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Lean Hospital: Creating a Lean Culture of Continuous Improvement Part 2
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Lean Hospital: Creating a Lean Culture of Continuous Improvement Part 2


The PowerHealth OnDemand Webinar Series brings you Leonardo Group Americas LLC (authors of the books Lean in the OR, Supplies Management in the OR, Value Stream Mapping in the OR, Lean Training Games …

The PowerHealth OnDemand Webinar Series brings you Leonardo Group Americas LLC (authors of the books Lean in the OR, Supplies Management in the OR, Value Stream Mapping in the OR, Lean Training Games in the OR and Quick Changeover in the OR), who will share their experiences and learnings from working with hospitals across the country to develop a Lean mindset/environment that achieves continuous improvement and sustained profitability. The topics covered in Part 2 of a 3-part series include: The meaning of “Kaizen” and the definition of the two types of Kaizen activities,
Creating a Quick and Easy Kaizen initiative, and Benchmarking of Kaizen efforts with other Lean organizations.

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  • Lean Hospital Roadmap 101
  • We are at a pivotal point in time for hospitals in the US and in the world. Competition is beginning to be a meaningful market force, when it was not a short year ago. Pressure on cost is being brought to the forefront and many times not in the way we would like. Often staff appears to be the target for cost reduction, rather than the many forms of waste that plague the OR. We find ourselves right now where there are only two kinds of hospitals: those who have embraced Lean and those that will. Continuous Improvement is coming to a hospital near you and for your sake and that of your patients, we hope it is your hospital.  
  • This is the Lean Hospital Strategy roadmap, with the processes for this lesson circled. You can see that we’re just getting started! Remember too that the drill icon means that there is a detailed sub-roadmap for each of these two processes, with additional detail. So this is not as simple as it may look.   We’ll start by describing one of the deliverables of this part of the roadmap, an actionable Master Plan.
  • Instructor Notes: So Kaizen literally means good thinking, but continuous improvement is a better translation. It’s ok to be selfish about Kaizen, by focusing on things that make our jobs easier. By doing so you will be eliminating waste from your work, and be giving yourself more time to do what you were hired to do. Another possible misconception about Kaizen is the notion that you are expected to come up with big ideas. Big ideas are fine, of course, but there aren’t that many of them. What is more important as individuals is to contribute continually, but in small ways. A small change is easy to think up, and easy to get approved, and easy to implement, as it says on your reminder card. Also: ideas should be approved, since they may affect other areas that we are not aware of, or impact the patient. December 2009 Do not copy without permission Introduction to the Lean Hospital Instructor Notes
  • Instructor Notes: When we use the word Kaizen we are referring to two different ways of process improvement. One is Team Kaizen, where we work on improvements in teams, with event lasting 3 to 5 days or even longer for big projects. We pick an area of opportunity, and during a Kaizen “Event” we brainstorm improvements, test them, and implement them, all in a short period of time. Of course large projects, like building a new hospital building, take much longer, but we like to have a clear beginning and completion whenever possible, in a short period of time. We don’t like improvement teams that meet periodically and go on and on. The other type of Kaizen is called “Quick and Easy Kaizen”, which is more of a suggestion system focused on small improvements (but many of them). We’ll be setting up a structure here at ORMC to support the submitting, tracking and implementing of these kind of ideas. We need both types of Kaizen, but the Quick and Easy Kaizen, as the name implies, is something that you can start with immediately, with a 7S project for example. It only takes a few minutes typically to submit a Q&E Kaizen suggestion. We’ll have a chance to practice this in a few minutes. December 2009 Do not copy without permission Introduction to the Lean Hospital Instructor Notes
