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Mark Graban Intro to Lean - Frisco
Lean is a set of concepts and tools used to maximize value and minimize waste from the customer's perspective. It involves engaging employees in continuous improvement. Examples show how lean helped improve processes in healthcare, manufacturing, and government. Key lean principles include specifying value, mapping the value stream, creating flow, establishing pull, and seeking perfection. Continuous improvement involves small, incremental tests of changes through the Plan-Do-Check-Act cycle.
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Mark Graban Intro to Lean - Frisco
- 1. An Intro toLean @MarkGraban www.MarkGraban.com/frisco © 2016, Constancy, Inc., All Rights Reserved
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- 3. Lean ________ • LeanEnterprise • Lean Product Development • Lean Accounting • Lean Law • Lean Startups • Lean Retail • Lean Healthcare • Lean Government
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- 9. What problem are wetrying to solve?
- 10. Why Lean forHealthcare? No waiting No waste Zero harm Source: an NHS hospital, UK
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- 12. Grand Rapids (MI)Fire Dept. Time to Inspect a Building (Hours) 0 2 4 6 8 10 12 Before After “Reduction in fuel and depreciation for city vehicles because of fewer trips that inspectors have to make to a single building.”
- 13. Grand Rapids • “Inspectorsused to do an inspection and then come back to the office to type it up and mail the first violation letter requiring correction within 30 days. • Now, they issue the first violation notice on site at the end of the inspection, cutting days out of the overall lead time.”
- 14. Grand Rapids • LauraKnapp, deputy fire chief for Grand Rapids: – “For me, the whole lean thing just makes a lot of sense. It’s something that I think a lot of people do all of the time, but they don’t do it in a formal way,” – “You look at one piece of the whole process and see what you could do differently, but you never sit down and look at the whole thing.”
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- 16. Source: Dr. RichardShannon
- 17. ThedaCare “Door toBalloon” Time 91 65 52 37 37 45 0 10 20 30 40 50 60 70 80 90 100 2005 2006 2007 2008 2009 2010
- 18. Improving Radiology /MRI AccessTime 0 2 4 6 8 10 12 14 WeeksWaitingTime Outpatient Radiology Backlog
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- 20. Toyota “Meals PerHour”
- 21. Food Bank forNew York City Wait time for meals (minutes) 0 10 20 30 40 50 60 70 80 90 100 Before After
- 22. Food Bank forNew York City Food box packing time 0:00 0:28 0:57 1:26 1:55 2:24 2:52 3:21 Before After
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- 25. Lean is aset of concepts, principles and tools (thinking) used to create and deliver the most value from the customer’s perspective while consuming the fewest resources , and by engaging people in continuous problem solving. Text and image © Lean Enterprise Institute, used with permission
- 26. 5S Value Stream Maps StandardizedWork Kanban Visual Management A3s
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- 29. Right Tool, WrongCulture?
- 30. Right Tool, WrongCulture?
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- 34. “If people areupset, it’s not TPS”
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- 37. What is TPS? • Customer first – Provide customers with what they want, when they want it, and in the amount they want it • People are the most valuable resource – Deeply respect, engage, and develop people • Continuous improvement (kaizen) – Engage everyone each and every day • Shop floor (gemba) focus – Go to where the work is done to find & solve problems
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- 39. What is Value? • Will the customer pay for the activity? • Does the activity move the process forward? • Was the activity done right the first time? Value = 1 – Waste
- 40. What is Waste? • Type 1: Is required in today’s process and system and cannot be eliminated. Facilitates value-adding work for the patient. • Type 2: Can be eliminated immediately without ill effect. Value = 1 – Waste
- 41. The 8 Typesof Waste Type of Waste Example Defects Wrong prescription written for patient Overproduction Too many patients told to arrive at once Transportation Patient walking football fields between oncology clinic and chemotherapy Waiting Patients waiting for a late appointment Employees waiting on work to do Inventory Expired medications and supplies Motion RNs searching for the thermometer Processing Filling out the same form every time Human Potential Time spent on wasteful activities
- 42. Toyota’s Chairman Mr. Cho • Go See – “Senior Management must spend time on the front lines.” • Ask Why – “Use the “Why?” technique daily.” • Show Respect – “Respect your people.” Three Keys to Lean Leadership
- 43. Learning to SeeWaste
- 44. Reducing Podiatrist Walking • Created standardized cart • Along with standardized rooms, eliminated the need to leave the room during patient encounters Restocking Checklist
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- 46. Kaizen Card /Idea Card • Standardized Card in Use – Prompts staff through the problem solving process
- 47. Kaizen Kai = Change Zen= Good
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- 49. People Hate Change? “Peopledon’t resist change, they resist being changed.” – Peter Scholtes (1938-2009)
- 50. Not a SuggestionBox!
