2010 SHS/ASQ Conference
Welcome!
Introductions Who we are
Your Presenters <ul><li>Keith H. Poole </li></ul><ul><li>Corporate Manager Lean Six Sigma </li></ul><ul><li>[email_address...
Your Presenters <ul><li>Jamie Hinton </li></ul><ul><li>Regional Business Transformation Specialist </li></ul><ul><li>[emai...
Your Presenters <ul><li>Karl Kraebber </li></ul><ul><li>Lean Six Sigma Facilitator </li></ul><ul><li>Process Improvement P...
Introductions Your name Your expectations for this workshop
Objectives <ul><li>Learn how to identify the particular needs of clinical employees as Lean trainees </li></ul><ul><li>Lea...
Objectives <ul><li>“ The way you learned Lean is most likely NOT the way you will teach Lean in healthcare.” </li></ul><ul...
Overview of Lean Tools <ul><li>5S </li></ul><ul><li>7/8 Kinds of Waste </li></ul><ul><li>Pull Systems </li></ul><ul><li>Ka...
5S Fundamental tool of a lean organization Easy for staff to understand, relate to personal lives Helps to create “quick w...
7/8 Kinds of Waste <ul><li>Inventory and Storage </li></ul><ul><li>Motion </li></ul><ul><li>Overproduction </li></ul><ul><...
Pull Systems <ul><li>A system of controlling the flow of material by replacing only what has been consumed </li></ul>1/4 1...
Kanban <ul><li>A signal to produce or transfer material in a pull system </li></ul>######## Drum XJ Type “A” Starved Buffe...
Changeover Reduction / SMED <ul><li>Changeover is the elapsed downtime to change an area from the prior procedure or patie...
Visual Workplace / Visual Management <ul><li>Visual Workplace – the use of various forms of non-verbal communication to co...
Reference Materials for Lean Tools <ul><li>Recommended Web Sites: </li></ul><ul><li>Institute for Healthcare Improvement -...
Reference Materials for Lean Tools <ul><li>Recommended Journal Articles: </li></ul><ul><li>Varkey, P., Reller, M. K., & Re...
Reference Materials for Lean Tools <ul><li>Recommended Reading: </li></ul><ul><li>Womack, J. P., & Jones, D. T. (2003). Le...
Overview of Lean Tools <ul><li>5S </li></ul><ul><li>7/8 Kinds of Waste </li></ul><ul><li>Pull Systems </li></ul><ul><li>Ka...
Process Observation <ul><li>Begin with process observation and start to decide which Lean tools are best suited for the pr...
Process Observation
Observation Skills Test <ul><li>The picture on the next slide has a photo of two almost identical dolphins. </li></ul><ul>...
 
Process Observation in Healthcare <ul><li>Go to the Gemba – how do we know if we don’t go? </li></ul><ul><li>Have staff ob...
Process Observation in Healthcare <ul><li>But before going to the Gemba, we first we need to teach the skill of process ob...
Change Mindset: Folding Laundry <ul><li>We need two volunteers: </li></ul><ul><li>1. Who doesn’t care how your laundry is ...
Folding Laundry <ul><li>Directions: </li></ul><ul><ul><li>Each person naturally fold the items </li></ul></ul><ul><ul><li>...
What Did We See? <ul><li>What did folders see?  Any differences? </li></ul><ul><li>What did observers see? Any differences...
What Did We REALLY See? <ul><li>Instant Replay Please </li></ul><ul><li>Team:  </li></ul><ul><li>Help facilitator and scri...
Laundry Battle: Lean at War <ul><li>Laundry Battle </li></ul><ul><li>Jamie vs. Meticulous Folder Volunteer </li></ul><ul><...
Connections to Other Lean Tools <ul><li>This can also be a natural introduction to  process waste identification </li></ul...
Break! Attendee practice Time check – 2:00pm, resume at 2:15pm
Lean Tool Examples
7/8 Kinds of Waste <ul><li>SSFHS waste collection sheet </li></ul><ul><li>Toast Kaizen video </li></ul><ul><li>Snow cleari...
Pull Systems
Changeover Reduction / SMED
Visual Workplace / Visual Management
Kanban
Nursing Station 5S – Before
Nursing Station 5S – During Sort Straighten (Set in Order) Shine
Nursing Station 5S – After
5S <ul><li>Red dots during sort instead of red tags – measles </li></ul>
5S <ul><li>Karl will show us several additonal examples of how we have used 5S at our hospitals </li></ul><ul><li>Karl wil...
Training Staff in the 5S Methodology <ul><li>Relate to cleaning house </li></ul><ul><li>Simulation stations </li></ul><ul>...
4E Nursing Unit – Med Room 5S Before After
PT/OT Supply Room – Before
PT/OT Supply Room – Sort Phase
PT/OT Supply Room – Set in Order / Shine
ED Trauma Room – 5S Activity Pre-5S
ED Trauma Room – 5S Activity Sort Phase
ED Trauma Room – 5S Activity Post-5S
ED Trauma Room 30 Days Post-5S Activity
5S Numbers Game <ul><li>Participant training packet (21 pages) </li></ul><ul><ul><li>PowerPoint is not required for conduc...
5S Numbers Game
5S Numbers Game – Round 1 <ul><li>This sheet represents our current work place. </li></ul><ul><li>Our job is to strike out...
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 41 42 43 44 45...
5S Numbers Game – Round 2 <ul><li>For our first action, we are going to implement 5S in this area. </li></ul><ul><li>The f...
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 41 42 43 44 45 46...
5S Numbers Game – Round 3 <ul><li>Having achieved some improvement, we now need to move onto the next step ”Set In Order”....
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 41 42 43 44 45 46...
5S Numbers Game – Round 4 <ul><li>Having now made a significant step forward, we must “Shine” and “Standardize” the workpl...
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 41 42 43 44 45 46...
5S Numbers Game – Round 5 <ul><li>Now that we have standardized numbers, we must design the work area in order to produce ...
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44...
5S Game Quality Challenge <ul><li>We have recently discovered that two numbers are missing! </li></ul><ul><li>Return to ou...
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 41 43 44 45 46 47...
5S Game Quality Challenge (continued) <ul><li>During another shift, the workplace has been transformed utilizing 5S. </li>...
1 2 3 4 5 6 7 8 9 10 11 12 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46...
5S Numbers Game Reflection <ul><li>What did you learn in this 5S numbers game? </li></ul><ul><li>Anything else? </li></ul>...
