1. National Quality Center Technical Assistance Webinar Facilitator: Marti Beltz, PhD, LSSMBB Date: Thursday, March 19, 2015 Time: 3:00 pm, Eastern Daylight Time (New York, GMT-04:00) Meeting Number: 645 396 746 Meeting Password: nqctacall114 What LEAN Thinking Means to Your Organization

2. National Quality Center The Agenda for Our Call Lean is a process improvement methodology perfectly suited to increasing efficiency in the delivery of care, satisfaction in the receipt of care, engagement of the workforce giving care, and quality in the outcomes of care. Upon completion of this TA Call, participants will be able to: Describe Lean methodology, history, and basic tenants Compare and contrast Lean with other process improvement methodologies Employ basic Lean tools Identify improvement projects conducive to using Lean methodology List key factors for successful project implementation Describe key conditions for organizational implementation Identify next steps for skill development

3. National Quality Center What is Lean?

4. National Quality Center Lean 101 A process improvement methodology to achieve: the elimination of waste; increase speed via “flow”; reduction of costs; increased value for the customer; increased profits; increased quality and safety; increased flexibility for reacting to change. Projects focus on achieving outcomes: faster with fewer steps; with fewer resources; less expensively; less waste; less wait; and increased value. Advantages include: being intuitive; just-do-it; easily taught; quick results; appeals to the data-shy. Challenges include: some counterintuitive concepts; can be erroneously associated with increasing work demand and/or downsizing; does not directly target elimination of defects; necessity for culture change for best effect.

5. National Quality Center Why Lean? We can do better

6. National Quality Center Lean Healthcare Texts 3,790,000 Google Hits!

7. National Quality Center Concept A process improvement methodology to achieve: the elimination of waste; increase speed via “flow”; reduction of costs; increased value for the customer; increased profits; increased quality and safety; increased flexibility for reacting to change. Projects focus on achieving outcomes: faster with fewer steps; with fewer resources; less expensively; less waste; less wait; and increased value. Advantages include: being intuitive; just-do-it; easily taught; quick results; appeals to the data-shy. Challenges include: some counterintuitive concepts; can be erroneously associated with increasing work demand and/or downsizing; does not directly target elimination of defects; necessity for culture change for best effect.

8. National Quality Center Thought Leaders “all work is a process, and all processes can be designed measured and improved” – Phillip Crosby “if you can’t describe what you’re doing as a process, you don’t know what you’re doing” -W. Edwards Deming

9. National Quality Center Origins Toyota Production System “ The ability to eliminate waste is developed by giving up the belief that there is ‘no other way’ to perform a given task. It is useless to say, ‘It has to be done that way,’ or ‘This can’t be helped!’ At Toyota, we have found that there is always another way.” “We get brilliant results from average people managing and improving brilliant processes. Our competitors get mediocre results from brilliant people managing around broken processes. When they get in trouble, they try to hire even more brilliant people. We're going to win.”

10. National Quality Center Culture TraditionalLean Function in silos Managers direct Benchmark to justify not improving: "just as good“ Blame people Supplier is enemy Guard information Volume lowers cost Internal focus Expert driven Big projects; long term Interdisciplinary teams Managers teach/enable Seek the ultimate performance: complete absence of waste Root cause analysis of the process Supplier is ally Share information Removing waste lowers cost Customer focus Process driven Small projects; short term

11. National Quality Center Lean’s Relationship to Other Improvement Methods Six Sigma (DMAIC): The methods compliment one another. Six Sigma’s focus is on eliminating defects, statistical process control of variation. Lean focuses on the elimination of waste. Lean cannot bring a process under statistical control. Six Sigma alone cannot dramatically improve process speed or reduce invested capital. Both enable the reduction of the cost of complexity. Lean tools can be used in each phase of Define, Measure, Analyze, Improve, and Control. PDCA: Lean tools can be used in each phase of Plan, So, Check, Act. Baldrige: Lean tools can be an important part any organization’s process for improvement.

