1 housestaff lean academy module 1: lean principles for physicians robert martin, psyd performance...

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Housestaff Lean Academy

Module 1: Lean Principles for Physicians

Robert Martin, PsyD

Performance Excellence

UCLA Health

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Module # Module Description

1 Lean for Physicians (Important Concepts)

2 Focusing Improvement Projects/Efforts (Methods Overview)

3 Managing the Improvement Process (PDCA/A3)

4 Understanding the Current State (Process Mapping)

5 Identifying Waste in the Current State (5S, Waste, Standard Work)

6 Analyzing the Current State I (Organizing & Using Data)

7 Analyzing the Current State II (Organizing & Using Data)

8 Identifying Improvements & Actions (A3 Simulation)

9 Working as a Team (Frontline Empowerment & Engagement)

10 Understanding & Leading Change

11 Supporting Infrastructure (ADM, Huddles, A3/A4 Methodology)

Where does this module fit into the curriculum?

Module 1 Agenda…

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Physician Process

vs. Lean ProcessOrigins Important Concepts Post Questions

Physician Process

vs. Lean ProcessLean Origins Important Concepts Post Questions

Lean should be a familiar process for Physicians…

Scenario – a patient arrives with a problem (clinic, ED, etc.). What is the Physician’s process?

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Physician Process

Conduct Health & Physical

Develop Initial Diagnosis

Order Tests

Analyze & Understand Data

Develop Treatment Plan

Try, Measure, Adjust It

Lean Process

Understand Scope (Charter)

Develop Problem Statement

Conduct Observations & Collect Data

Analyze & Understand Data

Develop Improvement Plan

Try, Measure, Adjust It

Notes

Neither process jumps to solutions

Both processes involve the patient

Both processes use data

Both processes use the Scientific Method

QI & Lean call “The Scientific Method” PDCA (Plan-

Do-Check Adjust/Act)

Physician Process


Lean is a modern term, but the origins are not…

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Venetian Arsenal

• 1 Warship/day

• Standardized Parts

• Use of canals to flow galleys to workers

through assembly phases

UCLA Operating System

Established by Amir Rubin

1500s 1780s1908-1926

Scientific Management – Frederick Taylor

• Scientific study of tasks

• Employee development and training

• Managers use principles to plan work and

workers perform tasks

French Army Ordinance

• Concept of interchangeable parts for

muskets (pre-cursor to high-volume

flow production

American Meat Packers

• Conveyor belts to steadily remove

carcasses past workers after meat

removal

1880s 1890s1902- Present

Jidoka (1902)

• Sakichi Toyoda invents device to detect

broken threads in looms autonomously

Just-in-Time (1937)

• Kiichiro Toyoda establishes Toyota, has the

idea for JIT delivery of parts

Henry Ford

• 1908 Model T modular car with truly

interchangeable parts “there are no

files in my factory”

• 1913 Flow Production Moving assembly

line with processing feeder lines

• 1926 Mass Production with product

variety

1930s

Takt Time

• German aircraft industry pioneers use takt

time for synchronizing movement of

aircraft

• Mitsubishi brings idea back to Japan where

Toyota embraces it

1940s

Training Within Industry

• US Dept. of War introduces Job Instruction,

Methods, Relations to teach millions of

workers in war industries. Later

introduced to Japan after the war

1960s

Deming Prize

• Japanese Union of Scientists and

Engineers creates Deming Prize for

statistical quality and PDCA

1980s - 2009

Lean Research

• Toyota Production System (1982, Yasuhiro Monden)

• The Machine that Changed the World (1990, Womack,

Jones, Roo)

• Lean Thinking (1996, Womak, Jones)

• Learning to See (1998, Rother and Shook)

• DNA of the Toyota Production System (1999, Spear and

Bowen)

• The Toyota Way (2003, Liker)

• Shingo Research Award – Lean Hospitals (2009, Mark

Graban)

Toyota > GM (2007)

• Toyota becomes the world’s largest

automaker

Mission, Vision, Values, Commitment

Strategies

Objective Mgt: Goals,

Operating Plans, Dashboards

Performance Improvement

and Management

UCLA Operating

System

Physician Process


Lean is based on a few important concepts…

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Value

Waste

Scientific

Method

(PDCA)

Empowered

Staff

True North Alignment

Physician Process


Lean is more than a collection of tools….

