesn’t add value to the patient, healthcare provider or staff

– Transport
– Inventory...
‘Old’ process

NEW Process
Spaghetti mapping
Things to think about…
• Focus on 80% of the time (green stream)…people will always
remember the exceptions
• Look for bot...
Lean Principles
Define value from the
customers perspective
and express value in
terms of specific
requirements/measures

...
Flow
What stops flow ?
• Batching
• Searching
• Variation in way things are
done

Eliminate batching
5S
Standard working
V...
Batch production
Operator 3
Batch size 10
Operator 2
Batch size 10
1 min

Operator 1
Batch size 10

10 minutes
20 minutes
...
One piece flow
Operator 3
1 min

Batch size 1
Operator 2

1 min

Batch size 1

1 min

Operator 1
Batch size 1

3 mins
4 mi...
Lean Principles
Define value from the
customers perspective
and express value in
terms of specific
requirements/measures

...
Pull
•

A notification system of requesting either:

• work to be completed, or
• delivery instructions for work completed...
Lean Principles
Define value from the
customers perspective
and express value in
terms of specific
requirements/measures

...
What is the point of Lean?
• Improving quality & eliminating defects
– Poor quality costs money in re-work and time

• New...
Model for
Improvement –
the three questions
A3 Thinking
• Structured thinking way - thinking deeply
• Follows a series of standard steps
• Rigorous application of Pla...
Version:
Author:

Title: A3 Problem Solving -

Future state:

Current state:

Waste identified:

PLAN

Goal:

Action plan:...
Use data to
establish the
facts
Root Cause Analysis
• The cause(s) that, if taken care of, would
eliminate all future occurrences of the problem
Cause and Effect / Fishbone
Why? Why? Why? Why? Why?
Results are not being reported back to GP in addition to OP
clinic
Why? Results system has not be...
You need data to evidence improvement

“It feels like it has improved…” or
“I think it has improved…”
is not enough
Lean “Tools”
• Voice of the customer

•
•
•
•
• Work Combination
Sheets
• Total Productive
Maintenance
• Mistake Proofing
...
Visual Management
• The most important step in developing
standardisation.
• Define the ‘normal state’ (standard).
• To vi...
Examples of
Visual
Management
Stop/Start
Audit
Lean “Tools”
• Voice of the customer

•
•
•
•
• Work Combination
Sheets
• Total Productive
Maintenance
• Mistake Proofing
...
What do these organisations have
in common??
Why Standard work?
• Creating the best possible work method, with the least
amount of ‘waste’ to produce the best quality ...
Lean “Tools”
• Voice of the customer

•
•
•
•
• Work Combination
Sheets
• Total Productive
Maintenance
• Mistake Proofing
...
If only
we had
more
space!
Is this safe?
5S
•

Sort: Deals with the contents of a workplace and removes all
items that are not needed there.

•

Set in Order: Desi...
Before 5S
After 5S
A place for everything
and everything in its place
Simulation exercise
Designing your
“future state”
Designing your “Future State”
• 5 mins - What waste exists in the
“Current State”?
• 5 mins - Discuss and agree what
chang...
On your marks…..
Results
Success
•
•
•
•
•
•
•
•

Understand the principles
Processes not people
Accept all aspects (challenge the status quo)
Impl...
Thank you
@NHSIQ
enquiries@nhsiq.nhs.uk
www.nhsiq.nhs.uk
www.england.nhs.uk/ourwork/qual-clin-lead/nhsiq/
Introduction to lean   amy hodgkinson & trevor taylor
Introduction to lean   amy hodgkinson & trevor taylor
Introduction to lean   amy hodgkinson & trevor taylor
Introduction to lean   amy hodgkinson & trevor taylor
Introduction to lean   amy hodgkinson & trevor taylor
Introduction to lean   amy hodgkinson & trevor taylor
Introduction to lean   amy hodgkinson & trevor taylor
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Introduction to lean amy hodgkinson & trevor taylor

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Introduction to Lean Principles
Planning of your work processes to improve flow
Amy Hodgkinson and Trevor Taylor
National Improvement Leads, NHS IQ
Presentation from the Productive Endoscopy Workshop, Tuesday 15th October 2013 at Ambassadors Bloomsbury , London, WC1H 0HX

This meeting brought together teams from around the country, and embarked on creating and testing the productive endoscopy toolkit. The aim of the day is to allow time with your team for sharing of experiences and exchange of good practice, learn how to apply lean techniques and hear the impact of successfully implemented case studies.

