Pp, lean is the biology of business, pdf 20121219 (tp)

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Lean is entering healthcare and medical diagnostics - excellent fit between Lean practises and Biological system operation.

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Pp, lean is the biology of business, pdf 20121219 (tp)

  1. 1. Tom.Pettersson60@gmail.com Lean is the Biology of Business System Design for Quality in a Complex Organization Learning, Adaptive and Innovative Culture to Manage Crisis in Healthcare
  2. 2. If We All Knew What We All Know? Mobilize all Individual and Team Intelligence and Brain Power (IQ + EQ) in the Organization
  3. 3. Left-brainers Right-brainers Specialized in seeingGood at recognizes many things at once serial events Synthesizes Analyzes details the ”Big Picture” Emotional, Emphatic, Logic, Abstract Visual A Whole new Mind: Why Right-brainers will rule the Future
  4. 4. What do you see ? Human Microbiome 2012 Five Horses
  5. 5. Do we see the same ? Communicate through Dialogue and Active Listening
  6. 6. Learn to see and act ? Empower, Motivate See Waste, Uncover Problems Eliminate Waste, Correct Root Causes
  7. 7. Manage QualityQuality is in the process
  8. 8. A H B Linear Flow Complex A B C D G Adaptive C Newtonian Linear Process View SystemReductionist – Left brain approach F D E Quantum Complex Process View Holistic – Right brain approach
  9. 9. Evolution1.Self-creation Is2.Self-reflexivity continuous3.Self-regulation adaptation4.Communications among all parts of a5.Conservation of what works well complex Biological6.Creative change of what does not System work well.
  10. 10. Culture of a Complex Adaptive Organization1. Pursue agility and resilience Evolution Is2. Consciously learn from daily experience continuous3. Allow solutions to emerge adaptation4. Pull, don’t push of a5. Seek healthy mixtures complex6. Rely on vision and boundaries Biological System7. Appreciate the messy phases8. Expect non-linear progress9. Cooperate to create abundance10. Promote grassroots initiatives11. Work in a place designed for humans
  11. 11. ”No Waste” Process design Scientific methodSokrates Franklin Ford Taylor Juran Project TQM Deming 14 points Deming ”Purpose/People/Process”s The Evolution of Quality Management in IndustryToyoda Present The Toyota Way The Industrial Management TPS, TPM, 14 points and Quality Maturity Model Shingo Ohno LEAN (1990) Kaizen Production Imai A better Life Womack Seddon Jones Service Healthcare (IHI) ”Lean, Six Sigma, ISO Synchronization” ISO Six Sigma QMS CEN QA/QC ISO 9001/2008 ISO 17025/ISO 15189 QMS Smith Westgaard
  12. 12. Continuously Improve / eliminate Waste”/ Innovate Lean Synchronize Flow/ Focus Speed and Customer”Learn to see” Process Quality/ ”Quality by Design” / All Participate Reduce Variation and ErrorsSix Sigma ”World Class” Product Quality Data Design for Six Sigma / Expert Driven Documentation /Traceability/ Accreditation/ Certifying ISO Quality Through Control / Regular Audits (internal/external) Apply to Standards / Weak Focus on Process (traditional)Document Tendency to Hamper Improvement Culture Six Sigma Lean is is Left Brain Right Brain Thinking Thinking
  13. 13. Quality is Data driven Improvement
  14. 14. Lean Heritage from TPSToyota system is;“profit-making industrial engineering”Reduce the time from committingmoney to the raw materials to whencollect money from customers“Cash Flow””Design for best quality tolowest price””Mobilize all intelligence in theorganization to meet our purpose” Taiichi Ohno Father of the Toyota Production System (TPS)
  15. 15. “Yet the most powerful aspect of LEAN is not what participants do toadd to improve a process but what they remove from the process to improve it”
  16. 16. Lean Pillars for Lean Culture:1) Continuous Improvement2) Respect People Appreciate peoples brainsJob satisfaction motivates, self respect reduces negative Stress “Lean IS Healthcare”No Zero Sum but Win-Win !