  • Instructor Notes: Here’s the approach to take in order to advance step by step in the direction of perfection, and to reach a target condition. We apply what is called the PDCA method or cycle, which is really an application of the scientific method. It’s important to advance one step at a time, and not be changing too many things at the same time. Here’s how it works: We start with an idea or a Plan. This is the suggestion that we want to try, that we feel will advance us on our path to improvement. We try out the idea at the Do step. It is advised to try it out as a pilot or in a limited area of the hospital, since we don’t know with total confidence how it will work out. We Check or measure the results. Did the change work as expected or not? Finally, we Act on the results. If the test was successful we can move to roll the change out to other areas, or to the entire hospital. If the idea did not pan out, we don’t regard it as a failure but as a learning experience. We then return to Plan to try the next thing. How often do we repeat the PDCA cycle? Forever! This is the process improvement habit that needs to be taught and practiced, and mentors in the organization need to help “students” in the application of this way of thinking. This is one of the keys to the success of companies like Toyota. December 2009 Do not copy without permission Introduction to the Lean Hospital Instructor Notes
  • December 2009 Do not copy without permission Introduction to the Lean Hospital Instructor Notes
  • December 2009 Do not copy without permission Instructor Notes: We want to introduce you to a new term, the Target Condition. The target condition is the improvement goal for our department or individual process, that we are working towards in the near term. We have our vision statement, “Zero Errors” for example, and the Target Condition is a step in that direction. It is not necessary or even desireable when setting your target condition to know how you’re going to get there. If you already know how to get there, then you are in implementation mode, and you can just go do it. We probably don’t, however, know exactly how to get to “Reduced Errors”, and we will need to make and effort, try things out, apply the scientific method, to make our way step-by-step to that accomplishment. It’s important to understand that every process needs to have a Target Condition. The reason is simple: if we’re not working towards an improvement in our processes, the process is degrading. There is really no permanent state of “stability”. The reason is this: if we’re not making an effort to improve, the waste that exists in a process is not being addressed directly, we are creating workarounds and band-aids, and our attention is focused elsewhere. Training also tends to degrade over time. So continuous improvement means: every process every day. Introduction to the Lean Hospital Instructor Notes
  • Kusai : Things that smell bad. Kitsui : Things that are dark or hard to do. Kitanai : Things that are dirty. Kiken : Things that are dangerous.
  • December 2009 Do not copy without permission Introduction to the Lean Hospital Instructor Notes
  • December 2009 Do not copy without permission Introduction to the Lean Hospital Instructor Notes


  • 1. Sponsored by:Creating a Lean Culture of Continuous Improvement Part II
  • 2. • Principal, Leonardo Group Americas LLC. • Co-Author of Fundamentals of Flow Manufacturing, Aerospace Flow, In the OR series of Lean HospitalRichard books. • VP of Technology, John Costanza Institute of Rahn Technology. • MBA, University of Colorado and APICS CPIM certified. • Trained over 5,000 Lean professionals since 1994. • Lean Hospital work since 2002. • Creator of the Lean Operations track for the Aerospace Supplier Excellence Alliance (SEA). • 16 years of manufacturing management at Storage Technology Corporation and Ball Corporation prior to consulting career. • Bilingual Spanish-English.
