Lean Healthcare Exchange

It’s that time of the year! Football time is here in the state of Tennessee but I know that Tennesseans certainly don’t have any kind of monopoly on the excitement and anticipation associated with this sport season. No matter where I go, many of the people that I run into are anxiously awaiting their team’s opening game. It’s hard to miss the level of enjoyment that comes from this annual fall activity!

All team sports generally have one thing in common: a coach who is committed to making their team as successful as possible. Organizational improvement efforts, like applying Lean Healthcare concepts and tools to the improvement of regular healthcare value streams and work processes, need coaches too! Lean Healthcare initiatives can have a successful ‘kick off’ if leadership—especially at the middle management levels—accepts and relishes the opportunity to ‘Coach ’em Up.’

When we think about coaches of athletic teams, we typically can all agree on several of a good coach’s basic attributes:

• Knowledge of the game
• Ability to organize practices
• Capability to develop game strategies
• Interest in developing the skills of the team members
• Recognition of team strengths and weaknesses, and the ability to make appropriate adjustments when required

A successful Lean coach certainly needs the skill set listed above. However, Lean coaches who are focused on improving team performance often need a few additional skills. These include:

• The ability to resolve differences
• An interest in building relationships
• A drive to pursue creative solutions
• The talent and commitment to motivate and empower those on the team to improve how they do their work

How does this list differ from what we typically expect from our supervising level of employees? Our observations often reflect that the typical supervision situation might be almost exclusively focused on accountability (i.e., “Let’s get it done!”). There is certainly nothing wrong with this. Even in a mature Lean operating environment, supervisors are always responsible for adherence to work standards.

However, Lean success requires a more balanced role for supervision, one that includes actively coaching for improvement. For supervisors, the Lean coaching begins with a clear recognition of performance gaps (perhaps through process performance metrics), and moves toward the empowerment and motivation of those who do the regular work to respond with improvement ideas. We coach to make sure that these ideas include the appropriate Lean concepts and tools!

Coaching requires practice, but good coaching almost always begins with an attitude: “We’re good but never good enough!”  As always, the commitment to ‘Coach ’em Up’ is the vital first step!

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.

Imagine an existing hospital located in a large metropolitan U.S. city that is highly effective at delivering high quality patient care in an efficient manner. Those of us who are ‘on the voyage’ to achieving a truly LEAN organization maybe already familiar with this place. However, if you’re just beginning your LEAN healthcare ‘voyage’ maybe you’re not quite ready to venture a guess on who this is. However, I’m sure that you will all ultimately recognize the name!
 
Let me give you a few more hints:

• The 2008 Dartmouth Atlas of Health Care reported that of the 5 best ranked medical centers in this country, this location provided the most cost efficient care.
• This medical center works so well that its cardiac services ‘unit’ attracted over 39,000 ‘out of state’ as well as over 2,300 foreign residents from 102 countries. The revenues gained from these ‘out of towners’ easily offsets the poor margins that are associated with an even larger census of both Medicare and Medicaid patients.
• This facility is reported to be at the forefront of measuring and publicizing its results! This medical center is typically one of the few that that makes its own analyzed outcome data easily accessible to any interested party.
• This medical center has a fully staffed Continuous Improvement department led by a systems engineer with no healthcare experience. This department maps and analyzes every value streams that does not have outcomes that match the organization’s targets (i.e., the opportunities for improvement).
• This medical center has a fully implemented electronic patient charting system that not only includes order entry and routine patient charting but also provides “decision support” functions to clinical personnel that reduce med errors and allows real time IV medication effectiveness monitoring.

For those just starting the LEAN healthcare ‘voyage’, take heart! The Cleveland Clinic probably started their journey just as you have, uncertain of where it would lead them! Their LEAN healthcare journey probably isn’t complete but I’m certain that they (and their patients) are glad that they started.
  
Newsweek magazine highlighted these and other accomplishments of the Cleveland Clinic medical system in an article titled, “The Hospital That Could Cure Health Care’ written by Jerry Adler and Jeneen Interlandi in its December 7th edition. 

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.

