LEAN Principles as Management Mindset & Improvement Tool Set

A system: flow, pull and strive for excellence◦ Not a set of isolated practices

A process, a journey◦ Not an end state

A thought revolution

What is Lean?

A philosophy that shortens the time between the customer order and delivery by eliminating waste

Lean as a Thought Revolution

Traditional Thinking

Lean Enterprise Thinking

• Attack direct labor • Attack waste, complexity and variation

• Quality, cost and cycle time (speed) are addressed individually and often seen as conflicting

• Quality, cost and cycle time (speed) are addressed concurrently and are seen as highly related

• Optimize subsystems • Optimize the whole system (including suppliers and customers)

• Use information technology as “the answer”

• Use information technology as an enabler of lean processing

Myth or Reality?

It’s more efficient to process in batches

Zero defects is not a realistic target

End of process inspection will always protect patients from harm

A healthy clinical practice has a full waiting room and backlog of patients

Standard methods (procedures, protocols, methods) stifle creativity and are not a good cultural fit in medicine

Lean Challenges Us to Cut Waste in Half Today!

Half the errors

Half the cost

Half the space

Half the labor

Half the time• Half the complexity• Half the steps• Half the…….

Requires a Horizontal View

Traditional Improvement Approach

Value Stream Approach

Admission EvaluationAncillaryService

Discharge Billing

Admission EvaluationAncillaryService

Discharge Billing

What Is a Value Stream?

Everything, including non-value added activities, that achieves the transformation from raw information/material into what the customer is willing to pay for

Network of processes and operations that make materials and information flow

Includes the communication of current and future demand throughout the value stream

Types of Waste Waste Comes in Many Forms

Processing - Redundant and unnecessary process steps, excess processing (over utilization), excess checking and inspection. Excess use of energy of all types.

Correction - Re-do’s, fix-ups, returns, mark-downs, managing customer complaints.

Inventory - Idle in progress or finished materials, ingredients, supplies, or information.

Wait Time - Delays and queues of all types.

Search Time - Time spent looking for information, people, supplies and equipment.

Transportation - Multiple handling steps and needless movement of material and information.

Space - Storage of unneeded items, excess inventory or the general “mess” that builds up over time. Excess space required due to inefficient process flow.

Complexity - Complex process flows. Product choices that confuse customers. Organization boundaries which introduce inefficiencies and frustrates customers.

Value-Added (VA)

Value-Added Timeline

Non-Value-Added (NVA)

Total time = 70 minutes

VA time = 6.5 minutes

Percent of NVA time = 91%

Travel distance = .25 mile

Number of Process steps = 25

Value-added steps = 4

Number of Inspection steps = 4

Number of queues = 11

First Unit Dose for Medication on Nursing Unit

Write OrderDispense In

PharmacyEnter Data Administer

To Patient

Why Focus on Waste?

Because most processes are 95–99% non-value-added, a focus on eliminating waste is the best leverage for an improvement effort.

NVA 95%VA 5%

Requires Us To Think Differently…

VA

NVA

VA NVA

VATypicalOrganization

TraditionalImprovementWith Traditional Investment Strategy

Lean WasteReduction

NVA

MinorImprovement

OriginalLead Time

MajorImprovement

•Speed up value added steps•Add capacity

Is it possible to get all the waste out?

Lean Methods / Language

5S◦ 5S is a visually-oriented system used to create and

maintain greater organization, efficiency and safety while reducing training time, search time, wasted time and resources

Rapid Process ImprovementValue Stream Mapping

Simplify

SortSeparate the needed from unneeded items

Create a place for everything and a way to keep everything in its place

Visually examine the work area to differentiate normal from abnormal conditions

Document and use consistent work methods

Hold the gains

Sweep

Standardize

Sustain

Tell at a glance if things are normal or abnormal

Rapid Process Improvement (RPI)

A fast-cycle METHOD for implementing lean practices within a particular process

Modeled after Toyota workshops for suppliers “Five Days and One Night”

RPI Workshops are….

Focused, intense one week events

Targeted processAll areas of process representedVision developedChanges are identified and made

during the workshopLittle or no money is spent

Four Phases of RPI Workshops

All Areas Represented

Common Goal of Removing Waste

Which Management Problem Would You Rather Have?

Problem 1 Problem 2

Performance

Target

Level 3: Work Unit Inspect

Level 2: Company Inspects

Level 1: Customer Inspects

Level 5: Eliminate

Opportunities for Errors

Levels of Quality System

PreventErrors

Level 4: Self Inspection

Check forDefects

Detect Errors

Level 5

Level 4

Level 3

Level 2

Level 1

.You have 60 seconds to inspect this document.

.Count the o’s.

.Score the number at the bottom of the page.

To be, or not to be; that is the question:Whether ‘tis nobler in the mind to suffer

The slings and arrows of outrageous fortune,

Or to take arms against a sea of troubles,

And, by opposing, end them. To die, to sleep—

No more—and by a sleep to say we end

The heartache and the thousand natural shocks

That flesh is heir to—‘tis a consummation

Devoutly to be wished. To die, to sleep.—

To sleep, perchance to dream. Ay, there’s the rub.

adapted from Hamlet, William Shakespeare

____ Total

What did we do?

1st Implementation of RPI at VUMC Pre-work with planning team Development of charter 4 day intensive workshop Includes all segments of Department

Focus on Transition Bundles Report out to Management Guidance Team

Creation of reliable processes Measureable metrics for continual improvement

Questions