Lean Healthcare Exchange

In the year 1906 Italian born economist Vilfredo Pareto made a very famous observation while studying the wealth and property distribution in Italy. What he found in his study by applying a mathematical algorithm was that about eighty percent (80%) of the wealth was controlled by only twenty percent (20%) of the people. This fact in itself was not a significant observation at the time but during the early nineteen thirties (1930’s) a management pioneer by the name of Dr. Joseph Juran credited this finding as a significant principle and he surnamed it the “Pareto Principle.” Juran began to apply and generalize this principle often referring to it as the “vital few or the 80/20 rule.” Today a pareto chart is used to graphically display data cause types from largest to smallest in a bar chart form. Using the top twenty percent (20%) cause type application, one can focus efforts toward eighty percent (80%) problem effect resolution by focusing on the first one (1), two (2), or three (3) bars that usually make up twenty percent (20%) of the cause types.

Value Stream Mapping

Value Stream Mapping is probably the most widely utilized lean tool used to analyze business and production systems. The Value Stream Mapping process begins by first establishing the process scope based on the business case scenario (the problem you are trying to solve). Next, a “Current State Map” is drawn using a set of standard icons. The result is a snap-shot in time of the process being mapped.

Value Stream Mapping is somewhat different than other types of process mapping in the fact that both the steps or process flow are shown at the bottom of the map and the information that drives the steps is shown at the top of the map. In addition, all the steps or processes are mapped with one key point in mind; the customer. Knowing and understanding who and exactly what the customer expects is a key tenant in lean. Value Stream Mapping helps to formally clarify what the customers’ requirements are. More importantly, the process and information flows that support that customer are identified. In lean, the organizational challenge is to identify the true customer requirements and develop a process to do only that. This is the essence of lean and the premise that makes Value Stream Mapping a great tool.

Applying the Pareto Principle to Value Stream Mapping:

The third step involved in Value Stream Mapping is called the “Future State Map.” In this step a vision for the future of the value stream is determined. The goal is to improve by focusing on the correct improvement projects that really make a difference and effect the total system lead time. It is in the Future State Mapping step that the pareto principle can be applied. If truly eighty percent (80%) of the results can be driven by the correct twenty percent (20%) of the improvement projects identified then, it is imperative that the correct projects are identified. The pareto principle will hold true in this case if and only if the correct projects are identified and implemented.

Improvements for the future state are identified by systematically evaluating the information flow and key process steps from the Current State Map. In a sense, the Current State Map is used as a launching pad for the Future State Map. This process always begins at the customer. As each step and the information flow is evaluated, brainstorming begins on what might be improved for the future. The value stream lead time which is measured at the bottom of the Current State Map becomes the basis for prioritization of the projects and activities that will be directed to improve the value stream.

The opportunities for improvement that are identified during the Future State Mapping analysis are known as “Kaizen Bursts.” These kaizen bursts are best classified by type of activity that must be conducted or completed in order to achieve the future state vision. Typically, those activities fall into one of three types of activities. First, there are those activities that require a team in some type of dedicated focused rapid improvement activity or what is commonly known as a “Kaizen Event”. Kaizen Events are usually five (5) days in duration and the associates involved are one hundred percent (100%) dedicated to workshop related activities. Second, there are those types of activities that require a focused team approach. In this type of activity, associates may work on and off on a project for a specific amount of time. The associate carries on regular work duties but participates for periods of time with a focused team on project work related to the Future State Map. Finally, there may be individual tasks identified. Individual tasks are activities that do not require a group or a team approach. These tasks are assigned and can be completed quickly utilizing one person.

How Does One Eat An Elephant?

The age old question of “How do you eat an elephant?” is very applicable when it comes to implementing the future state map. One simply cannot eat an elephant all at once. It must be consumed one bite at a time. The same is true with value stream mapping. There are usually many projects and activities that can be improved within a given value stream. There can be so many items identified to improve that an organization can become consumed with activities to do. Without focus, Value Stream Mapping will not just open up a can of “to do” but it may open up an entire case of it.

