Lean Leadership by Dr Prem Jagyasi | carving path for lean culture, ultimate productivity and customer value.

Dr Prem Jagyasi | DrPrem.com
Dr Prem Jagyasi
Award winning leader and global speaker
MD & CEO – Dr Prem & Associates
carving path for lean culture, ultimate
productivity and customer value.Lean Leadership

Topic Roadmap
Understand Lean Lean Leadership Lean Principles
Lean Management
tools in Healthcare
Facts and Case
studies
Developing Lean
Culture in
Organization
A Presentation by Dr Prem | Do not Copy | Do Not Amend | Do not Use | All Right Reserved | Terms Applied.

What is Lean?
• Lean leaders have clear focus to
understand the waste in Organization.
• Lean leaders enhance value for the
end customers
• Lean means respect for people and
improvement in process

What is Lean?
• The basic principle of implementing
lean is to ultimately increase
performance and output of
organization that meet customers
demand.
• Lean focuses on flow, continuous
improvements and respect for people.

Adding Value
Disney 3PM Parade

Lean Leadership
If you want 1 years of
prosperity grow grain
prosperity grow tree
prosperity grow people

Leadership Participation
Leadership participation in evaluating
business problem situation and their
role and responsibilities to overcome
problems.

Lean Leadership
• Organizations needs transformations,
revenues are shrinking and cost is
increasing. Leaders need to initiate
such transformations.
• Leaders need to go out of traditional
thinking and bring innovation and
value to organization.
• Efficacy, Efficiency and Effectiveness.

A Lean Leader
• Willing to learn not only instructLearn
• Curious to listen & understand Understand
• Believes in evidence based practice.Evidence
• Continuous and sustainable lean thinkingSustainable
• Keeps communication open and bilateralCommunication
• Committed to consistency, disciplined and outcome. Commitment
• Cause-effect relationships advocateRelationship
• A true leadership personalityPersonality

Traditionalleadership
Sole Leadership.
Leaders set Objectives
and Goals
Focuses on end results
Rigid enforcement of
rules and regulations
Directive about
problems LeanLeadership
Collective Leadership.
Team provides input in
Objectives and Goals.
Focuses on process
and outcomes
Realistic expectations
after careful
evaluation
Encourage “Root
Cause” analysis
Traditional Leadership vs Lean Leadership

Tool 1. 7 Wastes
12
• Defects
• Overproduction
• Waiting
• Non-utilized staff talent
• Transportation
• Inventory
• Motion

Case Study
• In Royal Bolton Hospital, using Bolton
Improving Care, Systems (Lean),
resulted direct savings of £3.1m. Death
rate for patients fell by a third. The time
taken to process important categories
of blood fell from 2 days to 2 hours.
Average turnaround time in pathology
from over 24 h to 2-3 h.
Source: http://ijbssnet.com/journals

2. Waiting
When Patients,
people parts,
systems, or
facilities wait for a
prior step in the
process to be
completed.
Waiting for
Doctor
Patient
Waiting Time
Process
Waiting Time
Goal is to reduce the wait, and add value to process of waiting.

Case Study - Mayo Clinic
Mayo Clinic, Rochester FL.,
• Comprises more than
2,400 physicians and
scientists and 30,200
• Mayo treats more than
500,000 people each
year.
“I’m not trying to change the
moment of care, the touch
moment between you and
your patient. What I’m trying
to change is the 95% of the
time when the patient is not in
your office and you’re not
seeing them or providing care
to them. And that’s the 95%
where we have opportunity for
improvement.”

Case Study
• In Scotland Cancer Treatment using
Lean, resulted customer waiting times
for first appointment from an average
23 to 12 days and improvement of
customer flow time for patients of 48%.