Attendee Discussion and Practice <ul><li>Look at the Faciliator’s Guide for the 5S numbers game </li></ul>
Lean Training Programs
LSS Training Program - Overview <ul><li>LSS Fundamentals </li></ul><ul><li>Baseline information available online </li></ul...
LSS Roadmap Lean Leader Program LSS Basics Computer based training
What is the LSS Basics Course? <ul><li>14 Week training program </li></ul><ul><li>7, 2-hour sessions </li></ul><ul><li>7-1...
Participant Expectations <ul><li>Active participation in all sessions </li></ul><ul><li>Complete all homework between sess...
LSS Basics Syllabus
Session 1 – Quick and Easy Kaizen <ul><li>AIDET </li></ul><ul><ul><li>A – Acknowledge </li></ul></ul><ul><ul><li>I – Intro...
5 Steps of Quick and Easy Kaizen <ul><li>U – Uncover Ideas </li></ul><ul><li>D – Discuss with Manager </li></ul><ul><li>O ...
 
Tell Others <ul><li>Idea form is posted for others to see. </li></ul><ul><li>All ideas reach a conclusion. </li></ul>
Simulation Activity
Session 2 – Process Map and Flowcharting <ul><li>Why map processes? </li></ul><ul><li>Process mapping and organizational t...
Process Mapping pointers <ul><li>List activities at the same level of detail </li></ul><ul><li>Document every activity - w...
SCMC Simulation Process Map
Session 3 – Seven Kinds of Waste <ul><li>“ Toast Kaizen” Video </li></ul><ul><ul><li>Introduction to seven kinds of waste ...
Identifying Waste
Waste Exploration Activity
Session 4 – 5S / Workplace Organization <ul><li>Benefits of 5S </li></ul><ul><li>How to conduct a 5S event </li></ul><ul><...
The 5S’s
5S Simulation Stations
Session 5 – Flow and Pull <ul><li>“ The Goal” video </li></ul><ul><li>Introduction to flow </li></ul><ul><li>Discussion ab...
Flow Where You Can… <ul><li>Continuous movement of people, materials, supplies </li></ul><ul><li>Exceptional flow leads to...
Strategies for Improving Flow <ul><ul><li>Focus on the constraint or bottleneck of the process </li></ul></ul><ul><ul><li>...
…  and Pull Where You Can’t Flow <ul><li>Timely transition of work from one step to another </li></ul><ul><li>When a downs...
Session 6 – Problem Solving <ul><li>Problem Identification </li></ul><ul><li>Data Analysis </li></ul><ul><li>Root Cause An...
Problem Identification Tools <ul><li>Brainstorming </li></ul><ul><li>Cause and Effect Diagrams </li></ul>
Data Collection and Analysis Tools <ul><li>Pictographs </li></ul><ul><li>Check Sheets </li></ul><ul><li>Pareto Diagrams </...
<ul><li>Scatter Diagrams </li></ul><ul><li>Run Charts </li></ul><ul><li>Control Charts </li></ul>Data Collection and Analy...
The problem solving process <ul><li>Identify and define the problem </li></ul><ul><li>Organize the team </li></ul><ul><li>...
Session 7 – Putting it All Together <ul><li>LSS Basics Tools Review </li></ul><ul><li>Conducting a Rapid Improvement Event...
Middle Management must champion and spread lean in both directions to ensure transformation
Lean Leader Program – Key Points <ul><li>Decide on a learning strategy: learning while doing (part of an event) versus a s...
Lean Thinking is Very Similar to… <ul><li>The scientific method </li></ul><ul><li>Great medical care </li></ul>
Analogy to Great Medical Care  <ul><li>Tackle work problems with the rigor and systematic thinking we use for  patient pro...
Break! Time check – 3:45pm, resume at 4:00pm
Teaching Lean in Healthcare
Lessons Learned - Vocabulary <ul><li>Minimize use of Japanese terms </li></ul><ul><li>Don’t say, “that’s not how we did it...
Attendee Practice <ul><li>Explain this Lean concept to a healthcare audience </li></ul>1 2 3 4 5 6 7 8 9 ELECTRONIC SIGNAL...
Attendee Practice <ul><li>Convert the given project summary for use in a healthcare setting </li></ul>
Objective One – Identify Particular Needs <ul><li>They are scientists at heart </li></ul><ul><li>They want to spend more o...
Objective Two – Address Particular Needs <ul><li>Show them data and evidence-based best practices </li></ul><ul><li>Allow ...
Objective Three – Creative Applications <ul><li>Customization to healthcare (settings of examples, vocabulary, terminology...
Operational Definition Exercise <ul><li>Divide into groups of up to 4 people. </li></ul><ul><li>Create an operational defi...
Presentation Skills <ul><li>Know what you are talking about (or at least act like you do) </li></ul><ul><li>Admit what you...
Learning Styles in Healthcare <ul><li>Clinicians tend to be very vested in their job, at a personal level </li></ul><ul><l...
Learning Styles – Executives <ul><li>Executives want the short version, but don’t leave out anything important </li></ul><...
Learning Styles – Management <ul><li>Managers want to know the short-term and long-term plan </li></ul><ul><li>Managers wa...
Learning Styles – Physicians <ul><li>Physicians are scientists </li></ul><ul><li>Physicians like data and statistics </li>...
Learning Styles – Nurses <ul><li>Nurses are caregivers first and scientists second </li></ul><ul><li>Nurses want to see it...
Learning Styles – Front-Line Staff <ul><li>Front-line staff want to know who’s doing the work </li></ul><ul><li>Front-line...
Attendee Practice <ul><li>Choose a specific audience and their learning style </li></ul><ul><li>Convert the given the give...
Workshop Recap <ul><li>Objectives </li></ul><ul><li>Learn how to identify the particular needs of clinical employees as Le...
Questions and Discussion ?
Wrap-up Kindly complete the workshop survey! Be sure to take home your workbooks Contact us if you need further advice Tha...
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Teaching Lean Workshop Shs Asq Poole Hinton Kraebber 2010 02 25

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  • Jamie The goal here is to engage without them knowing they are about to get taken through a lesson. Clinical personnel typically don’t like to get told a new approach to something or what they SHOULD be doing unless: 1. You hold their position and have more seniority; 2. Are a physician; 3. If a physician - Are a physician in the same specialty In working with medical field, their position is what they live and in this setting they tend to think clinically. With these teaching sessions, we aim to appeal to their personal self, address every-day things, and apply the methodology to something they can use in life – both personally and professionally. And hence… today we will fold laundry...with scrubs. Discussion first – The answers we are looking for are: 1. Who doesn’t care how your laundry is folded? (it doesn’t even matter as long as it gets done) 2. Who feels emphatically different? (No, it must be done to my standards and look presentable, neat, and be ready when I need it) If you don’t get them from the group take the closest you get to the personality types and emphatically blame your spouse for being just like the other personality type and volunteer X will be playing their role.