The pareto principle will keep the organization focused on the one bite at a time. Not only will it be “one bite at a time” but it will be the correct bite first. In order to do this, the correct twenty percent (20%) of the projects must be identified. This is simply determined by relating the projects to the effect on the lead time as a basis for selection. In general this will narrow down the projects greatly. The cream always rises to the top and the vital few are born.

Implementation

Value Stream Mapping is a great tool. It really helps the organization to see the whole related to the customer. However, in the end it is just a tool. It is not lean in a bottle. The end result of the initial activity is a vision for the future called the Future State Map and a plan to implement it. That is it. So, what should we say then? “Go get busy and do it!”

This week’s article was written by Ronnie Daughtry. Ronnie is Manager of Project Operations and a Senior Lean Consultant with The ACCESS Group (TAG) , HPP’s affiliate company. He has over seventeen years of experience holding various leadership and managerial roles in lean manufacturing, continuous improvement, supplier quality engineering, manufacturing operations, and human resources. The balance of his various leadership roles have been in the automotive sector for Robert Bosch Corporation in many locations in North America, South America, and Europe.

The Scientific Method tells us to start our problem-solving activities by clearly defining the “problem."

Remember PCSAM: Problem-Cause-Solution-Action-Measure. But what is a Problem? And how do you clearly define one? Unfortunately, because this critical first step required to truly eliminate problems requires some time and effort, we usually just work with the Symptoms of the Problem. This leads to dealing with those problems on a recurring basis, which of course, is Waste.

I would like to offer three simple definitions of a Problem to help you more quickly identify and define one:

1. No Standard
2. Deviation from Standard
3. Not IDEAL (new Standard).

No Standard

Standards are “expectations” of how things should be done to achieve pre-specified outcomes. Without Standards, workers have no clear expectations of how each piece of work should be done. Other than personal frustration, they have no way to know if they have a problem. This is why so many workers tell us that what we see as “work-arounds” are just the way things are done around here.

Deviation from Standard

Once you have Standards in place, it is important to make them visual via metrics charts, physical queues, or other methods so that everyone can easily tell if we are deviating from them. If so, we can very simply quantify the problem by determining the amount of the deviation. For example, if Turn-around Time in an OR is supposed to take 10 minutes and it takes 12 minutes between two specific cases, the deviation from standard is 2 minutes (the problem). This sets up a problem-solving opportunity for the team.

Not IDEAL

We are always striving for the IDEAL in Lean. If a new standard of performance is required by our customers or the business, then we need to clearly define the new Standard and Problem-solve to take our processes to a new level.

Therefore, the next time someone tells you they have a Problem, I hope this helps you to think about that problem a little differently so that it can truly be eliminated.

This week’s article was written by Dwayne Keller, Vice President of Healthcare Performance Partners and coach for HPP’s healthcare client companies. Before joining HPP, Dwayne spent many years with Alcoa in senior leadership roles and overseeing the Lean transformation of numerous facilities. Dwayne also worked with Michelin and DuPont in various management and engineering roles. Dwayne holds Masters and Bachelors degrees in Mechanical Engineering from Bucknell University and a MBA from Clemson University.

In my travels to facilities across the country, I often meet caregivers and front line staff who are not empowered to insist on quality in all aspects of their jobs.  Whether it be a nurse receiving an incomplete report on their patient or a chart being passed on in poor order, the predominant culture in healthcare organizations today is one that allows defects or errors in what is delivered and expects that those receiving defective materials, information, etc. do the best that they can with what is offered.  At the root of this issue is a lack of well defined customer/supplier relationships and a culture that typically insists on quality only as it relates to a perceived direct impact on patient care.

The remedy for this is certainly not a shortcut or quick fix.  What is needed is a shift towards the “Stop the Line” mentality that is frequently referenced in discussions about Lean but rarely practiced in the healthcare.  All too often, concerns about emergent situations and difficulties driving accountability across departmental boundaries stop us short of adopting a true defect free quality standard.  In order to drive closer to this key Lean principle, we must begin with some basic questions:

Q: Is Quality defined?

Q: Are staff empowered to reject incoming defects and “Stop the Line”?

