Starting the Lean Journey.
When I speak with people about Lean programs, I am often asked, “Where should we start?” While this sounds like a very simple question, it actually requires a lot of thought. However, the simple answer is that you must first decide where you want to go before you know where you should start. Think of it like this: If you don’t know where you want to go, it really doesn’t matter if you have a map.
I have a GPS for my car that is pretty high tech. It communicates with satellites that are orbiting thousands of miles above the Earth. It can tell me where I am, give turn-by-turn directions and even tell me how fast I am going. However, with all of that technology, if I can’t put in a final destination, the GPS is pretty useless.
The same is true for Lean, Six Sigma or whatever you call your continuous improvement effort. If you don’t know where you are trying to go, even the best Lean program won’t help very much.
There are mountains of information about Lean, Toyota Production System, and continuous improvement programs. You can read a book a week and probably spend several years digesting just what has been written so far. You can hire consultants that can make a process Lean down to the tenth of a second, and you can save a lot of money. You can even teach some of your folks about Lean in the process. All of these things are good, but they are not exactly what we are after – yet.
The Affordable Care Act has created angst among health care workers and administrators, not because big changes are coming, but because the impacts of those changes and their accompanying rules are not yet clear. For administrators, this level of uncertainty makes planning seem nearly impossible. Yet, healthcare organizations such as Mayo Clinic and Thedacare are currently developing robust plans for tomorrow, streamlining existing workflows, and delivering better outcomes in care—all while cutting costs, increasing cash flow, and growing the bottom line. How? Lean Six Sigma.
A Transformational Approach
Lean Six Sigma improves hospital operations with data-supported decision making. The goal is to drive continuous improvement throughout the organization, and in a way that aligns with the hospital’s strategic plan.
In health care, Lean Six Sigma focuses on both the process (workflow) and the service itself. When implemented properly, these practices train health care teams to react and adjust to changes efficiently, and even proactively create solutions to future problems. Typically, Lean Six Sigma projects yield between three and ten times the health care provider’s investment, as well as a 50% improvement in quality of care.
Financial Gains from Lean Six Sigma Result from:
n Eliminating rework, materials, and inventory
n Avoiding or reworking problematic processes
n Enhancing productivity and patient care quality
n Improving patient flow and cash flow
Lean Six Sigma methodologies make delivering and planning for high-quality care possible, even in the face of great change. Further, these practices prepare hospitals and staff for the coming changes while incorporating existing requirements from Medicare/Medicaid, ACO, avoidable adverse events, and much more.
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Building a Lean Culture.
What is the real objective of Lean Six Sigma? When I ask this question, I usually get responses such as increased quality, improved speed, reduced cost, reduced errors and many other tactical improvement measures. Those are all benefits to continuous improvement (CI). The real goal of CI is to build a culture or improve a culture. As Dr. Womack wrote in Lean Thinking, the fifth principle of lean is culture.
So what does it mean to build a culture or to enhance the culture? How does a world-class culture behave? A world-class culture has an engrained tendency to seek out, identify and drive improvements at all levels of the organization. It moves from a culture where lean and Six Sigma are something to be done (like a project) to a place where Lean Six Sigma is simply the way things are done.
As you are engaging your CI plan, ask yourself what your culture is like. Are you doing CI or is CI simply the way things are done? This shouldn’t be hard to figure out, so don't spend a lot of time dwelling on it. Either you are or you aren't. Either answer is OK. Just recognize where you are and where you are trying to go.
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How to make the customer feel appreciated.
I had occasion to go to the doctor’s office recently. It was for a basic checkup, and since I am a Lean guy to my bones, I want to focus on the visit from my perspective — the customer. My appointment was for 10 a.m., and I arrived there promptly at about five minutes until 10. I signed the sign-in sheet, found a magazine and started reading. At about 10:25 (25 minutes after my appointment time), I was called back to the exam area, where the nurse told me to go in and wait. I then sat in the smaller waiting room for about 15 more minutes before the nurse came in to examine me. This was not the real exam; this was merely a preliminary exam. She took my weight and blood pressure and asked me if I had been feeling sick or otherwise had any concerns. This process of her visit with me took her about five minutes. So on the time scale, I had been in the office for 45 minutes and had human interaction for about five of those minutes.
As the nurse left, she told me to get comfortable, and the doctor would be right in. I turned on the TV in the room and was watching a cooking channel. I sat there for another 30 minutes before the doctor casually breezed in. She didn’t apologize for my wait, nor did she greet me other than to ask, “And how are you today?” The doctor then went through her normal routine of checking a few things on me that amounted to about five more minutes of interaction. She then asked me if I had any questions, and I did not, so she left the room after scribbling some notes in my folder.
