pp, lean is the biology of business, pdf 20121219 (tp)
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Lean is entering healthcare and medical diagnostics - excellent fit between Lean practises and Biological system operation.TRANSCRIPT
[email protected] Lean is the Biology
of BusinessSystem Design for Quality
in a Complex
Organization
Learning, Adaptive and Innovative Culture to
Manage Crisis in Healthcare
Mobilize all Individual and Team
Intelligence and Brain Power (IQ +
EQ) in the Organization
If We All Knew What We All Know?
Specialized in seeing
many things at once
Synthesizes
the ”Big Picture”
Emotional, Emphatic,
Visual
Good at recognizes
serial events
Analyzes details
Logic, Abstract
A Whole new Mind: Why Right-brainers will rule the Future
Left-brainers Right-brainers
What do you see ?
Human Microbiome 2012 Five Horses
Do we see the same ?
Communicate through Dialogue and Active Listening
Learn to see and act ?
Empower, Motivate
See Waste,
Uncover Problems
Eliminate Waste,
Correct Root Causes
Manage Quality
Quality is in the process
F
HA
B
C
DE
GA B C D
Newtonian Linear Process View
Reductionist – Left brain approach
Quantum Complex Process View
Holistic – Right brain approach
ComplexAdaptive System
Linear Flow
Evolution Is
continuous
adaptation
of a
complex
Biological
System
1.Self-creation 2.Self-reflexivity 3.Self-regulation4.Communications among all parts5.Conservation of what works well6.Creative change of what does not
work well.
Culture of a Complex Adaptive Organization
1. Pursue agility and resilience
2. Consciously learn from daily experience
3. Allow solutions to emerge
4. Pull, don’t push
5. Seek healthy mixtures
6. Rely on vision and boundaries
7. Appreciate the messy phases
8. Expect non-linear progress
9. Cooperate to create abundance
10. Promote grassroots initiatives
11. Work in a place designed for humans
Evolution Is
continuous
adaptation
of a
complex
Biological
System
TQMDeming 14 points
”No Waste”
Process design
Scientific method
Project
KaizenA better Life
ISO
CENISO 9001/2008
ISO 17025/ISO 15189
The Toyota WayTPS, TPM, 14 points
”Purpose/People/Process”s
LEAN (1990)
Production
Service
Healthcare (IHI)
Six Sigma
QA/QC
QMS
Franklin Ford Taylor Juran
Deming
Toyoda
Shingo Ohno
ImaiWomack Seddon Jones
Smith Westgaard
The Evolution of Quality
Management in Industry
PresentThe Industrial Management and Quality Maturity Model
”Lean, Six Sigma, ISO Synchronization”
QMS
Sokrates
Lean”Learn to see”
Continuously Improve / eliminate Waste”/ Innovate
Synchronize Flow/ Focus Speed and Customer
Process Quality/ ”Quality by Design” / All Participate
Six SigmaData
Reduce Variation and Errors
”World Class” Product Quality
Design for Six Sigma / Expert Driven
ISODocument
Documentation /Traceability/ Accreditation/ Certifying
Quality Through Control / Regular Audits (internal/external)
Apply to Standards / Weak Focus on Process (traditional)
Tendency to Hamper Improvement Culture
Lean is
Right Brain
Thinking
Six Sigma
is Left Brain
Thinking
Quality is Data driven Improvement
Taiichi Ohno
Father of the Toyota Production System (TPS)
Toyota system is; “profit-making industrial engineering”
Reduce the time from committing money to the raw materials to when collect money from customers“Cash Flow”
”Design for best quality to lowest price”
”Mobilize all intelligence in the organization to meet our purpose”
Lean Heritage from TPS
“Yet the most powerful aspect
of LEAN
is not what participants do to
add to improve a process but what
they remove from the process
to improve it”
Lean Pillars for Lean Culture:
1) Continuous Improvement
2) Respect People
Appreciate peoples brains
Job satisfaction motivates, self
respect reduces
negative Stress
“Lean IS Healthcare”
No Zero Sum but Win-Win !