Transforming your healthcare organization into one that fully utilizes the Lean concepts and tools takes time. Many experts estimate that this Lean Healthcare ‘journey’ will lead to truly tangible results only after as much as 3 years of dedicated, transformation effort! Now the ‘good news’! I believe that the much anticipated changes associated with the proposed U.S. healthcare reform effort offer a perhaps “once in a lifetime opportunity” to create a clear case for major change in any healthcare organization that counts on government reimbursement as a major element of their revenue stream. If you are familiar with change management, you’ll remember that one basic element of change management is the need to identify and articulate, as clearly and forcefully as possible, the need to ‘do something different’ in order to assure survival.  Since it has never been very likely that U.S. healthcare services would ever be ‘outsourced’ to Mexico, finding a rationale for the absolute necessity to get better at improve the levels of healthcare quality and service have been few and far between!

Why now?  As I have consistently read the multitude of commentaries on pending healthcare reform, I have picked up on a few common threads:

1. Our government leaders have clearly focused the coming legislation on increasing the accessibility of health insurance, including that available from both government and non-government sources. Most reviews of the current healthcare reform proposals focus nearly exclusively on how many additional people will be insured through each of the various options. An additional 30 million insured healthcare consumers through these reforms seems like a popular estimate.
2.  The ‘quid pro quo’ of expanding the pool of insured people in the U.S. (and significantly increasing the demand for healthcare services) appears to be a long term series of big time price concessions (something like $150 billion, that’s billion with a ‘B’) via reduced government reimbursements, over the next 10 years. I’ve read that this represents about $2.7 million in annual concessions per hospital!

There you have it! The typical U.S. hospital will see significantly higher demand for services but receive less reimbursement for government paid for care; a true ‘burning platform’ for working smarter not harder! The proposition of providing more of something and getting paid less for it easily registers as a bad strategy for long term success!

Lean healthcare leaders, don’t let this opportunity to clearly state the need for change go by without capitalizing on it in your organization! Three years of effort is a formidable investment but if not now, when?

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.

Previous Lean Healthcare blogs have discussed the basic principles of the Toyota Production System in detail. Like Toyota’s own improvement efforts, we can apply Spear and Bowen’s 4 Rules in Use to move any healthcare value stream as close as possible to an ideal condition. However, from a training perspective, the 4 Rules are perhaps, not as explicit as one could hope for. This leads to the question, how do the workers in Toyota’s own operations learn to do standard work?

Interestingly, Spear and Bowen also tell us that Toyota’s managers don’t directly tell their associates how to do standard work! They use a teaching approach that allows their workers to discover the rules as a consequence of solving problems. This is, of course, an extension of the ‘old and reliable’ Socratic teaching methodology. Spear and Bowen have observed that at Toyota, the supervisor teaching a person standard work will come to the work site and while the person is doing their job, ask the following:

• How do you do this work?
• How do you know that you are doing it correctly?
• How do you know that the outcome is free from defects?
• What do you do if you have a problem?

This process of continual questioning is the catalyst for providing the worker with opportunities to achieve deeper insights into their specific work. Through this questioning approach to training, Toyota workers continually gain an implicit and deep understanding of the standard activities required in their work.

Most importantly, Spear and Bowen maintain that the Toyota Production System has so far only been successfully transferred when managers are able and willing to engage in this process of questioning that facilitates learning by doing! If this is the case, how many of us who are attempting to ‘cement our culture’ to Lean Healthcare concepts and tools are operating in this fashion? If Toyota’s sixty years of Lean success demands that worker’s are educated in this manner, how can those of us who are just beginning our Lean Healthcare journey train our associates in our standard work otherwise?

As we have said many times before in this blog, successful Lean transformation begins and ends with Leadership.  One of the most critical parts of that role to changing culture is the development and training of your staff in not only how to do the work but also how to think about the work.

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’m sure that most of you have recognized that management in a healthcare organization ‘driven’ by LEAN principles should be a bit different from the traditional management paradigm! Although we have covered this topic before, I believe that it is good for all of our readers to reconsider this topic on an on-going basis. One thing is for certain, no matter how integrated LEAN principles and practices are into your healthcare operations, leadership matters!

