Lean Culture. Creating a Culture for continuous improvement to better serve our Customers

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1 Lean Culture Creating a Culture for continuous improvement to better serve our Customers

2 Purpose: To understand the need for improvement and outcomes we can achieve through a new way of thinking,, leadingl eading,, and working!

3 Objectives: To develop an understanding of Lean Thinking Eight Wastes - What are they? Daily problem solving at the clinic level Knowing what it takes to make a change

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5 Promoting a Lean Culture Focus on the Customer Provide the customer exactly the right product, on time, and without flaw Communicate a clear vision for the company Lean is the path to achieving business objectives Establish performance metrics and share them with everyone Provide Lean Training LIVE LEAN

6 DO WE NEED TO CHANGE? Changes are perceived as Positive or Negative. People aren t Positive or Negative; It is just how they perceive change.

7 Why Change? LEAN exposes obstacles that prevent continuous improvement. There is no such thing as staying the same : You are either striving to become better or allowing yourself to get worse The improvement effort is never ending!

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9 If 99.9% Good Enough is Good Enough then 1,095 incorrectly reported lab results would be reported each year at one hospital. 500 incorrect medical procedures would be performed each day 20,000 incorrect prescriptions would be filled each year 12 babies would be delivered to the wrong parents each day 1,314 phone calls would be misplaced every minute 602,500 guaranteed FedEx packages would not be delivered this year 132,412,800 cans of soft drinks will be delivered without carbonation.

10 LEAN Lean is an approach and an attitude - not a specific set of techniques or tools. Lean is a way of thinking Lean is a whole system approach that creates a culture in which everyone is continuously improving processes It is a human system that is customer focused and customer driven - Employees ARE the driver of the system LEAN IS NOT ABOUT REDUCING THE WORK FORCE IT IS ABOUT REDUCING THE WASTE

11 EIGHT WASTES WHAT ARE THE EIGHT WASTES EIGHT WASTES EIGHT WASTES EIGHT WASTES

12 Defects and Rework Anything that prevents you from doing the process the best way the first time Rework causes variability, takes more time and may lead to batching which may compromise quality.

13 Over Production Any time you have MORE inventory than the process can consume or more than the customer demand. Results: Excess handling, inventory costs, excessive processing time.

14 Waiting for something to happen; for material or information to move Results: Inefficient processes leading to compiled waiting-delay in patient, information, and employee flow. Waiting Have you ever felt like this at the doctor s office

15 Non-Value Added Processing Process steps that don t t add VALUE to the product but adds cost Extra copies of forms or extra labels Duplicate information system entries Just in case you need them! Entering data in multiple systems since they don t talk - Results: Employees do extra work that is NOT needed for the given task and is inconsistent with the customers perception of VALUE

16 Transportation Moving people and products; creates delays, consumes resources, and requires management Result: The distance and time it takes to move a patient to where it is needed is waste EXAMPLES Poor Layout of office or hospital floors Copying medical records - for transfer of patient when records are available through mutual computer system Transportation is the MOST significant direct cost

17 Inventory Stuff waiting to be used; Takes up valuable space, requires someone to manage it, ties up cash, possible quality concerns.

18 Results of Excess Inventory Excess products or supplies do not add value they increase operating cost by taking up space and additional equipment. Lower inventory helps to identify problems

19 MOTION Unnecessary human movement (reaching awkwardly for documents, equipment or supplies)- walking, lifting, positioning and turning. Result: Excess motion adds time to processes; searching reaching, grabbing, walking, etc.. Motion does not equal work.

20 Employee Utilization Damage to people if you do not tap into their mental, creative, and physical skill sets-challenge people to continuously improve Result: Staff skills are not utilized to their fullest and employee engagement is decreased

21 Reflection TELL ME and I will Forget SHOW ME and I will Remember INVOLVE ME.and I will Understand

22 How does Waste Get There? Forget to change solutions when we change a process Fail to understand why we do something a certain way. We build waste into our process Root cause of a problems is not addressed or a band-aid solution is implemented.

23 How Can we Find it? Find the value added worked everything else is waste. Go out there and see it Go to the Gemba! Observe the process Talk to the staff Spaghetti diagrams Map the Flows Use Problem Solving Tools Implement one piece flow waste will be identified

24 MDI Managing Daily Improvements Real-time problem solving will help to sustain improvements and keep new ideas flowing. It is all about engagement. Every team member is empowered with the ability to improve their work environment. This includes everything from quality and safety to the environment and productivity.

25 Tools. Huddle Boards - Problem Solve Here! 5S Audits Process Change Alerts

26 One Page Problem Solving Form Problem Statement PDCA - PLAN What was observed? What is the effect? Identify the GAP: ie., what is the Current Condition vs what should it be (the Target Condition)? Team Engagement Who (else) on staff observe the same? How did you engage the 'observers'? Was the Provider included if he/she was an observer? What Process Step is the "Point of Cause"? Grasp the Situation (understand what actually happened) What the Object/ Defect is/ is NOT When did it occur/not occur? Where did it occur/not occur? How Many/ How Often did it occur? Cause Statement WHY 1 WHY 2 WHY 3 WHY 4 WHY 5 How did you engage the 'observers' and other staff members at "Point of Cause"? ROOT CAUSE PROPOSED IMPROVEMENT (countermeasure) Was 'brainstorming technique' used?

27 Repeating Cycles built in to create process rhythm Visit and Dictation Status Management at Source. Level Load Schedule Time Exam 1 Arrival Completed Dictated Exam 2 Arrival Completed Dictated 7:30 7:35 7:40 OV 7:45 7:50 Procedure 7:55 Nurse 8:00 8:05 8:10 New :20 8:25 OV 8:30 8:35 OV 8:40 8:45 OV 8:50 8:55 OV 9:00 9:05 OV 9:10 9:15 OV 9:20 9:25 New 9:30 9:35 9:40 Procedure 9:45 OV 9:50 9:55 10:00 Nurse 10:05 10:10 10:15 10:20 10:25 New 10:30 10:35 10:40 OV 10:45 10:50 OV 10:55 11:00 OV 11:05 11:10 OV 11:15 11:20 OV 11:25 11:30 OV 11:35 11:40 New 11:45 11:50

28 Kanban System Replenishment System A method for maintaining an orderly flow of material. Kanban cards are used to indicate material order points, how much material is needed, from where the material is ordered, and to where it should be placed. Section : Alcohol Wipes Refill Quantity ~ 1 box Location: Supply Closet 3 Shelf: I Slot : Bin System is another form of Kanban system

29 Standard Work Audits Visual tools used to trigger a reaction One Piece Flow Rapid Improvement Events Visual Boards ex: hour by hour board PDCA Plan Do Check Adjust (Act)

30 So what does it take to get there? Behavior is the source of a culture. Changing what people do every day and how they do it will change culture This is the reason for the importance of standard work and continuous process improvement in lean

31 The Impact of Change Change has a considerable psychological impact on the human mind. To the fearful it is threatening because it means that things may get worse. To the hopeful it is encouraging because things may get better. To the confident it is inspiring because the challenge exists to make things better. King Whitney, Jr.

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33 Questions?

34 Thank You