kaizen event presentation · kaizen event – definition a two- to five-day focused improvement...

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Kaizen EventsKaizen Events: : Achieving Rapid Improvement in Achieving Rapid Improvement in

Healthcare SettingsHealthcare SettingsSociety for Health Systems

Orlando, FL

February 21, 2008

Building a Lean Enterprise

© 2008 Karen Martin & Associates 3

KAIZEN

Kai Zen

Break apart

To change

Study

Make better

EVENTEVENTRapid ImprovementRapid Improvement


Who? Accountability Tool

Leadership “What has to happen” Value Stream Mapping / A3

Workforce “How it will happen” Kaizen Events

Improvement RolesS

tra

teg

icT

ac

tic

al

Middle Management


Value Stream Defined

Value Stream: All of the activities, required to satisfy a customer need from request to receipt.

Value Stream

Process ProcessProcess

Customer

Request

“Order”

Customer

Receipt

“Delivery”

Customer


Typical Healthcare Value Stream

Need

Determined

Appointment

or

Admission

Scheduled

Patient

Arrival /

Admission

Evaluation

&

Testing

Diagnosis

&

Treatment

Patient

Discharged

Claim

Submitted

Payment

Received

Patient

Follow-up

Start

End

“Pre-Production”

“Production”

“Post-Production”


Individual vs. System Performance

Isolated pockets of excellence =

sub-optimization risk

Systems focus =

0ptimal value stream performance

Transcribe Report

(MDI)

Lead Time = 5 mins.

% C&A = 75 %

Customer Demand:

15 patients per Day

(Takt Time = 32 minutes)

8 hours per day

Check-in

Patient(Admitting)

Cycle Time = 2 mins.

% C&A = 90 %

5

Send

Reports(Imaging)

Cycle T ime = 3 mins.

% C&A = 90 %

6

Current State Value Stream MapOutpatient Imaging Services

Schedule

Appointment

Cycle T ime = 11 mins.Lead Time = 12 mins.

% C&A = 98 %

6

Pre-register

Patient

Cycle T ime = 30 mins.Lead Time = 990 mins.

% C&A = 100 %

5

CT=Cycle Time

LT=Lead Time

%C&A=% Complete & Accurate

0.0833 hrs.

2 mins.

0.0833 hrs.

1 mins.

1.33 hrs.

28 mins.

4.13 hrs.

15 mins.

6.08 hrs.

5 mins.

16 hrs.

1 mins.

1.83 hrs.

1 mins.

2 hrs.

3 mins.

LT = 32.5 hrs.

CT = 56 mins.

CT/LT Ratio = 2.87%

Lead T ime = 990 mins.

Prep Patient, Conduct

Exam, Transmit

Images (Tech)


% C&A = 90 %

2

Check-in

Patient(Imaging)


% C&A = 98 %

3

Read/Dictate

Exam(Radiologist)


% C&A = 95 %

2

Review / Sign

Report

(Radiologist)


% C&A = 95 %

2

Print

Reports(Imaging)


% C&A = 99 %

2365 mins. 960 mins. 110 mins. 120 mins.80 mins.

E Pay

Excel

ADS

Symposium

Internet

Waiting Room

Management

System

Fax Order

Solutions

PACS

5 mins.

Lead Time = 10 days

Meditech

234

5 6 78 9

1011 12

Auto Fax 50%

Us Mail 25%

MD Mailbox 25%

Rework Loop

via Fax 25% of

the time

Rolled First Pass

yield = 30%

Patient

1

Value Stream Champion: Paul Scanner

Created July 19, 2005

Refer Patient

(Physician)

% C&A = 65 %

Lead Time = 12 mins. 2

5 mins.248 mins.