3. Transportation
17
Unnecessarily moving
patients, specimens or
materials throughout a
system is wasteful.
This type of waste is
evident when the
hospital has a poor
layout
Storage of
Emergency
Products
Moving papers
and files through
slow system
Medical
Departments not
well connected

4. Over Production
Producing
more than
what
customer
actually need
Unnecessary
Diagnosis Procedure
Providing over
quantity supply –
Example Hand
Sanitizer
Creating meals that
patient doesn't eat
Over ICU or Over
ventilation stay

Case Study
• In Flinders Medical Centre, using Lean
thinking, resulted 20% more work,
fewer safety incidents, same budget,
same infrastructure, staff, and
technology (Guthrie, 2006; Radnor,
Walley, Stephens, & Bucci, 2006);
(Fillingham, 2008; Young & McClean,
2008).

5. Inventory
Producing
more than
what
customer
actually need
Excess supply and
medicines
Expiry of supply and
medicine causes storage,
flow and elimination
expenses
Overstocked
consumables,
Too much bedside
equipment,
Too many printed forms

6. Over Processing
Over-processing
– Doing more
work than is
needed by the
customer.
Performing a surgery
when a non-invasive
intervention will
suffice
Not assisting patient
to identify which
department he/she
should visit
Asking patients to
come to clinic
unnecessarily
Asking patients/staff
to fill out too much
paperwork

Case Study
• In the Pittsburgh General Hospital,
using Lean techniques, resulted in
change to the procedure for
intravenous line insertion giving a 90%
drop in the number of infections after
just 90 days. Saving almost $500,000 a
year in intensive-care-unit costs.

7. Motion
Unnecessary
movement
within a
work center.
Nurses desk to the
rooms
Walking to the
copier
Bending down to
access equipment
or supplies
Reaching to answer
your phone
Lifting heavy boxes
or carrying your
laptop

Case Study
• In Nebraska Medical Centre, using Lean
principles to redesign the work area in
the sterile processing centre and in the
clinical laboratories, resulted in reduced
staff walking by 167 miles a year. Reduce
lab space by 825 sq ft and specimen
processing turnaround time by 20%.
Reduced manpower by 11 full time
equivalents, who were redirected to
other critical work. Average length of stay
decreased from 6.29 days to 5.72 days.

5S in Lean
Sort Set Shine Standardize Sustain

Tool 2. 5S (Sort, Set, Shine, Stardadize & sustain)
26
First Steps
Second
Step
Third Step
Sustain - Train and
maintain discipline of
the personnel engaged
Standardize - Set up the
First 3S as norms in
every section of the
workplace
Shine - Maintain high
standard of cleanness
Set - Organize
everything needed in
proper order for easy
operation
Sort - Identify and
remove
unwanted/unused items
from the workplace;

Tool 3. PDCA
Plan
Do
Check
Act

Case Study
• A rapid improvement team at Lehigh
Valley Health Network, Allentown,
Pennsylvania, implemented a plan,
do, check, act cycle to determine
problems in the central sterile
processing department, test solutions,
and document improved processes.

Visual Management
29
The key to Visual
Management: Being able to
identify things “at a glance” –
project status, file
confidentiality, where things
go, categorization, etc.

Communication Boards
30
Visual management tools that can be understood in 30 seconds or less
Source: MagnaTag

Communication Board
Source: MagnaTag

KaiZen
Change for Good – A lean approach to continues development.

Hospital Kaizen Example
Source: Mark Graban- Talk at Masaai Imai Event

Swim Lane Mapping
Need better tools
Need better
Record
management
Need Faster
Billing Process

Group Mapping Exercise
• You may want to remind participants
of the following benefits of a process
map:
• Process maps clarify the task,
sequence and time for each step;
• Process maps help identify
improvement opportunities (errors,
inconsistencies, wastes)
• Process maps document staff
knowledge
35

Problem Solving
• “If I had an hour to solve a problem I'd
spend 55 minutes thinking about the
problem and 5 minutes thinking about
solutions.”
- Albert Einstein
36

Problem Solving
37
Symptoms
Root Cause

5 Whys
• 5 Whys is a SIMPLE but POWERFUL
technique for uncovering the root
cause of a problem when you lack
data regarding why the problem is
occurring.
• If we don’t solve problems at the
level of the root cause, we risk the
same problem resurfacing in the
future.
38