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Transcript of "Introduction to lean amy hodgkinson & trevor taylor"

  1. 1. Introduction to Lean Principles Planning of your work processes to improve flow Productive Endoscopy Workshop Tuesday 15th October 2013 Amy Hodgkinson and Trevor Taylor National Improvement Leads, NHS IQ
  2. 2. Simulation exercise “The current state”
  3. 3. Simulation Exercise • Practical simulation designed to introduce Lean principles • 2 teams - all team members with a role • 2 rounds with different focus
  4. 4. Simulation Exercise 1. Simulate the process within healthcare from end to end 2. Observe the process and capture key metrics to identify the key waste areas 3. Brainstorm improvements to the process 4. Try the key improvements and capture key metrics to measure the success of the changes
  5. 5. Teams 1. Operator #1 (at step 1) 9. Metrics/Time Keeper 2. Operator #2 (at step 2) 10. Finance Manager 3. Operator #3 (at step 3) 11. Observer 4. Operator #4 (at step 4) 12. Observer 5. Operator #5 (at step 5) 13. Observer 6. QA Inspector 14. Observer 7. Porter 1 8. Porter 2
  6. 6. Simulation One Objective: • Produce 40 Endoscopy reports for scoped patients
  7. 7. Simulation Rules Each Operator: • Collect lego pieces from stock room • First operator ONLY - place sticky 1 on piece 1, sticky 10 on piece 10, 20 on piece 20, 30 on piece 30, 40 on piece 40 • Build as fast as you can • Build according to batch size • Call a Porter once batch size completed • Porter will pass to next operator • No pre-assembly • No helping slower teammates
  8. 8. Simulation Rules QA Inspector: • Check report by report – confirm pass / fail • Inform Metrics/Time keeper • when 1st, 10th, 20th, 30th and 40th report is completed • when sticky numbers 1, 10, 20, 30 and 40 arrive • how many reports are correct (pass) / incorrect (fail)
  9. 9. Simulation Rules Process Observers - closely observe for the following: • How the piece moves from step to step • How many times the operator collects stock from the stock room • Where work builds up • Movement of people and pieces • Other aspects you feel are important
  10. 10. Simulation Rules Leadership Observers - closely observe for the following: • What do you observe about leadership in this process? • How do the “staff” feel about their work? • What leadership behaviours are missing? • How productive would this team be over the long term?
  11. 11. Simulation Rules Porter: • When called by operators 1-5, collect pieces and transport to next operator or to the QA Inspector
  12. 12. Simulation Rules Metrics / Time keeper: • Start the process (start the stopwatch) • Do not stop stopwatch until end of game • Record time when 1st, 10th, 20th, 30th and 40th reports are received by QA Inspector • Record time when sticky numbers 1, 10, 20, 30 and 40 are received by QA Inspector • Stop the stopwatch when 40th report and sticky 40 have been received • Record pass/fail rate, no. of staff and cost (request cost figures from Finance Manager)
  13. 13. Simulation Rules Finance Manager: • Calculate profit and loss results and unit cost per report Correct Final Report £25 Incorrect Final Report £100 penalty Inventory £5 per WIP piece Staff & Equipment £1 per person per minute
  14. 14. On your marks…..
  15. 15. Results
  16. 16. What are the principles of Lean?
  17. 17. What is Lean? • Perfected by Toyota – from 1928 (Deming & Ford) • ‘Lean’ coined by Jones & Womack in 1990s • Lean is about improving flow and eliminating waste – getting the right things, – to the right place, – at the right time, – in the right quantities, • while minimising waste and being flexible and open to change. • Customer at heart of the process • Driver for Quality and Safety
  18. 18. Lean Thinking… It is – • A way of thinking • A philosophy • A mind set • An approach • A new culture It is not – • A management fad • Rocket science • A cost cutting exercise • About making everyone work faster • A magic wand • Just for manufacturing
  19. 19. NHS Change Model Lean principles support the capability to deliver the new NHS Change Model
  20. 20. The 4Ps of Lean Problem Solving Solve problems using Root Cause Analysis, ‘Go See’ and data People & Partners Respect, challenge & grow them - become a learning organisation Process Eliminate Waste Right process will deliver the right result Philosophy Long-term Thinking and Continuous Improvement Ref: Liker 2004
  21. 21. Lean Principles Define value from the customers perspective and express value in terms of specific requirements/measures 1 Specify Value 2 Map the Value Stream 3 Establish Flow 5 Work to Perfection The complete elimination of waste so all activities create value for the customer Map all of the steps… value added & non-value added… 4 Implement Pull The continuous movement of patients, samples, request cards, reports from end to end through pathways Nothing is done by the upstream process until the downstream customer signals the need