Yes, management of a LEAN healthcare organization is different and those differences with traditional management practices are very important! I routinely encourage those who want to better understand these differences to “read, read, and read”! One of my favorite ‘reads’ on this subject is David Mann’s book, ‘CREATING A LEAN CULTURE’, which provides a detailed look at some of the key elements that are vital to the management of a transformation to a LEAN healthcare culture. One of Mann’s most important areas of focus in this book is what follows the conscious acceptance of new LEAN practices by ‘front line’ management. Two key points that he raises really stand out for me:

• LEAN Requires Regular Management Attention to the Process
  If the process is to reliably produce the results for which it was intended, management must pay attention to it! HPP believes that one of the first rules of a process focused organization (like Toyota, for example), is for management to regularly see the process operating with their own eyes!  This is the reason that in the best LEAN operations, front line supervision is allowed to spend the majority of their time training operators in the process, monitoring the process or improving it!
• Attention to Process Includes Regular Measurement of Performance
  One of the ‘points of emphasis’ in Mann’s book that has always resonated with me is that unlike managing in a traditional, ‘bottom line’ focused organization, a process performance oriented organization is driven to obtain regular process performance measurements that are linked to or directly contribute to the expected outcomes! Frequent performance measurements in a LEAN process supply the ‘raw material’ for continuous improvement! They aid in problem analysis, guide the development of short-term countermeasures and contribute to permanent corrective actions through process and skills improvement!

If your organization has actively begun to apply LEAN practices through Kaizen Events or reVIEW© courses you’ve just begun the LEAN ‘journey’! You’re now at the ‘oh so critical’ point where the management of the complete implementation of the newly identified LEAN ‘transformed’ process is very important! Middle or functional management’s role must include a specific effort to make the new way of doing work attractive and the status quo method uncomfortable! One way to do this is to carefully connect the objectives of the effort to specific, existing breakthrough organization goals. Fortunately, there are many opportunities to do this in healthcare.

Top management has a slightly different responsibility. Senior management’s most fundamental LEAN job is to be involved in the selection of improvement projects and their connection to the business case.

HPP believes that new management priorities are called for in a LEAN healthcare transformation. LEAN processes usually work best when there is specific, disciplined attention to routine work. Also, first tier management (the ‘owner’ of the process) must be allowed the opportunity to do this! Top management’s job is to assure that LEAN healthcare projects are strategically selected and the organization is committed to developing additional resources to grow your improvement initiatives! 

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.

To those of you now somewhat familiar with the LEAN principles and tools, I’m sure that you have recognized that management in a LEAN ‘driven’ organization should be a bit different from the traditional management paradigm! Although we have covered this topic before, I believe that it is good for all of our readers to reconsider this topic an on-going basis. One thing is for certain, no matter how integrated into your operations LEAN principles and practices are, leadership matters!

One of my favorite books is David Mann’s book  ‘CREATING A LEAN CULTURE’, which provides an interesting look at some of the key elements that are vital to the management of a transformation to a LEAN culture. One of Mann’s most important areas of focus in this book is the effect of the conscious acceptance of LEAN operating practices on ‘front line’ management. Two key points that he raises really stand out for me:

• LEAN Requires Regular Management Attention to Process- If the process is to reliably produce the results for which it was intended, management must pay attention it! HPP believes that one of the first rules of a process focused organization (like Toyota, for example), is for management to regularly see the process operating with your own eyes!  This is the reason that in the best LEAN operations, first line supervision must be allowed to spend nearly all of their work time either training operators in the process, monitoring the process or improving it! In this paradigm, middle and upper level management assume the primary role of supporting and encouraging the efforts of the ‘front line’ leadership. This ‘attention to process’ priority must be clear and adhered to by all functions and leadership levels!
• Attention to Process Includes Regular Measurement of Performance- One of the ‘points of emphasis’ in Mann’s book that has always resonated with me is that unlike managing in a traditional, ‘bottom line’ focused organization, a process performance oriented organization is driven to obtain regular process performance measurements that are linked to or directly contribute to the expected outcomes! Frequent process performance measurements in a LEAN process supply the ‘raw material’ for continuous improvement! They aid in problem analysis, guide the development of short-term countermeasures and contribute to permanent corrective actions through process and skills improvement! Leadership must be driven to fully recognize the variances from the expected as shown through measurement and work to define the required improvements. 

HPP agrees that new management priorities are called for in a LEAN transformation. LEAN processes usually work best when there is a disciplined attention to the daily variation in outcomes and first tier management (the ‘owner’ of the process) must be allowed the opportunity to do this! 

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.

