Presented by:

Karissa Craig

Lean Change Agent, Geisinger

Objectives:

Interactive activity to

practice concepts learned

Problem Solving and basic lean concepts

Key components of

a successful lean

transformation

Lean is more than a set of

tools

The application of lean in

Healthcare

• Lean is all about looking at things from the customer’s (or patient’s) perspective to deliver the highest value.

• It focuses on improving culture and processes so that we can deliver the best experience possible to patients.

• Front-line employees are developed and empowered through problem-solving and coaching.

• Leadership is also developed alongside of an effective daily management system.

3

Lean Transformation at Work

4

https://youtu.be/zHc5U38ZcU8

The Lean Management System

5

2000s 1990s 1980s 1950-1970

Toyota Production System is developed at Toyota and shared with domestic suppliers.

Shared with all of Toyota’s suppliers and other automobile OEMs.

Adopted by other assembly and manufacturing industries

Adopted by other industries such as hospitals, healthcare systems, banks, retailers, logistics, hospitality, airlines and the military.

Successful Components of Lean Transformation

Improvement System

Lean Leadership

Mindsets & Capabilities

Performance Management

Voice of Customer

Customers are the actual and potential users of our services

Patients are the primary customers of healthcare organizations • Internal/External customers • Primary/Secondary customers

8

Who is our customer?

3 Lean Categories

Lean divides all work into three categories to determine if they are waste

9

Time Spent Adding Direct

Value to Patients/

Customers

Time Spent on Necessary

Tasks that May Not Add Direct

Value to Patients/

Customers

Time Spent on Unnecessary

Non-Value Activities

8 Wastes

10

Excess

Processing

Waiting

time

Wasted

Intellect

Value Added

Over- Production

Rework

Wasted Motion

Excess Inventory

Wasted Transportation

Capabilities of people

that are not used or

leveraged

Waiting for ANYTHING

Unnecessary

effort to get the

work done

Unnecessary

movement of work

Work that is

waiting to be

processed

Producing unnecessary work

or deliverables

Correcting

error/defects

People moving or working

without producing

Activity

Rules:

• One person starts by holding 1 ball. • The ball must pass through each person’s hands once

each cycle. • The ball must start and stop at the same person- This is

one complete cycle. • Not allowed to pass the ball to the people standing

directly next to you • Two people cannot touch the ball at the same time • The team must complete 3 cycles without dropping

the ball. A dropped ball is a quality defect and you must start over

• Form Teams of 7-10 people & Stand in a Circle. • Decide who will be the timer.

• How did that process feel?

• What wastes did you observe?

14

Problem-Solving is More Than Tools

15

Improvement Project

Current Condition

Improved Condition

Old vs New Thinking

4-Step Problem-Solving Approach

16

Confirm &

Sustain Describe

the

challenge

Identify root

cause

Develop

Counter-

measures

1

2

3

4

Customers

Patients

Members

Problem A3- [TITLE] Sponsor(s):

Strategic Priority Alignment: Team Lead (s)

1. Describe the Challenge

Problem Statement:

Background / Business Case:

3. Hypothesis Testing / Develop Countermeasures

Metric Baseline Target Benchmark

Team:

Last updated:

2. Identify Root Causes

Understanding Current State: What is currently happening?

Target Condition / Goal: What Should be happening?

4. Confirm & Sustain

What is the problem or gap to be solved?

Why the problem or gap to be solved.

What is currently happening today?

What should be happening?

How will we know we are successful in

solving this problem?

Who is closest to the process that should be involved in problem-solving?

What are the potential root causes of the

identified problem?

What potential solutions are we

trialing and implementing to remove

the root causes?

How will we know we have

sustained the improvement?

18

Root Cause Analysis Basics

19

SYMPTOM of the problem

Underlying CAUSE below the surface

The word “root”, in root cause analysis refers to many causes, not necessarily just one.

The 5 Whys

Problem

description

Problem

definition

Symptom

Why?

Why?

Why?

Why?

Why?

Symptom

Symptom

Symptom

Root

Cause

5 Whys Saved the Jefferson Memorial The stone on the Jefferson Memorial was crumbling

Solution: Delay the daily lighting to one hour after sunset. Midge population is down 90%, they have broken the food chain and there are less frequent washings.

Example provided by Juran Institute

1. Why was it crumbling?

Too frequent washings were causing the stone to crumble

2. Why was it washed so often?

To remove bird drippings

3. Why were so many birds in the building?

There is an abundant food supply: hundreds of little fat spiders1

4. Why are there so many spiders?

Spiders were attracted to the midges

5. Why were there so many midges? Every evening at dusk they emerge in a mating frenzy. At the same time, the Park Service turns on its powerful spotlights. The midges are then attracted to the lights.

Don’t Jump to Solutions

• Why do we want to break this habit?

• How do we change this mindset?

Before I state the problem are there any solutions?

Improve the process, remove root causes and eliminate waste.