  17. 17. Business Customer Value Value “(Cost)” “(Delivery) “ Quality inStaff Value Process“(Motivation)” “(Quality)” Input - Process - Output • Quality in raw material/sample • Quality in process • Product Quality
  18. 18. Do not sellout Quality Allways improved Quality/Value to Lower Price
  19. 19. First Kaizen Culture then Tools Process VSM 5S 5W PDCA/A3 Kaizen Dayly Spagetti Board Steering JIT Takt time map Flow Mäta Transformation Team Pull Onepiece Flow Muda Mura Muri Root Cause Initiate first < Kaizen feeling among staff ”Lean Toolbox” ”Lean Thinking”
  20. 20. First Kaizen Culture then Tools Initiate first Kaizen feeling among staff < ”Lean Toolbox” ”Lean Thinking”
  21. 21. First Kaizen Culture then Tools 5S/5W Initiate first VSM Spagetti map Selected Kaizen Flow Tools feeling among Measure staff PDCA/A3 < ”Lean Toolbox” ”Lean Thinking”
  22. 22. First Kaizen Culture then ToolsAbandon Command and Control Culture (No Blame) Cease dependence on inspections for quality Empower people to continuously improve quality Establish Lean Coach, Facilitator, Change Agent Pull according to Need - do not Push !
  23. 23. Lean Design Healthcare EnterpriseIntegrated Delivery System
  24. 24. Design System for Value and Flow1. Understand ”Big Picture”2. Utilize Industrial Maturity Model for Management Quality, Competence and Skills3. Design Education and R&D for right Knowledge, Science and improvement Culture4. Lean Value Stream Design all interconnected Processes involving all Stakeholders (Extended Value Stream)5. Deliver right Care and Health/Wellness Support
  25. 25. Manage all Parts that Interact ActThe Lean House Add Resources Base Decisions on Data of Identify relevant Problems to Solve Understanding the Big Picture and NeedsIndividual/Global Industrial Global/Individual Global/Individual Patient need of Quality and Patient need of Academia Healthcare Management Medical Cure Health - Wellness Education for Maturity Adequate Design for Flow 1 Sokratic direction Clinical Specialities Practice ”Dialogue” 2 B Franklin ”No waste” People 3 F Taylor ”Scientific Focus on Relevant Management” Processes Knowledge, Dismiss Irrelevant Knowledge 4 H Ford ”Assembly line – Process for Purpose Waste Waste Out Massproduction” Out 5 E Deming – Total Quality Management” 6 J Juran ”The Quality Triangle” Academia R & D for 7 Toyoda – ”TPS . Toyota Production System” Medical New Biology 8 Womack/Jones/ Seddon – ”Lean Production / Services” Diagnostics Knowledge 9 B Smith, “Six Sigma” Medical 10 JH Holland ”CAS Biology Systems Thinking” Applications 11 “CEN- ISO regulation” In Vitro Health Pharma Medical Devise IT/ICT/IST Diagnostic Wellness Industry Industry Indsutry Industry Industry Waste Out
  26. 26. Look for waste ! Category Sources Excess Costs Unnecessary Services 210 billion US Inefficiently delivered Services 130 billion US Excess Administrative Costs 190 billion US Prices That are Too High 105 billion US Missed Prevention Opportunities 55 billion US ”Best Care at Lower Fraud 75 billion US Cost” Total 765 billion US Report IOM USA 2012 5 202 000 000 000 Skr
  27. 27. Science and Technology RevolutionNew Possibilities – New Demands Intuitive Healthcare Empirical Healthcare Precision HealthcarePatient Participation
  28. 28. The Ecological Approach ”The New Biology” Health, Food, Energy, EnvironmentMedical Diagnostics support Integrative and Functional Medicine Personalized Medicine, Pharmaco- and Nutrigenomics
  29. 29. New Business Paradigm Power through Collaboration In Complex Organizations Capability and Capacity depends on Relationship Management and Collaboration in Multifunctional Teams
  30. 30. Extended Value Stream
  31. 31. New RolesChanging Roles in Healthcare –Customer Always in FocusThe intelligent PatientThe well informed PatientPatient Health AwarenessPatient as Health ConsumerPatient as a Healthcare ProfessionalDoctor as ConsultantHealthcare professional Team effort
  32. 32. Access Healthcare Information
  33. 33. Patient Mobilisation patientslikeme ”Because of PatientsLikeMe, we are better able to recognize warning signs... [and] keep things in perspective. In short, PatientsLikeMe empowers us.” ”PatientsLikeMe has provided me with new friends- people who are experiencing the same problems as I am.” ”I joined because I didnt want to feel alone anymore. Simply put. And I knew that I could be helpful [by sharing] my experience.” http://www.patientslikeme.com/