Key Metrics: Time

�Process time (PT)

� The time it takes to actually perform the work, if one is able to work on it uninterrupted

� Includes “think” time if process is analytical in nature

� aka “touch time,” work time, cycle time

�Lead time (LT)

� The elapsed time from the time work is made available until it’s completed and passed on to the next person or department in the chain

� aka throughput time, turnaround time, elapsed time


Value Stream Lead Time vs. Process Time

Lead Time

Order (Request)

Delivery (Receipt)

Process Time

LT = PT + Delays


Process Block Lead Time vs. Process Time

Work Received

Work passed to next

step

Process Time

LT = PT + Delays

The time it takes

to do the work

Lead Time


Key Metrics: Quality

�%Complete and Accurate (%C&A)

� % time downstream customer can perform task without having to “CAC”:

�Correct information or material that was supplied

�Add information that should have been supplied

�Clarify information that should have been clear


Summary Metrics (continued)

�Activity Ratio (AR)

� The percentage of time work is being done to the product passing through the process

� AR = PT/LT × 100

� 100 – AR = Idle time

�Rolled First Pass Yield (RFPY)

� %C&A × %C&A × %C&A × …

� Out of 100 occurrences, what percentage of the time does the product pass through the entire process error-free?

Refer Patient

(Physician)

% C&A = 85 %

Patient

Send

Reports

(Imaging)


% C&A = 90 %

6

Future State Value Stream MapOutpatient Imaging Services

Schedule appt

Pre-register


Lead T ime = 45 mins.

% C&A = 98 %

6

CT=Cycle Time

LT=Lead Time

%C&A=% Complete & Accurate

0.0833 hrs.

1 mins.

1 hrs.

28 mins.

2 hrs.

15 mins.

7 hrs.

1 mins.

0.0333 hrs.

1 mins.

0.5 hrs.

3 mins.

LT = 11.4 hrs.

CT = 49 mins.

CT/LT Ratio = 7.14%

Lead Time = 45 mins.

Lead Time = 5 days

Prep Patient,

Conduct Exam,

Transmit Images

(Tech)


% C&A = 90 %

2

Check-in

Patient

(Imaging)


% C&A = 98 %

3

Read/Dictate

Exam

(Radiologist)


% C&A = 95 %

2

Review

/Sign

(Radiologist)


% C&A = 95 %

2

Print

Reports

(Imaging)


% C&A = 99 %

22 mins. 30 mins.60 mins.

E Pay

Excel

Symposium

Internet

Waiting Room

Management

System

Fax Order

Solutions

PACS

5 mins.

Set-up

Reduction

Remove

Redundant

Check-in

Standard

Work

Pull System

(Supplies

Kanban)

Visual

Workplace

Voice

Recognition

Batch

Reductions

5S

Co-locate

Standard

Work

Work

Balance

Continuous

Flow

Value Stream

Alignment

Auto Fax 80%

Us Mail 15%

MD Mailbox 5%

Rolled First Pass

yield = 59%

Rework Loop

via Fax 10% of

the time

Customer Demand:

15 patients per Day

(Takt Time = 32 minutes)

8 hours per day

23

4 56 7 8 9

Risk

Reduction

(Joint Commision)

Meditech

420 mins.

1

Value Stream Champion: Paul Scanner

Created July 20, 2005

120 mins.

Reduce Data

Entry

Requirements

Standard

Work

Cross

Training

Standard

Work


Outpatient Imaging Improvement Results

ProjectedMetric Current State Future State % Improvement

Lead Time 32.5 hrs 11.4 hrs 65%

Process Time 56 Mins 49 Mins 13%

Activity Ratio 2.9% 7.1% 145%

RFPY 30% 59% 97%

# steps 11 8 27%

Report rework 25% 10% 60%

Tech Morale Poor Good Significant

Value Stream

1 2 3 4 5 6 7 8 9 10 11 12

2 Improve quality of referral KE Sean O'Ryan

3, 4Reduce lead time beween schedulingand preregistration steps

PROJDianne

Prichard

5, 6Eliminate the need for two patient check-ins

KEMichael O'Shea

6 Eliminate bottleneck in waiting area KEDianne

Prichard

9Eliminate lead time associated with transcription step

PROJ Sam Parks

10 Eliminate batched reading KE Sam Parks

7Reduce inventory costs, regulatory risk and storage needs

KEMichael O'Shea

12 Reduce delay in report delivery PROJ Martha Allen

12 Reduce delay in report delivery KE Martha Allen

Future State Implementation Plan

Executive Sponsor

Value Stream Champion

Value Stream Mapping Facilitator

Implementation Plan Review Dates

11/1/2007

Outpatient Imaging

Date Created

11/21/2007

Allen Ward

Sally McKinsey

Dave Parks 12/13/2007

10/18/2007 1/10/2008

Type OwnerImplementation Schedule (weeks) Date

Complete

Block

#Goal / Objective Improvement Activity

Implement standard work for referral process

Signature:

Date: Date: Date:

Signature: Signature:

Value Stream Mapping Facilitator

Increase percentage of physicians

receiving electronic delivery (rather than

hard copy)

Approvals

Executive Sponsor Value Stream Champion

Implement voice recognition technology

Reduce setup required

Cross-train and colocate work teams

Implement additional fax ports

Collect copays in Imaging

Balance work / level demand

5S CT supplies area; implement kanban


Kaizen Event – Definition

A two- to five-day focused improvement activity during which a sequestered, cross-functional team designs and fully

implements improvements to a defined process or work area, generating rapid results and learned behavior.

Karen Martin & Mike Osterling

The Kaizen Event Planner, 2007


Kaizen Events: Defining Characteristics

� Typically linked to a value stream map

� Aggressive, measurable objectives

� Sequestered cross-functional team (100% focus)

� Short duration: 2-5 consecutive days

� Professionally facilitated

� Emphasis on the elimination of unnecessary non-value-adding activities

� Low cost� Define and exploit the “technical boundaries” of existing

resources

� “Creativity before capital” thinking

� Rapid Implementation (during the event)� Not simply planning for change

ACTION!


Examples of Healthcare Kaizen Events

�Patient flow

� Imaging

� Emergency Department

� Surgery

� OB/GYN

� Cardiac

�Ancillary services

� Lab / pathology turnaround

�Administrative

� Payroll

� Recruiting/hiring process

� Claims

� Medical Records

� Physician Credentialing

�Space

� 5S Nursing areas

� 5S Laboratory


5-Day Kaizen: Sample Structure

Day 1 & 2 Analyze current state and Plan perform root cause analysis;

design future state

Day 3 & 4 Design & test improvements Do, Check using Lean tools; obtain

buy-in

Day 5 Finalize improvements; train Check, Act process workers and

affected stakeholders; provide closeout briefing; CELEBRATE!


Interim Briefings to Leadership

�Every day or two

�Team presents their ideas; leadership assures team has considered all options and thought through all implications

�Leadership’s role – not to say “no”� To say “Have you considered this?” “How would we

handle…?” “What if…?”

�Workforce grows stronger as they learn how to identify and eliminate waste

�Leadership grows stronger as they’re able to shift their focus to strategic planning, performance monitoring, and coaching staff.


Kaizen Event Phases

Execution2-5 Days

FollowUp

4-8 Weeks Post

Planning4-6 Weeks Prior

Workforce

Training

1

2 1

3 2

4 3

5 4

5

1 6

2 7

3 8

4 9

5 10

1

2 1

3 2

4 3

5 4

1

2

3

4

Every day 3:30 - 4:30

Conference Room A

Signature:

No backup if a non-team member tech calls in sick

Executive SponsorPotential Joint Commission surprise audit

Sally McKinsey

Possible Obstacles Approvals

Allen Ward Dave Parks

Marlene Diosdado

IT

MD advisotry board pres

Jerry Gambrell

Dave Madden

Standard work for referral process / patient education piece Function

Radiologist practice president

Potential Deliverables On-Call Support

Reduce LT for report sign-off from 16 hrs to 7 hrs (65% improvement)

Reduce waiting area time from 3 hrs to 30 mins (83% improvement)

Eliminate patient check-in at Admitting

Improve quality of referral from 65% to 90% (38% improvement)

Event Goals and Objectives

Patient dissatisfaction re: "hassle factor"