When HPP is guiding our clients through their LEAN Healthcare transformation, none of the concepts is more important than learning to recognize the characteristics of an Ideal process. Once this recognition is attained and the ‘gaps’ identified between the current condition and the Ideal, our attention must shift to “How do we get there?”. Fortunately, we have some help available to develop a solid strategy. The history of Toyota’s winning culture can give us a clear ‘roadmap’ to follow! 

Steve Spear and Kent Bowen in their infamous 1999 Harvard Business Review article ‘Decoding the DNA of the Toyota Production System’ articulated the difficulties in understanding the basics of the Toyota system. Fortunately, they also took on the challenge to describe how the Toyota’s system works. They did this through a description of the four principles or rules that Toyota uses to teach the scientific method to workers at every level of the organization. Spear and Bowen contend that these 4 rules form the essence of Toyota’s system and are fundamental to an improvement strategy that moves regular work toward the Ideal. Sometimes I think that there is a perception that these rules have a sense of ‘mystery’ attached to them. The reality is that they are quite straightforward! 

Let’s take a closer look at the 4 Rules:

• RULE #1: According to Rule #1, all work must be specified according to content, sequence, timing and outcome. At Toyota, it is clearly recognized that process variation can lead to potential quality concerns. Pre-specification of work helps to limit variation and just as importantly, will set a necessary ‘baseline’ for future improvement work. Through specification of the expected successful outcome, staff will easily be able to recognize both defect free and defective outcomes.
• RULE #2: The second rule explains how the people involved in a work process should connect with one another. Simply put, Rule #2 states that every connection in the process must be direct and binary (yes/no responses). Direct connections also typically deliver significantly less customer frustration. This rule is particularly appropriate to the “request for service” processes so prevalent in healthcare.
• RULE #3: This rule specifies that every service process must flow along a simple, specified path. The specified pathways should involve as few steps, people and delays as possible. This concept of ‘continuous flow’ is vital to approaching the goal of an Ideal process. Spear and Bowen also believe that by requiring that every pathway in a process is specified, this rule positions the organization to conduct an improvement ‘experiment’ each time the path is used!
• RULE #4: Rule #4 stipulates that process improvement must be done based on the scientific method, under the guidance of a coach and by  those doing the work closest to the problem. This implies that ‘frontline’ workers are empowered (and expected) to make improvements to their own jobs. Their supervisors are responsible to provide both direction and assistance to this effort as coaches.

You will recognize that Rules 1 through 3 are really ‘work and system design’ related, while Rule 4 truly ‘sets the stage’ for the continuous improvement effort that must exist to get the process closer to the Ideal! As you can see, there really is no ‘mystery’ here. Embrace these 4 rules and you, and your improvement team, will be moving closer to the Ideal!

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.

Most readers of the HPP Lean Healthcare ‘blog-site’ are very familiar with the Lean principles usually identified with the Toyota Production System. Perhaps it would surprise a few of our readers to know that it was an American, Dr. W. Edwards Deming, who really led much of the war torn industrial base in Japan to adopt the principles that form the ‘bedrock’ of the Lean Healthcare philosophy. Dr. Deming began his work in Japan in 1947 and is so honored for his efforts there that the most sought after award for quality and business management in Japan is named the Deming Prize!

I believe that one of Dr. Deming’s major achievements was to clearly articulate many principles of management that are fundamental to achieving a successful Lean organization. I also believe that it is useful for all of us to review these principles occasionally as we work to move our healthcare organizations to Lean based operations. Some of this 50+-year-old thinking remains amazingly appropriate as we all struggle to achieve our Lean transformation! Please consider these Deming ‘prizes’:

• Dr. Deming’s view is that the management of any business is primarily responsible for: (1) the ‘design’ of a service, (2) specification of the process for the delivery of the service, (3) measurement (by simple statistical methods) the amount of issues encountered with the delivery of the service and finally, (4) timely action on the issues found.
• Beyond those specific management responsibilities listed above, Dr. Deming also held the view that management should supply a job description (or standard work description) that allows a responsible worker to regularly achieve basic statistical ‘control’ of his work, without the costs associated with rework and/or inspection.
• He also believed that if a basic level of process performance (i.e., basic statistical control) is maintained in any process, defects that occur are not the responsibility of the worker but are the responsibility of the service delivery process!

An important corollary to this point is that once a process is in basic ‘control’, fewer defects can only come from changes to the process, and not from the efforts of the workers in the process.