BusinessValue
“(Cost)”
Quality in
Process
“(Quality)”
Customer Value
“(Delivery) “
Staff Value
“(Motivation)”
Input - Process - Output• Quality in raw material/sample
• Quality in process
• Product Quality
Allways improved Quality/Value to
Lower Price
Do not sell
out Quality
Kaizen
Board
Process VSM 5S 5W PDCA/A3
JITDayly
SteeringTakt time
Spagetti
map
Onepiece
Flow
Flow Mäta Transformation Team Pull
MuraMuda Muri Root Cause
Initiate first
Kaizen
feeling among
staff
”Lean Thinking”
<”Lean Toolbox”
First Kaizen Culture then Tools
Initiate first
Kaizen
feeling among
staff
”Lean Thinking”
<”Lean Toolbox”
First Kaizen Culture then Tools
Initiate first
Kaizen
feeling among
staff
”Lean Thinking”
VSMSpagetti map
5S/5W
PDCA/A3
Flow
Measure
<”Lean Toolbox”
First Kaizen Culture then Tools
Selected
Tools
Abandon Command and Control Culture (No Blame)
Cease dependence on inspections for quality
Empower people to continuously improve quality
Establish Lean Coach, Facilitator, Change Agent
Pull according to Need - do not Push !
First Kaizen Culture then Tools
Lean Design Healthcare
Enterprise
Integrated Delivery System
1. Understand ”Big Picture”
2. Utilize Industrial Maturity Model for Management Quality,
Competence and Skills
3. Design Education and R&D for right Knowledge, Science
and improvement Culture
4. Lean Value Stream Design all interconnected Processes
involving all Stakeholders (Extended Value Stream)
5. Deliver right Care and Health/Wellness Support
Design System for Value and Flow
Industrial Quality and Management Maturity
1 Sokratic direction
”Dialogue”
2 B Franklin ”No waste”
3 F Taylor ”Scientific
Management”
4 H Ford ”Assembly line –
Process for
Massproduction”
5 E Deming – Total Quality
Management”
6 J Juran ”The Quality
Triangle”
7 Toyoda – ”TPS . Toyota
Production System”
8 Womack/Jones/ Seddon –
”Lean Production /
Services”
9 B Smith, “Six Sigma”
10 JH Holland ”CAS Biology
Systems Thinking”
11 “CEN- ISO regulation”
Global/Individual
Patient need of
Medical Cure
Global/Individual
Patient need of
Health - Wellness
MedicalDiagnostics
Academia
R & D for
New Biology
Knowledge
Medical
Applications
Academia
Education for
Adequate
Practice
Focus on Relevant
Knowledge, Dismiss
Irrelevant Knowledge
Pharma
Industry
Medical Devise
Industry
In Vitro
Diagnostic
Industry
IT/ICT/IST
Indsutry
Health
Wellness
Industry
Understanding the Big Picture and NeedsIdentify relevant Problems to Solve
Base Decisions on Data
Add Resources
Act
Clinical Specialities
People
Processes
Purpose
Waste
Out
Waste
Ou
t
Waste
Ou
t
The Lean House
of
Individual/Global
Healthcare
Design for Flow
Manage all Parts that Interact
Look for waste !
”Best Care at Lower
Cost”
Report IOM USA
2012
Category Sources Excess CostsUnnecessary Services 210 billion US
Inefficiently delivered Services 130 billion US
Excess Administrative Costs 190 billion US
Prices That are Too High 105 billion US
Missed Prevention Opportunities 55 billion US
Fraud 75 billion US
Total 765 billion US
5 202 000 000 000 Skr
Science and Technology
Revolution
New Possibilities – New
Demands
Intuitive Healthcare
Empirical Healthcare
Precision Healthcare
Patient Participation
The Ecological Approach
”The New Biology”
Health, Food, Energy, Environment
Medical Diagnostics support Integrative and
Functional MedicinePersonalized Medicine, Pharmaco- and Nutrigenomics
New Business Paradigm
Power through Collaboration
In Complex Organizations Capability
and Capacity depends on
Relationship Management and
Collaboration in Multifunctional
Teams
Extended Value Stream
The intelligent PatientThe well informed PatientPatient Health AwarenessPatient as Health ConsumerPatient as a Healthcare Professional
Doctor as ConsultantHealthcare professional Team effort
Changing Roles in Healthcare –Customer Always in Focus
New Roles
Access Healthcare Information
patientslikeme
”Because of PatientsLikeMe, we are better able to recognize warning signs... [and] keep things in perspective. In short, PatientsLikeMe empowers us.”
”PatientsLikeMe has provided me with new friends- people who are experiencing the same problems as I am.”