  • Jamie The goal here is to not skew the process by giving too much away of what you are looking for -the first time of folding. We want a natural process. It doesn’t take long - about a minute unless the “quality driven” person is meticulous to a fault. ;)
  • Jamie Discussion: What did folders see in their own process? (Ask this group first – and ask a scribe to list on flipchart. Usually they see nothing except time , or says the “relaxed” person – then they debate lovingly) Discussion: What did observers see? (Usually obvious differences like time, quality, process Steps) Good time to discuss why we need to take a step back and look at our every day rut or go to the place where the activity happens. This term in my experience has caught on and people like it because they remember what it means. Once they have lean, they get it and they see things in a different light. I walk past previous team members in the halls now and they will ask – “Going to the Gemba?” with a smile. This term stands. Kindly thank the “relaxed” volunteer - everyone give them a hand - and request the meticulous person to stay for a few more minutes.
  • Jamie Document as the person is folding. Asking her to perhaps go a little slower so that the team can watch closely. Here we are training on basic flow charts. For clinical people just starting out they won’t get all of the little steps. Bring their attention to them by asking if that is truly what happened next or did the person do X? In the clinical world, we don’t think in absolutes, our minds are always sifting through what could be and exceptions. With Process Mapping and Value Stream Mapping, we are forced to look at the details for what they are - without exceptions or thinking about the patient in room 235. After steps are numbered, ask for another instant replay- this time folding normally and assigning a timekeeper to take the score. (if you do both the instant replay 1 and the time keeping at the same time, the time will be skewed by discussion.) On second time of folding, ask for a timekeeper to give us a time of how long it takes to go through those steps. As a class, document the steps of the meticulous person folding the scrub tops Construct simple process flowchart Time participant vs Jamie X 3 scrub tops each
  • Jamie You can usually have the shirts flat and positioned prior to starting and no one notices. Even still – it’s a lean process. Clinical teams and people not in the industry tend to be wowed by this example. Discussion follows.
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  • Karl Nursing units, Offices, Materials Management, Mechanical/Engineering areas, Laboratory, Pharmacy
  • Karl 4E at St. Elizabeth. Came up with the standard layout that was done at 3 places in the room, depending on room number
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  • Karl This sheet represents our current work place. Our job during a 15 second shift, is to strike out the numbers 1 to 49 in correct sequence. Example: 1 2 3 The team score will be represented by the lowest individual score achieved.
  • Implement 5S In This Area “ Sort” 50………………………………..90 = GONE Items that aren’t numbers = GONE “ Showcase” Clean it up, make it look “Like New” 3. Strike out numbers 1 to 49 in sequence during a 15 second shift.
  • Having achieved some improvement, we now need to move onto the next step ”Set In Order”. Same rules apply 15 second shift, lowest individual score equals team score etc…
  • Having now made a significant step forward, we must “Standardize”. Mention colorblind considerations. Since we are dealing with numbers 1 to 49 in sequence, it seems logical to re-organize them in a standard way that makes the completion of the work task as easy as possible. This should ensure that everyone is able to complete the task (and therefore produce a team score of 49.)
  • This sheet represents our current work place. Our job during a 15 second shift, is to strike out the numbers 1 to 49 in correct sequence. Example: 1 2 3 The team score will be represented by the lowest individual score achieved.
  • All three phases are part of the LSS Roadmap Roadmap serves as a guide for developing Lean Leaders
  • Considerations as to: Activities (Mr. Potato Head) Training format – frequency, length of time on a topic, homework Amount of content that can be covered each session
  • Same level of detail Every activity One unit as it passes through – one patient, lab specimen, bill, food tray Always and sometimes activities – days vs. nights, weekday vs. weekend, etc
  • What things, can you think of, that flow through the hospital?
  • Need to see the bigger picture of the (patient, med, supply) experience to use these flow techniques What do you think of when you hear the term bottleneck? In the LSS lingo it is referred to as the constraint – or its limiting/constraining the system performance and output
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  • Teaching Lean Workshop Shs Asq Poole Hinton Kraebber 2010 02 25

    1. 1. 2010 SHS/ASQ Conference
    2. 2. Welcome!
    3. 3. Introductions Who we are
    4. 4. Your Presenters <ul><li>Keith H. Poole </li></ul><ul><li>Corporate Manager Lean Six Sigma </li></ul><ul><li>[email_address] </li></ul><ul><li>(219) 775-6215 </li></ul><ul><li>11 years experience as a Quality Engineer </li></ul><ul><li>9 years experience with Lean and Six Sigma </li></ul>
    5. 5. Your Presenters <ul><li>Jamie Hinton </li></ul><ul><li>Regional Business Transformation Specialist </li></ul><ul><li>[email_address] </li></ul><ul><li>(219) 616-4283 </li></ul><ul><li>5 years experience with Lean and Six Sigma </li></ul>
    6. 6. Your Presenters <ul><li>Karl Kraebber </li></ul><ul><li>Lean Six Sigma Facilitator </li></ul><ul><li>Process Improvement Project Manager </li></ul><ul><li>St. John’s Hospital </li></ul><ul><li>[email_address] </li></ul><ul><li>(765) 490-8777 </li></ul><ul><li>4+ years experience with Lean facilitation and transformation in healthcare </li></ul>
    7. 7. Introductions Your name Your expectations for this workshop
    8. 8. Objectives <ul><li>Learn how to identify the particular needs of clinical employees as Lean trainees </li></ul><ul><li>Learn how to address the particular needs of clinical employees as Lean trainees </li></ul><ul><li>Learn creative applications of traditional Lean tools in healthcare </li></ul>
