The document outlines a webinar focused on leveraging lean principles for long-term success in organizations under short-term pressures, featuring insights from Mark Graban and Warren Stokes. Key learnings include the importance of engaging frontline employees, simplifying lean processes, and fostering trust for continuous improvement. The presentation emphasizes effective communication, understanding key business drivers, and using visual tools to support incremental improvements in operations.

1. Leverage Lean for Long-term Success
(Under Short-term Pressures)
Mark Graban
VP of Improvement & Innovation Services
Mark@KaiNexus.com
@MarkGraban
Warren Stokes
Director, Process Improvement
HonorHealth
Warren.Stokes@honorhealth.com

2. Webinar Logistics
• Presentation (45 minutes)
• Q&A (10 minutes)
– Use the GoToWebinar
Meeting Panel to
submit a question at
any time
• Recording link & slides will be sent via email
– Also – see the “Handouts” feature and Chat box

3. Warren Stokes
• Director, Process Improvement
– HonorHealth
• BS, Aeronautics/Aerospace Science
and Technology
– Embry-Riddle Aeronautical University
• MA, Public Administration
– Columbus State University
• Formerly with:
– CTCA, Pratt & Whitney, Hamilton
Sundstrand, USAF

4. Key Learnings
■ How to leverage the intellectual capital and experience of your frontline employees first
■ To not overcomplicate your Lean improvement with too much of the scientific and not
enough of the practical
■ Why it’s important to build trust and support for continuous improvement
■ How Lean best fits into a larger, long-term continuous improvement strategy in a way
that avoids succumbing to short-term pressures
■ How leadership and a Lean team can create and empower laser-focused energy

5. How
■ Effective use of Lean language
– Simple
– Practical
■ Defining the problem
– Identify critical data and information
– Prioritize quickly and simply
■ Executing with Rapid Cycles of Improvement
– Alignment to the priorities
– Scope-chunking

6. Theme
Lens of Simplicity and Practicality

7. The Plot
■ Budget gap
■ Demand has decreased
■ Prices have increased
■ Contract has changed

8. The Plot…continues
Immediate ACTION!
Reduce costs by….10%, 20%, 30%
“We’re committed to Lean, but right now
we don’t have time.”

9. Approach
BOTH…AND not EITHER…OR!
■ Do not focus on the “One-fell swoop” idea
■ Be mindful of organizational disruption
“….solution to a problem is usually as bad as the problem.”
- Milton Friedman

10. Opportunity
Just Grab It!
Front-line Knowledge
~10%
Low-hanging
Operational Risks
~20%
Bulk
Restructure
~30%

11. Align. Quickly
■ Understand your true current state
– Key Business drivers
– Validate the definitions and calculations
■ Turn data into information
– Context – “SoWhat?”
– Picture-ize the data

12. Prioritization
Frequency/Likelihood
High - Low High-Medium High-High
Low-Low Low-Medium Low-High
Impact (Time and/or Dollars)
Scope of Key Business Drivers
■ Quantify
■ Program, Process, Function,
Equipment
– Rework/Overtime
– Repair
– Scrap/Expired
– Downtime (Unplanned)
Average cost of poor quality (COPQ)
is ~15% of sales

13. Creating the Right Energy
■ Provide clarity around the situation
– Use effective language
– Make it visible
■ Engage at all levels
Create the right energy to capitalize on the right energy!

14. Effective Language
■ Risk of stakeholders feeling “targeted”
– Open intellectual capital
– Motivate
■ Be specific with the challenges
■ Avoid generic phrases
– “Just gonna have to do more, with less”
– “Work smarter, not harder”

15. Effective Language of Lean
“We’re Blackbelts, this is how we all speak!”

16. Effective Language of Lean
The language of Lean is the language of your organization
Learning a new language WHILE trying to problem-solve is an
additional barrier

17. Effective Language of Lean
What You Said What You Mean
Mura Uneven workload
Muri Overburden – too much
Muda Wasted time
Gemba Where the work is happening
Kaizen Change for better, improve
Kanban Material replenishment
Poka-yoke Error-proofing
Heijunka Smoothing the workload

18. Doing the Work
■ Engage the front-line
■ Incremental ideas with minimal impact on other departments
■ Source for information

19. Doing the Work
■ Focus on the waste
– COPQ ~15% of sales
■ How many meetings are needed?
– Talent
– Overprocessing
■ Daily Management