”I joined because I didn't want to feel alone anymore. Simply put. And I knew that I could be helpful [by sharing] my experience.”
http://www.patientslikeme.com/
Patient Mobilisation
Lean Design and
Innovation
Medical Diagnostics
Common Purpose
Lean HealthcarePatient Experience/Flow/Security/Medical and Operational Excellence
Customer/Patient level
Radiology”Imaging”
Physiol. Laboratory Medicine
TissuesCells
Micro-Organisms
Biological Fluids
MoleculesNucleic acids
Biochemistry
Toxicology
Hematology
Coagulation
Immunology
Transfusion Med
Virology
Physiology
Histopathology
Imaging
Cytology
Medical Diagnostics Services Integrated
Lead, Improve, Innovate, Transform, Drive Change
Service level
Integratedinformation
Integrated Production
Level
IntegratedScientificMedical
Knowledge Base
Skills
BacteriologySerology
Diagnostic, Scientific, Operational, Managerial
Pharmacology
1
2
3
4
5
6
7Develope the Medical Diagnostics Knowledge Worker through
Collaboration and Shared Purpose
Core, Rapid Response, POC Functions
Key Qualities
• Integrate
• Consolidate
• Automate
• Share
Knowledge
• Mobilize all
intelligence in
organization
• Continuously
learn
Integrate Diagnostic Services
Design End to End Processes (Lean Six Sigma)
Key Deliveries 1) Order, 2) Sample material, 3) ReportCorrect from me in every step KPIs for Flow, Timing, Continuous improvenet, Team efforts
Improve and
Innovate;• Methods
• Process design
• Flow, Value
• Team
• Autonomate(Instrumentation/IT)
Potential TAT within 24
hours (TAT = Turn Around Time)
Sample
Quality WorkCellFLOW - Autonomate
No
Delay
Lean Histopathology - Model
Repeat
Improve and
Innovate;• Methods
• Process design
• Flow, Value
• Team
• Autonomate(Instrumentation/IT)
Potential TAT within 24
hours (TAT = Turn Around Time)
Lean Bacteriology - Model
Organize for Single Unit Patient Flow !
Lean Healthcare.org
LEAN for the patient
would change
Health Care forever.
Klaus Schipper Med Dr, Viborg, Danmark, 2010
Central vs Decentralized
Patient in real Focus ?
Scientific
Depth
Diagnostic
Excellence
Operational
Excellence
Management
Leadership
The Diagnostic Team
Educate for Team Effort
Basic Common Design
Lean Organization
and
Biological System
Hierarchy of a Biological System
Gastrointestinal Tract
Microbiome, Skin, Environment
Top Brain, Hypothalamus,
Pituitary,
Pineal
MiddleEndocrine
Organs
Front LineOrgans
Tissues
Cells)
Blood
Cells
Plasma
Nutrients
Hormones Interstitial
fluid
O2/CO2
Re/Ox, pH
ElectrolytesProteinsXYZ
Hormones
Vitamins
Metal Ions
Carbohydrates
Amino Acids
Lipids
Complex
Signaling
Complex
Crosstalk
Sensing Environment
Stimulating
Hormones
Releasing
Hormones
Autonomous
Activities
Neural
Signaling
Biological System vs Lean System
Biology
System
Hierarchy
Lean System
Hierarchy
Top Down
Bottom up
Lean Leadership
Transforming Leadership
Traditional
Manager
Future
Leader
The Lean Organisation - Model
Cell
Tissue
Testing
Testing
Biological
Fluids
Cultivation
Blood
Donation
Trans. Med
The Meeting Point
Direction through Why ?
Why ? Identifies Purpose - Sets Direction
Direction through Why ?