    9. 9. Objectives <ul><li>“ The way you learned Lean is most likely NOT the way you will teach Lean in healthcare.” </li></ul><ul><li>- Karl Kraebber </li></ul>
    10. 10. Overview of Lean Tools <ul><li>5S </li></ul><ul><li>7/8 Kinds of Waste </li></ul><ul><li>Pull Systems </li></ul><ul><li>Kanban </li></ul><ul><li>Changeover Reduction / SMED </li></ul><ul><li>Visual Workplace / Visual Management </li></ul>
    11. 11. 5S Fundamental tool of a lean organization Easy for staff to understand, relate to personal lives Helps to create “quick wins” for staff Establishes pride in workplace Creates a new expectation for all staff Can generate savings in capital and operating $$$
    12. 12. 7/8 Kinds of Waste <ul><li>Inventory and Storage </li></ul><ul><li>Motion </li></ul><ul><li>Overproduction </li></ul><ul><li>Overprocessing </li></ul><ul><li>Transportation </li></ul><ul><li>Rework / Correction </li></ul><ul><li>Waiting </li></ul><ul><li>Underutilized Intellect </li></ul>
    13. 13. Pull Systems <ul><li>A system of controlling the flow of material by replacing only what has been consumed </li></ul>1/4 1/2 3/4 F E Fuel Tank Point of Replenishment
    14. 14. Kanban <ul><li>A signal to produce or transfer material in a pull system </li></ul>######## Drum XJ Type “A” Starved Buffer Op 10 Op 20 75 PCS Wire Bskt EMPTY
    15. 15. Changeover Reduction / SMED <ul><li>Changeover is the elapsed downtime to change an area from the prior procedure or patient to the next </li></ul><ul><li>Time  </li></ul><ul><li>Changeover reduction was originally named Single Minute Exchange of Dies (SMED) </li></ul><ul><li>Convert internal steps to external steps, and reduce the time to carry out the remaining internal steps </li></ul>Next Patient . . . Changeover . . . Previous Patient
    16. 16. Visual Workplace / Visual Management <ul><li>Visual Workplace – the use of various forms of non-verbal communication to control the way work is performed and indicate the status of parts </li></ul><ul><li>Visual Management – ensuring everyone understands the current status of the system by providing indicators and a clear view of activities </li></ul>
    17. 17. Reference Materials for Lean Tools <ul><li>Recommended Web Sites: </li></ul><ul><li>Institute for Healthcare Improvement - http://www.ihi.org/ihi </li></ul><ul><li>Going Lean in Healthcare White Paper - http://www.ihi.org/IHI/Results/WhitePapers/GoingLeaninHealthCare.htm </li></ul><ul><li>Society for Health Systems - http://www.iienet2.org/SHS </li></ul><ul><li>Lean Enterprise Institute - http://www.lean.org/ </li></ul><ul><li>iSixSigma - http://www.isixsigma.com/ </li></ul><ul><li>American Society for Quality - http://www.asq.org </li></ul><ul><li>Lean Healthcare Exchange - http://leanhealthcareexchange.com/ </li></ul>
    18. 18. Reference Materials for Lean Tools <ul><li>Recommended Journal Articles: </li></ul><ul><li>Varkey, P., Reller, M. K., & Resar, R. K. (2007). Basics of quality improvement in health care. Mayo Clinic Proceedings , 82(6), 735-739. </li></ul><ul><li>Bush, R. W. (2007). Reducing waste in US health care systems. Journal of the American Medical Association , 297(8), 871-874. </li></ul><ul><li>Nelson-Peterson, D. L. & Leppa, C. J. (2007). Creating an environment for caring using lean principles of the Virginia Mason production system. The Journal of Nursing Administration , 37(6), 287-294. </li></ul><ul><li>de Koning, H., Verver, J. P. S., van den Heuvel, J., Bisgaard, S., & Does, R. J. M. M. (2006). Lean six sigma in healthcare. Journal for Healthcare Quality , 28(2), 4-11. </li></ul><ul><li>Bahensky, J. A., Roe, J., & Bolton, R. (2005). Lean sigma – Will it work for healthcare? Journal of Healthcare Information Management , 19(1), 39-44. </li></ul><ul><li>Taner, M. T., Sezen, B., & Antony, J. (2007). An overview of six sigma applications in healthcare industry. International Journal of Health Care Quality Assurance , 20(4), 329-340. </li></ul><ul><li>Kim, C.S., Spahlinger, D.A., Kin, J.M. & Billi, J.E. (2006). Lean health care: What can hospitals learn from a world-class automaker? Journal of Hospital Medicine , 1(3), 191-199. </li></ul>
    19. 19. Reference Materials for Lean Tools <ul><li>Recommended Reading: </li></ul><ul><li>Womack, J. P., & Jones, D. T. (2003). Lean thinking: Banish waste and create wealth in your corporation (2nd Ed.). New York: Free Press. </li></ul><ul><li>Womack, J. P., Jones, D. T., & Roos, D. (1991). The machine that changed the world: The story of lean production. New York, NY: HarperCollins Publishers. </li></ul><ul><li>Porché, R. A. (Ed.). (2006). Doing more with less: Lean thinking and patient safety in health care. Oakbrook Terrace, IL: Joint Commission Resources. </li></ul><ul><li>Ohno, T. (1995). Toyota production system: Beyond large-scale production. New York, NY: Productivity Press Inc. </li></ul><ul><li>Liker, J. K. (2004). The Toyota way: 14 Management principles from the world’s greatest manufacturer. Chicago: McGraw-Hill. </li></ul><ul><li>Chalice, R. (2007). Improving healthcare suing Toyota lean production methods: 46 Steps for improvement (2nd Ed.). Milwaukee, WI: ASQ Quality Press. </li></ul><ul><li>Kotter, J. (1996). Leading change. Boston, MA: Harvard Business School Press. </li></ul><ul><li>Grunden, N. (2008). The Pittsburgh way to efficient healthcare: Improving patient care using Toyota based methods. New York, NY: Productivity Press. </li></ul><ul><li>Caldwell, C., Brexler, J., & Gillem, T. (2005). Lean six-sigma for healthcare: A senior leader guide to improving cost and throughput. Milwaukee, WI: ASQ Quality Press. </li></ul><ul><li>Trusko, B.E., Pexton, C., Harrington, H.J., & Gupta, P. (2007). Improving healthcare quality and cost with six sigma. New York: Financial Times Press. </li></ul>
    20. 20. Overview of Lean Tools <ul><li>5S </li></ul><ul><li>7/8 Kinds of Waste </li></ul><ul><li>Pull Systems </li></ul><ul><li>Kanban </li></ul><ul><li>Changeover Reduction / SMED </li></ul><ul><li>Visual Workplace / Visual Management </li></ul><ul><li>Process Observation (start here before jumping into application of the Lean tools above) </li></ul>