100% tech turnover in 6 months

Ann Marie

Losing patients to new outpatient imaging center Function

Referring physician complaints re: slow report turnaround

Interim

Briefings

Location

Value Stream

Event Drivers / Current State Issues Team Members

3/27/2008

3:30 - 4:30 pm

Team

Presentation

Event Boundaries &

Limitations

$1,000 budget

No major program changes to Medi-TechEvent Coordinator

Allen Ward

Last Step Referring physician receives report

First Step Physician's office calls scheduling department

Imaging

Outpatient ImagingExecutive Sponsor

Event Name

Team Lead

Kaizen Event CharterEvent Scope Leadership Schedule

Sean Michaels

Dave Parks

Specific Conditions CT ScansValue Stream

Champion

Facilitator

Sally McKinsey

Process Trigger Referral from physician

3/24 - 3/27/2008

7:30 am - 4:30 pm

FacilitatorValue Stream Champion

3/27/2008; TBD (11 am - 1 pm)

Name

Dates

Start & End

Times

Signature: Signature:

Name

Date:Date: Date:


Imaging

Scoping: Refining the Focus

Inpatient

Outpatient

Nuc Med

MRI

CT

X-Ray

Nuc Med

MRI

CR

X-Ray


Kaizen Event Facilitator Traits

� Skills / Knowledge� Lean tools� Root cause analysis� Project & time management� Team building / facilitation� People effectiveness – from front line workers to execs

� Authority / Respect� Designated change agent / influence leader� Trustworthy� Comfortable removing obstacles & reaching out to senior leadership

� Personality / Energy� Challenging, yet supportive� Positive, upbeat, energetic� Pushy without irritating ☺

� Objectivity / Fairness� No attachment to outcome


The Kaizen Team

� The single greatest determinant of event success

� No more than 10

� Cross-functional composition� Process workers

� Upstream suppliers (internal)

� Downstream customers (internal)

� Subject matter experts

� Outside eyes

� External suppliers / contractors

� External customers

� Administrative support (if needed)

� Union representatives (if relevant)

� Maintenance / facilities representatives

� Management (limited representation)

� Sequestered; Must be relieved of regular duties


Kaizen Event Phases

Execution2-5 Days

FollowUp

4-8 Weeks Post



Team Dynamics

Forming

Storming

Norming

Performing

Tuckman Model Bruce Tuckman, 1965

Adjourning


Kaizen Commandments – “Top Twelve”

1. No interruptions from outside the Event.

2. No veto power from outside the team.

3. Rank has no privilege.

4. Abandon departmental / silo thinking.

5. Finger-pointing has no place.

6. Avoid scope creep.

7. Use creativity before capital.


Kaizen Commandments (continued)

8. Think “yes, if…” instead of “no, because…”

9. Get good data, then add experience and “instinct” to the mix.

10. Seek the wisdom of ten rather than the knowledge of one.

11. Keep an open mind. Challenge existing paradigms. Challenge everything!

12. Improvements implemented today are better than planning to implement in the future.


Execution Phase Activities

�Document the Current State Plan

�Perform Root Cause Analysis

�Brainstorm and Prioritize Improvements

�Design the Improvement(s) Do

�Test the Design(s) Check

�Finalize the Design(s) Act

�Implement the Improvement(s)



�Document the Current State



�Design the Improvement(s)

�Test the Design(s)

�Finalize the Design(s)



Current State Documentation Tools/Activities

�Go to Gemba

�Spaghetti Diagrams

� Calculate motion / transportation costs and productivity losses

�MBPM

�Videotape

�Product samples

�Floor plans / blueprints

�Photos

�Process measurements


What to Look for at Gemba

�“Waste walk”�Workplace organization�Variation in how the work is performed�Work-in-process

� Quantity, oldest in queue, “problem” work, etc.

�Layout� Where people are located relative to their upstream

suppliers and downstream customers� Where people, equipment, and supplies are located

relative to each other

�Ergonomic concerns�Environmental issues – noise, temperature, air

quality, etc.

