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Implementing Lean Management as the Foundation for ISO 15189 in a Hospital Lab: Secrets of Gaining Staff Buy-In, Establishing Benchmarks, and Celebrating Success
RITA D’ANGELO PH.D.ILA SINGH MD, PH.D.
Learning Objectives
1. Understand the history of quality and determine how to obtain the knowledge from our past leaders to guide our goals and objectives for implementation of a successful continuous improvement initiative
1. Identify how Lean management and ISO 15189 accreditation can be achieved and supported by development of a solid foundation of quality and process standardization
1. Recognize the leadership characteristics necessary to initiate, plan, lead and direct a system wide implementation of Lean management
Definitions1. Lean Management- The design and implementation of structures
to support the elimination of all non-value-adding activities and
waste from the business
2. Continuous Improvement - “incremental” improvement over time
or “breakthrough” improvement all at once
3. ISO 15189- Requirements for quality and competence is an
international standard that specifies the quality management
system requirements particular to medical laboratories
4. Quality Management system- a formalized system that
documents processes, procedures, and responsibilities for
achieving quality policies and objectives
ASQ, (2018)
History of Quality
How did we get here?
1. The American response to the quality revolution in Japan
2. 1980- “If Japan Can Why Can’t We?” Quality revolution and introduction the methods of W. Edwards Deming to American managers
1984- United States Navy: adopted the teachings to improve Navy's operational effectiveness
3. Quality evolution
Quality assurance to organizational quality
History of Total Quality Management
Lean production, six sigma quality, TQM and company Culture & Dahlgaard & Dahlgaard, (2006)TQM's Challenge to Management Theory and Practice. Grant, Shani et al, (1994)
TV Documentary Clare Crawford-Mason Lloyd Dobyns
Out of the Crisis 1982
Elements of TQMIntegrated
organizational effort
Customer focus
Continuous improvement
Employee empowerment
Integration and standardization
of quality management
Requires strong leadership to create and sustain
philosophy
structure
process
incentives for teams
A True Lean Management System
Restarting a Lean Program at Texas Children’s Hospital
A Six Sigma Program was started 10 years ago
A dozen Greenbelts were trained
No activity for 10 years
We decided to initiate a Lean Program in 2017
Process of Rolling Out an Accelerated Lean Program Got buy-in from Hospital leadership
Engaged an outside facilitator
Encouraged lab staff to join Division chiefs, Pathologists, Lab Directors, Managers, Supervisors Medical technologists, Specimen Processors, Phlebotomists
All three shifts, All three campuses, Anatomic, Lab Medicine
Held a Two day Lean training session
Trainees choose their projects
Help create teams, determine team leads
Hold Lean meetings every week – 7 am and 3 pm
Final Presentations in 6 weeks
Mission
Vision
Values
Goals
Lean principles
VSM
A3
Model Line: Plan for Success
Jan FebFeb Mar Mar Mar April May July
Leadership Meeting
Kick off meeting
with staff
Observation sessions
Training staff
Structure and team formation
Team leader
meetings
Customer-supplier meetings
Process improve
ment
Project Share
Continuous improvement
Jeff Liker, (2004)
The Toyota Way
Jeffrey Liker’s 14 principles of Lean
Base your management decisions on a long-term philosophy, even at the expense of short term financial goals
Short term… Many reasons were given for not participating
No time
No resources
Things are good as they are
Persuasion/influence
It is only 2 days! And maybe a little more…
Build a culture of stopping to fix problems, to get quality right the first time
Fine Needle Aspiration CartBEFORE
AFTER
Time saved: 30-45 min/day No interruptions
Standardized tasks and processes are the foundation for continuous improvement and employee empowerment
Inventory
Management
BEFORE
AFTER
AFTER
AFTER
Use visual controls so problems
are not hidden
5S in the Microbiology LabURINE/STOOL BENCH – BEFORE
URINE/STOOL BENCH – AFTER
URINE/STOOL BENCH – AFTER
Develop exceptional people and teams who follow your company philosophy
CAP Proficiency SurveysBEFORE
AFTER:
Grow leaders who thoroughly understand the work, live the philosophy, and teach it to others
Phlebotomy CartsBEFORE AND AFTER
24 people became very familiar with Lean
Concepts
13 Complete Lean projects – that still work
Set the stage for more projects
Outcomes of the Accelerated Lean Program
Building an Organizational Structure
Building ORGANIC processes
Results as Lean Evolves to Aligned Continuous Improvement
Tota
l Bu
sin
ess
Res
ult
s fr
om
Lea
n T
ran
sfo
rmat
ion
Starting out Maturing
Maturity in Integrating Lean and Business Strategy
I. Apply Tools II. Management Led LeanIII. Aligned
Continuous Improvement
Without Philosophy
With Philosophy
From The Toyota Way to Continuous Improvement by Liker & Franz
Target
For
Quality
Managing Towards the Goal
How does the development of Lean differ from the necessary structure for ISO 15189?
ISO
LEAN
Management Principles LEAN ISO 15189
Leadership Support Leadership to own and direct the initiative
Strategic Directives Goals objectives and outcome measures
EducationLean rules, tools and scientific
method of problem solvingUnderstand standardization,
requirements and regulations
Performance MetricsUnderstand the importance of pre-data and post- data to
identify a baseline and determine successful outcomes
Team FormationTeam formation - Identify and
eliminate defects
Identify gaps and develop new processes or redesign the
existing processes
Worker EmpowermentAutonomous ownership and
resolution of defects
Suggest and implement process design or redesign to
incorporate requirements
Employee Recognition Reward employees for their contribution
Organizational Structure Develop a team/leader
hierarchical structure for change
Standard to redesign polices, procedures, processes
The Dependent Variable –Characteristics of the Facilitator
A conceptual model for the successful deployment of Lean Six Sigma. Roger, Hilton, (2012)
Organizational competence
Interpersonal skills -project leaders
Relationship between the successful deployment of
Lean continuous improvement and
facilitator
Technical skills -project leaders
Level of influence
Interpersonal skills
Technical skills
• See for yourself to understand the situation
• Make decisions slowly by consensus,
implement decisions rapidly
• Become a learning organization through self
reflection and continuous improvement
Spreading Lean Outside of the Pathology Department
Create an informal organization structure
Define the expectation for workers
Create only one culture
Create constancy of purpose
Remove barriers
Educate employees/Plan Do Check Act
Lesson Learned for Adoption of Lean Management
Personal conversation with Jeffrey Liker
Loading dock – before
Loading dock – before
Loading dock – before
Loading dock – before
20.1%
53.5%
74.5% 75.1%84.7%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Baseline(11/1/17 - 1/7/18)
Staff Up(1/8/18 - 1/29/18)
Std. Op. Procedures(2/1/18)
12 Carts (2/26/2018 -3/6/2018)
1+ FTE/3rd Receiving Line(03/7/2018 - Current)
Packages delivered the same day
Loading dock – after
Loading dock – after
Lean & ISO 15189The road to continuous Improvement