    21. 21. Process Observation <ul><li>Begin with process observation and start to decide which Lean tools are best suited for the project </li></ul><ul><li>Simple process flowcharting </li></ul><ul><li>Sometimes versus always process steps </li></ul><ul><li>Swim lane flowcharts </li></ul><ul><li>Process maps (with data, inputs and outputs) </li></ul><ul><li>Value Stream Mapping (VSM) when they are ready </li></ul>
    22. 22. Process Observation
    23. 23. Observation Skills Test <ul><li>The picture on the next slide has a photo of two almost identical dolphins. </li></ul><ul><li>This photo is actually used in Navy SEALS training, to test their vision under water. </li></ul><ul><li>A well-trained person will find the difference in 1 – 2 minutes. </li></ul><ul><li>  </li></ul><ul><li>See if you can spot the subtle difference... </li></ul>
    24. 25. Process Observation in Healthcare <ul><li>Go to the Gemba – how do we know if we don’t go? </li></ul><ul><li>Have staff observe each other’s processes </li></ul><ul><li>Have staff observe their own processes, but as an outsider – badge off, street clothes </li></ul><ul><li>When staff put on scrubs, do they put on blinders as well? </li></ul>
    25. 26. Process Observation in Healthcare <ul><li>But before going to the Gemba, we first we need to teach the skill of process observation </li></ul><ul><li>Jamie will lead us through an exercise that you can use to build process observation skills in clinical staff </li></ul>
    26. 27. Change Mindset: Folding Laundry <ul><li>We need two volunteers: </li></ul><ul><li>1. Who doesn’t care how your laundry is folded? </li></ul><ul><li> (as long as it gets done) </li></ul><ul><li>2. Who feels emphatically different? </li></ul><ul><li>Need 6 towels, 6 washcloths, 6 scrub tops, free table in front of room </li></ul>
    27. 28. Folding Laundry <ul><li>Directions: </li></ul><ul><ul><li>Each person naturally fold the items </li></ul></ul><ul><ul><li>Place in a pile </li></ul></ul><ul><ul><li>“ Team” - watch how it’s done </li></ul></ul><ul><li>There’s no RIGHT or WRONG way. </li></ul>
    28. 29. What Did We See? <ul><li>What did folders see? Any differences? </li></ul><ul><li>What did observers see? Any differences? </li></ul><ul><li>Obvious differences between the two perspectives? </li></ul><ul><ul><li>Time </li></ul></ul><ul><ul><li>Steps </li></ul></ul><ul><ul><li>Quality </li></ul></ul>
    29. 30. What Did We REALLY See? <ul><li>Instant Replay Please </li></ul><ul><li>Team: </li></ul><ul><li>Help facilitator and scribe document steps that are taken to fold a scrub shirt. Number the steps. </li></ul><ul><li>Instant replay please – still don’t have definitive call. Timekeeper please. </li></ul>
    30. 31. Laundry Battle: Lean at War <ul><li>Laundry Battle </li></ul><ul><li>Jamie vs. Meticulous Folder Volunteer </li></ul><ul><li>Fold three scrubs </li></ul><ul><li>Time keeper keep time, team document steps </li></ul>
    31. 32. Connections to Other Lean Tools <ul><li>This can also be a natural introduction to process waste identification </li></ul><ul><li>We will cover 7/8 kinds of waste after the break </li></ul><ul><li>Handout showing how to fold scrub tops the Lean way </li></ul>
    32. 33. Break! Attendee practice Time check – 2:00pm, resume at 2:15pm
    33. 34. Lean Tool Examples
    34. 35. 7/8 Kinds of Waste <ul><li>SSFHS waste collection sheet </li></ul><ul><li>Toast Kaizen video </li></ul><ul><li>Snow clearing video </li></ul><ul><li>Our own new video? </li></ul>
    35. 36. Pull Systems
    36. 37. Changeover Reduction / SMED
    37. 38. Visual Workplace / Visual Management
    38. 39. Kanban
    39. 40. Nursing Station 5S – Before
    40. 41. Nursing Station 5S – During Sort Straighten (Set in Order) Shine
    41. 42. Nursing Station 5S – After
    42. 43. 5S <ul><li>Red dots during sort instead of red tags – measles </li></ul>
    43. 44. 5S <ul><li>Karl will show us several additonal examples of how we have used 5S at our hospitals </li></ul><ul><li>Karl will also lead us through a game you can use to teach 5S effectively in a healthcare setting </li></ul>
    44. 45. Training Staff in the 5S Methodology <ul><li>Relate to cleaning house </li></ul><ul><li>Simulation stations </li></ul><ul><ul><li>Practical, simple stations that provide trainees the opportunity to practice in a controlled format </li></ul></ul><ul><li>Show examples from all areas of a hospital (internal and external examples) </li></ul><ul><li>Abstract game to demonstrate 5S methodology </li></ul>
    45. 46. 4E Nursing Unit – Med Room 5S Before After
    46. 47. PT/OT Supply Room – Before
    47. 48. PT/OT Supply Room – Sort Phase
    48. 49. PT/OT Supply Room – Set in Order / Shine
    49. 50. ED Trauma Room – 5S Activity Pre-5S
    50. 51. ED Trauma Room – 5S Activity Sort Phase
    51. 52. ED Trauma Room – 5S Activity Post-5S
    52. 53. ED Trauma Room 30 Days Post-5S Activity
    53. 54. 5S Numbers Game <ul><li>Participant training packet (21 pages) </li></ul><ul><ul><li>PowerPoint is not required for conducting the 5S numbers game </li></ul></ul><ul><ul><li>Contains brief explanations of each S </li></ul></ul><ul><li>Facilitator Guide (6 pages) </li></ul><ul><ul><li>Facilitator orientation </li></ul></ul><ul><ul><li>Step-by-step guide through the 5S numbers game </li></ul></ul><ul><ul><li>Round-by-round question and discussion guide </li></ul></ul><ul><ul><li>Flipchart setup </li></ul></ul>
    54. 55. 5S Numbers Game
    55. 56. 5S Numbers Game – Round 1 <ul><li>This sheet represents our current work place. </li></ul><ul><li>Our job is to strike out the numbers 1 to 49 in correct sequence. Example: 1 2 3 </li></ul><ul><li>Sheets are to be kept face down until instructed to start by facilitator. </li></ul><ul><li>You will have 60 seconds for round 1. </li></ul><ul><li>Don’t worry about your score, you will have plenty of chances to improve. </li></ul>
    56. 57. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 41 42 43 44 45 46 47 48 49 50 51 52 53 54 54 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 40
