Learning Lean
He karakia whakatimatanga – Opening karakia Tūtawa mai i runga Tūtawa mai i raro Tūtawa mai i waho Tūtawa mai i roto Kia tau ai Te mauri tū, Te mauri ora Ki te katoa Haumi e. Hui e. Tāiki e!
I summon from above - from below - from the surronding environment and from within The universal vitality and energy To infuse and enrich all present Enriched, unified and blessed
PG X | SECTION X
Workshop Aims: • To provide both an introductory overview and a practical toolkit to support HCH practice teams to implement Lean Methodology and thinking • To strengthen the capacity of general practice teams to become more lean and stay lean • Where to start and how to make it stick
Programme Time
What
1.45pm-2.00pm
Welcome & Introductions
2.00pm-3.00pm
Workplace Organisation
3.00pm-4.00pm
Visual Workplace
4.00pm-5.00pm
Continuous Improvement
5.00pm-6.00pm
Lean Leadership
6.00pm-6.30pm
Debrief/Wrap Up
Lean Tool
Focus Areas o o
Workplace Organisation o
Visual Workplace Visual management, standardisation
Continuous Improvement
Lean Leadership Structured Problem Solving (Plan Do Check Act)
5S events (facility and electronic filing systems) Huddles – Agenda’s, tips for huddle chairs and action note taking. What is value add in the huddles, how do you get it and keep it ? Flow initiatives – when and how to use this tool
o o o o o
Team Boards - making them work for you One Point Lessons – what is the value add of OPLs? Checklists andFlow charts Stock and inventory areas labelled Kanban inventory system
o o o o o
Process mapping Creating Lean Teams Professional development opportunities/initiatives Suggestion Boxes/Ideas Boards Daily Lean, Project Lean and Lean Culture improvement Gemba walks/Rounding Leading Lean – top tips of how to lead Lean Implementation of Root cause analysis Tracking and measuring and feeding back of PDCA cycle
o o o o
How
∞ • • •
Overview of the tool Purpose of the tool Application of the tool
? • • • • •
What is working What are our challenges What are others doing How are we measuring How does PDCA fit into al of this
Key elements of the HCH model
Urgent and Unplanned Care
Proactive Care
Routine and Preventative Care
Business Efficiency
Urgent & Unplanned Care
Proactive Care for High Needs
Routine and Preventative Care
Business Efficiency
What is Lean?
Philosophy of Kaizen ‘Everything can be improved’ • Clarence W Barron
Change
for the Better‌ everybody every day everywhere
Kai = Change
Zen = Good (for the better)
What is Lean (Kaizen)? • A business culture characterised by the endless pursuit of the elimination of waste • Comes from the Toyota Production system • Continuous improvement • Respect for people
5 key principles of Kaizen
1. 2. 3. 4. 5.
Value – what your customers value Value stream –value delivered to the customer Flow – removing barriers to deliver value Pull – triggered on demand from the customer Perfection – continuous improvement
The ultimate goal of Lean is to To eliminate: 1.Overburden - muri 2.Uneveness - mura 3.Waste - muda
Kaizen Lean foundations Create Customer Value
Value-added activities
Non-value added activities
transform materials & information into products or services the customer wants/needs
consume resources without contributing to the product or service
We want to develop processes & facilities that streamline the 7-Flows of Healthcare: • Patients
• Providers/Staff • Medications • Supplies • Information • Equipment • Patient Families
Kaizen Foundations CREATE CUSTOMER VALUE
PULL & FLOW
ELIMINATE WASTE
PROCESS & RESULTS
ENGAGE (RESPECT) PEOPLE
MANAGE VISUALLY
GO AND SEE
Who is the customer?
Patient
Workforce
Business / or System
Break out exercise – What does good look like?
The Lean tools… “Give a man a fish feed him for a day, teach a man to fish feed him for a lifetime” - Chinese Proverb
7 wastes of a process value-added transportation defects/ rework inventory/ WIP
overproduction
motion overprocessing waiting
Prepare proposal for new prospect
In s id e Sales Rep
Selecl proposal
len-olat.
liJraty
CuSIOmiZll Boilerpla.'s text
Salos RoptOSentat ve
Sales Manager
VP Sa e s
lnside sales Manager
Director
Proposal
1o"'!ll•t•
Salos Aclm ln
L
Write new pro!JOsal text
5S events, Huddles, Flow initiatives
5S – Workplace Organisation
5S in action
Red Tag Files!
Before
After
5S Events
“Red Tag“
Why is 5S so important? • Minimises & prevents waste • Underpins FLOW of… • information, services, materials, products • Engages people o o o o
Pride Loyalty Commitment Discipline
• Helps to create, sustain and improve standards • Makes problems obvious
versus
Team Boards, One Point Lessons, Checklists and Flow Charts, Stock and inventory areas labelled, Kanban inventory system
Visual Management - Can everyone see it?