  34. 34. Lean Design and InnovationMedical Diagnostics
  35. 35. Integrate Diagnostic Services1 Customer/ Lean Healthcare Key Qualities Patient level Patient Experience/Flow/Security/Medical and Operational Excellence2 • Integrate Service level Medical Diagnostics Services Integrated3 Integrated Radiology Physiol. Laboratory Medicine • Consolidate information ”Imaging”4 Biological Integrated Tissues Micro- Fluids Nucleic • Automate Production Cells Organisms Molecules acids Level Core, Rapid Response, POC Functions Diagnostic, Scientific, Operational, Managerial • Share5 Integrated Knowledge Imaging Biochemistry Transfusion Med Scientific Physiology Histopathology Hematology Immunology Medical Cytology Coagulation Toxicology • Mobilize all Knowledge Base Bacteriology Virology Serology Pharmacology intelligence in6 organization Skills Lead, Improve, Innovate, Transform, Drive Change7 Common Develope the Medical Diagnostics Knowledge Worker through • Continuously Purpose Collaboration and Shared Purpose learn
  36. 36. Design End to End Processes (Lean Six Sigma)Key Deliveries 1) Order, 2) Sample material, 3) ReportCorrect from me in every stepKPIs for Flow, Timing, Continuous improvenet, Team efforts
  37. 37. Lean Histopathology - ModelImprove andInnovate;• Methods• Process design• Flow, Value• Team• Autonomate (Instrumentation/IT)Potential TAT within 24hours (TAT = Turn Around Time) Sample No Quality WorkCell Delay Repeat FLOW - Autonomate
  38. 38. Lean Bacteriology - ModelImprove andInnovate;• Methods• Process design• Flow, Value• Team• Autonomate (Instrumentation/IT)Potential TAT within 24hours (TAT = Turn Around Time)
  39. 39. Lean Healthcare.org Organize for Single Unit Patient Flow !
  40. 40. Patient in real Focus ?Central vs DecentralizedLEAN for the patientwould changeHealth Care forever. Klaus Schipper Med Dr, Viborg, Danmark, 2010
  41. 41. Educate for Team Effort The Diagnostic Team Operational Excellence Diagnostic Scientific Excellence Depth Management Leadership
  42. 42. Basic Common Design Lean Organization and Biological System
  43. 43. Hierarchy of a Biological System Sensing Environment Top Brain, Hypothalamus, Releasing Pituitary, Hormones Pineal Stimulating Neural Middle Signaling Endocrine Hormones Organs Autonomous Activities Hormones Interstitial fluid Front Line O2/CO2 Re/Ox, pH Blood Organs Electrolytes Complex Complex Cells ProteinsXYZ Tissues Plasma Hormones Signaling Crosstalk Vitamins Cells) Metal Ions Carbohydrates Nutrients Amino Acids Lipids Gastrointestinal Tract Microbiome, Skin, Environment
  44. 44. Biological System vs Lean System Biology System Hierarchy Lean Leadership Top Down Lean System Hierarchy Bottom up
  45. 45. Transforming LeadershipTraditionalManagerFutureLeader
  46. 46. The Lean Organisation - Model Cultivation Blood Donation Trans. Med Cell Tissue Testing Testing Biological Fluids
  47. 47. The Meeting Point
  48. 48. Direction through Why ? Why ? Identifies Purpose - Sets Direction
  49. 49. Direction through Why ? Fractal Thinking5 WhyIn Depth Analysis Why ? Finds the Root Cause Focuses the Countermeasure
  50. 50. World Class Lean Organization IT/ HR/Procurement/Accounting
  51. 51. Lean DilemmaLean and Nature Manage• Need• Risk• Damage• RepairTraditional Industry Manage• Financial Bottom Line
  52. 52. Design Lean HealthcareSystemNew Roleof Leadership – Quantum LeadFronline Autonomy - Sustained TeamsImprove and Innovate Complex Value Streams
  53. 53. System - Synchronization Core – Discipline Integrated Central Function RRL – Rapid Response Function POCT – Function at Point of Decision
  54. 54. System - Flow System Lean Healthcare Components of Flow / Lab Deliveries / Lab Patients Medical Excellence Patient security Clinical Information Data Sample material Information • Biological fluids Knowledge • Cultivation Fast - Timely • Tissues Coordinated Correct – no Error • Nucleic Acids Reproducible Operational Excellence
