lean management & the lean in daily work model foundations for successful leadership
TRANSCRIPT
Lean Management & The Lean In Daily Work Model
Foundations for Successful Leadership
Learning Objectives
- Gain a foundational understanding of Lean Thinking & Concepts
- Understand the difference between Traditional Management and Lean Management
- Become familiar with the Lean In Daily Work Model – including the important role of the supervisor within the model
- Learn how to support your staff in surfacing waste and addressing problems on a daily basis
- Recognize the true value managers can provide to their teams through the application of leadership standard work
What is Lean Thinking?
“The endless transformation of waste into value from the customer’s perspective”.
---Womack and Jones, Lean Thinking
To increase Value Added Work and reduce Waste to Increase Throughput, Lower Cost and Improve Quality
Lea
d T
ime
The Objective of Our Lean Work
What Is Waste?
Waste can be found:• In areas with lots of rework• Areas experiencing long wait times• Process steps requiring multiple reviews and revisions• Areas where multiple handoffs occur within & across depts.
Any element of the process that adds no value to the final product or service
Waste only adds cost & time to a process
How Does Waste Affect Me?
• Causes physical fatigue• Causes emotional fatigue• Increases frustrations• Increases stress• Causes you to blame others • Steals your time
• Pacing by Demand
• Continuous Flow
• Pull Systems
Just-in-Time Built-in Quality
• Error Proof
• Surface Problems
• Stop and Respond to Abnormalities
• Solve Problems at Root Cause
Health Care House – Sources: J. Shook, J. Billi, J. Liker, S. Hoeft, J. Womack, Park-Nicollet. Revised 5/09 W. Walters
Make Value Flow by Eliminating Errors and Waste
LeveledWorkload
Continuous Improvement (P-D-C-A) and Learning
Standard Work
Safe – Effective – Patient Centered – Timely – Efficient - Equitable
Customer Defines
Value
Foundational StabilityVisual Mgmt
Mutual Trust
Lean is a system...
Visual Mgmt
StandardizedWork
ErrorProofing
QuickChangeover
Load Leveling
Andon System
Flow & Pull Systems
Problem Solving & Value Stream
Mapping5S
Traditional vs. Lean Structure
Traditional Team Structure
Team Members
Leaders
Lean ThinkingTeam Members
Leader
In a traditional team structure, Leadership is often looked at as the ultimate customer and employees primary duties are to carry out the wants and needs of management. There is usually very little input from the employees on how business operations can be improved.
The Lean Leadership model is often described as an inverted triangle with team members as the largest base on top all the way down to Leadership supporting the team members on the bottom. It is a true servant leadership approach where Leaders develop the capacity to support team members in improving what needs to be done.
Create a Fear-Free Environment
• Fear…–Makes people defensive–Keeps issues submerged for years–Creates a crisis orientation
• Use information to drive improvement –NOT pass judgment
How can we create (liberate)“20,000 problem solvers”?
• Help each worker take initiative to find and fix causes of problems he/she faces daily– This means each of us has two jobs:
• Do the work• Improve the work
• Leaders’ role:– Support improvement work (time, mentoring)– Align improvements so value flows to the
customer
Modified from John Shook
Value Creating Work of Management
• Gain agreement on what is important. (which must be to solve customer problems)
• Engage and mentor workers to be problem solvers (through performing the above work in dialogue)
• Create brilliant process to achieve what is important
• Create stable process and continuously improve
Adapted from Womack on Lean ManagementPresented by LEI
Key Metrics: Define, Measure, & Display
Routine Interactions to Identify Problems
Problem Solving Approaches
Transfer Knowledge for Shared Learning
*Links to strategic deployment *Part of daily standard work *Design and run experiments *Share across organization
Hourly / daily key operational
metrics and targets
Daily / weekly cumulative counts of complex problems
Daily team huddles at
visual board
Daily leadership walks in the gemba(also wkly/mthly)
Monthly review & problem prioritization
by team leads
“Just Do It”no written
plan needed
“Everyday Lean Ideas”structured form
(8.5”x11”)
“A3 Problem Solving”structured form
(11”x17”)
The Lean In Daily Work Model: Standard Work for Daily Problem Solving
Assessment of Problem Complexity
Triage based on problem complexity
Low
High
Med. Share learning from experiments
across UMHS
*Takes place in the gemba
Problems
Problem
s
Problems
Baseline Lean Culture Survey
This survey is taken prior to implementing the Lean In Daily Work Model and again, a few months or so after the team has
built the model into their daily work
Employees
Management
Employees
Mgmt
Value Metrics
• To be successful, we must base all of our improvement efforts on what our customers value most
• By clearly defining this value (as a metric), it will serve as the compass to tell us when we are on course & when we need to improve
Without clearly defined Value Metrics,
Value Metrics Need To Be…
• High-level enough to represent the over-arching Value we deliver
• Allow us to surface many different problems related to the Value Metric (vs. focusing on a specific problem)
it would be impossible for us to continuously improve
Value Metric Traits
• Traits of Value Metrics:
High level enough to represent the over-arching Value we deliver
Are best measured in small increments – by hour, by day, etc.