  22. 22. Lean “Tools” • Voice of the customer • • • • • Work Combination Sheets • Total Productive Maintenance • Mistake Proofing Standard work Data and Measures Visual Management 5S • • • • • Value Stream Mapping • Process sequence charts • Spaghetti map • Handoff diagram • A3 thinking / problem solving (PDCA) • Root cause analysis • One piece flow Kanban Demand smoothing Load levelling Takt time
  23. 23. Lean Principles Define value from the customers perspective and express value in terms of specific requirements/measures 1 Specify Value 2 Map the Value Stream 3 Establish Flow 5 Work to Perfection The complete elimination of waste so all activities create value for the customer Map all of the steps… value added & non-value added… 4 Implement Pull The continuous movement of patients, samples, request cards, reports from end to end through pathways Nothing is done by the upstream process until the downstream customer signals the need
  24. 24. The Customer defines Value Added A visit to the Doctors Where is the added value? • Making the appointment • Registration • Waiting • Diagnosis • Treatment • Who is your customer? • What do they need / want? • How do you know? • Do you understand the ‘voice of your customer’?
  25. 25. Lean Principles Define value from the customers perspective and express value in terms of specific requirements/measures 1 Specify Value 2 Map the Value Stream 3 Establish Flow 5 Work to Perfection The complete elimination of waste so all activities create value for the customer Map all of the steps… value added & non-value added… 4 Implement Pull The continuous movement of patients, samples, request cards, reports from end to end through pathways Nothing is done by the upstream process until the downstream customer signals the need
  26. 26. Understanding Value & Waste Value Added Activity Any activity that changes the form, fit, or function of a product/transaction — OR — Something customers are willing to pay for Eliminate Non-Value Added Activity Any activity that absorbs resources but adds no value is a Waste Minimize Unnecessary Waste Necessary Waste Value Maximize
  27. 27. Types of Waste - Simple Mnemonic • Doesn’t add value to the patient, healthcare provider or staff – Transport – Inventory – Motion WASTEcosts – Automating an inefficient process money and – Waiting adds time! – Overproduction – Over processing – Defects – Skills appropriate to task
  28. 28. ‘Old’ process NEW Process
  29. 29. Spaghetti mapping
  30. 30. Things to think about… • Focus on 80% of the time (green stream)…people will always remember the exceptions • Look for bottlenecks & “batching” (Triage, vetting, authorisation) – what stops flow? • Look for “work arounds”… often duplication • Focus on what “adds value” from the patient perspective • Is unpredictable demand really unpredictable? • Where are you losing capacity? • Is everyone following the same system / protocol ? (standard working) • Could visual display help save time?
  31. 31. Lean Principles Define value from the customers perspective and express value in terms of specific requirements/measures 1 Specify Value 2 Map the Value Stream 3 Establish Flow 5 Work to Perfection The complete elimination of waste so all activities create value for the customer Map all of the steps… value added & non-value added… 4 Implement Pull The continuous movement of patients, samples, request cards, reports from end to end through pathways Nothing is done by the upstream process until the downstream customer signals the need
  32. 32. Flow What stops flow ? • Batching • Searching • Variation in way things are done Eliminate batching 5S Standard working Visual Management • Poor layout / excess walking • Variation in demand • Variation in turn around times Ergonomic layout Level demand Stabilise process
  33. 33. Batch production Operator 3 Batch size 10 Operator 2 Batch size 10 1 min Operator 1 Batch size 10 10 minutes 20 minutes 3 step process 3 operators 30 minutes Batch size 10
  34. 34. One piece flow Operator 3 1 min Batch size 1 Operator 2 1 min Batch size 1 1 min Operator 1 Batch size 1 3 mins 4 mins 3 step process 5 mins 3 operators 12 minutes Batch size 1
  35. 35. Lean Principles Define value from the customers perspective and express value in terms of specific requirements/measures 1 Specify Value 2 Map the Value Stream 3 Establish Flow 5 Work to Perfection The complete elimination of waste so all activities create value for the customer Map all of the steps… value added & non-value added… 4 Implement Pull The continuous movement of patients, samples, request cards, reports from end to end through pathways Nothing is done by the upstream process until the downstream customer signals the need
  36. 36. Pull • A notification system of requesting either: • work to be completed, or • delivery instructions for work completed • Nothing is done by the upstream supplier until the downstream customer signals the need One more please! Okay supplier customer Pull: Customer centric
  37. 37. Lean Principles Define value from the customers perspective and express value in terms of specific requirements/measures 1 Specify Value 2 Map the Value Stream 3 Establish Flow 5 Work to Perfection The complete elimination of waste so all activities create value for the customer Map all of the steps… value added & non-value added… 4 Implement Pull The continuous movement of patients, samples, request cards, reports from end to end through pathways Nothing is done by the upstream process until the downstream customer signals the need