23

Error-

proofing

Process

Redesign

Visual

Management

Standard

work

24

Everybody SEE

Everybody KNOW

Everybody ACT

25

26

Visual

Management

cycle

27

Process

Redesign

28

Reduce the time it takes to

complete a given step

Reduce the number of

steps

Complete steps in parallel

Reduce time in between

steps

Basic Lean Concepts

Before process redesign

29

After process redesign

30

Standard

work

Reduces

Variability,

Redundancy,

and

Inflexibility

31

3 Methods for Standardizing Operations

32

1. Make timing consistent

2. Make roles and responsibilities consistent

3. Make materials and information consistent

33

Error-

proofing

What examples can you

think of?

34

How can these basic lean concepts be applied to remove waste in Round 2 of the Tennis Ball Activity?

35

Error-

proofing

Standard

Work

Visual

Management

Process

Redesign

Apply 4 steps of problem solving

Use the Basic Lean Concepts to remove waste from the process

Rules:

• One person starts by holding 1 ball. • The ball must pass through each person’s hands once

each cycle. • The ball must start and stop at the same person- This is

one complete cycle. • Not allowed to pass the ball to the people standing

directly next to you • Two people cannot touch the ball at the same time • The team must complete 3 cycles without dropping

the ball. A dropped ball is a quality defect and you must start over

• Stay with same team as you were in for round 1 • Decide who will be the timer.

• How did you feel?

• What lean concepts did you apply?

What is Lean Leadership •Definition: Leadership’s presence in their staff’s work environment, preparing them for change and helping them manage through it.

39

Show respect

• Connect with staff. Show interest in teams’ efforts, individual suggestions and help people with obstacles

Always think of the customer first

• Focus front line and all leadership levels to address patients’ needs first

Be present

• Check the visual management, participate in problem-solving and observe front line

Ask questions

• Develop problem-solving skills through thought provoking questions

• What do you consider to be Lean Leadership?

• What do you do now (or have done in the past) that you might consider Lean Leadership?

40

Successful Transformations

41

Successful transformations require leaders to lead the change journey. Lasting impact is hard to achieve.

Results of transformations1

~70% of transformations fail because management behavior undermines the

transformation and employees are often not empowered

SOURCE: 1 Beer and Nohria (2000); Cameron and Quinn (1997); CSC Index; Caldwell (1994); Gross, et al. (1993); Kotter and Heskett (1992); Hickings (1988); Conference Board report (Fortune 500 interviews); press analysis; team analysis

Program fulfils objectives Employee resistance

Management behavior does not support change

Other obstacles

Insufficient resources

Successful Transformations Successful transformations require leaders to lead the change journey…and leadership behavior is crucial

42

1

Leadership is critical to inspire the

transformation – role of the

sponsor creating a movement

2

Leadership matters to role model and drive the transformation – role of

the managers during the transformation

to ‘go and see’

3

Leadership is the backbone of

sustainability and continuous

improvement

What message do you think this picture is illustrating?

43

Stages of Change As individuals move through stages of change, they experience a variety of responses

44

Concern

Will I

be

able to

do it?

Something

is finally

going to

change Change?

What

Change?

What

impact will

it have?

How will it

affect me?

It is more

than I

expected!

Who

am I?

I'm going!!

This is not

for me!

I see a

future for

myself

It works and

is effective!

Relief

Denial

Fear

Threat Dejection

I'll prove that

it is

unnecessary!

Disappoint

ment

Hope

Confidence

Animosity

What can you do to stay motivated and to

motivate others?

• Shares Best Practices

• Encourages Learning & Reflection

• Drives key behaviors

• Role models collaboration

• Allows staff time to do problem-solving

• Creates a safe space

• Allows the team to fail forward fast

46

Continuous Improvement

47

Time! Calendars! Meetings! … “Oh my!”

Workload variability

Lack of feedback loops to support the development of ideal behaviors

Dependent on lagging indicators to determine success

Geisinger is geographically dispersed

Firefighting

Other non-value added work

•Lean Leadership is a responsibility for each level of leadership from executive leaders to front line managers

48

Map your standard work

Role Model Lean Leadership–

including good change

management

Support your direct reports - including accountability for

change and improvement

Lean Leadership & the 4 Key Areas that Need to be Implemented Into Your Week in the Life of (WILO)

49

Action

Gemba - understanding

the frontline

Engaging in problem-

solving sessions

▪ Conduct in-person floor visits to understand

state of operations, confirm processes and

identify issues before they arise

▪ Actively lead your management team in

problem-solving sessions on their most

challenging priorities

Conducting regular

discussions about

performance

▪ Have group-based performance

management discussions with direct

reports and connect performance to vision

Coaching

▪ Actively provide coaching and feedback to

all staff in an informal or formal manner

Week in

Life of

a Lean

Leader

(WILO)

Description

Bringing it all together

Improvement System

Lean Leadership

Mindsets & Capabilities

Performance Management

Voice of Customer