It is about creating a culture based on a few important concepts.

There are more- but these are sufficient for now!


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Physician Process


Value

Waste

Scientific

Method

(PDCA)

Empowered

Staff


What is Value?

• What patients are willing to pay for

• Value must be discerned

• Lean systems produce what the patient values

What do Patients Value?

• “Timely” Nursing & Physician Time

• Information to participate in choice

• A safe and effective Treatment Plan to become healthy, alleviate their pain and suffering, or restore function

• To be listened to; Trust and Privacy


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Value

Waste

Scientific

Method

(PDCA)

Empowered

Staff


Activity (Individual or self-organized)

• Spend a few minutes to discern what your patients value

• Group Discussion

Physician Process



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Value

Waste

Scientific

Method

(PDCA)

Empowered

Staff


Waste is: the opposite of what patients value…

• Waste hides in complex systems, and healthcare is complex!

• Waste must be understood so that it can be discovered and highlighted as abnormal

Focus on minimizing or eliminating waste:

• Waiting for appointments, to be seen, etc

• Waiting for physician’s orders to be written

• Late/Missing callback for test results

• Clinicians who don’t listen, lack of trust, lack of privacy, etc.

• Administrative errors

• Clinical Errors

• Unnecessary documentation protocols & approvals

Physician Process



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Value

Waste

Scientific

Method

(PDCA)

Empowered

Staff


Activity (Individual or self-organized)

• Spend a few minutes to discern

• What your patients do NOT value (i.e. waste)

• Wasteful activities that inhibit your value production

• Group Discussion

Physician Process



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Value

Waste

Scientific

Method

(PDCA)

Empowered

Staff


The Scientific Method (PDCA) …

• Was discussed earlier!

• Is taught to staff so that they can

• Use data to solve problems

• Support value-added activities

• Minimize or eliminate waste

• Continuously improve

• Also known as Plan-Do-Check-Adjust/Act

• (We are going to have a whole class on this)

Physician Process



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Value

Waste

Scientific

Method

(PDCA)

Empowered

Staff


What does Empowered Staff mean? Why is it important?

• The best ideas from the smartest physicians often result in:

• Passive or Active resistance from staff

• Staff who feel disempowered and disengaged

• No change

• Staff must feel that they “Own” changes which will support value-added activities and minimize/eliminate waste

• They are experts in their areas and have great ideas on how to improve

• Leaders (Administration & Physician) must engage, empower, and align staff

• (We are going to have a whole class on this also!)

Physician Process



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Value

Waste

Scientific

Method

(PDCA)

Empowered

Staff


What would happen if all staff was trained in PDCA, engaged and empowered without alignment to the organization’s

goals?

• Some improvement certainly!

• Likely much silo’d improvement which might sub optimize the system (i.e Schegistration might make their job easier and everyone else’s more

difficult!)

• Improvement can occur at all levels, but always in consideration of linked-activities in the organization

What is True North Alignment?

• A vision or ideal from Leadership that can “rally” the case for change (should be aligned or supports the hospital or SoM vision)

• “Minimally sufficient” strategies and initiatives (3 to 5, not 25 to 75) to focus staff effort

• The most ideal strategies include participation from all layers of management and staff (i.e. catchball) to ensure that they are realistic

Physician Process


Post Questions & Next Module Preview…

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Module # Module Description

1 Lean for Physicians (Important Concepts)

2 Focusing Improvement Projects/Efforts (Methods Overview)

3 Managing the Improvement Process (PDCA/A3)

4 Understanding the Current State (Process Mapping)

5 Identifying Waste in the Current State (5S, Waste, Standard Work)

6 Analyzing the Current State I (Organizing & Using Data)

7 Analyzing the Current State II (Organizing & Using Data)

8 Identifying Improvements & Actions (A3 Simulation)

9 Working as a Team (Frontline Empowerment & Engagement)

10 Understanding & Leading Change

11 Supporting Infrastructure (ADM, Huddles, A3/A4 Methodology)

Physician Process


1 housestaff lean academy module 1: lean principles for physicians robert martin, psyd performance...

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