Finally, Deming realistically understood that variation in process performance should be expected. However, he clearly believed that variation has two sources: (1) special cases, which are the responsibility of the process workers and (2) common causes, which are by-products of the process and the responsibility of management!

Hopefully this short collection of some of Dr. Deming’s ideas ’strikes a chord’ in your Lean Healthcare transformation thinking! More detailed information on his lifetime of amazing achievements is easily found on the Internet.

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.

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.

While HPP strives to go “above and beyond” in guiding organizations on their Lean journey, there are some elements of the transformation process that must be owned by the organization’s leadership in order to create long term, sustainable change within the organization.  Outlined below are both the short and long term expectations for the leadership involvement necessary to move your Lean transformation toward success!  When supported properly, these actions will bolster your Lean efforts and can accelerate the desired culture change.

Short Term Expectations

Assign a Dedicated Lean Resource:

Designating a dedicated Lean resource well integrated into the ‘local’ organization is essential to creating a sustainable Lean culture. If you have difficulty in identifying a Lean resource, HPP provides clients materials to assist in the search (i.e. sample job descriptions, etc.) and is available to participate in the interview process. Designation of this individual sooner rather than later, is the best way to maximize the economic benefit of the Lean effort.

Form a Lean Steering Committee:

A Lean Steering Committee should ideally be formed prior to the execution of the first Kaizen activity.  The steering committee should include but is not limited to:
 - At least 1 representative/champion from the Admin team
 - The dedicated Lean resource
 - A Quality and/or Risk Management representative
Additional members could include operations and financial management personnel. The committee should be scheduled to meet monthly and participate in all 30, 60, and 90-day reviews of past Kaizen activities.  The committee should also assist team leaders in breaking down barriers to reaching Kaizen goals across the organization.

Implement Regular Process Performance Tracking:

Ongoing process performance (aka results) tracking for Kaizen and reVIEW© (Value Stream Mapping and A3 Problem-solving) activities is not only vital to sustaining the initial success but also the identification of implementation issues that need to be revisited.  As part of each activity, process performance targets are determined based on the team’s trials of the Future State processes.  While HPP assists with developing results tracking processes as much as possible, we have seen greater ownership developed when this task is coordinated through the site Lean resource and the organization’s Lean Steering Committee.

Go to the Gemba Regularly:

Gemba is a Japanese term meaning “actual place” or the location where the ‘regular’ process work is happening.  An essential part of any Lean transformation is the dedication of time by the leadership team to go to where front line work is being performed. “Going to Gemba” provides leaders the opportunity to:
• Observe the Environment, People and Processes
• Establish relationships and trust between Leadership and Staff
• Show management commitment to Lean initiatives
• Review the process performance measurements
• Motivate staff and drive accountability within the organization
• See what written or verbal reports cannot reveal

Communicate, Communicate, Communicate (Share Results / Success):

Just as initial communication is important to “jump start” a Lean Transformation, ongoing communication of results and successes must also be a priority.  It is important that information on Lean activities not be limited to just Kaizen and reVIEW© activity participants. Including results in facility newsletters, associate ‘forums’ / town hall meetings as well as creating high visibility Lean displays throughout the facility have all proven to add momentum to Lean initiatives.

Long Term Expectations

Align Business Goals & Objectives with the Site Lean Strategy:

Soon after you begin your Lean journey, the site must begin to align the goals & objectives of individual Lean efforts with those of the overall business. While this will ultimately be achieved through implementation of Policy Deployment in Phase 2 of your Lean journey, moves made early in the transformation process to better align objectives will accelerate this process.

Give Your Lean Effort a Budget:

We strongly encourage our clients to consider the addition of Lean activities in their next planning/budget cycle.  This not only allows the organization to more easily track the impact of its Lean work, but also creates a model for sustainability by budgeting the time required to continue improvement efforts.

Develop Lean Minded Employees:

A final item for consideration is the identification of talent within your organization with the potential to become reVIEW© coaches and Kaizen facilitators.  As resources are freed through Kaizen activities, a portion of that benefit must be reinvested in growing your Lean capability.  HPP is available to guide you in the qualities and characteristics, which typically make for good “Lean Thinkers”.

This week’s blog was written by HPP consultants David Krebs & Marshall Leslie.  Both David & Marshall oversee various HPP projects and Lean Healthcare transformations for clients throughout the USA.