Lean Overview and Case StudyUCSF Medical Center – Information Technology

Pierre BrickeyOctober 2013

2

Agenda• What is Lean?

• Origins

• Aligning Vision and Purpose with Lean

• What is Customer Based Value?

• Value Stream Analysis

• Identifying Operational Waste

• Case Study: UCSF Information Technology– Reason for Action

– Gap Analysis and Rapid Experiments

– Summary of Improvements

– Baseline, Achievements and Targets

– Sustained Results

– Final Staff Insights and Quotes

3

What Is Lean?

Organizational alignment in vision and purpose – How many number one priorities can you have?

Customer based value – Which steps in your business process are of value to the customer?

Identify and eliminate waste – The right process will produce the right results

Develop and empower your people – The people doing the work know more than you think.

Continuous Improvement – Question paradigms, chase root causes, and don’t rest on past improvements

Philosophy, process, methods, tools and eventually culture

4

Origins Manufacturing-

1902: Sakichi Toyoda, the father of the Japanese industrial revolution, invented an automatic power loom that stopped itself when a problem occurred.

Automobile Industry –

1908: Henry Ford invented the moving assembly line and raised the daily wage to $5.00.

1940’s: Taiichi Ohno, a production engineer at the Toyota Motor Company, applied the same concepts to eliminate waste –non-value added activities – within the Toyota organization, and the concept of Just in Time (JIT).

These two pillars would be supported by a foundation of Standard Work, and would become the Toyota Production System.

Just

In

T

ime

Sto

p t

he

Lin

e

TPS

Standard Work

5

Aligning Vision and Purpose with Lean

• To Be the Best Provider of Health Care– Standard Work that enables staff to provide safe, outcomes-

oriented care each and every time

– A relentless focus on value from the patient’s or internal customer’s perspective

• To Be the Best Place to Work– Improvement initiated and driven by staff

– Engaged leaders encourage and supported efforts

• To Be the Best Environment for Teaching and Research– All are encouraged to participate and contribute

What is Customer Based Value?

6

Value Added Activity Non-Value Added

Activity Non-Value Added but

Essential Activity

A step or a process that is perceived to add value, from the customer’s perspective

A step that is considered waste but is required either because of regulations or as a pre-requisite to completing a value-added step

A step that does not directly contribute to or add value to the product or service.

7

Value Stream AnalysisId

eal State

Current State

Process

Lean Tools & Kaizen Events

Elimination of Waste

Future State

Process

• Sort -Straighten –Scrub-Standardize -Sustain -Safety

• Standard Work• Pull Systems and One Piece Flow

8

Value Stream Analysis

Current State Future State

9

Identifying Operational Waste

Sources of Non-Value Added Activity1. Defects Production or goods or services that require rework,

or correction.

2. Waiting Patients waiting for tests & procedures, care delays stemming from staff not being available, staff waiting for equipment, approvals etc.

3. Motion/Movement Excessive motion by staff

4. Transportation Transporting resources, supplies or equipment

5. Inventories Accumulation of items awaiting processing (email, orders, work queues)

6. Over-Processing Repeat placement of requests due to process errors, vetting a decision that was already made

7. Over-Production Producing products or services “just in case,” duplicative paper work, reports and documentation,

8. Under-Utilization Equipment, staff, physical space that is not fully utilized or working at potential

10

Case Study – UCSF Information Technology

• Turnaround time for new iPhone and PC request fulfillment did not meet customer expectations

• Field Services team routinely faced variable workflows and demand, preventing timely delivery of new hardware

• Lack of standard work drove unnecessary complexity for customers and IT staff

Reason for Action

11

Gap Analysis and Rapid ExperimentsProblem Potential Root Causes Rapid Experiments

