Raising the Bar
Lean Thinking and Continuous
Improvement in Healthcare
Norm Nopper, MA, BBA
Director, Varanor International
Delivered for the ABC Heath Centre*
April 12, 2010
12-Apr-10 * The client name has been masked for confidentiality. 1
• Describe the key concepts of Lean
Thinking, Six Sigma and Kaizen.
• Review areas where Lean Thinking and
Continuous Improvement can be applied
Lean Thinking: How are Healthcare,
Manufacturing, and Supermarkets Related?
L Thi ki
• T ii h Oh was th f th of the Toyota Production
Taiicho Ohno the father f th T t P d ti
System, on which Lean Thinking is based.
• The Supermarket was Taiicho Ohno’s inspiration for the
Toyota Production System, and he learned from it.
• TPS, Lean, the Supermarket and Manufacturing can be
inspiration f th ABC H lth
i ti for the Healthcare O
You’re Already Familiar with Lean
Production: The Kitchen
• The V i
Th Voice of the Customer: Family says “W ’ h
f th C t F il “We’re hungry!” !”
• Value Added: Delicious, nutritious food.
• Pull System: Family of four is hungry not twenty – five
• Standard Work: Recipe book.
• Equipment Capability: Working stove, p
q p p y g , pressure cooker,,
toaster, electric skillet, etc.
• Kanban: Cupboards, refrigerator, the supermarket.
• Reduce Waste: Spoilage, burnt food, uneaten leftovers.
• 5S: Everything in its place, within reach.
• Gemba: Go and See See.
World Class through Capability
Process Capability Human Capability
• Products/Services • Employee Capability
• Machinery & Equipment
y q p – Individual’s education,
training, skills, experience
– Values and behaviours
– Industry Specific Processes
• C ti
Stamping, M hi i
i Machining, • Organizational Capability
Extruding, Brewing, Refining . . . – Values, vision, mission
• Inpatient care, Ambulatory – Collective “Know – How”
care, Emergency, Surgery . . .
, g y, g y
– Collective Behaviour
C ll ti B h i
– Process Management
– Reputation and History
• Lean, Kaizen, Six Sigma
Hi h Level Definitions
l D fi iti
Lean: R d ti i W t
Reduction in Waste
• Kaizen: Continuous Incremental Improvement
• Six Sigma: Process Control
– 99.9996667% Good Outcomes
– 3.4 per million Bad Outcomes
• Define, Measure, Analyze, Improve, Control
Productivity and Sustainability:
It’s About the People
A sustainable company i not a collection of
i bl is ll i f
"human resources." It is a community* of
human b i
Henry Mintzberg McGill University
Globe and Mail, July 18, 2008
* Italics are my emphasis.
The Changing Nature of Work
Th Ch i N t fW k
"Everyone has two jobs - to do what
they do and to improve what they do ”
Sven-Olaf Karlsson, CEO
Jonkoping County Council, Sweden
Quoted by Tom Closson, President
Ontario Hospital Association
at HealthAchieve 2008
Voice f th C t
V i of the Customer
• Voice f th P ti t
V i of the Patient
• Voice of the Family
• Voice of the Public
• Voice of the Internal Customer
– Doctors, Nurses, Front – line Staff
– Various Departments
Value Add d
V l Added
• B i
Business C t t
– What does the customer really want for his/her dollar?
• Healthcare Context:
– What does the patient really want?
– Determine value added vs. non – value added activity.
– Increase the former; reduce or eliminate the latter.
Th Seven Wastes (Muda)
W t (M d )
• Processing ( pp p
g (Inappropriate or Over p
G b Go and See
• Value Stream Mapping
• Gemba walks
• Observe and record
• Video tape a process
Japanese English English
(Manufacturing) (Healthcare: 6S)
Seiri Sort Sort
Seiton Straighten (Set in Order) Straighten
Seiso Sweep, Shine Scrub
S ik Standardize
S d di Standardize
S d di
Shitsuke Sustain Sustain
Standard W k
St d d Work
Every team member does th same t k
t b d the tasks,
in the same manner, using the same skills,
– Create a standard outcome.
– Eliminate process variation.
– Eliminate human error.
K b = Si l
• A signal t replenish supply.
i l to l i h l
– Build product, parts, components.
– Buy/order product parts components
product, parts, components.
– Deliver product, parts, components.
• Kanban techniques:
– Painted square on the floor.
– Line painted on the wall.
– Bin, cupboard, shelf
– Ticket or card
– Sh ld b VISIBLE
Si Sigma in a Nutshell
i N t h ll
• Sigma (σ) a Greek letter used In statistics to indicate the
measure of difference (or variance) in a group of similar
• Th G l
– Improve Stakeholder Satisfaction
– Gain Process Knowledge/Improve Process Capability
g p p y
– Reduce Process Variation
– Reduce Defects and Improve Outcomes
• Focus on Data Driven Decisions
• DMAIC: Define, Measure, Analyze, Improve, Control
Si Sigma Performance
I terms of Good Parts (
f G d P t (Long – Term Yield):
3σ Capability 93.32% Most Companies
4σ Capability 99.38% Not Good Enough
Capability 99.99966% World C
In terms of Defects:
6σ capability means 3.4 ppm.
3σ capability means 66 807 ppm
Key Features of Six Sigma
K F t f Si Si
• Data Driven
• Structured and Disciplined
• Team Approach
K i T l
• Customer O i t ti
C t Orientation • Kanban (Kamban)
K b (K b )
• Total Quality Control • Quality Improvement
• Robotics • Just – in – Time
• Quality Control Circles • Zero Defects
• Suggestion System
gg y • Small – group Activities
• Automation • Cooperative Team
• Discipline in the Member/Leader Relations
Workplace • Productivity Improvement
• Total Productive • New Product/Service
Further R di
F th Reading: Lean
• Gemba Kaizen: A Commonsense, Low Cost Approach to
Management, Masaaki Imai, McGraw-Hill, March 1997
• Lean Production Simplified: A Plain-Language Guide to the
World's Most Powerful Production System, Second Edition,
Pascal Dennis, Productivity Press Inc, September 2007
• Lean Thinking: Banish Waste and Create Wealth in Your
Corporation, Second Edition, James P. Womack and Daniel T.
Jones, Free Press, June 2003
• Learning to See: Value Stream Mapping to Create Value and
Eliminate Muda, Mike Rother and John Shook, Lean Enterprise
Institute, June 2003
Lean Sigma for Healthcare
• Lean Six Sigma for the Healthcare Practice: A Pocket Guide
Roderick A. Munro, American Society for Quality, 2009
• R i
Reinventing th Factory with Lifelong L
ti the F t ith Lif l Learning.
– TRAINING, May 1993
– Author: Norm Nopper
• Learning for Life: Employee Literacy at Honeywell
– Conference Board of Canada, December 2002
Th k you f your ti
Norm Nopper MA BBA
Director, Varanor International
Productivity Through Capability