What is visual management? • Displaying information to drive behaviour • Helps us…
Standard Agenda 1. 2. 3. 4.
Fixed Meeting time:
People
Continuous Improvement
Performance Compass Health Annual Plan Policy deployment matrix 2016-2017 Q1 Q2 Q3 Q4 Jul-Sep Oct-Dec Jan-Mar Apr-Jun
Comments (if not green)
X
First 90 days onboarding
X
Design standard operating procedures for all team functions
X X
Streamlining room/event use
XXXXXX X X
X
Implement REMWISE
X
X
Implement ASKYOURTEAM
X
X
Coaching model adopted
X
Increase catering efficiency
X X
Skill/Competency & training needs
75%
Pamela Wahlers
<8
PayGlobal 100% accurate
90%
Responsible Team/Person
Success - gain the best value from the resources available
Year to date plan
Empowerment - strengthening general practice capacity and capability Navigation - improve the quality, safety and experience of care
X
Catering costs vs budget
X
Operating procedures for all team functions
X
X
90% of staff with PDRPs
X
Fewer than 8 sick days per annum per employee
Implement the Health Care Home & Health Care Neighbourhood
Empowered patients and whanau
High Performing network & PHO
Targets to improve
X
New improvement ideas
X
Reception
PayGlobal audit Health & Safety plan implemented
Claire Dixon
X
Alice Graham
X
X
Responsibility
Workforce Development Plan
X
Chris Richard
Status
X
Bernie Phipps
Improvement Projects
Roles & Responsibilities matrix
Year to date actual
100% 100%
Annual plan
Wellbeing - improve health and equity for our population
Date as at
How are we doing today?
What does a good day/ week look like?
Just do it
Problem Solving
Daily KPIâ&#x20AC;&#x2122;s (Targets vs. Actual) 1. Perf Reviews completed 1. Perf Reviews completed 2. Payroll re-openings
Rosters, planners
Register of completed ideas What
Who
When
Problem Solving Working Docs
New Std?
define the problem
root cause PLAN
verify
solutions
Action plan
Completed
TROLLEY LAYOUT â&#x20AC;&#x201C; DRAWER 2
Lab Bags =10
Thermoscan Covers =1 box
Specimen Containers: Plain (Yellow) =2 Formalin (Red) =1 Mark Pen =1
empty
Crepe Bandages =1 of each size: 15cm; 10cm; 7,5cm
Eye Pads =1
Crepe Bandage 5cm =1
Cotton Buds = 10 sticks
Triangular Sling =1
Eurofix =1/2 roll each size: 10mx10cm; 10mx5cm
Blood Glucose Meter
Opsite =1/2 roll each size: 10mx10cm; 10mx5m
Micropore Tape =1 of each: 9.1mx5cm; 10mx2.5cm
Leukofix Tape 1.25cmx9.1m =1 2.5cmx5m =1
Standardisation â&#x20AC;&#x201C; enabling personalisation
Purpose of a standard? Basis for training
Simplifies recurring / routine work
â&#x20AC;Ś in
Maintains existing know how
Guarantees stability in processes and procedures
Prevents defects
Basic for audit or diagnosis
order to do something in the best, simplest and certain way.
Standards: Leave Notification - Doctors Practice Manager
24.3.14
001
A. DOCTOR ON ANNUAL LEAVE Apply these processes at least one week prior to the commencement of your annual leave.
1. Set "Out of Office" assistant on Manage My Health (MMH) This process will inform patients to contact the surgery by telephone as this email will not be replied to. 1. Go to Manage My Health website and log in with your user name. 2. Open your "Inbox".
3. Click on Settings (far right hand tab) and tick "Enable Out of Office Reply" i.e. make sure there is a tick in this box.
4. Write your "Out of Office" message in the bottom box.
5. Click on "Save Settings" to save this (otherwise the out of office reply wonâ&#x20AC;&#x2122;t be activated).
45
One Point Lessons
Cannon Creeks
Staff Portfolio Matrix
Lead
Diabetes B4 School Check-up Immunisations IV Management Cardiovascular Management
Wound Care Infection Control Smears & Womensâ&#x20AC;&#x2122; Health Sexual Health Preceptorship Respiratory, Asthma, CORD MCA Preceptor Employee Health & Drug Testing Plasters / Suturing
Accountable Deputy
Responsible
Process mapping, Creating Lean Teams, Professional development opportunities, Suggestion Box/Ideas Boards, Daily Lean, Project and Lean Culture improvement
Prepare proposal for new prospect
In s id e Sales Rep
Selecl proposal
len-olat.
liJraty
CuSIOmiZll Boilerpla.'s text
Salos RoptOSentat ve
Sales Manager
VP Sa e s
lnside sales Manager
Director
Proposal
1o"'!ll•t•
Salos Aclm ln
L
Write new pro!JOsal text
Gemba Walks, Rounding, Leading Lean
Standard Agenda 1. 2. 3. 4.