Information Gathering• Type• Timing• Accuracy

• Use of free text in Service Now tickets• High potential for error within intake process• Lack of standard workflow and Service Now

use• Source data not trusted and multiple manual

checks required

• Remove / redirect non standard procurement portals

• Test Customer Intake form with several customers

No Standard Work within Field Services Team

• Priority over task• No ticket “Pull System”• Non-Specific categorization of work• Internal “Trust” issue with accuracy of data and

completion of other’s work

• Development categorization and priority workflow

• Define Pull and Fulfillment standard work

• Test dedicated resource model

Inventory Management • Zero demand analysis• No integrated inventory management system• Very manual process• No global transparency (across the entire Field

Services team)• No process for removal of obsolete equipment

(stock-piles of equipment that will never be deployed); clutter distorts visibility

• Validate inventory• Define Par Levels• Remove obsolete inventory• Explore Pull inventory systems• Explore Service Now and PMM

inventory management options

No established iPhone deployment process

• Porting Blackberry process to new product• Forms obsolete • Lack of oversight

• Define HW Standard review cycle• Explored self deploy strategy

Field Services managing scope beyond IT• Network• Facilities

• Lack of single Service Management platform• Field Services first and last touch point• Poorly defined roles and responsibilities

• Explore wireless standard deployment

• Meet with Facilities to understand process, scope, tools

12

Summary of Improvements: Request Intake and Deployment

Manual and variable information gathering

process

Service Now standard request form/script

Multiple procurement channels

Service Now as only procurement source

Competing Field Service demands

Better categorization of work and dedicated

deployment resource model

Extended wait times for new requests

Self-deployment option

Network cable install significantly increase

turnaround time

Standard wireless deployment

Problem Solution

13

Summary of Improvements: Inventory Management

Manual Inventory Management

Automated Inventory Management with

Reporting Capability

Limited Inventory Transparency Across Techs & Locations

Increase transparency through PMM and

ServiceNow

Large Quantities of Surplus Inventory

Right Sized Inventory With Monthly Par Levels

Identified

H-Level “Off the Grid”No Cleaning in H-Level

Space for Several Years

Now Added to the Hospitality Services Cleaning Priorities

Fragmented Storage in 3 locations

Consolidated Inventory with Real Time Reporting

& JIT Replenishment

Problem Solution

14

Baseline, Achievements and TargetsKaizen Metrics Baseline Achieved

during Kaizen

30 days 60 days 90 days

iPhone Fulfillment

16-24 days 5 days 2-5 days 2-5 days 2-5 days

PC Fulfillment 8-19 days 5 days 3-5 days 1-5 days 1-5 days

0

5

10

15

20

25

30

iPhone Fulfillment

Initial State Current State

PC Fulfillment

Initial State Current State0

5

10

15

20

25

30

79% Reduction!

74% Reduction!

Sustained Results

15

July August Sept Oct Nov Dec Jan Feb March April May June

Days 11.3 9.2 19.6 17.6 7.9 10.2 7.8 4.2 4.3 6 5.88 5.29

2.5

7.5

12.5

17.5

22.5

IPhone Provisioning

Sustained Results

16

July Aug Sept Oct Nov Dec Jan Feb Mar April May June

Days 11.8 13.8 9.2 13.3 15.2 12.6 13.8 11.5 6.3 4 3.2 3.25

1

3

5

7

9

11

13

15

Desktop/Laptop Provisioning

17

Final Staff Insights and Quotes“Two dedicated weeks of focused work, netted the equivalent of nine months of regular work.” – Vishnu S

“A multi-disciplinary approach enables full utilization of existing tools”

– Rob H

“Everybody has a great idea.”– Dave G

Insights

• Customer feedback is key

• Customer satisfaction makes work satisfying

• Standard Work is only possible if documented and consumed

• Mapping the workflow and process reveals waste

• To make true progress, we had to demolish existing paradigms

• Having the doers be part of the process creates a foundation for continuous improvement

• The camaraderie that we’ve developed in this room will carry forward to our other work together

“For the first time, I feel like we’re really thinking outside the box”

– John C

“The collaboration in this room is awesome!”

– Mark U