12. National Quality Center Characteristics Systems Approach: Theory of Constraints Focus on the Customer: Critical to Quality Characteristics Create Value vs. Non-Value Added Steps Flow: Pull vs. Push Systems Eliminate Waste

13. National Quality Center System Approach: The Theory of Constraints The Weakest Link – The Rate Limiting Step Dependency A change to most of the variables in an organization will only have a small impact on the bottom line. Variables that have significant impact on the bottom line are called constraints; the rate limiting step. Exploit the constraints, subordinate everything else. $$

14. National Quality Center Bottleneck Exercise

15. National Quality Center Focus on the Customer: Kano Model

16. National Quality Center Focus on the Customer: Critical to Quality Characteristics CTQs (Critical to Quality) are the key measurable characteristics of a product or process whose performance standards or specification limits must be met in order to satisfy the customer. They align improvement or design efforts with customer requirements. increase doc satisfaction with lab service NEEDDRIVERS CTQ timeliness convenience accuracy computer order entry remote access to results regular TPM on equipment standardized workforce training capacity for routine labs smaller batch size for transport

17. National Quality Center CTQC Exercise What are some CQC for: Lab Dietary Police Human Resources Waste Management Finance Care from Ryan White Providers

18. National Quality Center Create Value Non-value-added: Business-value-added: Customer-value-added:

19. National Quality Center Value Exercise

20. National Quality Center Flow: Eliminate Push Systems

21. National Quality Center Flow: Create Pull Systems

22. National Quality Center Waste: Muda Defects or Delay Overproduction Waste Non-utilized talent Transportation Inventory Motion Extra processing

23. National Quality Center Identifying Waste Exercise YOU OTHERS WASTEFULLEAN WASTEFUL OTHERS YOU

24. National Quality Center Methodology Value Stream Mapping Metrics: Kaizen

25. National Quality Center Value Stream Mapping

26. National Quality Center Cycle Time vs. Takt Time # of hours in a shift minus breaks per person # of times the process must be performed each shift Example: 8 hour shift – 30 minutes lunch and 15 minutes for 2 breaks X 2 techs = 840 min. 120 EKGs per shift required by customer demand Takt = 7 minutes per EKG

27. National Quality Center Percent Load Chart Minutes Process Steps

28. National Quality Center Percent Load Chart Minutes Process Steps 50+70+35+25+55 = 235 235÷60 = 3.91

29. National Quality Center Kaizen (Rapid Improvement) Events

30. National Quality Center Tools 5S Error Proofing Total Productive Maintenance SMED Standard Work Spaghetti Diagram Check-list Kanban

31. National Quality Center Lean: Projects Faster Fewer steps Less expensively Less waste Less wait Increase quality Increased value-added time, decrease non-value added time

32. National Quality Center Success Factors in Lean Projects Map the process from end-to-end, and from the perspective of the customer Scope the improvements so they can be completed within one week Measure … before, during, after, and later Focus on the work, not on the workers Bring in suppliers and objective observers to help “see” the process

33. National Quality Center Success Factors Implementing Lean Organizationally Enable the people who work in the process to improve the process Engaging more people in continuous daily work improvement is often more valuable than a few people doing big projects Leaders modeling the method will be a catalyst to culture change Lean is not an fad, add-on work, or a panacea for all improvement opportunities; it is a mindset

34. National Quality Center If You’d Like to Lean More Free Resources: www.lean.org www.asq.org Books: A Lean Guide To Transforming Healthcare Lean Hospitals Lean Six Sigma Healthcare On The Mend Questions: Marti Beltz, martibeltz@gmail.com, 978-290-9007martibeltz@gmail.com

35. National Quality Center To access the call recording Go to https://meetny.webex.com/meetny/lsr.php?RCID=ce b8934842f64606a55ce9bca5d5bc33 Please be advised that due to server/connection issues, the recording started about 7 minutes into the presentation.