Lean What Is It, and How Does It Work


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Lean What Is It, and How Does It Work

  1. 1. Lean – What Is It, and How Does It Work? Dean Bliss Iowa Health System WCBF 9th Annual Lean Six Sigma And Business Improvement in Healthcare Summit
  2. 2. A little about me…
  3. 3. Where did Lean come from?
  4. 4. Key Publications 1990: The Machine that Changed the World – The Story of Lean Production 1996: Lean Thinking 1998: Learning to See 1999: Decoding the DNA of the Toyota Production System (Harvard Business Review article) 2004: The Toyota Way 2005: Lean Solutions 2006: The Lean Healthcare Pocket Guide 2006: A Lean Guide for Transforming Healthcare 2007: Lean for Dummies 2008: Toyota Culture 2009: Lean Hospitals
  5. 5. What is Lean? “Lean provides a way to specify value, line up value-creating actions in the best sequence, conduct these activities without interruption whenever someone requests them, and perform them more and more effectively.” “Lean thinking also provides a way to make work more satisfying by providing immediate feedback on efforts to convert muda (waste) into value.” - quotes from Lean Thinking, by James Womack and Daniel Jones (1996)
  6. 6. Womack’s 5 Principles of LeanThinking Specify value from the customer’s perspective Identify the value stream for each product and remove the waste Make value flow without interruptions from beginning to end Let the customer pull value from our processes Pursue perfection – continuous improvement Do this every day in all our activities 6
  7. 7. Does this sound familiar? Call the clinic, 3 voice prompts, on hold, leave message Clerk calls back and sets a date for next week Arrive for visit, check in, sit in waiting room Called into exam room, wait for doctor Doctor sees you, says she’s been waiting for you Diagnoses a URI, and BP is worse Doctor prints antibiotic prescription, goes to staff room to get it. You are allergic to that drug Doctor says to return in a week for the BP At check out you ask the cost – clerk says they’ll bill you No appointments available next week Pharmacist says insurance prefers a different drug Is there a problem here? 7
  8. 8. Using Womack’s 5 Principles Inthe Clinic VisitSpecify value from the customer’s perspective A quick, effective clinic visitIdentify the value stream Request, appointment, arrival, seeing doctor, checkoutMake value flow Staff and patient moving continuously from check-in to exit No waiting room, no staff waiting Errors surface immediatelyLet the customer pull value from our processes Pull the appointment or med refill when you want itPursue perfection – continuous improvement Every day, every clerk, every doctor, every nurse thinks about how to redesign work to improve value to the customer 8
  9. 9. Keys to Success Those who do the work should be those who develop the new process Involve all affected stakeholders Don’t settle for the “easy” stuff Have resources available Do what we say we are going to do Make changes now But what kinds of things are we looking for?
  10. 10. 7 Forms of Waste
  11. 11. 7 Forms of Waste 1. WaitingTime spent waiting on items required to complete task(i.e., Information, Material, Supplies, etc.)
  12. 12. 7 Forms of Waste 2. Excess MotionAny motion that does not add value to the product or service
  13. 13. 7 Forms of Waste 3. Moving ItemsTransporting information or Material by mail, cart,conveyor or foot travel
  14. 14. 7 Forms of Waste 4. Fixing DefectsTime spent repairing or reworking material or information
  15. 15. 7 Forms of Waste 5. Over ProductionProducing more information or product than theultimate customer requires
  16. 16. 7 Forms of Waste 6. InventoryMaterial or Information that is waiting for processing
  17. 17. 7 Forms of Waste 7. Over Processing APP APPRO OVED ROVED APPROVED PRVV D AP RO E PP AEffort and time spent processing information or materialthat is not adding value
  18. 18. Lean Tools
  19. 19. Lean Tools Value Stream Analysis- Process map w/ data Standard Work- best way to complete a task 5S- organize and manage a workplace A3- structured problem solving tool 19
  20. 20. Lean ToolsError Proofing- limits operations to desiredeffectVisual Controls- guide action of the groupKanban- visual inventory managementSpaghetti Charts- distance traveledRoot Cause Analysis- 5 why’s and fishboneAndon Signal- stop the line/fix theproblem 20
  21. 21. Value Stream MappingDefines value from the customer’s perspectiveAll of the actions and tasks, both value addedand non-value added, required to bring an item(an idea, information, product or service) fromits inception through delivery.Mapping the process brings commonunderstanding and the ability to seeweaknesses that can be corrected/improved
  22. 22. Value Stream Map - Emergency Room Treatment Information Attending Patient history Attending Insurance Hospital Patient Nurse Vital Statistics Physician Company Records Treatment Information Information Flow Insurance Info Nature of Injury Available Room Patient ready for Treatment Diagnosis & Patient history Supply Needs Patient history Vital Statistics Patient Info Patient history Vital Statistics Diagnosis & Departing Instructions Departing Inst. Material Flow Wait Wait Wait Wait Wait WaitOut Patient Go to Nurse Doctor Nurse brings Taken to ER Doctor Treats Departing Patient GoesRegistration Waiting Examines Examines Medical Room Patient Instructions Home Area Patient Patient Supplies
  23. 23. Lean Tools Standard WorkRepresents the current best, easiestand safest way to do a job.