5 Whys Example
Problem: The Jefferson Memorial
was disintegrating rapidly
Why was it
disintegrating?
Because the
cleaning methods
were abrasive
Why?
Why?
Why?
.
Root Cause!
Five Why Analysis helps
drive to source of the
problem.
The actual technique can
take more or fewer
iterations.
39

Developing Lean Culture

Sub Topic Landscape
What is
Corporate
Culture
Key
Ingredients
of Corporate
Culture?
How to
develop
Lean Culture
Best
Practices

Working Together – Corporate Culture
• Monkey and
Banana Culture.

What is Culture?
• Culture means the patterns or
the characteristics that is seen
and followed in one particular
area, say it country or region
or association or group.

What is Corporate Culture
Working Together

How do I define Corporate Culture
Way of
Working
Way of
Thinking
Corporate
Culture
Way of
acting/rea
cting

How do I define Corporate Culture
Way of
Working
Way of
Thinking
Corporate
Culture
Way of
Acting or
Reacting
Professionalism
Knowledge
Experience Attitude
Work Environment

How to Develop
LEAN Culture

Difficult but Not Impossible

1. Communicate the purpose not only the task

1. Communicate the Purpose not only task
Communicate
• Purpose Benefits
• Challenges
Arrange
• Meetings
• Workshops
• Gatherings
Involve
• Stars
• Key Employees

2. Be there for staff

2. Be there for staff
• Management must
support members /
staff
Support
• Leaders must inspire
and motivate
Inspire
• Regular Training is the
key for improvement
and involvement
Training

3. Finds the root cause of mistakes rather than
directly hitting staff / members.

3. Finds the root cause of mistakes rather
than directly hitting staff / members.
Lean management believes in finding the actual
cause of problem or mistake.
It gives a direction to check out the errors which
have evolved because of faulty procedure rather
than blaming the members for it.
When problems are investigated, tackle the
process first not the people.

4. Setting examples to improve
Be the change you want to
see in the world
My life is my message

4. Setting examples to improve
Lean management also admires accepting mistakes, especially by the leaders or
the management.
If the management expects certain things from its subordinates then they
themselves should try it under live circumstances to experience the problems
faced of the followers.
Simple things like honesty, sincerity and morality are very important in an
organization.

5. Encourages members to treat
others with respect

5. Encourages members to treat
others with respect
Lean has a principle which encourages people to treat others
as they would love to be treated by others
This creates a sense of behaviour with customers/ patients
and most importantly with colleagues.
In such environment, even mistakes will be treated as
opportunities to improve.
Respect

Best Practices
Develop Lean Culture

Wake-Up - Crawl – Walk - Run

Don’t Blame.
If you are throwing
mud, you are making
your hands dirty on first
place.

Focus
Do only Important work.
Do what is needed.
Don’t do all.

Use tools based on problem
Use selective tools
Don’t use all tools
Use separate tools for
separate problem

Innovate

How Google Innovate?

Google Innovation
Ideas come from Everywhere from everyone.
Share everything about innovative projects. Give a
chance to add to or comment on the process.
If you are brilliant we are hiring, If your company
thrives on innovation, you cant afford to pass talent.

Google Innovation
Give employees a license to pursue their
dream
Prototypes (beta) vs Perfection.
Don’t fool. Use Data.

Google Innovation
Set boundaries. Deadline.
Worry about User and Usage. Money will
follow.
Don’t kill projects. Learn from 3m post note.

Religion of Reuse
Toyota’s 80-80-80 Rule
80% reuse will cut lead time
by 80% at 80% productivity
which results:
Shorter Lead Time
Higher Productivity

Honor & Celebrate Achievements
Honor Progress
Celebrate milestones

Lean Leadership by Dr Prem Jagyasi | carving path for lean culture, ultimate productivity and customer value.

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