5 Why
Why ? Finds the Root Cause
Focuses the Countermeasure
Fractal Thinking
In Depth Analysis
World Class Lean Organization
IT/ HR/Procurement/Accounting
Lean DilemmaLean and Nature Manage
• Need
• Risk
• Damage
• Repair
Traditional Industry Manage
• Financial Bottom Line
Design Lean Healthcare
System
New Roleof Leadership – Quantum Lead
Fronline Autonomy - Sustained Teams
Improve and Innovate Complex Value Streams
System - Synchronization
Core – Discipline Integrated Central Function
RRL – Rapid Response Function
POCT – Function at Point of Decision
System Lean Healthcare
System - Flow
Components of Flow / Lab
Patients
Clinical Information
Sample material
• Biological fluids
• Cultivation
• Tissues
• Nucleic Acids
Deliveries / LabMedical Excellence
Patient security
Data
Information
Knowledge
Fast - Timely
Coordinated
Correct – no Error
Reproducible
Operational Excellence
Medical Excellence
Patient security
Data
Information
Knowledge
Fast - Timely
Coordinated
Correct – no Error
Reproducible
Operational Excellence
Patients
Clinical Information
Sample material
• Biological fluids
• Cultivation
• Tissues• Nucleic Acids
”Lean Management” (System value)
”Lean Operations ” (Process value)
Lean
Customer Service
Lean
Human Resources Lean ITLean
Procurement
Lean
Accounting
Start
Input Output
Medical DiagnosticsRadiology, Physiology
Laboratory Medicine
Goal
System Lean Healthcare
System - Connectedness
Top Down
Bottom Up
System – Diagnostic Work Station – Patient Focus
• Historic• Intelligent• Standardized
EHR, EMR, EPR
RIS/PACS/LIS/LIMS
Disciplin Integrated
Single Patient Flow
”Cloud Computing – abundant but waste free data flow”
”Lean for the Information Age”
System – Access and Share
Manage Change
Responsibility
Accountability
Committed
Respected
“Your vision becomes your beliefsYour beliefs become your thoughtsYour thoughts become your wordsYour words become your actionsYour actions become your habitsYour habits become your valuesYour values become your destiny”
Mahatma Gandhi
The test question is:
Am I working with or against
nature?
Manage Change
Toyota Kata
Nature and Healthcare are Fractal
Autonomous Lean Cell in a Fractal Organization
Autonomation = Automation
with a human touch for a better life
Create the Medical Diagnostic
Konwledge Worker in Team Organization
Balancing left with right
Make it Simple but not Simpler
Lean is the Biology of Business
TPS Approach
Classic Drucker
A Einstein
Learn from Nature - Work with Nature - Altruism - No Ego
Weight 2 - 20 g 50 - 110 kg
Heart size (% wight) 2,43 0,31
Heart beat / min 300 - 1000 70 - 120
Lifetime O2 cons. L / kg 500 000 180 000
Lifespan /years 10 80
Rel. Longevity / kg 200 1
Hummingbird versus Working Man / Team
Lean is the Biology of Business
System design
The Question is How
do we Become more
like Birds ?
Lean Ceases to be Lean when
used for Bad
Biology dies when abused
Business fails when driven by
Greed
Appendix: Proposed Change Agenda
1. Improve Patient Involvement in Care and Health Process – Individualized / Personalized Medicine – Patient Role as a
Profession
2. Transfer Healthcare / Medical Diagnostics Focus towards Prevention and Culture of Wellness – Integrative and Functional
Medicine shifting Mindset from fragmented (reductionist) to a holistic (quantum) View
3. Foster Healthcare Organization in Continuous Learning, Respect for People and continuous Work Process Improvement for
a better Life – Healthcare Kaizen
4. Design Healthcare / Medical Diagnostic system for Patient Flow and Flow of Work – Lean /Complex Adaptive System (CAS)
oriented Healthcare
5. Design Laboratory Processes for Analytical Material Flow and timely Delivery of Reports through Integration, Consolidation,
Autonomation (= Automation with a human touch) and Multifunctional Operational Teams – Lean Laboratory Medicine
6. Utilize new Technology and Biological Knowledge in Genome, Proteome, Metabolome and Microbiome for new Diagnostic
Applications – The New Biology, Systems Thinking and Science Integration
7. Designing IT / ICT / IST for Process Management, Flow of Data, Access of Information and Knowledge Sharing – Lean
Process Design for Lean IT, Impact of Internet and Social Media
8. Transforming Leadership towards Teaching, Coaching, Motivation and Self-sustaining / Empowered Operational Teams –
Lean Management / Quantum Leadership
9. Shifting Quality Focus from End Product to Process Quality through Continuous Improvement Culture for Medical
Excellence, Operational Excellence and Patient Safety – Lean Six Sigma and ISO Synchronization
10.Shifting Healthcare / Medical Diagnostic Operations towards a Biological Adaptive Business Model generating Power
through Collaboration – Participation, Responsibility, Accountability, Flexibility and Growth
11.Developing Relationship IT / IVD Industry, Medical Diagnostics Laboratory and Healthcare for Innovation - Lean Extended
Value Stream and Innovation Sourcing, Ecological Approach
12.Educational Programs for improving Diagnostic and Scientific Knowledge Base , Operational Management Competence and
Skills for Team Operations, Productivity and Value for Money – Lean / Biological Systems Thinking / Lean Higher Education