    57. 58. 5S Numbers Game – Round 2 <ul><li>For our first action, we are going to implement 5S in this area. </li></ul><ul><li>The first step of this is “Sort” and so we have removed from the area all the numbers from 50 to 90 which are not needed. </li></ul><ul><li>Same rules apply. Strike out numbers 1 to 49 in sequence. </li></ul><ul><li>This round you will have 50 seconds. </li></ul>
    58. 59. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 41 42 43 44 45 46 47 48 49 40 18
    59. 60. 5S Numbers Game – Round 3 <ul><li>Having achieved some improvement, we now need to move onto the next step ”Set In Order”. </li></ul><ul><li>We have installed some “racking” in the workplace using a 3x3 grid. </li></ul><ul><li>We have organized the items so that with Number 1 in the bottom left hand corner, the numbers are located from bottom to top and left to right </li></ul><ul><ul><li>Example: 1 in the bottom left, 2 in the middle left, and 3 in the top left…and so on. </li></ul></ul><ul><li>Same rules apply. Strike out numbers 1 to 49 in sequence. </li></ul><ul><li>This round you will have 40 seconds. </li></ul>
    60. 61. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 41 42 43 44 45 46 47 48 49 40 18
    61. 62. 5S Numbers Game – Round 4 <ul><li>Having now made a significant step forward, we must “Shine” and “Standardize” the workplace. </li></ul><ul><li>Since we are dealing with numbers 1 to 49 in sequence, it seems logical to standardize the font, size and color of the numbers in a clean and standard way that makes the completion of the work task as easy as possible. </li></ul><ul><li>Same rules apply. Strike out numbers 1 to 49 in sequence. </li></ul><ul><li>This round you will have 30 seconds. </li></ul>
    62. 63. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 41 42 43 44 45 46 47 48 49 40 18
    63. 64. 5S Numbers Game – Round 5 <ul><li>Now that we have standardized numbers, we must design the work area in order to produce sustainable performance. </li></ul><ul><li>Since we are dealing with numbers 1 to 49 in sequence, it seems logical to standardize the font, color and location of the numbers to make the completion of the work task as easy as possible. </li></ul><ul><li>This should ensure that everyone is able to complete the task. </li></ul><ul><li>Same rules apply. Strike out numbers 1 to 49 in sequence. </li></ul><ul><li>This round you will have 20 seconds. </li></ul>
    64. 65. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49
    65. 66. 5S Game Quality Challenge <ul><li>We have recently discovered that two numbers are missing! </li></ul><ul><li>Return to our original work area and find the missing numbers. </li></ul><ul><li>We cannot complete the task without these numbers - so first we have to find them. </li></ul><ul><li>A running clock will be kept until everyone has found the missing numbers. </li></ul>
    66. 67. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 41 43 44 45 46 47 48 49 50 51 52 53 54 54 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 40
    67. 68. 5S Game Quality Challenge (continued) <ul><li>During another shift, the workplace has been transformed utilizing 5S. </li></ul><ul><li>There are numbers missing again! </li></ul><ul><li>Identify the missing numbers as fast as you can – we cannot proceed with work until the numbers are found. </li></ul><ul><li>A running clock will be kept until everyone has found the missing numbers. </li></ul>
    68. 69. 1 2 3 4 5 6 7 8 9 10 11 12 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49
    69. 70. 5S Numbers Game Reflection <ul><li>What did you learn in this 5S numbers game? </li></ul><ul><li>Anything else? </li></ul><ul><li>How might you incorporate the 5S process into your current workplace? </li></ul><ul><li>What difference would you expect it to make? </li></ul>
    70. 71. Attendee Discussion and Practice <ul><li>Look at the Faciliator’s Guide for the 5S numbers game </li></ul>
    71. 72. Lean Training Programs
    72. 73. LSS Training Program - Overview <ul><li>LSS Fundamentals </li></ul><ul><li>Baseline information available online </li></ul><ul><li>Common terminology and methodology </li></ul><ul><li>LSS Basics </li></ul><ul><li>First part of internal Lean Leader development </li></ul><ul><li>Comprehensive intro to Lean and conducting events </li></ul><ul><li>Lean Leader </li></ul><ul><li>Comprehensive leadership development program to embed Lean Leaders throughout the organization </li></ul><ul><li>In-depth exploration of Lean methods, leadership and additional improvement tools </li></ul>
    73. 74. LSS Roadmap Lean Leader Program LSS Basics Computer based training
    74. 75. What is the LSS Basics Course? <ul><li>14 Week training program </li></ul><ul><li>7, 2-hour sessions </li></ul><ul><li>7-14 participants per session </li></ul><ul><li>Interactive simulations and activities </li></ul><ul><li>Train-the-trainer style program </li></ul><ul><li>First step in becoming a Lean Leader </li></ul>
    75. 76. Participant Expectations <ul><li>Active participation in all sessions </li></ul><ul><li>Complete all homework between sessions </li></ul><ul><li>Embrace and champion change </li></ul><ul><li>Generate new improvement ideas </li></ul><ul><li>Implement improvements within your department </li></ul><ul><li>Train staff or coworkers on improvement tools covered in the LSS Basics </li></ul><ul><li>Lead a lean improvement team </li></ul><ul><li>Champion lean improvement teams </li></ul>
    76. 77. LSS Basics Syllabus
    77. 78. Session 1 – Quick and Easy Kaizen <ul><li>AIDET </li></ul><ul><ul><li>A – Acknowledge </li></ul></ul><ul><ul><li>I – Introduce </li></ul></ul><ul><ul><li>D – Duration </li></ul></ul><ul><ul><li>E – Explanation </li></ul></ul><ul><ul><li>T – Thank You </li></ul></ul><ul><li>Quick and Easy Kaizen </li></ul><ul><ul><li>QEK for the Department Manager </li></ul></ul><ul><ul><li>QEK Train-the-Trainer </li></ul></ul><ul><ul><ul><li>Improvement through changes in methods </li></ul></ul></ul><ul><ul><ul><li>Small changes </li></ul></ul></ul><ul><ul><ul><li>Changes within realistic constraints </li></ul></ul></ul><ul><ul><li>3. Simulation Activity </li></ul></ul>
    78. 79. 5 Steps of Quick and Easy Kaizen <ul><li>U – Uncover Ideas </li></ul><ul><li>D – Discuss with Manager </li></ul><ul><li>O – Opportunity to Improve </li></ul><ul><li>I – Illustrate Changes </li></ul><ul><li>T – Tell others </li></ul>Quick and Easy Kaizen…U DO IT!