While tactical improvements in process and clear communication of standards will assist in driving toward this goal, the critical element of culture change cannot be ignored.  Initially, strong leadership support will be needed to empower staff, bridge interdepartmental boundaries and ensure that the focus remains on providing better service to patients and families.  In addition, staff must begin to adopt a new way of thinking about their work and redefine the concept of who their customers are before sustained success can be realized.  Ultimately, the organization’s goal must be that these behaviors are driven not through mere compliance but by a facility wide respect for patients, people (other staff and facility partners) and process.

This week’s blog was written by HPP’s Marshall Leslie. Marshall, a Six Sigma Blackbelt, oversees various HPP projects and Lean Healthcare transformations for clients throughout the USA.  As a former multiple year “top-ten percent” performer at General Electric, Marshall brings clients the much needed tools and techniques needed in any industry, including healthcare. Marshall is a graduate of General Electric’s Operations Management Leadership Program; he has experience in various supply chain capacities including quality engineering and global sourcing for both GE and Procter & Gamble. Marshall’s expertise in both Six Sigma and Lean enables him to apply a broad spectrum of process improvement tools tailored to the healthcare industry’s needs. He holds a degree in Industrial and Systems Engineering from Georgia Tech.

Lean Transformation changes not only the tools and methodology of an organization, but also the people. That is why we say- Lean is not what you do but how you do it. People can be taught and told what to do but true cultural transformation begins when people start thinking how to do things differently.

In most organizations, people have different aptitudes which determine their desire for the rate of change. The rate of how fast someone changes can be divided up into five general classifications that indicate their aptitude. They are the Innovators, Adaptors, Settlers, Mainstreamers and the Cave People. On average in Healthcare, the number of people having the five general aptitudes for change is distributed in approximately the same proportions as the general population in the United States. Usually the organization will have 10% Innovators, 20% Adaptors, 40% Settlers, 20% Mainstreamers and 10% Cave People. Professional change agents in an organization must be able to identify and work with each general type of person’s aptitude for change. Facilitators during Kaizen events should be particularly aware of the types of persons and the following tips for dealing with them.

So, in a team of ten people gathered from an organization there should be at least one who has the aptitude of an Innovator. They seek change at a rapid rate. They will think that Lean is the best thing since sliced bread and will immediately become a proponent for Lean during the event and throughout the organization. When the team is in the Forming stage during the event, the facilitator can look for the Innovator for assistance in encouraging the rest of the team to open up to the Lean tools and methodology.

The Adaptors will on average be two of the people on a team of ten. Adaptors are the ones who are willing to give it a try but will reserve judgment until after they have experienced some of the change. The facilitator will be able to identify Adaptors by their willingness to participate in observations and simulations during the event’s training sessions. Facilitators should be able to clearly identify the Adaptors by the time the team reaches the Norming phase of the event. The Adaptors can be used to give a more open minded opinion of Lean and their experience during the event’s final report out.

Settlers make up the largest segment of a team. In a team of ten, on average facilitators should look for four Settlers. They are best described as being people whose aptitude for change is contingent on the potential benefits of the change verses the benefits of remaining in the current state. Initially a facilitator will have difficulty identifying them from the Mainstreamers described below. However, by the time the team reaches the Performing phase of the event, the Settlers will begin the move to the new culture. Until the organization as a majority has established the new Lean culture, Settlers can move between continuing the change and returning to the previous state. During the preparation for the report out, the facilitator should try to mingle suspected Settlers with either the Innovators or Adaptors.

In general, Mainstreamers comprise two of the ten people on a team. Mainstreamers are not opposed to change. They just rather wait till the rest of the team or organization has changed before they do. Their aptitude for change is very neutral and usually occurs through a process of unconscious Osmosis rather than conscious decision. During the event, a facilitator will find Mainstreamers to be actively participative during the Performing phase of the team. During the rest of the event, Mainstreamers will participate only if they see others initiating participation. The rate of change for mainstreamers will depend on the rate of change for the organization as a whole. Therefore, facilitators should not push Mainstreamers to change. Their complete change will occur naturally with the rest of the organization.