Do not require intense, pain-staking review in order to measure
Connect directly to what our customers tell us they value
Connect directly to departmental and institutional priorities
Value Metric Examples
Patient Relations -Customer: Patients and Patient’s Families (External)Customer’s Value: Timely & successful resolution of grievancesValue Metric: “Successfully resolve 80% of all patient grievances within 10 days”
Cardiac Procedures Unit – Customer: Patients (External), Ordering Physicians & Clinical Units (Internal)Customer’s Value: Timely & accurate completion & interpretation of ordered Surface ECHOsValue Metric: “Complete, Read & Accurately Interpret 100% of all inpatient Surface ECHOs ordered before 10 am – before the end of the business day”
Urology Taubman Clinic– Customer: Patients (External), Physician (Internal)Customer’s Value: Having the right records available during the clinic visitValue Metric: “100% of outside New Patient records received, reviewed, and imaged prior to clinic visit”
Pro Fee Payment Posting – Customer: Patients (External) & Clinical Departments (Internal)Customer’s Value: Timely posting of paymentsValue Metric(s): Post 100% of payments within 3 days of receipt
Orthopaedics Surgery Clinic – Customer: Orthopaedic Patients (External)Customer’s Value: Expeditious clinic visit (while still meeting needs)Value Metric(s): 80% of patient visits to be completed within 1 hour
What do all of these examples have in common?
Brainstorm Possible Team Value Metrics - Team Activity
Process Check At 20 Minutes
Visual Management
Attributes of visual management tools:
• Create “status at a glance” – enabling quick and simple detection of normal vs. abnormal operating conditions
• Provide clear information actionable at the point of communication
• Be maintained by those carrying out the workThose performing the work are the first to detect abnormalities
• Provide a clear and common understanding of goals & measures
• Allows employees to align their actions and decisions with the overall strategic direction of the department
The scoreboard provides real-time information about important game parameters to be monitored
• What is the score of the game?
• What is the batting avg. of the hitter – should we pitch differently to him based on it?
• What inning is it?
• What is the count?
• Was that a ball or strike?
• How many hits, errors?
• How are the other teams in the league performing today?
Visual Management - Example
Baseball Scoreboard
The scoreboard answers important questions about the status of the game – it tells us how our team is doing in relation to the Goal…Namely to win the game!!!
Questions to be answered: • What will the visual display look like?
How will it display the Value Metric and the current status?
How will problems be captured?
Where will the visual board be located?
Who will maintain it?
How often will the Value Metrics be updated?
Identify how the team might respond (Andon) to surfaced problems?
• Develop action plan for implementation of the visual display
Who, What, By When
Developing LIT’s Level 1 - Visual Management System
Urology Adult Clinic Visual BoardOngoing Visual Monitoring
Of Value Metrics
Value Creating Work of Management
• Gain agreement on what is important . (which must be to solve customer problems)
• Engage and mentor workers to be problem solvers (through performing the above work in dialogue)
• Create brilliant process to achieve what is important
• Create stable process and continuously improve
Adapted from Womack on Lean ManagementPresented by LEI
Why Huddle?
