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.

My adoration recently went much deeper than the iPhone’s simple intuitive function or the endless assortment of apps to solve any problem that exists. It is now a loyalty that transcends the hardware. I knew it was true love the day I had to take my beloved in for service at the Apple Store’s Genius Bar.

Previous wireless providers had left me severely scarred by the painful memories of crowded stores, long lines and unending frustration. Seriously, at what point does waiting for the root canal become more painful than the root canal itself? After some reassurance from my 23-year-old daughter, I made an online appointment with the Genius Bar at the Apple Store. From that moment, as they say in the iPhone ads, ‘This changes everything.’ I became a diehard Apple loving convert.

As I entered the Apple Store at 4:35pm, I immediately noticed the large number of customers in the store. There was no greeter – no information desk or sign-in kiosk, no lines and yet the many customers inside were moving about, stopping to interact with the various Mac products on display. There was no overhead paging. There was no waiting room with a TV or prominent service counter lined with computer monitors for these “Geniuses” I was to meet. Instead, there were two large wall-mounted monitors that displayed the first name, and last initial for the appointments in queue. My appointment was scheduled for 4:45pm. There were five people in front of me. My instincts told me, ‘This is going to be like a trip to the DMV,’ but, fascinated by the customer flow before me, I moved to a neutral corner and just observed the action.

The large monitors rotated through valuable quick tips for improving the use of various Mac devices while returning to the appointment queue about every 30 seconds. There were well behaved children playing computer games at a kid-sized work table. Others walked in with their Mac Books and made their way to their scheduled education sessions at the Training Bar. Accessories lined the walls; a myriad of gadgets and gizmos for every iPhone and iPad need. At precisely 4:45pm, a young “Genius” named April emerged from a small group in the center of the store and called my name. “Teresa”? I walked closer to her as she introduced herself and shook my hand. April listened to my iPhone issue as I explained the symptoms. As she examined the “patient,” she pulled what looked like an otoscope from the tool pouch attached to her belt. Obviously very knowledgeable, April explained each step she was taking to determine the cause of the problem. April used her personal iPhone to look up my account and warranty information. Empowered to make decisions, she explained the steps she would take to resolve the issue and even printed a copy of the work order for my employer without ever stepping away from me. At 4:51pm my issue was resolved and I was on my way.

Now, as with any process, it was not entirely without waste; I left the Apple Store just in time to get stuck in Nashville’s rush hour traffic. The bumper-to-bumper drive home did give me time to ponder the same questions I now pose to you:

• Can this kind of experience be consistently achieved through Lean Healthcare initiatives?
• Are we promoting customer service or enabling inefficient processes by designing large waiting rooms with comfortable amenities?
• Have we really challenged ourselves to simplify access to the healthcare services we provide?
• What does the healthcare customer of tomorrow really want and how can we leverage Lean Healthcare thinking to provide it?

This week’s blog was written by Teresa Carpenter. Teresa is the Director of Lean Clinical Design with HPP and brings a unique perspective to lean healthcare as a registered nurse with extensive architectural design and facilities planning experience. With over 12 years experience in theacute care environment, Teresa moved to Nashville where she spent almost a decade as Clinical Operations Coordinator for an internationally recognized leader in healthcare architectural design. Teresa facilitated process engineering services as a component of the design process for hospital renovations, as well as large-scale green field and replacement facility projects. Teresa assists hospitals and healthcare systems in all aspects of applying Lean to the master plan, design, and operational aspects of a facility design or clinical expansion. Teresa holds a bachelor’s degree in Business Administration from the College of Charleston, and a degree in nursing from Trident College in Charleston, South Carolina.