  38. 38. What is the point of Lean? • Improving quality & eliminating defects – Poor quality costs money in re-work and time • New future state – In god we trust, everyone else brings data! – What are you going to measure to ‘prove’ the change is an improvement? • PDCA / A3 thinking – Structured problem solving & RCA – Cycle of continuous quality improvement (CQI)
  39. 39. Model for Improvement – the three questions
  40. 40. A3 Thinking • Structured thinking way - thinking deeply • Follows a series of standard steps • Rigorous application of Plan Do Study/Check Act (PDCA) cycle • Output is a concise, condensed document A3 Report (11 x 17 inch paper)
  41. 41. Version: Author: Title: A3 Problem Solving - Future state: Current state: Waste identified: PLAN Goal: Action plan: Root cause analysis: Next Steps: CHECK / ACT Results and measures: PLAN DO Problem Statement: Date: Team:
  42. 42. Use data to establish the facts
  43. 43. Root Cause Analysis • The cause(s) that, if taken care of, would eliminate all future occurrences of the problem
  44. 44. Cause and Effect / Fishbone
  45. 45. Why? Why? Why? Why? Why? Results are not being reported back to GP in addition to OP clinic Why? Results system has not been coded to report to GP as well as OP clinic Why? Person booking in did not include GP information when booking in Why? Request to report to GP not on request card Why? OP clinician did not complete the field on the request card Why? Process for completing request cards is not standardised
  46. 46. You need data to evidence improvement “It feels like it has improved…” or “I think it has improved…” is not enough
  47. 47. Lean “Tools” • Voice of the customer • • • • • Work Combination Sheets • Total Productive Maintenance • Mistake Proofing Standard work Data and Measures Visual Management 5S • • • • • Value Stream Mapping • Process sequence charts • Spaghetti map • Handoff diagram • A3 thinking / problem solving (PDCA) • Root cause analysis • One piece flow Kanban Demand smoothing Load levelling Takt time
  48. 48. Visual Management • The most important step in developing standardisation. • Define the ‘normal state’ (standard). • To visualise deviations from the standard (problems) • Indicate if there is a shift from what is expected • We are visual creatures
  49. 49. Examples of Visual Management
  50. 50. Stop/Start Audit
  51. 51. Lean “Tools” • Voice of the customer • • • • • Work Combination Sheets • Total Productive Maintenance • Mistake Proofing Standard work Data and Measures Visual Management 5S • • • • • Value Stream Mapping • Process sequence charts • Spaghetti map • Handoff diagram • A3 thinking / problem solving (PDCA) • Root cause analysis • One piece flow Kanban Demand smoothing Load levelling Takt time
  52. 52. What do these organisations have in common??
  53. 53. Why Standard work? • Creating the best possible work method, with the least amount of ‘waste’ to produce the best quality result. • Maximise quality and safety • Reduce variation • Reliable and repeatable process CONSISTENT METHOD = CONSISTENT RESULTS
  54. 54. Lean “Tools” • Voice of the customer • • • • • Work Combination Sheets • Total Productive Maintenance • Mistake Proofing Standard work Data and Measures Visual Management 5S • • • • • Value Stream Mapping • Process sequence charts • Spaghetti map • Handoff diagram • A3 thinking / problem solving (PDCA) • Root cause analysis • One piece flow Kanban Demand smoothing Load levelling Takt time
  55. 55. If only we had more space!
  56. 56. Is this safe?
  57. 57. 5S • Sort: Deals with the contents of a workplace and removes all items that are not needed there. • Set in Order: Designating locations to enable easy access to needed items. • Shine: Refers not just to cleaning, but to "being proud" about the way the workplace is organised. • Standardise: Refers to having standards that everyone agrees & adheres to. Visual management is an important aspect to facilitate easy understanding of these standards. • Sustain: Refers to training of and communication with all employees to ensure continuous 5S application.
  58. 58. Before 5S
  59. 59. After 5S
  60. 60. A place for everything and everything in its place
  61. 61. Simulation exercise Designing your “future state”
  62. 62. Designing your “Future State” • 5 mins - What waste exists in the “Current State”? • 5 mins - Discuss and agree what changes you will make to improve your process NEW Objective: • Produce 40 Endoscopy reports in 5 minutes
  63. 63. On your marks…..
  64. 64. Results
  65. 65. Success • • • • • • • • Understand the principles Processes not people Accept all aspects (challenge the status quo) Implementation (not recommendations!) Implement carefully (ever mindful of VOC) Systematic implementation (not just 5S) Leadership Communication
  66. 66. Thank you @NHSIQ enquiries@nhsiq.nhs.uk www.nhsiq.nhs.uk www.england.nhs.uk/ourwork/qual-clin-lead/nhsiq/
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