• Make Our Customers The Focus Of Our Improvement (Through Our Value Metrics)
• Builds Stronger Staff Morale
• Improves Communication
• Gives Everyone On The Team The Ability to Surface “Waste” & Solve Daily Problems As A Team
Team Huddles
• The team meets at the visual board at a regular frequency (ideally on a daily basis)
• The board is reviewed to determine the status of the value metrics
• The team documents the waste / problems standing in the way of improving the value metric
• An Everyday Lean Idea (E.L.I.) form is initiated for identified wastes / problems the team has influence over and can be easily solved (process description to follow)
• A volunteer is identified to take ownership of each E.L.I. with responsibility to report back on progress at the next huddle
• The process repeats during the next huddle
Everyday Lean Idea (E.L.I.) Process
ELI’s Should Be Initiated Any Time You Have An Idea, Whether In Between Or During A Huddle
• Initiate a few Everyday Lean Idea (ELI) on a common everyday problem
Familiarize yourself with the form in order to better facilitate your team’s use back in your home area
Practice completing the form, thinking through the waste and potential solution
Be prepared to report out on one of your Everyday Lean Ideas
Break-out Activity
Leadership Gemba Rounding
“Gemba” is a Japanese term meaning “the place where the truth can be found” – for us this means the actual place where the work is being done
• Leadership Gemba Walk Route & Instructions
• Calendar for Leaders to initial upon Walk completion
• Leaders’ Open Issues Tracker Or equivalent form
• Everyday Lean Idea Visual Status (ELVIS) Or equivalent form
• Summary of “What the Patients Are Telling Us” Direct Feedback During Walk Survey completed at end of visit Other input mechanisms
• Summary of Key Success Measures
1. Leadership reviews monthly calendar of standing meetings – seeks to identify up to 3 hours of meeting time per week to be replaced with Gemba time
2. Leaders create their visual management board (Which Includes):
Leadership Gemba Rounding
Orthopaedic Taubman Visual Leadership Board
Visual evidence of Leadership Gemba Walks Open Issues Tracker
Patient FeedbackSuccess MeasuresELI Feedback
Leadership Gemba Walk Standard Work & Layout
Why Go To The Gemba?
• Supports Continuous Improvement By Allowing Us To:
Observe the process first hand rather than making assumptions
See the entire value stream
Identify & observe problems & waste
Observe process changes
Monitor sustaining of gains, compliance with standard work, and the determination of root cause for problems that surface
“Your ears will lie to you, but your eyes never will”
References on Gemba Benefits: Baptist Health Care Leadership Institute
Why Go To The Gemba?
There are many benefits when a Leader adopts regular Gemba Activity as a part of their Leadership Standard Work;
• Leader Benefits:
Helps you to better know your staff
Builds relationships / Solicits feedback
Gives you opportunities to teach, train and share information
Engages and empowers your staff
Reveals areas where improvement is needed
Establishes who should be rewarded and recognized
Ensures quality and safety of services provided
“Your ears will lie to you, but your eyes never will”
Why Go To The Gemba?
There are many benefits when a Leader Includes Regular Gemba Activity Into Their Leadership Standard Work
• Staff Benefits:
Emphasizes that the environment is one of open communication
Gives employees increased access to leaders
Enables staff to be recognized for service excellence
Builds trust between staff and leadership
Allows staff to communicate the biggest barriers & challenges
Ensures quality and safety of services provided
“Your ears will lie to you, but your eyes never will”
Why Go To The Gemba?
There are many benefits when a Leader Includes Regular Gemba Activity Into Their Leadership Standard Work
• Patient Benefits:
Observes caring behavior on the part of leadership
Perception of service improves
Feels valued through being given the opportunity to share information
Inspired to loyalty
More likely to recommend the organization to others
“Your ears will lie to you, but your eyes never will”
Leadership Behavior during Gemba Visits
Key Questions for Lean Leaders to ASK OFTEN!
• What problem are you working on now?• What was the last experiment you tried?• What happened?• What did you learn?• What do you plan to try next?
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- Get in groups of three
- Identify a Problem Owner, a Lean Leader, and an Observer
- Problem Owner: briefly describe the problem
- Lean Leader: practice “asking effective questions” that are framed around “pure inquiry” (use handout as a guide)
- Observer: provide feedback on how the Lean Leader did (both positive things and opportunities for improvement)
- Switch roles (repeat until everyone has a chance to play each role)
Practice “Asking Effective Questions”Use Mentoring / Coaching Handout as a guide
Reflection on Exercise
The Lean In Daily Work Model is a System
• Visual Metrics in the Absence of Team Huddles & Leadership Gemba Walks Quickly Becomes Wallpaper…
• Team Huddles & Leadership Gemba Walks in the Absence of Visual Metrics Quickly Becomes a Social Event…
Value Creating Work of Management
• Gain agreement on what is important . (which must be to solve customer problems)
• Engage and mentor workers to be problem solvers (through performing the above work in dialogue)
• Create brilliant process to achieve what is important
• Create stable process and continuously improve
Adapted from Womack on Lean ManagementPresented by LEI
Solving Problems Allowing Rapid Knowledge Spread
Lean Implementation Teams
L.I.T. S.P.A.R.K.S.
Over 500
Implemented
Ideas To Date
Primary Goals Key Measures of Success UMHS Strategic Alignment
Lean In Daily Work Process Sustained Monthly audits taking place in each Pilot area,
surfacing necessary corrective actionsSustaining Gains
Continuous Problem Solving
on Relevant Issues
500+ Everyday Lean Ideas Implemented as of 7/2011 (Many more in queue!!!)