First, Seek to Understand: Go to Gemba

Spaghetti DiagramEmergency Services

Benefits Verification

Patient History

VitalsPhysician

Office

Imaging

Exam Room

Laboratory

Check-out / Billing

Waiting Area

ORDER CASH


The Cost of Unnecessary Motion

�Distance traveled to printer

� Work Group A = 92 ft. per occurrence

� Work Group B = 696 ft. per occurrence

�120 occurrences / day = 4,656 miles/year

�Walk pace = 1 mile per hour = 582 days/year of unproductive, non-value-adding time = 2.2 FTEs

Understand the Current State: Metrics-Based Process Mapping (MBPM)

Future State Projected Results

Projected

Metric Value Units Value Units Up Down Improvement

Critical Path PT Sum 140.0 minutes 65.0 minutes 53.6%

Critical Path LT Sum 2325.0 minutes 405.0 minutes 82.6%

Activity Ratio 6.0 % 16.0 % 166.5%

Rolled First Pass Yield 23.8 % 75.3 % 217.1%

# of Activities 16 activities 8 activities 50.0%

Projected

Metric Value Units Value Units Change

Sum of Total PTs 155.0 minutes 65.0 minutes -58.1%

Occurrences per Year 37500 occurrences 37500 occurrences 0.0%

Staffing Requirements 46.6 FTEs 19.5 FTEs -58.1%

Desired Direction

Summary Metrics

Projected Future State

Pre-Defined Performance Metrics

Current State

Staffing Metrics

Current State Projected Future State


Root Cause Analysis


Root Cause Analysis

�Waste is a symptom.

�Causes often lie very deep.

�Must discover the root cause to:

� Avoid band-aid fixes

� PERMANENTLY eliminate the waste.


Key Root Cause Analysis Tools

�Five Whys

�Cause-and-Effect diagrams (aka Fishbone or Ishikawa diagrams)

�Check Sheets / Pareto Charts

PACE Improvement Prioritization Chart

High LowAnticipated Benefit

Ease of Implementation

Dif

fic

ult

Ea

sy

20

7

513

4 23

1

228

9

2

10

16

11

6

12

1419

15

17

321

18

Building a Lean Enterprise

Standardize Work


Install Kanban

Time to ReplenishOK

AFTERBEFORE

Organize the Workplace










�Celebrate!


Implementation = Training

�Training must occur within the Kaizen Event itself.

�Therefore, it must be innovative� Stand-up sessions at the work site

� Multiple offerings in a conference room

� Conference call sessions

� Voice mail blasts

� Web-based support

� Email blasts (NEVER sole training method!)

� Designated mentors

55

Event Name

Event Dates

5

6

7

1

2

3

4

• 30-Day List

• Process being addressed

• First & last steps

• Specific conditions

• Event drivers / current state issues

• Objectives

• Boundaries & limitations

• VSM and/or MBPM review

• Relevant metrics

• Photos (if relevant)

Opening Comments

• Key improvements and accomplishments implemented during the event

• Tools used

Kaizen Event

Final Presentation AgendaValue Stream Champion

Agenda Item

Facilitator

Scope and Objectives

• Team introductions

• Agenda

• "Rules" for attendees

"Before" Condition

Key Improvements Implemented

"After" Condition

• Potential obstacles that could prevent attaining projected performance

levels

• New process description

• Projected results (direct and collateral)

Key Open Action Items

Sustainability Plan

Presenter(s)


Kaizen Event Phases

Execution2-5 Days

FollowUp

4-8 Weeks Post



Sustaining Improvement

�Hold weekly follow-up meetings

� Full team presence highly desirable

� Event Facilitator or VS Champion leads

� Monitor process, refine if needed

� Transition improvement oversight from Kaizen Team to area supervision/management

�Execute Sustainability Plan

�Update VSM

�Conduct 30-Day and 60-Day Audits

58

Plan to Succeed – The Sustainability Plan

59

Sustainability Plan – Page 2


Karen Martin, Principal7770 Regents Road #635San Diego, CA 92122(858) [email protected]

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kaizen event presentation · kaizen event – definition a two- to five-day focused improvement...

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