    79. 81. Tell Others <ul><li>Idea form is posted for others to see. </li></ul><ul><li>All ideas reach a conclusion. </li></ul>
    80. 82. Simulation Activity
    81. 83. Session 2 – Process Map and Flowcharting <ul><li>Why map processes? </li></ul><ul><li>Process mapping and organizational transformation </li></ul><ul><li>How to create a process map </li></ul><ul><li>Types of process maps </li></ul><ul><li>Making improvements based on process mapping activities </li></ul><ul><li>Simulation continued </li></ul><ul><li>Improvements made based on process map created by participants </li></ul>
    82. 84. Process Mapping pointers <ul><li>List activities at the same level of detail </li></ul><ul><li>Document every activity - work, moves, checks, waits </li></ul><ul><li>Follow one unit of work as it passes through the process </li></ul><ul><li>Include both “always” and “sometimes” activities </li></ul><ul><li>Show what really happens, not what is supposed to happen </li></ul>
    83. 85. SCMC Simulation Process Map
    84. 86. Session 3 – Seven Kinds of Waste <ul><li>“ Toast Kaizen” Video </li></ul><ul><ul><li>Introduction to seven kinds of waste </li></ul></ul><ul><ul><li>Process everyone has done before </li></ul></ul><ul><li>Exploration of the seven kinds of waste encountered at the department and hospitals levels </li></ul><ul><li>Simulation improvement by eliminating wasteful activities within the process </li></ul>
    85. 87. Identifying Waste
    86. 88. Waste Exploration Activity
    87. 89. Session 4 – 5S / Workplace Organization <ul><li>Benefits of 5S </li></ul><ul><li>How to conduct a 5S event </li></ul><ul><li>Keys to a successful 5S event </li></ul><ul><li>“ Numbers” Game training activity </li></ul><ul><li>5S simulation stations </li></ul>
    88. 90. The 5S’s
    89. 91. 5S Simulation Stations
    90. 92. Session 5 – Flow and Pull <ul><li>“ The Goal” video </li></ul><ul><li>Introduction to flow </li></ul><ul><li>Discussion about why flow is important </li></ul><ul><li>Types of flow, what flow looks like </li></ul><ul><li>Identification of a process bottleneck </li></ul><ul><li>Strategies for improving flow </li></ul><ul><li>Identify pull versus push systems </li></ul>
    91. 93. Flow Where You Can… <ul><li>Continuous movement of people, materials, supplies </li></ul><ul><li>Exceptional flow leads to: </li></ul><ul><li>Lower inventories </li></ul><ul><li>Better quality </li></ul><ul><li>Less floor space </li></ul><ul><li>Better communication </li></ul><ul><li>Quicker response to problems </li></ul><ul><li>Faster throughput </li></ul>
    92. 94. Strategies for Improving Flow <ul><ul><li>Focus on the constraint or bottleneck of the process </li></ul></ul><ul><ul><li>Identify how the process is inadequate – methods, equipment, etc. </li></ul></ul><ul><ul><li>Decrease time for changeovers </li></ul></ul><ul><ul><li>Make the area organized and ready for work </li></ul></ul><ul><ul><li>Eliminate quality or scrap issues that consume time and resources </li></ul></ul>
    93. 95. … and Pull Where You Can’t Flow <ul><li>Timely transition of work from one step to another </li></ul><ul><li>When a downstream process is ready to accept more supplies, patients, etc., a signal is made </li></ul><ul><li>Results of exceptional pull: </li></ul><ul><li>Allows decision-making at appropriate levels </li></ul><ul><li>Allows replenishment of only what is needed by the customer </li></ul><ul><li>Visual controls improve communication of customer needs </li></ul><ul><li>Common system for moving material through the hospital </li></ul><ul><li>Reduces work-in-process inventory </li></ul><ul><li>Organizes the workplace </li></ul>
    94. 96. Session 6 – Problem Solving <ul><li>Problem Identification </li></ul><ul><li>Data Analysis </li></ul><ul><li>Root Cause Analysis </li></ul><ul><li>Corrective Action </li></ul><ul><li>Test Correct Actions and Improvement </li></ul><ul><li>Replicate and Spread </li></ul>
    95. 97. Problem Identification Tools <ul><li>Brainstorming </li></ul><ul><li>Cause and Effect Diagrams </li></ul>
    96. 98. Data Collection and Analysis Tools <ul><li>Pictographs </li></ul><ul><li>Check Sheets </li></ul><ul><li>Pareto Diagrams </li></ul><ul><li>Frequency Tables </li></ul><ul><li>Histograms </li></ul>
    97. 99. <ul><li>Scatter Diagrams </li></ul><ul><li>Run Charts </li></ul><ul><li>Control Charts </li></ul>Data Collection and Analysis Tools
    98. 100. The problem solving process <ul><li>Identify and define the problem </li></ul><ul><li>Organize the team </li></ul><ul><li>Describe the problem </li></ul><ul><li>Contain the problem </li></ul><ul><li>Find the root cause </li></ul><ul><li>Generate, select, & verify the corrective action </li></ul><ul><li>Implement the permanent corrective action </li></ul><ul><li>Prevent reoccurrence </li></ul><ul><li>Communicate and congratulate the team </li></ul>
    99. 101. Session 7 – Putting it All Together <ul><li>LSS Basics Tools Review </li></ul><ul><li>Conducting a Rapid Improvement Event </li></ul><ul><li>Project and team selection </li></ul><ul><li>Goal setting and project timeline </li></ul><ul><li>Event logistics </li></ul><ul><li>Tool training for team </li></ul><ul><li>Improvement identification </li></ul><ul><li>Action planning </li></ul><ul><li>Lean Leader Training Program Next Steps </li></ul>
    100. 102. Middle Management must champion and spread lean in both directions to ensure transformation
    101. 103. Lean Leader Program – Key Points <ul><li>Decide on a learning strategy: learning while doing (part of an event) versus a structured program </li></ul><ul><li>Event-based strategy versus developing experts </li></ul><ul><li>In the long term developing experts requires fewer hours of training </li></ul><ul><li>Candidates for Lean Leaders </li></ul>
    102. 104. Lean Thinking is Very Similar to… <ul><li>The scientific method </li></ul><ul><li>Great medical care </li></ul>
    103. 105. Analogy to Great Medical Care <ul><li>Tackle work problems with the rigor and systematic thinking we use for patient problems. </li></ul><ul><li>Help every worker become an expert clinician . </li></ul><ul><li>(Billi, 2005) </li></ul>
    104. 106. Break! Time check – 3:45pm, resume at 4:00pm
    105. 107. Teaching Lean in Healthcare