- 51. Six Sigma Projects Large Kaizen Medium Kaizen Small Kaizen Lean Events Bubble size ismeant to roughly represent relative size of effort Complexity Daily Kaizen Woman’s & Children’s 3P EMR Implementation New Indy Bed Tower COG Group Best Practices PACE
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- 53. Kaizen Events (RIE,RPIW) • “Kaizen Blitz” – A rapid improvement effort designed to fix a specific problem of limited scope – Brought to the U.S. by Shingujitsu Consulting – a.k.a. Rapid Improvement Event, – Rapid Process Improvement Workshop • “Kaikaku” – Dramatic revolutionary change – “Radical Kaizen”
- 54. Kaizen Event Steps 54 Monday Preparation& info gathering • Teach relevant lean concepts • Set ground rules and expectations • Gemba walk to gather data Tuesday Data assessment • Use gemba data to identify improvement opportunities • Scope the project • Brainstorm improvement ideas • Plan for time and resources if needed Wednesday Implementation • Experiment with solutions • Follow the PDCA cycle • Bias for action, not analysis Thursday Standardization • Select ideas that worked best • Establish standards • Results and metrics Friday Presentation • Experiment with solutions • Follow the PDCA cycle • Bias for action, not analysis Audit and Follow- up
- 55. Franciscan St. FrancisHealth
- 56. Franciscan St. FrancisHealth • 27,000 improvements since 2007 • 33 to 40% staff participation each year • >$6 million in hard cost savings • Better patient & staff safety, quality, patient satisfaction, waiting times
- 57. “The culture hereis staff input into everything. They want staff figuring out how to fix things. What can we do to make our job easier? They allow us to implement things to see if it will work.” See videos at www.leanblog.org/franciscanvideos
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- 66. “Treat each idea as agift” • Norman Bodek
- 67. “From Judge toCoach”
- 68. Find Something toImplement
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- 73. Seeing Katie’s Outbox BeforeAfter It was hard for Dee to see Katie’s outbox because other items were in the way Swapped outbox to right side and moved it over on the desk. Effect Outbox is visible from the door, which makes it easier for Dee to take a peek when she walks by. Documents and mail don’t get delayed when they are ready to go out. Less disturbance to Katie since Dee doesn’t have to ask if something is in the outbox. Name ID # Dept # Supervisor Date Dee Long, Katie Hanners BV20120502-1 Business Ventures Katie 5/2/2012
- 74. Title: WORN Hangtagattachment method Before After Effect Old method for attaching hangtag was very tedious and time consuming (measure string from spool, cut it, thread through hangtag, manually tie around care label). The improved method is based on a pre-cut string that has a plastic locking clasp. The string needs to be looped through the hangtag and then simply locked around the care label. Reduces the packaging time by approximately 1-2 minutes per scarf. Name ID # Dept # Supervisor Date Susan Vinson WORN2012 .5.16.12 WORN Katie Hanners 5/16/12 www.HCKaizen.com
- 75. Kaizen “Wall ofFame”
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- 77. QPIC’s Lean Government GeneralPrinciples: 1. One stop shopping whenever and wherever possible – the customer only has to see one person to complete their business. 2. Right the first time – identify and eliminate all sources of errors and rework – this is huge. 3. Reduce waste for the customer: a. Easy forms b. Easy websites to navigate c. What info do they need and how easy is it to get it? d. High use of Checklists Courtesy, QPIC & Harry Kenworthy: http://www.leangovcenter.com/
- 78. QPIC’s Lean Government GeneralPrinciples: 4. Really “Learn to See” the wastes in all processes by going to the actual work area 5. Focus on areas with high leverage and set challenge goals 6. Benchmark (“steal shamelessly and legally”) from others to get to a far better place to then improve from 7. Statutes/ordinances/laws – ensure they are really being adhered to and not morphed over time into unintended consequences. Get rid of the old stuff that isn’t necessary and leads to waste and unnecessary costs Courtesy, QPIC & Harry Kenworthy: http://www.leangovcenter.com/
- 79. QPIC’s Lean Government GeneralPrinciples: 8. A leader is anyone who has people working for them – hire great people and teach them how to be coaches 9. Engage all people in Dynamic Daily Data Collection and Idea Generation 10. 5S driven throughout the organization to “find stuff quickly” Courtesy, QPIC & Harry Kenworthy: http://www.leangovcenter.com/
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- 83. What Next? • Training?Learn by Doing? • Kaizen and continuous improvement? • Lean pilot projects? • Lean management systems?
- 84. Q&A / ContactInfo • Web www.MarkGraban.com – www.MarkGraban.com/frisco • Email Mark@MarkGraban.com • Twitter @MarkGraban www.leanblog.org