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Lean Healthcare Gemba Walks

Gemba – The place where work is being done

Lean Healthcare Gemba Videos

Earll Murman, MIT

Lean Healthcare- Uma transformação na saúdeUNICAMP, São Paulo, Brazil

October 14, 2013

UNICAMP 2013 Murman - Slide 2© 2013 Massachusetts Institute of Technolgy

Lean Learning Levels: John Shook

Shook, J., 2011, “Lean Education”, 5th Lean Educator Conference, Huntsville AL, Sept 31, 2011


Introduction

• Challenge of bringing students to the Gemba• Gemba video project

• Collaboration of Indiana University School of Medicine, MIT and Jefferson Healthcare

• Five 5-9 minute videos produced with accompanying 30-45 min instructional modules

• Videos are teaching supplements, not tutorials• Presentation Plan

• Overview of module contents• Introduce two modules: DMS and A3 Thinking• Seek “testers” for all five modules


Instructional Modules Have Common Architectures

Several DidaticSlides

2 Context Slides

Gemba Video

Class Discussion

Wrap Up, Reading List, Acknowledgements

Pre/Post Assessment

Learning Objectives


A3 ThinkingModule: 30 minutesVideo: 4 min 55 sec

5 or 6SModule: 45 minutes

Includes 15 min exerciseVideo: 5 min 13 sec

Rapid Process Improvement WorkshopModule: 35 minutesVideo: 8 min 45 sec

Standardizing WorkModule: 30 minutesVideo: 6 min 44 sec

Daily Management SystemModule: 30 minutesVideo: 6 min 8 sec

Glossary

Speaker Notes


A3 ThinkingModule: 30 minutesVideo: 4 min 55 sec

Daily Management SystemModule: 30 minutesVideo: 6 min 8 sec

Agenda for Talk

• Not all the module content will be covered• Videos will be shown



Daily Management System (DMS)


Virginia Mason Medical Center World-Class Management

Management by Policy (Hoshin Kanri)Alignment of entire organization to achieve strategic objectives

Cross-Functional ManagementAlignment of separate departments to improve patient care

Daily Management SystemAlignment within each unit to improve coordination, patient care, and achievement of organizational objectives

Adapted from Graban, Lean Hospitals

Patient Care Team

Photo by Earll Murman


Daily Management System

• At Jefferson Healthcare, DMS focuses on a 5 minute daily meeting in each organizational unit to:• Review previous day’s performance• Transmit any new enterprise directives• Review current day’s plans• Review employee suggestions• Note any special achievements or issues

• Organized and run by unit administrative lead

Photos by Earll Murman


DMS Tracks Enterprise Relevant Metrics


Clinic ProvidersYe

ster

day

Clinic Totals

Start of day

End of day

Same day

Double bookNo showOverflow

TodayTomorrowHuddle attendance

Did provider leave on time?

Actual vs Goal


DMS Gemba Video


DMS – Summing Up

Daily Management Systems include:• Daily stand-up huddles• Frequent process audits• Tracking of metrics linked to enterprise goals• Employee suggestions for improvements• Recognition of accomplishments

“This approach has been implemented in many hospitals as they begin their journeys, or it has been adopted after struggling with the aftermath of a tools-driven approach to Lean” Mark Graban, Lean Hospitals



A3 Thinking


Structured Improvement

Lean is not a set of tools. It is a continuous improvement mindset using multiple PDSA cycles

PlanSet objectivesCurrent stateDevelop plan

DoExecute planGather dataDocument

StudyAnalyze data

SummarizeReflect

ActNext PDSA?

Standardize? Make changes?

Time

Impr

ovem

ent

Source: LAI Lean Academy® v7.6© 2013 Massachusetts Institute of Technology


A3 Enables PDSA

A3 is..• Both a way of thinking and a tool• A management process evolved at Toyota• Named for the A3 sheet of paper

(similar to 11” x 17” US Ledger paper)

&



Title: What you are talking about.

Background

Current Situation

Goal

Analysis

Plan

Follow - up

Why you are talking about it. What is the business context?

Where do we stand?

Where we need to be?

Where we want to be?

What is the specific change you want to accomplish now?

-What is the root cause(s) of the problem?

-What requirements, constraints and alternatives need to be considered?

Recommendations

What is your proposed countermeasure(s)?

What activities will be required for implementation and who will be responsible for what and when?

How we will know if the actions have the impact needed? What remaining issues can be anticipated?

Toyota A3 SheetA PDS



Jefferson Healthcare Example



A3 Gemba Video


A3 Thinking – Summing Up

The thought process used is paramount to the tool (A3 Report)

It is a collaborative problem-solving method

It promotes:• Logical, objective (data-driven) thinking• Results and process• Synthesis, distillation, and visualization• Alignment• Coherence within and consistency across• Systems perspective

References: Sobek, Durward K., Smalley, Art., (2008). Understanding A3 Thinking: A Critical Component of Toyota’s PDCA Management System. Boca Raton: Productivity Press, Taylor & Francis Group



Wrap Up

• Materials are “open source” under the Creative Commons License• Limited to non-commercial educational uses• No fee• May be used for derivative works

• Testers are being sought to establish educational effectiveness of modules

• Once tested, modules will be submitted to open source, peer reviewed MedEd portal of the American Association of Medical Colleges


If You Are Interested in Being a Tester…

• Contact Prof. Murman [email protected]• Instructions will be provided for downloading

the modules and videos• You can test the module or video with a class,

and internal training session or another audience

• You will be asked to fill out an online feedback form for each module or video tested for each audience

• If you give permission, you will be acknowledged as a module tester

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