Uninformed Optimism
Exposed to the possibility of improvement in our everyday work, most of us will be at least a little bit open to change.  Early in a Lean journey, healthcare leaders hear words that philosophically they can embrace; increasing value/decreasing waste, increased satisfaction & quality, decreased cost & time, and increased decision making or empowerment of staff to name a few.  We do not know what will be expected of us, but we know the problems we are dealing with that we would like to go away.  Front line supervisors, generally demonstrate behaviors consistent with such optimism; attending leadership training sessions, volunteering staff to participate in kaizen events,  showing up at stakeholder meetings and asking good questions. 

Informed Pessimism
Following the first request to change our work, informed pessimism frequently takes hold.  Fixing one set of problems will often result in exposing more problems.  Lean healthcare supervisors, who previously made the change decisions, now have first hand exposure to staff making decisions and are confronted with a new reality to support change that was not their personal decision.  Part of supporting that change is holding staff accountable to new standards and coaching staff in solving the newly exposed problems using the scientific method.  It is at this juncture that lean leaders need to reflect on the areas they have control over, instead of looking to blame other departments and the “lean” process.

Informed Adoption
As leaders support the changes made by their staff they adopt valuable skills to promote the lean journey.  Critical to every lean healthcare transformation is leaders moving from asking “who” questions to asking “why” questions. One front line supervisor gave me a terrific example of her own evolution of moving from “who to why”. Following a kaizen event, she learned that clear expectations for what to document and at what time were not in place.  Working with her staff they identified that charting as they went instead of batch charting cut down the time information was available to other disciplines from an average of 32 minutes to 6 minutes.  On further examination, a few of her employees were outliers and appeared to be non-compliant with the new standards. When she went to talk to these employees to find out why, she learned that as night employees utilizing batch charting was difficult due to inadequate lighting on wireless laptops. After implementing new lighting these employees also were able move to one piece flow charting.

 Building Competencies
One lean event or change does not make a lean healthcare organization. Stringing together multiple improvements, such that leaders & staff begin to solve problems using lean principles every day at every level is a sign the organization is on its way. It is in coaching these improvements daily that leaders build their own competency in lean leadership.   Continually reflecting on and building our own competencies is essential to the growth of our organizations. Our organizations can only become lean as fast as we as leaders, including consultants embrace, and change our own behaviors, skills and competency in lean principles. 

This week’s blog was written by Maureen Sullivan, a senior associate at HPP. Maureen has over 28 years of healthcare experience in clinical nursing, management and quality leadership to Healthcare Performance Partners. Previously Maureen was the director of lean and quality improvement for Exempla Lutheran Medical Center. As a registered nurse, Maureen’s clinical experience is in medical surgical nursing with progressive responsibilities in nursing management at the front line, middle management, and administrative levels. Maureen began her quality management career in 1996, coordinating, facilitating and managing improvement and accreditation programs at a departmental, site and system level within Exempla Healthcare. Maureen has an associate degree in Nursing from Joliet Junior College in Joliet, Illinois and a bachelor of science in nursing with an emphasis in healthcare management from Metropolitan State College in Denver, Colorado. Maureen achieved certification from National Association for Healthcare Quality, certified professional in healthcare quality (CPHQ), Colorado State University in process mapping, and University of Michigan in lean healthcare.

Click here to listen to the podcast of this interview with Dr. Richard P. Shannon, MD.

I couldn’t help but notice that everyone first checked with a nurse named Samantha before signing off to their work stations or assigned areas. Her role seemed to be the “captain of the ship” so to speak. Like everyone else, I too checked in with Samantha. I introduced myself and proceeded in asking Samantha a few questions. She replied, “Follow me, young man, and talk to me as we walk.” Wow! I like Samantha already.

I asked her about the processes and if she could walk me through the Value Stream.

“Sure,” she said, looking at me with a smile. “You see, things weren’t like this several months ago. Our patients were complaining that they were waiting too long to get registered and processed. Things were really disorganized, the staff was frustrated, and it just seemed that we couldn’t ‘win’ on a daily basis.”