There is usually one person from the tribe of Cave People on a team of ten. The Cave Person has no aptitude for change. They are comfortable with the current state of the organization. They will also consciously make a decision to try to keep others from changing. By the time the team reaches the Storming phase, the Cave Person should be readily identifiable. “Never” is one of their favorite words. They also rely on past failures as examples of why something won’t work. They are also quick to point out that their organization is the “Best” and change will only make it worse. In some situations during the event a facilitator may need to isolate the Cave Person from Mainstreamers and Settlers. Sometimes, know Cave Persons are not included on event teams. However, organizationally this is a mistake. They do have knowledge and experience that other team members need to acquire. The facilitator’s job is to manage the Cave Person while harvesting their experience and knowledge. As an organization, Cave People will become extinct either by finally evolving professionally or deciding to leave.

Facilitators should be aware of the cultural tribes that comprise the team during events. Some disciplines in Healthcare are comprised more of one type of tribe than the average. Historically in Healthcare, areas of the organization that utilize technology more or that have a higher degree of regulatory requirements are the ones that will actually a have greater population of Cave People. Those that have more of their time devoted to direct patient care have a higher population of Innovators and Adaptors. No level of the organization is immune from any particular type of tribe member. They exist at all levels. Facilitators and executive management both need to understand the team and organizational dynamics that can enable or interfere with the cultural transformation.

David Pickens is the author of this week’s article. David is an HPP Lean Healthcare facilitator, consultant, trainer, and certified lean six-sigma Master Black Belt. Dave has a B.A in Statistics and M.B.A., and is currently working on his DBA.  Dave has worked with HPP healthcare clients throughout the USA by assisting them with their Lean Transformations. Dave has years of industry experience from his time in the automotive and consumer goods industry, including time with Panasonic, Allied Signal and BOSCH. He has trained with Matsushita in Hong Kong, Japan and Singapore in Japanese Manufacturing Management.

At a recent conference, I was asked if Lean can be applied to improve employee motivation. 

From a technical standpoint

• Is motivation a process?
• Can you write standard work for motivation? 
• Is there a motivation value stream?
• Is motivation one of those problems to which Lean Healthcare tools do not apply?

 Hmm… (pondering pause… a good delaying tactic when I don’t have a ready answer…)

Sometimes, the first step to solving a problem is taking a deeper look at how you are defining the problem.

For the most part, people start out motivated.  Think of that new nurse or tech, fresh out of school, coming to work so bubbly.  But why do we find a lack of motivation? 

If you come to work energized and ready to provide top-notch patient care, what is the impact of having to spend 45 minutes searching for an IV pump for every admission?  Or having to walk 2 miles per shift going back and forth to the supply room because supplies are not kept at point-of-use?  Or having your fresh perspective and suggestions ignored?  I think the problem is not really a lack of motivation, but rather an abundance of DE-motivation.  These wastes, hassles, roadblocks, red tape are all de-motivators.  And yes, Lean tools can be applied to eliminate all of these. 

However, the way that Lean tools are applied can also affect motivation.  One key element of Lean Healthcare, along with Continuous Improvement, is Respect For People.  Leaders of change must respect those on the frontline doing the work every day as the experts in that work.  If I walk in with the answers and just tell people how to do things differently, I am not showing respect for those people.  (I could also get a massive dose of malicious compliance that makes me fall on my face.)  I must work with them to see the problem that I see, or better yet, learn myself to see the problem as they see it.  I don’t need to be out there pushing solutions, but coaching problem-solving.  If people don’t recognize something as a problem, they are not very likely to be motivated to implement a change.  And it is actually possible to apply Lean tools in such a way (i.e. by force) that is actually detrimental to motivation. 

People are not only motivated by being heard and having an impact on their workplace.  I find that many people enjoy the challenges of problem solving.  Given time and support, they will come in every day excited about what can be improved today.  This motivated energy spills over into better employee satisfaction which leads to improved patient satisfaction. 

Not to mention the benefits of the improvements themselves.