20. Wastes

21. Meetings
Now we’re going to INCREASE the number of meetings!

22. Make it SimplyVisual
Dashboard Crashboard
Narrow and Focus on the critical few

23. Daily Management
Avoid adding waste and cost while trying to eliminate waste and cost

24. Storyboarding (A3)
■ Simple
■ Visual
■ Empowering
■ Motivational

25. Storyboarding (A3)
Post and Share!

26. Doing the Work
■ Understand requirements (SIPOC)
■ OptimizeValue Streams
– Cross-functional
– Multi-departmental

27. Align to Requirements
Metrics for Inputs Metrics for Outputs
Suppliers
(Who provides
the input?)
Inputs
(What do you need
for the process?)
(How do you need
the input?
(When do you
need the input?)
Process
Outputs
(What does your
process produce?)
(How does the
customer need the
output?)
(When does
the customer
need the
output?)
Customer
(Who directly
receives the output
of your process?)
SIPOC

28. SIPOC
Metrics for Inputs Metrics for Outputs
Suppliers
(Who provides
the input?)
Inputs
(What do you need
for the process?)
(How do you need
the input?
(When do you
need the input?)
Process
Outputs
(What does your
process produce?)
(How does the
customer need the
output?)
(When does
the customer
need the
output?)
Customer
(Who directly
receives the output
of your process?)
Pre-Admission
Testing
Case Prep
1

29. SIPOC
Metrics for Inputs Metrics for Outputs
Suppliers
(Who provides
the input?)
Inputs
(What do you need
for the process?)
(How do you need
the input?
(When do you
need the input?)
Process
Outputs
(What does your
process produce?)
(How does the
customer need the
output?)
(When does
the customer
need the
output?)
Customer
(Who directly
receives the output
of your process?)
Pre-Admission
Testing
Interview
Testing results
Case Prep Case kitted
21

30. SIPOC
Metrics for Inputs Metrics for Outputs
Suppliers
(Who provides
the input?)
Inputs
(What do you need
for the process?)
(How do you need
the input?
(When do you
need the input?)
Process
Outputs
(What does your
process produce?)
(How does the
customer need the
output?)
(When does
the customer
need the
output?)
Customer
(Who directly
receives the output
of your process?)
Pre-Admission
Testing
Interview
Patient
Testing results
Case Prep Case kitted Surgeon
31 2

31. SIPOC
Metrics for Inputs Metrics for Outputs
Suppliers
(Who provides
the input?)
Inputs
(What do you need
for the process?)
(How do you need
the input?
(When do you
need the input?)
Process
Outputs
(What does your
process produce?)
(How does the
customer need the
output?)
(When does
the customer
need the
output?)
Customer
(Who directly
receives the output
of your process?)
Pre-Admission
Testing
Interview
Complete, according
to criteria
10 days prior
to date of
surgery
Patient
Testing results
100% complete and
accurate (zero-
defects)
5 days prior to
date of surgery
Case Prep Case kitted
100% complete and
accurate (zero-
defects)
3 days prior to
date of surgery
Surgeon
Stored in proper
location
4 31 2

32. SIPOC
Metrics for Inputs Metrics for Outputs
Suppliers
(Who provides
the input?)
Inputs
(What do you need
for the process?)
(How do you need
the input?
(When do you
need the input?)
Process
Outputs
(What does your
process produce?)
(How does the
customer need the
output?)
(When does
the customer
need the
output?)
Customer
(Who directly
receives the output
of your process?)
Patient scheduled
Pre-Admission
Testing
Interview
Complete, according
to criteria
10 days prior
to date of
surgery
Patient
Testing results
100% complete and
accurate (zero-
defects)
5 days prior to
date of surgery
Preference Card(s)
Case Prep Case kitted
100% complete and
accurate (zero-
defects)
3 days prior to
date of surgery
Surgeon
Supplies
Stored in proper
location
Instruments
5 4 31 2

33. SIPOC
Metrics for Inputs Metrics for Outputs
Suppliers
(Who provides
the input?)
Inputs
(What do you need
for the process?)
(How do you need
the input?
(When do you
need the input?)
Process
Outputs
(What does your
process produce?)
(How does the
customer need the
output?)
(When does
the customer
need the
output?)
Customer
(Who directly
receives the output
of your process?)
OR Scheduling Patient scheduled
Pre-Admission
Testing
Interview
Complete, according
to criteria
10 days prior
to date of
surgery
Patient
Testing results
100% complete and
accurate (zero-
defects)
5 days prior to
date of surgery
Surgeon Preference Card(s)
Case Prep Case kitted
100% complete and
accurate (zero-
defects)
3 days prior to
date of surgery
Surgeon
Supply Chain
Supplies
Stored in proper
location
Instruments
6 5 4 31 2

