Presented by: Karissa Craig Lean Change Agent, Geisinger

Transcription

1 Presented by: Karissa Craig Lean Change Agent, Geisinger

2 Objectives: The application of lean in Healthcare Lean is more than a set of tools Key components of a successful lean transformation Problem Solving and basic lean concepts Interactive activity to practice concepts learned

3 Lean is all about looking at things from the customer s (or patient s) perspective to deliver the highest value. It focuses on improving culture and processes so that we can deliver the best experience possible to patients. Front-line employees are developed and empowered through problem-solving and coaching. Leadership is also developed alongside of an effective daily management system. 3

4 Lean Transformation at Work 4

5 The Lean Management System s 1990s 2000s Toyota Production System is developed at Toyota and shared with domestic suppliers. Shared with all of Toyota s suppliers and other automobile OEMs. Adopted by other assembly and manufacturing industries Adopted by other industries such as hospitals, healthcare systems, banks, retailers, logistics, hospitality, airlines and the military. 5

6

7 Successful Components of Lean Transformation Improvement System Performance Management Voice of Customer Lean Leadership Mindsets & Capabilities

8 Who is our customer? Customers are the actual and potential users of our services Patients are the primary customers of healthcare organizations Internal/External customers Primary/Secondary customers 8

9 3 Lean Categories Lean divides all work into three categories to determine if they are waste Time Spent on Unnecessary Non-Value Activities Time Spent Adding Direct Value to Patients/ Customers Time Spent on Necessary Tasks that May Not Add Direct Value to Patients/ Customers 9

10 8 Wastes Capabilities of people that are not used or leveraged Wasted Intellect Value Added Wasted Motion People moving or working without producing Wasted Transportation Rework Unnecessary movement of work Excess Processing Over- Production Correcting error/defects Waiting time Excess Inventory Unnecessary effort to get the work done Waiting for ANYTHING Producing unnecessary work or deliverables Work that is waiting to be processed 10

11 Activity

12 Form Teams of 7-10 people & Stand in a Circle. Decide who will be the timer. Rules: One person starts by holding 1 ball. The ball must pass through each person s hands once each cycle. The ball must start and stop at the same person- This is one complete cycle. Not allowed to pass the ball to the people standing directly next to you Two people cannot touch the ball at the same time The team must complete 3 cycles without dropping the ball. A dropped ball is a quality defect and you must start over

13 How did that process feel? What wastes did you observe?

14 14

15 Problem-Solving is More Than Tools Old vs New Thinking Current Condition Improved Condition Improvement Project 15

16 4-Step Problem-Solving Approach Confirm & Sustain 4 Describe the challenge Develop Countermeasures 3 Customers Patients Members 1 Identify root cause 2 16

17 Problem A3- [TITLE] Strategic Priority Alignment: 1. Describe the Challenge Problem Statement: What is the problem or gap to be solved? Background / Business Case: Sponsor(s): Team Lead (s) 2. Identify Root Causes Last updated: Why the problem or gap to be solved. Understanding Current State: What is currently happening? What are the potential root causes of the identified problem? What is currently happening today? 3. Hypothesis Testing / Develop Countermeasures Target Condition / Goal: What Should be happening? What potential solutions are we trialing and implementing to remove the root causes? What should be happening? 4. Confirm & Sustain Metric Baseline T arget Benchmark Team: How will we know we are successful in solving this problem? How will we know we have sustained the improvement? Who is closest to the process that should be involved in problem-solving?

18 18

19 Root Cause Analysis Basics SYMPTOM of the problem Underlying CAUSE below the surface The word root, in root cause analysis refers to many causes, not necessarily just one. 19

20 The 5 Whys Problem description Why? Why? Why? Why? Why? Problem definition Symptom Symptom Symptom Symptom Root Cause

21 5 Whys Saved the Jefferson Memorial The stone on the Jefferson Memorial was crumbling 1. Why was it crumbling? Too frequent washings were causing the stone to crumble 2. Why was it washed so often? To remove bird drippings 3. Why were so many birds in the building? There is an abundant food supply: hundreds of little fat spiders1 4. Why are there so many spiders? Spiders were attracted to the midges 5. Why were there so many midges? Every evening at dusk they emerge in a mating frenzy. At the same time, the Park Service turns on its powerful spotlights. The midges are then attracted to the lights. Solution: Delay the daily lighting to one hour after sunset. Midge population is down 90%, they have broken the food chain and there are less frequent washings. Example provided by Juran Institute

22 Don t Jump to Solutions Before I state the problem are there any solutions? Why do we want to break this habit? How do we change this mindset?