This week’s blog was written by Richard Tucker who assists HPP clients throughout the USA with Lean Healthcare transformations. Richard has over sixteen years of experience in business and industry fields in operational and leadership positions. Additionally, he has many years of Lean experience having worked with a major Japanese automaker, and received much of his experience and formal training in the Toyota Production System, Lean Manufacturing, and Shainin Statistical Engineering while in Japan. Richard’s educational background includes BS and MS degrees from Tennessee Technological University in Cookeville, Tennessee.

One of the most common approaches used to implement LEAN or process improvement in an organization is for the leadership of the organization to identify potential areas where improvement is needed and then form process improvement teams to attack the issue. The team ‘charter’ is typically to apply proven principles and tools to make focused and rapid process changes. What’s wrong with this model? Absolutely nothing, BUT anyone using this approach should be aware of a few common ‘pitfalls’!

Using cross-functional teams to apply process improvement techniques in a structured way to solve critical process problems is a great idea. HPP’s nearly universal experience is that team involvement usually leads to the expedited development of good improvement strategies as well as bringing some other valuable ‘side benefits’ like improved relationships between those involved in the process and a clearer understanding of those always important ‘customer – supplier’ relationships. However, as a recent article in ‘Industrial Engineer’ magazine pointed, this approach can often lead to some unintended consequences such as:

1. The organization may begin to develop a belief that improvement can only be accomplished through a team- based effort.
2. Functional or area leaders begin to think that if they are not part of the designated process improvement team, then they may not be responsible for following through with the team- developed process improvement effort!  Since teams are typically temporary entities, when leaders assume this, long-term event follow-up is very likely to become an issue.

I believe that team based process improvement efforts present a specific set of follow-up challenges. My own empirical evidence tells me that a lack of sustainability after a process improvement initiative is very likely if the top leaders of the organization can’t (or won’t) do two vital things: 1) clearly recognize who the ‘process owner’ is and 2) formally modify the routine job duties of the ‘owner’ to allow them to focus on reinforcing the new or modified process. This can take many forms.  Most of us would agree that completely relying on the improvement team to train and hold accountable those who participate in the new or amended process is both unworkable and unfair!

Organizations that are relatively ‘far along’ on the team-based process improvement ‘path’ often apply several ‘tricks’ to keep functional or area management involved. The classic approach is to include both the cost of the team-based process improvement effort and the expected returns from the effort in the department budget. The theory here is that if a manager budgets staff time for the effort, there will likely be a greater emphasis on ‘seeing it through’.

HPP believes that a visual display of process performance that is maintained / reviewed by the process owner is a far simpler but more effective means to get management’s ‘skin in the game’!  In any case, the ability of leadership to redesign work systems and individual management roles and responsibilities to support the team-based process improvement effort will have a direct relationship to sustainability.

Every organization should have a culture that supports team based process improvement. Great organizations have a culture that engages a high percentage of their workforce in these types of activities. However, management must recognize that ‘turning the team loose’ on a problem is not the end of their responsibilities, but only a beginning! 

This week’s blog was written by HPP consultant and engineer David Krebs.  David, a Six Sigma certified engineer, oversees various HPP projects and Lean Healthcare transformations for clients throughout the USA. David is also a Licensed Professional Engineer in the state of Tennessee, with over 30 years of experience in a variety of process and systems intensive industries, as part of firms in the U.S, Germany, and France.  David has achieved and maintained QS-9000 and ISO-14001 certification & received Nissans’ “Quality Master Award” on three occasions.  He holds a Bachelor of Science degree in Mechanical Engineering from the University of Detroit & an MBA from the University of Notre Dame.

I enjoy reading. However, I rarely find enough time to read the stacks of books which seem to pile up faster than I can read them. Traveling has helped that. Air travel seems to leave plenty of time to read. Through my travels, I find that others suffer from the same reading dilemma that I do. Because of this, I like to refer books which I think make a significant impact on Lean Implementation. One such book is called Creating a Lean Culture: Tools to Sustain Lean Conversion by David Mann. Though this very practical guide references mainly examples based in Lean Manufacturing techniques, Mann provides an excellent definition of Lean Culture. He defines culture as, “the collective sum of work habits in an organization.”