    106. 108. Lessons Learned - Vocabulary <ul><li>Minimize use of Japanese terms </li></ul><ul><li>Don’t say, “that’s not how we did it at ___________” </li></ul><ul><li>Avoid manufacturing terminology </li></ul><ul><li>Use medical terminology, but only if you know you are using (and pronouncing it correctly) </li></ul><ul><li>Admit mistakes, show respect, move forward, improve </li></ul><ul><li>Physician is a better term than doctor </li></ul><ul><li>Unless you are also a physician, they are always “Dr. _______” to you </li></ul><ul><li>Not all physicians are MDs </li></ul>
    107. 109. Attendee Practice <ul><li>Explain this Lean concept to a healthcare audience </li></ul>1 2 3 4 5 6 7 8 9 ELECTRONIC SIGNALS Instruction Sent From the Consumer to the Provider to Replace Resources that have been Used COMPUTER SIGNALS CARDS EMPTY CONTAINER EXCHANGE NUMBER QUANTITY WIDGET ADDRESS
    108. 110. Attendee Practice <ul><li>Convert the given project summary for use in a healthcare setting </li></ul>
    109. 111. Objective One – Identify Particular Needs <ul><li>They are scientists at heart </li></ul><ul><li>They want to spend more of their work time doing what they were trained to do </li></ul><ul><li>They are patient-focused </li></ul><ul><li>They are personally vested in healthcare </li></ul><ul><li>They will believe it when they see it </li></ul><ul><li>They are peer-oriented </li></ul><ul><li>They enjoy learning </li></ul><ul><li>They enjoy teaching </li></ul>
    110. 112. Objective Two – Address Particular Needs <ul><li>Show them data and evidence-based best practices </li></ul><ul><li>Allow them to use the skills they do have </li></ul><ul><li>Connect what they are learning to the patient – better care, clinical outcomes, more time at the bedside </li></ul><ul><li>They take it personally, and you had better as well </li></ul><ul><li>Always have a digital camera with you – show me! </li></ul><ul><li>Show them their peers (at other facilities and their own) applying Lean knowledge </li></ul><ul><li>Let them learn in their own way </li></ul><ul><li>Let them teach what they learn </li></ul>
    111. 113. Objective Three – Creative Applications <ul><li>Customization to healthcare (settings of examples, vocabulary, terminology and abbreviations) </li></ul><ul><li>Use exercises and games that take trainees out of healthcare yet have clear parallels – it still has to be about service, communication, and people </li></ul><ul><li>Allow trainees to explore using the tools in ways that may not be ‘correct’ – they might surprise you </li></ul>
    112. 114. Operational Definition Exercise <ul><li>Divide into groups of up to 4 people. </li></ul><ul><li>Create an operational definition of a ‘defect’ within your bag of Teddy Grahams. </li></ul><ul><li>Count the number of defects in your bag, according to your operational definition. </li></ul><ul><li>Exchange bag of Bears with the group to your right, but keep your operational definition. </li></ul><ul><li>NO discussion between groups!! </li></ul><ul><li>How robust was your operational definition? </li></ul>
    113. 115. Presentation Skills <ul><li>Know what you are talking about (or at least act like you do) </li></ul><ul><li>Admit what you do not know – clinical expertise, vocabulary, skills, experience </li></ul><ul><li>Emphasize that everyone has something to contribute (including you) and that everything is a collaborative effort </li></ul><ul><li>Ask your audience to teach you something, to get them engaged </li></ul>
    114. 116. Learning Styles in Healthcare <ul><li>Clinicians tend to be very vested in their job, at a personal level </li></ul><ul><li>Clinicians tend to take failure very personally </li></ul><ul><li>Clinicians can be very hard on themselves, even for things the patient is unaware of </li></ul><ul><li>Clinicians don’t generally want advice from non-clinical people, unless you first show understanding and appreciation of their world and their work </li></ul><ul><li>Hierarchies and chains of command are very important, although acceptance is earned at a peer level </li></ul>
    115. 117. Learning Styles – Executives <ul><li>Executives want the short version, but don’t leave out anything important </li></ul><ul><li>Executives want to see the big picture </li></ul><ul><li>Executives want to know what’s in it for the organization as a whole </li></ul><ul><li>Executives want to see a connection to the strategic plan </li></ul>
    116. 118. Learning Styles – Management <ul><li>Managers want to know the short-term and long-term plan </li></ul><ul><li>Managers want to know what’s in it for their staff and their department </li></ul><ul><li>Managers want structure and order </li></ul><ul><li>Managers generally want things to stay the same </li></ul>
    117. 119. Learning Styles – Physicians <ul><li>Physicians are scientists </li></ul><ul><li>Physicians like data and statistics </li></ul><ul><li>Physicians like evidence-based practices </li></ul><ul><li>Physicians want to know what’s in it for them </li></ul><ul><li>Physicians want you to get to the point </li></ul><ul><li>Physicians want a role in decision-making </li></ul>
    118. 120. Learning Styles – Nurses <ul><li>Nurses are caregivers first and scientists second </li></ul><ul><li>Nurses want to see it for themselves </li></ul><ul><li>Nurses like evidence-based practices </li></ul><ul><li>Nurses want to know what’s in it for their patients </li></ul><ul><li>Nurses want to hear (true) stories </li></ul><ul><li>Nurses want you to walk a mile in their shoes </li></ul>
    119. 121. Learning Styles – Front-Line Staff <ul><li>Front-line staff want to know who’s doing the work </li></ul><ul><li>Front-line staff want to know what will change and what will stay the same </li></ul><ul><li>Front-line staff want to know who made the decisions </li></ul><ul><li>Front-line staff want to be heard and acknowledged </li></ul>
    120. 122. Attendee Practice <ul><li>Choose a specific audience and their learning style </li></ul><ul><li>Convert the given the given project summary for that specific learning style in a healthcare setting </li></ul><ul><li>Present to the class as if we are that audience </li></ul><ul><li>Discussion </li></ul>
    121. 123. Workshop Recap <ul><li>Objectives </li></ul><ul><li>Learn how to identify the particular needs of clinical employees as Lean trainees </li></ul><ul><li>Learn how to address the particular needs of clinical employees as Lean trainees </li></ul><ul><li>Learn creative applications of traditional Lean tools in healthcare </li></ul><ul><li>Attendee expectations </li></ul>
    122. 124. Questions and Discussion ?
    123. 125. Wrap-up Kindly complete the workshop survey! Be sure to take home your workbooks Contact us if you need further advice Thank You!

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