Fixed Meeting time:
People
Continuous Improvement
Performance Compass Health Annual Plan Policy deployment matrix 2016-2017 Q1 Q2 Q3 Q4 Jul-Sep Oct-Dec Jan-Mar Apr-Jun
Comments (if not green)
X
First 90 days onboarding
X
Design standard operating procedures for all team functions
X X
Streamlining room/event use
XXXXXX X X
X
Implement REMWISE
X
X
Implement ASKYOURTEAM
X
X
Coaching model adopted
X
Increase catering efficiency
X X
Skill/Competency & training needs
75%
Pamela Wahlers
<8
PayGlobal 100% accurate
90%
Responsible Team/Person
Success - gain the best value from the resources available
Year to date plan
Empowerment - strengthening general practice capacity and capability Navigation - improve the quality, safety and experience of care
X
Catering costs vs budget
X
Operating procedures for all team functions
X
X
90% of staff with PDRPs
X
Fewer than 8 sick days per annum per employee
Implement the Health Care Home & Health Care Neighbourhood
Empowered patients and whanau
High Performing network & PHO
Targets to improve
X
New improvement ideas
X
Reception
PayGlobal audit Health & Safety plan implemented
Claire Dixon
X
Alice Graham
X
X
Responsibility
Workforce Development Plan
X
Chris Richard
Status
X
Bernie Phipps
Improvement Projects
Roles & Responsibilities matrix
Year to date actual
100% 100%
Annual plan
Wellbeing - improve health and equity for our population
Date as at
How are we doing today?
What does a good day/ week look like?
Just do it
Problem Solving
Daily KPIâ&#x20AC;&#x2122;s (Targets vs. Actual) 1. Perf Reviews completed 1. Perf Reviews completed 2. Payroll re-openings
Rosters, planners
Register of completed ideas What
Who
When
Problem Solving Working Docs
New Std?
define the problem
root cause PLAN
verify
solutions
Action plan
Completed
Change Management â&#x20AC;&#x153;Change makes people feel uncertainâ&#x20AC;?
Personal Change Curve
The Pit
ADKAR Desire
Awareness
Knowledge
Ability
Reinforcement
Awareness of the need for change Desire to support the change Knowledge of how to change Ability to deliver new skills and behaviour Reinforcement to make the change stick
Why should you care about change management? • • • • • •
More likely to succeed More likely to make a good return on time and money invested Help ensure a smooth transition to Health Care Home Motivate your practice team Manage resistance to change Lead the way by being a high performing practice
Root Cause Analysis, Plan Do Check Act, Tracking and Measuring
Problem Solving â&#x20AC;&#x201C; problems are opportunities
Breaking down the problem
What happened? Speak with data. Why did it happen & why is it an issue? When did it happen? Has it happened before & how often?
root cause
define the problem Who was involved / affected? Where did it happen? How did it happen – sequence of events?
PLAN
DO
GET TO THE BOTTOM
BE VERY SPECIFIC
Structured problem solving template
Ask 5 x Why? What is REALLY causing this?
verify What will it look like when it has been fixed?
solutions How can we fix the ROOT CAUSE? Who needs to do what when?
WHAT WILL FIX THE PROBLEM?
HOW WILL WE KNOW IT’S FIXED?
ADJUST CHECK
Ishikawa or fishbone diagram Causes People / manual power Submitting timesheets late
Process / method
Poor planning
Calculating mistakes
Tiredness
Too many drop-off points
Effect or Problem
Long time to approve Price increase
The die is overheating
Trolley is cluttered
Long walk to stock area
Part deliveries
Insufficient RAM
Window is dirty
Running out of stock
Suppliers / material
Equipment & software / machinery
Environment
All possible causes are taken into consideration and assessed with respect to their impact on the problem
Potential solutions Evaluation
Measures
Collect ideas
(implementation)
(brainstorming)
High
Action Plan Solution alternatives
What?
Cost Solution 1
Solution 2
Solution 3
Time
Long
By whom?
By when?
Status
PDCA / SDCA cycles
Start anywhere â&#x20AC;&#x201C; there is waste everywhere!
Start by doing! Put a good person in a bad system and the system wins every time!
Start by using this type of thinking: • Discard conventional fixed ideas • Think of how to do it, not why it cannot be done • Don’t make excuses – question current practices • Do it straight away, even if for only 50% of the target • Correct it straight away if you make a mistake • Ask why, why, why, why and then why again • Avoid spending money on Lean: ‘wits not wallets’ • Involve people in the area • See the wisdom of 10 people, not the knowledge of one
He karakia whakamutunga – Closing karakia Kia whakairia te tapu Kia wātea ai te ara Kia tūruki whakataha ai Kia tūruki whakataha ai Haumi e. Hui e. Tāiki e!
Restrictions are moved aside So the pathways are clear To return to eveyday activities Enriched, unified and blessed