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Communicate for Transitions
A few years ago, I came to the realization that I needed to improve my engagement with team members and colleagues. One of the things I decided to change was to push myself deeper into the details of the multitude of ongoing projects. I realized there was so much going on that I was having trouble providing enough attention to the details involved in each project. I was only brought in and sought after if there was a problem or a tough decision needed to be made.
As this little epiphany came into light, I realized that this was not good for me or my team members. So, I set about making it one of my priorities to work on from that point forward (in the name of my own continuous improvement).
However, it also occurred to me at the same time that a change of my level of attention could cause the organization to take a step back and feel a little nervous about what I was doing and why I was doing it. As I pondered this notion, I decided to seek out some advice. I reached out to one of my mentors and explained to him the dilemma that I was facing and asked for his counsel in how I should proceed.
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Change Management in Hospital Transitions, Part 1.
Relocating hospital operations from one facility to another is a highly complex endeavor that requires years of planning, especially when it comes to managing the change for employees and patients. This blog series addresses the serious challenges hospitals face during a hospital transition .
Without change management practices, hidden issues can plague medical facility transitions, including:
- Clinical errors
- Reduced quality of care
- Employee stress and burnout
- Job dissatisfaction and increased attrition
- Resistance to change
- Communication problems
- Role confusion
- Workflow issues (current and future)
Hospital Transition Staff can mitigate known and unforeseen problems by initiating proactive change management activities:
- Initiate change management activities two years before facility completion
- Manage employee stress levels
- Communicate early and often with employees
- Engage actively with patients, vets, and other stakeholders
- Begin redesigning hospital workflow before the physical move
- Provide awareness orientations and workflow training
- Plan and train for move day activities (“dry runs”
Building Brick Walls - Lean Resistance
All successful and sustainable implementations of Lean start with an organization’s top management. Trying to implement Lean from the middle-out or the bottom-up may result in some improvements, but it will not result in your organization becoming a world-class company that is globally competitive.
In the book Leading Change by John Kotter, the author notes the change implementation prerequisites (for a lean implementation) that management must accomplish as:
n Creating a sense of change urgency
n Developing a guiding coalition/alliance to steer the organization through the change
n Developing a vision/picture of the company’s future state and a strategy to achieve it
n Communicating the vision and strategy to the entire workforce
n Empowering all associates/employees
Organizations inadvertently create brick walls to change, disguised as supervisors and middle managers, if any of the following topics are not covered or communicated clearly during these prerequisite activities:
n Associate/employee empowerment. How will the supervisors and managers jobs be affected? Will they have jobs?
n One of the four components of a Lean Implementation is the development of a Lean Culture to support the Lean Implementation. Have we planned for this?
n Have we linked our people measures (performance evaluations, promotion criteria, merit increases and bonuses) to the Lean Culture and the Lean Implementation Vision so we do not send mixed messages with regard to what is important.
It is important to remember that resistance to change is often the result of a lack of clearly communicated vision and strategy.
Now let’s look at each of the three brick wall building activities:
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In our daily work, we all know our duties and how to do our job, but often, although the procedures are not well-defined, we do our job a particular way because "we have always done it this way".
In the last posts (Kaizen in Time Managing and Kaizen in Time Managing - 2) we improved our daily job, managing it with daily-planned tasks, dividing our jobs in "categories" or "process" and planning our working hours to reflect our tasks-categories, so we split the day in standard work time-spans. Also we learned how to eliminate fire-fighting habits related to emergencies.
Now it is time to standardize each of our own processes.
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Process Evaluation for Waste Reduction
In this post I want to show a method to check whether or not your process is creating value, so you can easily recognize what are your improvement possibilities to eliminate wastes.
This method can be easily used on micro-processes since it is useful to identify all possible wastes.
This method consists in building a simple list of tasks to accomplish in order to get our job done. Then you must assign a category to each one of them.
Categories are aimed to check what is waste and what is not, and what kind of waste they represent.
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Supplier Evaluation with KPIs
Measuring supplier performance is something that is often done discontinuously, for example, whenever you think performance is lowering or you feel dissatisfied with the supplier.
However, a constant measurement of supplier performance is very important because it allows you to react to problems, prevent disasters, and set new goals. Measuring performance is not just a way to criticize or obtain cost reduction/refunds because of quality problems; it should also be a tool to help suppliers maintain service and build improvement plans.
Moreover, as discussed in the defining requirements post, a requirement can't be expressed just by feelings, because you need to justify what you are telling the supplier and avoid false alarms that can make the supplier judge you as unreliable. Because of these considerations, the starting point is that you and your suppliers need to speak a shared language, embodied in the key performance indicators, or KPIs.
A KPI is a numerical objective measurement that expresses performance from a single point of view. An example of a KPI might be “defects per thousand parts” or “percentage of delays per month”.
The Dimensions of Supplier Evaluation
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