  • 3. Webinar OverviewThe principles & tools related to Lean Thinking: • Help to eliminate wasteful activities • Lead to Continuous Process Improvement • Ultimately improve patient care experience and patient satisfaction
  • 4. Lean Hospital Implementation Roadmap Train Leadership Team in the principles of To support the Hospital’s Lean A Lean Hospital embraces a An initial assessment of current hospital Hoshin Kanri (Goal Deployment) and formalize journey, Leaders must participative model of Continuous operations, including future vision and level internal process. Use A3-X chart and Team understand the tools and Improvement. All Lean Hospital of process improvement maturity. Includes Charter forms for all Master Plans. culture of Continuous Process employees must be trained to be a analysis of potential benefits. Improvement. part of this culture. Conduct Value Stream analysis for each unit and department to identify 1 3 TRAIN 6 opportunities for improvement. Create a START LEAN HOSPITAL ASSESS O.R. TRAIN TRAIN unit-level Master Plan. START LEAN HOSPITAL ASSESS O.R. LEADERSHIP TRAIN TRANSFORMATION OPERATIONS LEADERSHIP HOSPITAL STAFF TRANSFORMATION OPERATIONS TEAM HOSPITAL STAFF TEAM The Lean Hospital Master Plan includes a definition of identified 2 VALUE STREAM 4 7 8 Formalize the VALUE STREAM SET UP SET UP IMPLEMENT IMPLEMENT improvements, resources DEVELOP UNIT DEVELOP UNIT process of soliciting, ANALYSIS AND ANALYSIS AND PERFORMANCE PERFORMANCE GOAL DEPLOYMENT GOAL DEPLOYMENT required, implementation MASTER PLANS MASTER PLANS receiving, MASTER PLAN MASTER PLAN DASHBOARD DASHBOARD TOOLS TOOLS timeline, estimated benefits, and evaluating, andROI for the selected value streams. implementing process Establish lean performance metrics improvement and method for reporting, analysis, suggestions for the 5 and follow-up. CONDUCT CONDUCT entire hospital. PILOT PROJECTS PILOT PROJECTS Select highly visible areas for proof 9 10 SUSTAINED of concept and buy-in. Follow CONDUCT INITIAL IMPLEMENT KAIZEN SUSTAINED Roll-out unit and department CONDUCT INITIAL IMPLEMENT KAIZEN PERFORMANCE Kaizen methodology to achieve KAIZEN EVENTS SUGGESTION SYSTEM PERFORMANCE process improvement KAIZEN EVENTS SUGGESTION SYSTEM results in less than 5 days. activities per the Lean Certify all Internal Lean Hospital Master Plan. Mentors through completion of actual projects and 15 14 IMPLEMENT Knowledge Checks. ROADMAP IMPLEMENT ROADMAP SUSTAINABILITY COMPLIANCE AUDIT SUSTAINABILITY COMPLIANCE AUDIT ROADMAP ROADMAP 13 12 KAIZEN MENTOR 11 KAIZEN MENTOR KAIZEN MENTOR INSTITUTE KAIZEN MENTOR CERTIFICATION INSTITUTE CERTIFICATION CERTIFICATION UNIT CPI TEAM Conduct a comprehensive, lean- CERTIFICATION TRAINING UNIT CPI TEAM TRAINING focused audit, with the objective of advancing the Lean Culture at the Hospital. Each team leader presents the status of Organize a local Continuous completed Kaizen projects to ensure Train a team of Hospital Staff Process Improvement Team to results and sustained performance. to become internal Lean identify, evaluate, and Mentors. implement improvements.
  • 5. Learning Objectives: Part II of III• The meaning of Kaizen.• The two types of Kaizen.• How to create a Quick and Easy Kaizen Initiative.• Benchmarking Kaizen efforts with other Lean organizations.
  • 6. What Is Kaizen?Looking for Improvement The Meaning of the Word  Japanese for Continuous Improvement  KAI = THINKING ZEN = GOOD  Make your job easier by changing the way you do things (methods)  Make small changes rather than big changes. Improve little by little
  • 7. Types of Kaizen
  • 8. The PDCA Cycle CPI
  • 9. Foundation for ImprovementOne Step At A Time To Improve You Must Have:  A mature process.  An improvement goal.  Taiichi Ohno: Without standardization there is no Kaizen.  Add to that: without process maturity there is no Six Sigma.
  • 10. Next Target ConditionIf You Stop Pushing Definition of Target Condition  Define Perfection and set course towards it  The next target condition is the next stop on the way to Perfection  Only two possible conditions: IMPROVING OR DEGRADING  Kaizen means: every process, every day.
  • 11. Value StreamNine Wastes The Mapping
  • 12. The Four K’s Smell bad.Dangerous. Hard to do. Dirty.