23 Improve the process, remove root causes and eliminate waste. Visual Management Standard work Process Redesign Errorproofing 23

24 Everybody SEE Everybody ACT Everybody KNOW 24

25 25

26 Visual Management cycle 26

27 Process Redesign 27

28 Reduce the time it takes to complete a given step Reduce the number of steps Complete steps in parallel Reduce time in between steps 28

29 Basic Lean Concepts Before process redesign After process redesign 29

30 Standard work Reduces Variability, Redundancy, and Inflexibility 30

31 31

32 3 Methods for Standardizing Operations 1. Make timing consistent 2. Make roles and responsibilities consistent 3. Make materials and information consistent 32

33 Errorproofing 33

34 What examples can you think of? 34

35 Visual Management Standard Work Process Redesign Errorproofing How can these basic lean concepts be applied to remove waste in Round 2 of the Tennis Ball Activity? 35

36 Apply 4 steps of problem solving Use the Basic Lean Concepts to remove waste from the process

37 Stay with same team as you were in for round 1 Decide who will be the timer. Rules: One person starts by holding 1 ball. The ball must pass through each person s hands once each cycle. The ball must start and stop at the same person- This is one complete cycle. Not allowed to pass the ball to the people standing directly next to you Two people cannot touch the ball at the same time The team must complete 3 cycles without dropping the ball. A dropped ball is a quality defect and you must start over

38 How did you feel? What lean concepts did you apply?

39 What is Lean Leadership Definition: Leadership s presence in their staff s work environment, preparing them for change and helping them manage through it. Show respect Connect with staff. Show interest in teams efforts, individual suggestions and help people with obstacles Always think of the customer first Focus front line and all leadership levels to address patients needs first Be present Check the visual management, participate in problem-solving and observe front line Ask questions Develop problem-solving skills through thought provoking questions 39

40 What do you consider to be Lean Leadership? What do you do now (or have done in the past) that you might consider Lean Leadership? 40

41 Successful Transformations Successful transformations require leaders to lead the change journey. Lasting impact is hard to achieve. ~70% of transformations fail because management behavior undermines the transformation and employees are often not empowered Results of transformations 1 Program fulfils objectives Employee resistance Other obstacles Insufficient resources Management behavior does not support change SOURCE: 1 Beer and Nohria (2000); Cameron and Quinn (1997); CSC Index; Caldwell (1994); Gross, et al. (1993); Kotter and Heskett (1992); Hickings (1988); Conference Board report (Fortune 500 interviews); press analysis; team analysis 41

42 Successful Transformations Successful transformations require leaders to lead the change journey and leadership behavior is crucial 1 2 Leadership is critical to inspire the transformation role of the sponsor creating a movement Leadership matters to role model and drive the transformation role of the managers during the transformation to go and see 3 Leadership is the backbone of sustainability and continuous improvement 42

43 What message do you think this picture is illustrating? 43

44 Stages of Change As individuals move through stages of change, they experience a variety of responses Will I be able to do it? Concern Something is finally going to change Relief Change? What Change? Denial What impact will it have? How will it affect me? Fear It is more than I expected! Who am I? I'm going!! This is not for me! Disappoint ment I see a future for myself It works and is effective! Hope Confidence What can you do to stay motivated and to motivate others? Threat Dejection I'll prove that it is unnecessary! Animosity

45

46 Continuous Improvement Shares Best Practices Encourages Learning & Reflection Drives key behaviors Role models collaboration Allows staff time to do problem-solving Creates a safe space Allows the team to fail forward fast 46

47 Time! Calendars! Meetings! Oh my! Workload variability Lack of feedback loops to support the development of ideal behaviors Dependent on lagging indicators to determine success Geisinger is geographically dispersed Firefighting Other non-value added work 47

48 Map your standard work Role Model Lean Leadership including good change management Support your direct reports - including accountability for change and improvement Lean Leadership is a responsibility for each level of leadership from executive leaders to front line managers 48

49 Lean Leadership & the 4 Key Areas that Need to be Implemented Into Your Week in the Life of (WILO) Coaching Action Description Actively provide coaching and feedback to all staff in an informal or formal manner Week in Life of a Lean Leader (WILO) Conducting regular discussions about performance Gemba - understanding the frontline Have group-based performance management discussions with direct reports and connect performance to vision Conduct in-person floor visits to understand state of operations, confirm processes and identify issues before they arise Engaging in problemsolving sessions Actively lead your management team in problem-solving sessions on their most challenging priorities 49

50 Bringing it all together Improvement System Performance Management Voice of Customer Lean Leadership Mindsets & Capabilities

51