Lean Healthcare Exchange

As HPP guides our clients through their LEAN Healthcare transformation, we constantly refer to the Four Rules in Use introduced by Steve Spear and Kent Bowen in their Harvard Business Review article ‘Decoding the DNA of the Toyota Production System’.   In the article, they describe the four principles or rules that Toyota uses to teach the scientific method to workers at every level of the organization. 

RULE #1:   All work must be specified according to content, sequence, timing, and outcome. 

In facilitating Kaizen events, standard work documents are typically created, and I have found that job aids are also very popular supplements.  A job aid is a storage place for information OTHER THAN MEMORY which…is accessed in REAL-TIME ON-THE-JOB; is written at a level of detail to minimize trial and error; reduces necessary amount of recall from memory; and gives directions on WHEN and HOW to perform the work.  For example, a job aid as simple as a phone list of critical numbers attached to an employee badge.  This quick reference guide can eliminate excess motion, confusion and searching for critical phone numbers.

In a LEAN Healthcare environment, Job Aids work well when high complexity tasks are being performed, low frequency or unpredictable frequency tasks are performed, or especially when tasks carry important or devastating consequences; i.e., EMERGENCIES; and consequences of error are intolerable.  Another example of a job aid is ICU lab specimen collection chart.  The job aid can include vital information such as test description, billing category, procedure, tube color to be used, amount required, etc.  This can eliminate confusion of how much specimen to collect, of defects in using the wrong sample tube and of excess processing in having to recollect specimen due to sample error.

Job Aid Methodology is a unique way to convey expert knowledge to performers on-the-job. Job Aids are most significantly — on-the-job INFORMATION.  A Job Aid represents a superior way to achieve performance improvement because it directly affects performance WHERE it counts — on-the-job — and WHEN it counts —at the time performance occurs which is so critical in improving patient care by applying LEAN principles in Healthcare.

This week’s blog was written by Ken Lowe. Ken brings over twenty six years experience in manufacturing which includes sixteen years in the automotive industry.  He has a proven background to be a change agent utilizing business metrics to analyze and develop lean strategies that address the voice of the customer.   His professional experience includes successfully leading operations in various roles to include Controller, Materials Manager, Operations Manager and Plant Manager. He was introduced to Lean Methodology while working with Johnson Controls, a lead supplier for Toyota, where he was Champion of Lean Implementation at his plant. Ken has a Bachelor of Science Degree from Bethel College with a focus in Finance.

Doing Lean Healthcare? What does that mean? Well, it is a common question that is asked. My response has been “Making the Right Work easier to do”. So as not to mislead, I looked up the definition of right on Dictionary.com and found that it means “in accordance with fact, reason, some set standard” and the definition of work means “to exert oneself by doing mental or physical work for a purpose”. 

In Lean Healthcare the right work by a caregiver is to exert as much effort and time necessary to meet the expectations of the patient. The Value Added work performed in patient care can be classified into three different categories:

• Direct (ex. value add time with patient, medication administration)
• Indirect (ex. medication prep, consult orders, medication reconciliation)
• Regulatory (ex. giving report, charting)

Any other work other than the above classifications is considered as waste or Non-Value Added. In order to “make the right work easier to do”, we have to eliminate the waste that takes up so much time and effort for the caregiver. Some examples of waste that are typical in the healthcare environment are: Motion – searching for equipment, Waiting – patient waiting for bed at admission, and Excess processing – duplicate orders to pharmacy. 

The one reality taught by Toyota is that there is always more than one way to achieve a desired result. By teaching and coaching Lean Methodology to all levels, we can create an environment to learn, to think about what we have learned, to apply it, to reflect on the process and to continuously improve in such a way that the patient experience is a good one.

Early in a Lean Healthcare Transformation, it is critical that your Team be able to clearly express or define “Why are we doing Lean?” “Making the Right Work easier to do” will allow you to meet your organizational goals and most importantly improve patient care.

This week’s blog was written by Ken Lowe. Ken brings over twenty six years experience in manufacturing which includes sixteen years in the automotive industry.  He has a proven background to be a change agent utilizing business metrics to analyze and develop lean strategies that address the voice of the customer.   His professional experience includes successfully leading operations in various roles to include Controller, Materials Manager, Operations Manager and Plant Manager. He was introduced to Lean Methodology while working with Johnson Controls, a lead supplier for Toyota, where he was Champion of Lean Implementation at his plant. Ken most recently worked with Cummins Filtration where he teamed up to lead the adoption of Lean Methodology in manufacturing plants worldwide.  He has experience in the leading and the training of:  Kaizen events (Rapid improvement, Breakthrough, 2P), Value Stream Mapping, Standard Work, 5S, Total Productive Maintenance (TPM), A3 reporting and Visual Management (QCDS – quality, cost, delivery, safety). Ken has completed Six Sigma Green Belt – DMAIC training. Ken has a Bachelor of Science Degree from Bethel College with a focus in Finance.