what have we learnt about lean?
TRANSCRIPT
What have we learnt about Lean?
Daniel T Jones
Lean is everywhere
But there is still much confusion Are we really doing Lean?
New ways of seeing the Work
From batches to Flow – model cells & lines
From MRP to Pull – to real not created Demand
Stabilise steps & Standardise work
Quality at source – never pass on defects
Make deviations &problems visible
See the whole value stream
Learnt through using the Lean tools
Software followed a parallel path
Agile – frustration with Waterfall & autonomy
Continuous Programming/DevOps – from batch to Flow
Scrum/Kanban – review cadence & pull the work
Extreme Programming/XP – standard & testable code
SOA/Amazon – modular architecture & daily releases
Lean Startup – frequent experiments & user feedback
Agile & Lean need to work together
Getting management involved“Do it for me” does not work
Runs up against MBO & financial targets
Need to show that “better processes lead to better results”
Better quality & responsiveness grows SalesCreating Flow releases Cash
Increased throughput lowers CostSimpler assets/systems saves Capital
What is your business problem?
Sustaining the gains
“Do it to others” – works for a while
Experts & Programmes – come & go!
How to help the front-line to learn to do it themselves?
And really get it by practicing it every day!
This has to be the responsibility of line management
Supporting learningMaking work transparent and visual
Regular reviews of P/A & responses
Coaching problem solving using A3 & PDCA
Capturing “ah ha” insights for the future
Later linking improvements along the value stream
Deselecting & aligning activities to close key performance gaps
A M J J A S O N D J F MX X X X X X Visual Hospital X X X X X X X X X X X X XX X X X X X X X X X X X X X X X X X X X X X X XX X X X Integrated 7 day working at back door X X X X X X X X X X XX X X X X X X X X X X X X X X X XX X X X X X X X X X X X X X X X X X X X X XX X X X X X X Pathway redesign X X X X X X X X X X X X X X X X X X XX X X X X Theatre utilisation X X X X X X X X X X X X X X XX X X X Endoscopy utilisation X X X X X X X X X X X X X X
X X X X X X X X X X X X X X
On TargetNot on Target or Missed
X X X X X X X X X XX X X X X X X X X X XX X X X X X X X X X X XX X X X X
X X X X X X XX X X X X X X X XX X X X X X X X X XX X X X X X X 061011 version 9
Release 9438 bed days in surgeryRelease 24627 bed days in medicine
Release of 735 OPD clinicsReduction of 1993 readmissions
Integrated Urgent Care Centres to release 2393 bed daysIncrease of 96 day cases
Imple
menta
tion o
f Urg
ent C
are S
tanda
rds
OPD new/ F/U ratio
Imple
menta
tion o
f Plan
ned C
are S
tanda
rds
Finan
cial B
alanc
e
Impr
oved
The
atres
/End
osco
py U
tilisa
tion
Rede
sign o
f fro
nt do
orLe
ngth
of Sta
y Red
uctio
nIm
prov
ed ac
cess
to pl
anne
d car
e - O
PD &
diag
nosti
cs
15%
redu
ction
in su
rgica
l leng
th of
stay
Redu
ce be
d occ
upan
cy to
95%
Transformation Deployment Matrix - Work Streams - Trust Level 2011/12
Integrated Urgent Care Centre
Plan for Every Patient
Senior daily review
Increase of 86 lists in endoscopyPotential efficiency equal to 4221 cases in theatres
15%
redu
ction
in em
erge
ncy m
edica
l leng
th of
stay
Plann
ed C
are A
cces
s - H
eathe
r Car
ter
Thea
tres &
Endo
scop
y - H
eathe
r Car
ter
Urge
nt Ca
re A
cces
s Ann
e Sym
on
50%
redu
ction
in on
the d
ay ca
ncell
ation
s
Leng
th of
Stay -
Dav
id Fu
rley
Read
miss
ions w
ithin
30 da
ys -
25%
redu
ction
25
% re
ducti
on to
ward
s 08/
09 ad
miss
ions l
evels
in E
D
Incre
ase d
ay ca
se ra
te by
25%
for s
elect
cond
itions
Incre
ase t
heatr
e utili
satio
n to 8
5%
Incre
ase d
ischa
rge r
ate to
mee
t tak
t 7 da
ys
Incre
ase e
ndos
copy
utilis
ation
to 92
%
Achie
ve 25
% re
ducti
on in
Outp
atien
t foll
ow up
s15
% re
ducti
on in
LoS f
or 5
ambu
lator
y path
ways
TRAN
SFOR
MATI
ON P
RIOR
ITIE
S
TIMELINE
TTT
TARGETSTARGETS
PROJECTS
TTT
PROJECT DELIVERABLES
TOP
LEVE
L MET
RICS
Leading and LearningThousands of problem solvers
learning to stabilise & practice PDCA
Lead by questioningchallenging& enabling
Leaders learn toface find & frame problemsby coaching the front line
The true power of Lean5% a year plus 30% every product generation
Through cumulative incremental improvements
40% less capital & operating costs
Capability to meet green challenges
Supply chain 97 weeks to 24 days
Digital connectivityIs transforming every sector
media, retail, mobility, money, health etc.
Technical capabilities + social organisation + user acceptance
Two way dialogue with communities of expert users agreed on sharing & privacy
Learn to think back from users
Based on frequent experiments, validated learning & continuous improvement
Meaningful work
Squads Teams KaizenChapters Knowledge Mastery Tribes Streams Purpose
Actions to support Teams = Leadership
How to avoid “Big Company” disease as you scale?
How to mobilise your “Smart creatives”
Conclusions
Making things better the ability to do more with less waste
Meaningful work developing capabilities with others
Managing by sciencewhether hardware or software
knowledge or physical work
What have we learnt about Lean?
Daniel T Jones
@DanielJonesLean