34. SIPOC
Metrics for Inputs Metrics for Outputs
Suppliers
(Who provides
the input?)
Inputs
(What do you need
for the process?)
(How do you need
the input?
(When do you
need the input?)
Process
Outputs
(What does your
process produce?)
(How does the
customer need the
output?)
(When does
the customer
need the
output?)
Customer
(Who directly
receives the output
of your process?)
OR Scheduling Patient scheduled
100% accurate date
and duration (time)
14 days prior to
date of surgery
Pre-Admission
Testing
Interview
Complete, according
to criteria
10 days prior
to date of
surgery
Patient
Testing results
100% complete and
accurate (zero-
defects)
5 days prior to
date of surgery
Surgeon Preference Card(s)
Updated and 100%
complete and
accurate
5 days prior to
date of surgery
Case Prep Case kitted
100% complete and
accurate (zero-
defects)
3 days prior to
date of surgery
Surgeon
Supply Chain
Supplies
Complete kit with
extra XYZ
In-place, in proper
location
Stored in proper
location
Instruments
Complete and
accurate according
to surgery type
76 5 4 31 2

35. SIPOC
Metrics for Inputs Metrics for Outputs
Suppliers
(Who provides
the input?)
Inputs
(What do you need
for the process?)
(How do you need
the input?
(When do you
need the input?)
Process
Outputs
(What does your
process produce?)
(How does the
customer need the
output?)
(When does
the customer
need the
output?)
Customer
(Who directly
receives the output
of your process?)
OR Scheduling Patient scheduled
100% accurate date
and duration (time)
14 days prior to
date of surgery
Pre-Admission
Testing
Interview
Complete, according
to criteria
10 days prior
to date of
surgery
Patient
Testing results
100% complete and
accurate (zero-
defects)
5 days prior to
date of surgery
Surgeon Preference Card(s)
Updated and 100%
complete and
accurate
5 days prior to
date of surgery
Case Prep Case kitted
100% complete and
accurate (zero-
defects)
3 days prior to
date of surgery
Surgeon
Supply Chain
Supplies
Complete kit with
extra XYZ
In-place, in proper
location
Stored in proper
location
Instruments
Complete and
accurate according
to surgery type
How often are you REWORKING?

36. Scope-chunking
2-week Rapid Cycles of Improvement

37. Storyboard (A3)
■ Storyboard each chunk
■ Make visible
■ Plan-Do-Check-Act

38. Go!
Leaders
BeVisible!
Do not need a table where a walk will do
Markers instead of Meetings

39. Moral of the story
■ The Crow and the Pitcher
– Where there’s a will there’s a way
– Small improvements add up
Can’t afford NOT to be Lean!

40. Announcements
(Then Q&A)

41. Ask Us Anything!
• Mark Graban & Dr. Greg Jacobson
• Next Episode (#14) August 15, 1 pm ET
• Register & submit questions via
http://kainexus.com/webinars
• Past episodes available
on YouTube

42. Our Next Webinar – Aug 30
• Register at www.KaiNexus.com/webinars
• “Teaming with Patients to Improve Safety”
Presenters:
• Laura B. Townsend
– Co-Founder & President of Louise H. Batz Patient Safety Foundation
• Elise Matocha
– BSN, RN, ONC Director, Clinical Performance Improvement
• Carol Wratten
– MD MBA FACOG, Retired from Seton Healthcare Family

43. Other Resources
www.KaiNexus.com

44. KaiNexus Podcasts
• www.KaiNexus.com/podcasts
• Subscribe via:
– iTunes
– Google Play
– Stitcher

45. Q&A
• Web:
– www.kainexus.com
– blog.kainexus.com
• Webinars on Demand:
– www.kainexus.com/webinars
• Social Media:
– www.twitter.com/kainexus
– www.linkedin.com/company/kainexus
– www.facebook.com/kainexus
Mark Graban
Mark@KaiNexus.com
@MarkGraban
Warren Stokes
Director, Process Improvement
HonorHealth
Warren.Stokes@honorhealth.com