  • 13. The Seven S’s1. Sort. Remove from the workplace anything not needed for current production.2. Set In Order. Organize remaining things. A place for everything.3. Shine. Clean and polish all machines, tools and area.4. Safety. Ensure that the work area contains no safety hazards.5. Security. Verify that the work area conforms to any safety requirements.6. Standardize. Create standards and procedures, and assign owners and champions.7. Sustain. Clean after every use and maintain everything in running order.
  • 14. The Hard Way or the Easy Way?
  • 15. Intro to Quick and Easy KaizenSource Book Key Q&E Concepts  Most suggestions should be small and easy to think up.  Supervisors and Team Leaders solicit ideas, as a part of a “Lean Management System”.  Participation is voluntary.
  • 16. Q&E Kaizen Rules1. Ideas need to be easy to write down 75 words or less.2. Ideas should be easy to approve Approval in 24 hours or less.3. Ideas should be easy to implement Usually done by the person who submitted the idea.
  • 17. Kaizen MemoWHAT IS THE PROBLEM? WHAT IS YOUR IDEA?We had this We took this problem action. WHAT WILL BE THE RESULT? We improved a little bit.
  • 18. What Can I Improve (I)?1. Patient Flow: can be improved2. Error Elimination: can be improved3. Costs: can be lowered4. Scheduling: improve scheduling process5. OR Turnover Time: can be reduced6. Supplies Inventory: reduce unnecessary stock
  • 19. What Can I Improve (II)?7. Safety: reduce possible accidents8. People: improve skills and knowledge9. Equipment: improve uptime and efficiency10. Environment: improve air quality and odors11. Visual: use colors, clean up, find more easily12. Location: reduce distance and movement
  • 20. Example: Acceptable Suggestions
  • 22. Kaizen Suggestion Database
  • 23. Tracking ResultsTrack the following results, by department and in total:1. Number of Suggestions Received2. Number of Suggestions Implemented3. Number of Suggestions Per Employee
  • 24. Performance Dashboard
  • 25. Making It HappenReview suggestions daily. Have a backup if you’re not there.Hold a Kaizen meeting at least once a week. 1. Solicit written ideas at that meeting. 2. Put the meeting on a regular schedule. 3. Discuss new ideas, areas for potential improvement.Work individually with non-contributors. Offer to document their ideas for them.
  • 26. Use An Electronic DatabaseMANUAL PROCESSES ARE RISKY EXAMPLE• Temptation is to develop dashboard manually.• Data consistency may be variable.• Completion depends on individual people.• Pitch is probably long.• Expensive.
  • 27. Convert Suggestion to A3 Team Charter
  • 28. Manage the Kaizen Projects
  • 29. KPI Board
  • 30. Process Owners Area Owner Number of EmployeesSoft Goods Leticia Castellanos 87Kapton John Lovato 44Metal Line John Ramirez 84Insulfab Mike Sieger 64Materials Johnny Rodriguez 22IT+ HR Kathleen Creamer, Pam Hale 8Accounting, Quality, Jane Horn, Dayle Benson, 24Contracts, Shipping Rick SpiresEngineering Bruce Farber 23Total 357
  • 31. It Can Be Done Ideas/PersoOrganization Ideas People n 1 114,179 1,800 63.4 2 280,932 8,000 35.1 3 893,274 35,494 25.2 4 122,319 614 199.2 5 843,536 7,800 108.1 6 534,000 58,000 9.2 7 352,594 28,482 12.4 8 46,589 804 57.9 9 176,122 9,118 19.3
  • 32. Case History From Toyota“Announcing” Quality Circles What Worked  Mandating participation does not work.  Genuine enthusiasm and participation is needed.  Plant the seeds by finding and encouraging your early adapters.  Find your Positive Deviants.
  • 33. Thank you for joining us today. Please be on the lookout for a follow-up email with a survey and a link to Part 3 scheduled mid-January. Leonardo Group Principals: Gerard Leone & Richard D Rahn 303-494-4404 Boulder, Co 80303 PowerHealthOnDemand Scott Calvert VP Business Development 303-683-8239 Greenwood Village, Co 80111