  55. 55. System - Connectedness System Lean Healthcare Start Goal Lean Lean Lean Lean Customer Service Human Resources Lean IT Procurement Accounting ”Lean Management” (System value) Medical Excellence Patients Top Down Patient security Clinical Information Data Sample material Medical Diagnostics Information Radiology, Physiology Knowledge • Biological fluids Fast - TimelyInput Laboratory Medicine Output • Cultivation Coordinated • Tissues Bottom Up Correct – no Error Reproducible • Nucleic Acids Operational Excellence ”Lean Operations ” (Process value)
  56. 56. System – Diagnostic Work Station – Patient Focus Single Patient Flow EHR, EMR, EPR • Historic • Intelligent • StandardizedRIS/PACS/LIS/LIMS Disciplin Integrated
  57. 57. System – Access and Share ”Cloud Computing – abundant but waste free data flow” ”Lean for the Information Age”
  58. 58. Manage ChangeResponsibilityAccountabilityCommittedRespected
  59. 59. Manage Change The test Toyota Kata question is:“Your vision becomes your beliefsYour beliefs become your thoughts Am I workingYour thoughts become your words with orYour words become your actionsYour actions become your habits againstYour habits become your values nature?Your values become your destiny” Mahatma Gandhi
  60. 60. Nature and Healthcare are Fractal Autonomous Lean Cell in a Fractal Organization
  61. 61. Make it Simple but not Simpler A Einstein Lean is the Biology of BusinessBalancing left with right Autonomation = Automation with a human touch for a better life TPS Approach Create the Medical Diagnostic Konwledge Worker in Team Organization Classic Drucker
  62. 62. Learn from Nature - Work with Nature - Altruism - No Ego
  63. 63. System designThe Question is Howdo we Become more Hummingbird versus Working Man / Team like Birds ? Weight 2 - 20 g 50 - 110 kg Heart size (% wight) 2,43 0,31 Heart beat / min 300 - 1000 70 - 120 Lifetime O2 cons. L / kg 500 000 180 000 Lifespan /years 10 80 Rel. Longevity / kg 200 1 Lean is the Biology of Business
  64. 64. Lean Ceases to be Lean whenused for BadBiology dies when abusedBusiness fails when driven byGreed
  65. 65. Lean is the Biology of Business Design Pull Systems – Do Not Push ! Contact: Tom.Pettersson60@gmail.com
  66. 66. Appendix: Proposed Change Agenda1. Improve Patient Involvement in Care and Health Process – Individualized / Personalized Medicine – Patient Role as aProfession2. Transfer Healthcare / Medical Diagnostics Focus towards Prevention and Culture of Wellness – Integrative and FunctionalMedicine shifting Mindset from fragmented (reductionist) to a holistic (quantum) View3. Foster Healthcare Organization in Continuous Learning, Respect for People and continuous Work Process Improvement fora better Life – Healthcare Kaizen4. Design Healthcare / Medical Diagnostic system for Patient Flow and Flow of Work – Lean /Complex Adaptive System (CAS)oriented Healthcare5. Design Laboratory Processes for Analytical Material Flow and timely Delivery of Reports through Integration, Consolidation,Autonomation (= Automation with a human touch) and Multifunctional Operational Teams – Lean Laboratory Medicine6. Utilize new Technology and Biological Knowledge in Genome, Proteome, Metabolome and Microbiome for new DiagnosticApplications – The New Biology, Systems Thinking and Science Integration7. Designing IT / ICT / IST for Process Management, Flow of Data, Access of Information and Knowledge Sharing – LeanProcess Design for Lean IT, Impact of Internet and Social Media8. Transforming Leadership towards Teaching, Coaching, Motivation and Self-sustaining / Empowered Operational Teams –Lean Management / Quantum Leadership9. Shifting Quality Focus from End Product to Process Quality through Continuous Improvement Culture for MedicalExcellence, Operational Excellence and Patient Safety – Lean Six Sigma and ISO Synchronization10.Shifting Healthcare / Medical Diagnostic Operations towards a Biological Adaptive Business Model generating Powerthrough Collaboration – Participation, Responsibility, Accountability, Flexibility and Growth11.Developing Relationship IT / IVD Industry, Medical Diagnostics Laboratory and Healthcare for Innovation - Lean ExtendedValue Stream and Innovation Sourcing, Ecological Approach12.Educational Programs for improving Diagnostic and Scientific Knowledge Base , Operational Management Competence andSkills for Team Operations, Productivity and Value for Money – Lean / Biological Systems Thinking / Lean Higher Education

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