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LEAN: 5 Keys to Success

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Check out this introduction to Lean processes in a health care setting—touching on 5 keys to Lean success. This presentation is from a recent AORN webinar, which is available for replay at …

Check out this introduction to Lean processes in a health care setting—touching on 5 keys to Lean success. This presentation is from a recent AORN webinar, which is available for replay at http://bit.ly/188O2uQ. Get complete Lean instruction and tools for implementation during a workshop in Denver, CO; more information on these August and September events available at http://bit.ly/14B9gLu.

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  • 1. 5 Keys to Lean Success: Avoiding Common Lean Pitfalls Tony Gorski BSIE, MBA Tuesday, June 25th, 2013
  • 2. • Tony Gorski is CEO of Safer Healthcare. Mr. Gorski is an award- winning speaker, published author and recognized subject matter expert in helping hospital boards, CEOs and management teams transform operational performance and creating High Reliability Organizations (HROs). Mr. Gorski is also driving the launch of www.MyRounding.com, an iPad Leadership Rounding application for directors, managers and frontline staff. Mr. Gorski holds a Bachelor of Science in Engineering from Marquette University and a Masters of Business Administration from the University of North Carolina in Chapel Hill. Mr. Gorski currently resides in Denver, CO. Tony Gorski, BSIE, MBA
  • 3. Disclosure Information Speaker: Tony Gorski, BSIE, MBA No Conflict Accreditation Statement AORN is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. AORN is provider-approved by the California Board of Registered Nursing, Provider Number CEP 13019. AORN IS PLEASED TO PROVIDE THIS WEBINAR ON THIS IMPORTANT TOPIC. HOWEVER, THE VIEWS EXPRESSED IN THIS WEBINAR ARE THOSE OF THE PRESENTERS AND DO NOT NECESSARILY REPRESENT THE VIEWS OF, AND SHOULD NOT BE ATTRIBUTED TO AORN. Planning Committee: Susan D. Root, MSN, RN, CNOR Manager Perioperative Education, AORN No conflict AORN’s policy is that the subject matter experts for this product must disclose any financial relationship in a company providing grant funds and/or a company whose product(s) may be discussed or used during the educational activity. Financial disclosure will include the name of the company and/or product and the type of financial relationship, and includes relationships that are in place at the time of the activity or were in place in the 12 months preceding the activity. Disclosures for this activity are indicated according to the following numeric categories: 1. Consultant/Speaker’s Bureau 2. Employee 3. Stockholder 4. Product Designer 5. Grant/Research Support 6. Other relationship (specify) 7. No conflict of interest
  • 4. Discuss 5 keys to making Lean work and improving your probability of success. Objective
  • 5. Quality is today’s health care mandate. Yet, there is a dark cloud blurring the vision of many nurse executives today because Lean has had some false starts and stops in days gone by. Ask 10 staff members what the definition of Lean is—chances are you will get 10 different definitions. Today we work in broken processes that require excellent people to achieve average results. Many nursing processes are inherently setup to fail. Lean running hospitals think differently – focused on building excellent processes. The key is applying Lean in the right way. While 90% of hospitals are doing Lean, less than 10% are “running” Lean. The Lean Dilemma
  • 6. In this webinar, we will discuss 5 keys to making Lean work and improving your probability of success: 1. Focus on throughput – this is one of the most powerful metrics for Lean, and you get a lot of other things for free, such as patient satisfaction, error rates, etc. 2. Avoid focusing on clinical tasks – Instead, focus on the things that get in the way of performing clinical tasks. 3. Don’t make every nurse a Lean expert – not every member of your staff needs to be a Lean expert. 4. Leading 3-steps ahead – Lean work must be facilitated by someone can think three steps ahead at all times to guide the transformation. 5. Educate yourself and then educate your team members – we must be able to think both from a process perspective and a clinical perspective. 5 Keys to Driving Success
  • 7. Six Aims for Improvement “Health care should be: • Safe • Effective • Patient-centered • Timely • Efficient • Equitable These aims are not new….Yet American health care fails far too often with respect to these aims, despite enormous cost and dedication and good efforts of millions of American healthcare workers”