People Development, Process Improvement, Service Excellence &
Lateral Spread
Improvement & Sustaining
of Value MetricsIn excess of 80% Improvement to team’s Value Metrics
Strategic Deployment, Process Improvement &
Service Excellence
Improvement in Lean Culture Survey Score
51% Improvement In Overall Score115% Improvement In “Willingness to Recommend”
People Development & Service Excellence
Evidence of Model Spread / Mentoring
Relationships
Proactive Mentoring from Established LIT Teams to New LIT Teams
Lateral Spread
Key Measures of Success / Strategic Alignment
Lean Leadership Articles
• We will be following up with these two articles
• After reading, list specific behaviors that you can practice and that can be observed by others.
– Commit to practicing before, during, and after Leadership Walks
– Can you think of a way to measure your own personal progress?
Focus of Master’s Course (addressing more complex problem)
• Creating a Visual Prioritization System for these more complex problems
• Building Structured A3 Problem Solving into existing meetings
Learning Objectives
- Gain a foundational understanding of Lean Thinking & Concepts
- Understand the difference between Traditional Management and Lean Management
- Become familiar with the elements of the Lean In Daily Work Model – including the important role of the supervisor within the model
- Learn how to support your staff in surfacing waste and addressing problems on a daily basis
- Recognize the true value managers can provide to their teams through the application of leadership standard work
Lean In Daily Work Train the Trainer Sessions Offered
The Virtual Lean Resource Center*Many additional resources available, below is a sample of the most utilized resources
http://www.med.umich.edu/i/quality/tools/lean_assist.html
• Requests for Lean Assistance– https://umichumhs.qualtrics.com/SE/?SID=SV_0MmahvI58YJgukQ
• Lean Coach Office Hours– https://wiki.umms.med.umich.edu/x/QZNSBw (unique ID and level 1 Kerberos password)
• Specific websites dedicated to… – Lean in Daily Work (https://wiki.umms.med.umich.edu/x/HgCwAw (unique id and level 1 Kerberos password)
– A3 Structured Problem Solving (https://wiki.umms.med.umich.edu/x/HgCwAw (unique id and level 1 Kerberos password)
– Value Stream Mapping (https://wiki.umms.med.umich.edu/x/rIIyBw (unique id and level 1 Kerberos password)
• In the Planning Phase…– Lean Networking Groups to share improvement work & address common
challenges
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Click on the Virtual Lean Resource Center
http://www.med.umich.edu/i/quality/about/mqs.html Click on this to directly link to the MQS Homepage
Michigan Quality System & Lean References
Books:• Womack J, Jones D. Lean Thinking.• Liker J. The Toyota Way; Liker J, Meier D. The Toyota Way Fieldbook.• Shook J. Managing to Learn.• Dennis P. Getting the Right Things Done.• Rother M, Shook J. Learning to See.• Womack J, Jones D, Roos D. The Machine That Changed The World.• Sobek D, Smalley A. Understanding A3 Thinking.• Marchwinski C, Shook J, eds. Lean Lexicon.• Bahri, S. Follow The Learner: The Role Of A Leader In Creating A Lean CultureArticles:• Kim CS, Spahlinger DA, Kin JM, Billi JE. Lean health care: what can hospitals learn from a world-class
automaker? J Hosp Med. 2006;1:191.• Bush R. Reducing Waste in the US Healthcare System. JAMA 2007;297:871.• Spear S. Fixing Health Care from the Inside, Today. HBR. 9/05.• Spear S. Learning to Lead at Toyota. HBR 4/04 • Spear S. Decoding the DNA of Toyota Production System. HBR 9/99• IHI Whitepaper: “Going Lean in Health Care”
www.ihi.org/IHI/Results/WhitePapers/GoingLeaninHealthCare.htm Web: • Michigan Quality System at UMHS: med.umich.edu/mqs• Lean Enterprise Institute: www.lean.org webinars, books, meetings…• Ideal Patient Care Experience at UMHS www.med.umich.edu/i/acs/ipe.htm • Crossing the Quality Chasm (IOM): newton.nap.edu/catalog/10027.html • Lean Enterprise Academy (UK): www.leanuk.org • National Health Service (UK): www.networks.nhs.uk/networks.php?pid=211
Questions / Comments?
Contact Information:
• Brendon WeilLean Coach, University of Michigan Health [email protected]
• Kevin DeHorityLean Coach, University of Michigan Health [email protected]