So how does that impact Lean Leadership? As implementers of change within a healthcare organization, we are constantly looking to create new habits for our employees. So how does management create a change in culture? Vision is the starting point for the culture change (see Figure 1). Without a clear vision, leaders within an organization can be pulled in several directions. Daily firefighting will consume their time without making significant progress towards the Lean Future State.

Figure 1 demonstrates how lean culture results from a clearly communicated vision rather than immediately trying to change culture itself. With a clear vision in mind, leaders will plant seeds for good thoughts to grow in their teams. Those thoughts are the triggers to actions. It is difficult for us to act differently than we think; eventually, our actions align with our thinking. Repeating the right actions (those that make progress towards the vision) leads to habits. Just as repeated negative actions can lead to negative habits, repeated positive actions lead to positive habits. As stated earlier, culture is the sum of an organization’s individual work habits. It is the framework in which we conduct our day-to-day work. In order to create a culture that supports and sustains continuous improvement, there has to be a vision created by leadership that contains a picture of an improved organization. So, take 2 hours with your team to create your Lean Healthcare Vision – a visual image of how work will be performed in the future state. Then talk about it every day. You will be amazed at the opportunity it creates to move your culture towards Lean.

This week’s article was written by Tom Stoffel, a director & consultant for HPP. Before joining HPP, Tom served as President of Transformation Group, Inc. Tom developed TGI Healing Healthcare - a brand of Lean Healthcare training tools designed to make lasting improvements. Tom has led healthcare organizations in both the development of high-level Lean Strategies down to hands-on implementation of Lean in a clinical setting. Tom has achieved the levels of Certified Lean Specialist from the Business Improvement Group and the National Institute of Standards and Technology (NIST), along with being an ASQ Certified Quality Engineer. These certifications build on an Engineering Degree from the University of Michigan. Training experience includes Lean, Quality, and Leadership Training, as well as serving as an Adjunct Faculty Member at Waubonsee Community College.

In Healthcare, we do lots of audits. Audits require inspection. But, did you know that each inspection is only about 80% effective? Audits may not be concurrent and are sometimes very after-the-fact. It is difficult to provide timely, accurate feedback to change outcomes when we are auditing the process so after-the-fact. It is also very difficult, if not impossible, to find the root cause of the problem after some time has passed.

By using source and self-checks, we can prevent errors at the start of a process and defects in outcomes. Successive checks shorten the feedback loop. By utilizing this concept, there are redundancies that can correct errors at the source and immediately as the process is taking place instead of providing feedback at some later time. But wait a minute – this all sounds like WASTE! In fact, it is a form of waste. However, until we have eliminated all of the causes of errors in a process, it is each supplier’s responsibility to deliver DEFECT-FREE service to their internal customers. Therefore, in Lean, we accept these temporary countermeasures until we find permanent solutions to the causes.

One obvious example of source, self and successive checks is implementation of the Universal Protocol to prevent wrong person and wrong site/side surgeries. The redundancies may seem annoying, however you can begin to see that the 20% ineffectiveness of audits is overcome by the successive checks, by checking everything at the source and doing your own self-checks.

Looking at the drawing, the person in operation “A,” begins the process by first inspecting everything at the source: are all necessary elements/materials present at the start? If not, the self-check provides immediate feedback that something needs to be corrected.

As the process is handed off, the person in operation “B,” begins their part of the process by inspecting everything from their source: are all necessary elements/materials present for their part of the process? If not, they can and should provide immediate feedback to Supplier A. Customer/Supplier B does a self-check of their work and prepares to handoff to Customer/Supplier “C,” who does the same.

This is why we do it, even if it feels like we do the same thing multiple times! Do those successive and, yes, sometimes redundant checks. If there is an error or issue, provide timely feedback to your source. This is how we achieve 100% percent inspection of the process and move toward 100% quality while relentlessly working to eliminate root causes.