  • 8. Six Aims for Improvement The IOM “Chasm” Report gives us a vision of where to go Lean Thinking gives us a path to get there – Process Improvement Framework – Tools and Problem-Solving Skills
  • 9. Lean Calibration • What is it? – The word “Lean” – only 1 word, but 100 definitions – Toyota Production System – not a Panacea – Bunch of tools or a fundamental shift in mindset – Cost-focused (common interpretations): • Reduce waste, Operational efficiency, Cost reduction • Customer-focused…….or Patient-focused – Speed and safe response to customer demand
  • 10. Random Acts of Lean  Value-Stream Mapping  Workplace Organization (5S), (6S), (7S)  Six Sigma  Visual Management  Total Preventive Maintenance  Balanced Scorecard / Lean Scorecard  Kaizen Events  Theory of Constraints  Workouts  Kanban  Reduce Waste – 7 Wastes, 8 Wastes, etc  Improve Efficiency  Hejunka Scheduling  Standard Work  Rapid Improvement Events  Operational Method Sheets  Changeover Optimization (SMED)  Case Sequencing  DMAIC  Production Preparation Process (3P)  Process Balancing Tools  Electronic Kanban Methods  Benchmarking Practices  Health Care Execution Systems  Green Belts, Black Belts  Mixed-Model Designs  Drum/Buffer/Rope  RFID/Bar Code Strategies  Flow Rate Management  Cellular Concepts  Rationalization Practices  Demand-Driven Metrics  Flexibility Practices  Process Mapping  Velocity Analysis  Mistake-Proofing (Poka-Yoke) Common problem… – Pockets of improvement are not tied or affect bottom line – Primarily focused on micro areas with micro results Common answer… – Many organizations end up creating their own Excellence System or Operating System
  • 11. Excerpt from U.S. News and World Report… “…During the visit, a team led by Virginia Mason's chief of medicine met with a Toyota guru, a sensei who absorbed the Toyota approach into his very marrow. Examining a layout of the hospital, the sensei learned that there were waiting rooms scattered across the campus. "Who waits there?" the sensei had asked. "Patients," said the chief of medicine. "What are they waiting for?" "The doctor." The sensei was told there might be a hundred or so such waiting rooms and that patients wait about 45 minutes on average. "You have a hundred waiting areas where patients wait an average of 45 minutes for a doctor?" He paused and let the question hang in the air. "Aren't you ashamed?“ What Medicine Can Learn From Business (U.S. News & World Report, June 17, 2008)
  • 12. Push Facility Originally Built to Push/Batch Product Traditional Push & Power of Pull
  • 13. vs. Push Facility Pull Facility Originally Built to Push/Batch Product Originally Built to Pull to Customer Demand vs. Traditional Push & Power of Pull
  • 14. • Consider the process of patient care – from a cross-functional viewpoint instead of individual functional departments – Get past the trees to see the forest • Both outcomes and patient satisfaction – depend on a healthcare experience that is a smoothly flowing series of connected steps • HCAHPS and Jiffy Lube… Outcomes vs Patient Satisfaction
  • 15. Where to focus efforts? • The 90/10 Rule of Value – Often, the same amount of effort applied to the non-value added activity (the 90%) as the value-added activity (the 10%) yields significantly greater results – However, most improvements focus solely on the 10% • In health care, this applies to both paper process(ing) and patient process(ing) 10%90% Time Non-value added activity Value added activity Typical NVA Activities:  Counting  Handling  Waiting  Stocking/Storing  Signoffs  Multiple Order Entry/Processing  Moving
  • 16. Where to focus efforts? Value Added Non-Value Added 1. Defects 2. Overproduction 3. Waiting 4. Transportation 5. Inventory 6. Motion 7. Excess Processing Typically 90+% of all cycle time is non-value added
  • 17. Throughput - Definition The time it takes to flow all the way through a process or value stream, from start to finish including waiting time, process time, queue and non-value added time. • What are your significant value streams? • What are throughput times? • Are they measured in seconds, minutes, days, weeks, etc.? • Use Value Stream Mapping to help identify a future state with improved Throughput
  • 18. TimeStart Finish Waiting WaitMove Wait Move/Wait = Value Added Time (VA) = Non-Value Added Time (NVA) Tests TreatTriage Traditional Focus  Improve the VA processes Lean focus  Eliminate the NVA processes Separating Waste from Value
  • 19. It’s Affect on 7 Wastes • The seven types of waste – Over-production – Waiting – Transportation – Over-processing – Inventory – Motion – Defects Throughput