  24. 24. Lean Tools Standard WorkRemoving Variation and VariabilityUsing Best Practices Consistently
  25. 25. A3A single sheet of paper (A3 size, 11x17)that, for a project, contains the: Problem Analysis Corrective actions Action plan
  26. 26. The Five S’s Sorting – separating the needed from the not-needed Simplifying – a place for everything and everything in its place, clean and ready to use Systematic Cleaning – cleaning for inspection Standardizing – developing common methods for consistency Sustaining – holding the gains and improving
  27. 27. Lean is a Culture Lean is a management style….not a bunch of tools. Lean initiatives aren’t successful from the conference room….go to where the work is being done. “SEE” the 7 wastes and remove them from your processes. 27
  28. 28. What is the Toyota Way? A total business philosophy aimed at driving value to the customer and society A culture, the “DNA,” “its in our blood.” A long-term, sustainable learning organization The particular culture that evolved over decades at Toyota Guiding principles of people, process, and technology A spirit of challenge and competitiveness 28
  29. 29. The Toyota WayRespect: Build mutual trustTeamwork: Maximize team performanceChallenge: A long-term vision to realizedreams through courage and creativityKaizen: Improve relentlesslyAlways go to the source CONTINUOUS IMPROVEMENT RESPECT FOR PEOPLE 29
  30. 30. Lean Leadership = MentorshipThe Lean Leader leads: By setting the vision (more why than how) By building systems and processes that cascade responsibility By influence by example by being knowledgeable by getting into the messy details by coaching and teaching through PDSA learning cycles through questioning 30
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  32. 32. Why is the Toyota Way difficult toteach and difficult to Sustain?Not the natural way to approach problems and makedecisions Going and seeing when we have already been there Observation is different than “walking around” Seeking alternative solutions when we have a “good enough” solution “Good” is the enemy of “great” Thinking beyond our own group’s interests in a budget- conscious culture Recording and analyzing data, following standardized procedures, updating standards as conditions change Data-driven decision-making, rather than intuition 32
  33. 33. The Leader’s ChallengeThe essence of Leadership can be summed up simply:“Get everyone in the organization to take initiative to continually improve their jobs”“Align all jobs (all processes, all work) around providing value for the customer. “ 33
  34. 34. This isn’t magic The concepts and practice of process improvement aren’t Rocket science, or Brain surgery, or Quantum physics With a little training and practice, anyone can do them Rawlings video
  35. 35. Healthcare Examples Chemotherapy turnaround time improved 37% Cash flow improved by $8.1 million Lab turnaround time improved 64% CT capacity increased 30% Nurse walking distanced decreased over a mile a day
  36. 36. So keep in mind… The 7 forms of waste The Lean tools The Lean vision “Learning to see” Willingness to change Continuous improvement
  37. 37. “Do what you can, with what you have, where you are.” Theodore Roosevelt
  38. 38. “The things that matter most must never be at the mercy of things which matter least.” Johann Wolfgang von Goethe
  39. 39. How can you do this? Your hospital association Local Lean companies Manufacturing Extension Partnerships (MEP) Institute for Healthcare Improvement Universities/Community colleges Online connections Start a group
  40. 40. Online resources www.lean.org Articles, events, information www.leanblog.org Discussion on lean topics http://finance.groups.yahoo.com/group/hme/ http://finance.groups.yahoo.com/group/NWLEAN/ Discussion groups, where questions can be posed and answered www.ihi.org Institute for Healthcare Improvement www.ihconline.org Information, resources, success stories
  41. 41. Questions? Dean BlissIowa Health SystemCedar Rapids, Iowa 515-979-9413 blissd2@ihs.org