 This week’s article was written by Bill Lowstuter. Bill has been a Sr. Consultant with HPP since its inception, and has worked with healthcare clients throughout the USA. Bill previously worked with HPP’s parent company, The ACCESS Group (TAG) for seven years prior to joining HPP. Bill has overseen the implementation of Lean within numerous facilities and industries, and has a Bachelor of Science degree in Engineering from the University of Illinois. He has also conducted numerous seminars and conferences in Kaizen principles and Lean.

A3s are still very new to Healthcare.  In fact, there are still a small percentage of manufacturing companies really using A3s to run their business.  As with any new improvement philosophy or tool, there is much more than meets the eye when it comes to A3s.  While there are multiple types of A3s with different purposes (e.g., Proposal and Problem-solving A3s), they all have the same origin.  Let’s dig into the intent of the A3 as designed by Toyota.

Paper size

The name comes from the 11 x 17 inch paper size, which is also called A3.  When Toyota first started driving for concise problem-solving documentation, the widest paper that could be transmitted electronically through a fax machine was 11 x 17 inches.  Hence, the name A3 became synonymous with the problem-solving document.

A3 Thinking

The real power of the A3 is in the “thought process” it is intended to drive.  It is laid out to essentially force the Problem-solver (A3 creator) to follow the Scientific Method: Problem, Cause, Solution, Action, Measure, also known as PCSAM.  Not coincidentally, the sections of the A3 are labeled: Problem, Current State, Future State, Action Plan, and Measures.  You are not allowed to go directly from Problem to Solution, as we do routinely in our jobs every day.  This structure provides the opportunity for a person or team to take time to think about the potential Causes of a well-defined Problem, and develop possible Solutions or Countermeasures to those Causes.  This is the only way to truly solve a Problem, and move from a Reactive to a Problem Prevention Culture.

Buy-in of Workers and Leadership

The A3 is intentionally designed to be a Visual form of communication, which most people find to be the easiest and quickest way to assimilate information.   Since the geography on an A3 is relatively small, it requires the creator to draw pictures, graphs, stick figures or other visuals to deeply understand the problem and clearly and concisely communicate the Causes and their Countermeasures to all stakeholders.  Used properly, the A3 will drive dialogue amongst the stakeholders (called “Catch ball” in Lean) that creates buy-in to the proposed Solution.

Call to Action

A3s are used at all levels of the organization to run Lean businesses.  Don’t be concerned about how pretty your A3 is.  It’s the content that matters.  As with anything worthwhile, it takes practice to write good A3s.  However, A3 Thinking is an integral part of Lean.  So find an experienced Lean practitioner to coach you and get started with your first A3 today.  It will transform you and your organization.

Click here for information on Lean Conferences this year 

This week’s article was written by Dwayne Keller, VP and coach for HPP’s healthcare client companies. Before joining HPP, Dwayne spent many years with Alcoa in senior leadership roles and overseeing the Lean transformation of numerous facilities. Dwayne also worked with Michelin and DuPont in various management and engineering roles.  Dwayne holds Masters and Bachelors degrees in Mechanical Engineering from Bucknell University and a MBA from Clemson University.

2008 Art of Innovation Award
3rd Annual Lean Healthcare Conference
Denver, Colorado
April 21-22, 2008

Don’t miss the opportunity to nominate your organization (or an individual) for the Art of Innovation Award at this year’s Lean Healthcare conference in Denver. 

Recognition for efforts to improve is sometimes overlooked in the “busy-ness” of daily work.  Please take a few moments to reflect on the good endeavors of your teams and submit a candidate!

A panel of judges will review the nominations and choose one healthcare organization or individual to be recognized at the conference for their creative and diligent applications of Lean methodologies.  The selection is based on the overall efforts of the organization to improve healthcare delivery and the description of one Lean activity that exemplifies their work.

A lovely piece of art from a local Colorado artist will go home with the honoree.  Make your nomination on line today at:

 http://leanhealthcarewest.com/lean_innovation_award.html

The deadline for this year’s entries is April 1st, so don’t miss this chance to see your nomination in the spotlight!

Cindy Jimmerson, President of Lean Healthcare West