  • 20. Throughput - Examples • Admission to discharge • Invoice process • Filling medications • Length of stay • Lead times on purchased items • Room turnovers • Time to fill employee requisition • IT help desk – problem resolution process
  • 21. • Reduce waiting time • Reduce non-value added activities (orange vs blue) • Reduce total amount of work-in-process • Accelerate value added processes • Improve linkages between processes • Implement “pull” techniques • Focus on flexibility Throughput – How to Improve
  • 22. Chase Variation, not Averages • Variability recognizes that processes do not produce identical results every time (inherent in nature) – Variability may be caused by identifiable forces acting on the process or by minute fluctuations in the process itself – Range (low to high spread), standard deviation (relative dispersion from the mean), and variance (how far a set of numbers is spread out) are common measures of variability μ = average σ = variation The Normal Distribution Curve
  • 23. Leading 3-steps Ahead • Presents a clear path moving forward • Must have a clear sense of where they are currently, as well as the ideal state to which they are heading • A leader is a change agent, not a magician – The leader doesn’t assume all tasks/actions • Lean leaders create a ‘creative tension’ for progress “Too many times, Lean Leaders are ‘forced’ into the roles and are setup to fail. Lean work must be facilitated by someone can think three steps ahead at all times to guide the transformation.” “Rely on someone who has ‘been there, done that’ versus struggling alone.”
  • 24. Shared Vision Skills / Training Incentives Resources Action Required Successful Change Skills / Training Incentives Resources Action Required Confusion Shared Vision Incentives Resources Action Required Anxiety Shared Vision Skills / Training Resources Action Required Gradual Change Shared Vision Skills / Training Incentives Action Required Frustration Shared Vision Skills / Training Incentives Resources False Starts Leaders Identify the Missing Link
  • 25. Nurses and Lean Experts not every member of your staff needs to be a Lean expert... but every Lean tool should be very well known by at least one person on your staff… “I just don’t process things that way” “It’s too much and can all be so intimidating” “I spend more time trying to understand the proper use of Lean language than I do getting anything done” “One person is the Value Stream Mapping leader, another is the Standard Work leader, another the workplace organization leader” “I’m very comfortable with identifying Standard Work, but the rest frankly confuses me” “Now I can focus on being great on one thing versus a laggard at everything”
  • 26. Educate Not Just on Tools… • Educate yourself – to ensure you can identify the roadblocks and know how to address them • Then educate your team members – properly – not a one-size fits all mentality “we must be able to think both from a process perspective and a clinical perspective”
  • 27. In this webinar, we will discuss 5 keys to making Lean work and improving your probability of success: 1. Focus on throughput – this is one of the most powerful metrics for Lean, and you get a lot of other things for free, such as patient satisfaction, error rates, etc. 2. Avoid focusing on clinical tasks – Instead, focus on the things that get in the way of performing clinical tasks. 3. Don’t make every nurse a Lean expert – not every member of your staff needs to be a Lean expert. 4. Leading 3-steps ahead – Lean work must be facilitated by someone can think three steps ahead at all times to guide the transformation. 5. Educate yourself and then educate your team members – we must be able to think both from a process perspective and a clinical perspective. 5 Keys to Driving Success
  • 28. Your Takeaways… • Feel – What do patient waiting times trigger in me? – Have I felt the “Missing Links” managing change? • Think – Are we more like McDonald’s years ago or like Subway today? – Are we doing “Random Acts of Lean”? – Am I focused on the ”ORANGE” or the “BLUE”? – Are we chasing Averages or reducing Variation? • Do – Eliminate something ”ORANGE”
  • 29. This highly-concentrated three day, hands-on workshop teaches critical thinking, problem solving, and leadership skills that are fundamental to creating and sustaining actual change using LEAN strategies. Work teams highly recommended as this course “explains by doing.” August 20-22 September 18-20 Denver, CO – AORN Headquarters www.aorn.org/LeanLeadership Know what counts. Measure what matters. Deliver results.