My antennas went up when I heard the word win. “‘Win?’ What do you mean by ‘win,’ Samantha?” I could tell that Samantha was well aware of all the potential breakdowns and how easily things can become undone.

“Well,” she said, “one of the first things we did was to fix the things that were very obvious and we could fix right away—the low hanging fruit. We also relied on an internal patient survey. We wanted to know what our patients were saying and where to spend our energy. Alex, please excuse me while I help this patient.”

As Samantha proceeded in assisting a patient, I started glancing around the department and noticed evidence of improvements. The one that really caught my attention was a small board that indicated each patient time from arrival to completion of registration. The board also indicated the reasons for delays, who, when, what, where, and other features that told the staff if they were winning or losing per their set goals. All this information was available at a glance. What really impressed me was the simplicity of the board. The staff updated it, communicated through it, and managed it. It clearly highlighted the areas for improvement. Very little to no technology was needed to maintain the board. No worries if someone forgot their password or the system was down, the staff just kept on marching. All that was needed was a marker and pen to generate the information to execute action.

I started having déjà vu from my many Lean events which I have facilitated and teams I have coached over the years on similar solutions and outcomes. Often in Lean Healthcare, many teams and leadership members feel or believe that the solutions will become too expensive to solve or too deep to dive into, that adding more staff would be the most helpful, or that installing the latest technology device on the market will completely resolve the issues.

While these concerns may be valid in some circumstances, in many cases the opposite situations are true. This team demonstrated that by visually posting metrics so the entire department can see where attention is needed, a target was set for each member to want to achieve the set goal. The board itself may only be a board, but the information it exposes are real issues in real time that navigate and guide the staff in which direction to shift or study the process to “win.”

“What do you think?” Samantha asked me with a confident smile.

“About what, the board or the information?” I replied.

“I mean the entire process, and especially the board.”

“I really like it, Samantha,” I said. “I’m proud of you guys for exposing the data and making the numbers visible for the entire staff to see.”

“Well, Alex,” she replied, “I will be honest with you. At first it was difficult to get the staff to see the need for posting the information and updating the board. They thought it would take more time and cause further delays in the processes by writing down information and managing the board. However, it was the only simple tool that we could try immediately and see if the changes were working or not, without adding cost and resources. We went from patients waiting an average of 22 minutes to now only waiting an average of 6 minutes. Today no one in the department has to ask another for information and data or wait for the monthly staff meeting to get this information.”

“Samantha,” I asked, “Were you and the staff a little hesitant at first about posting the data? And, was the staff worried about you posting information?”

“Yes, and yes! However, when they saw that we were acting on the issues and involving them in the improvements, and the numbers started to improve, their beliefs started to change. The board and information input is owned and managed by the staff, and in fact they have also added others’ information that they thought would be helpful and important. It did take some time, Alex, and there’s still much more to do. But you can see that some standards have been put in place.”

Posting metrics or exposing issues in the work areas can be an uncomfortable practice to do. The fear of people knowing what your breakdowns are—or that you might highlight that your department is the bottleneck in the process—is a scary thing, and you may feel that it may insinuate that you’re a poor leader. In fact, it’s a big part of a leader’s development. Samantha and her team made a decision that they were going to do everything to improve and exceed patients’ expectations.

Since then, they have not looked back.

This week’s blog was written by Alex Maldonado, an associate with HPP. Alex’s professional experience includes process improvement, operational, and leadership positions in the medical delivery systems and appliance manufacturing industries with Baxter Healthcare and Whirlpool. Alex has had a successful track record in improving results-driven processes with an emphasis in personnel training, project leadership, and operating systems designed to improve customer service and sustainability. He has led the development and implementation of processes to support Lean initiatives that reduce critical path lead-time, reduce expediting costs, capital improvement projects, inventory reduction, and trained and educated staff/employees in Lean Methodology. He has a B.S. in Industrial Technology Engineering from Mississippi State University and has also completed the Six-Sigma black belt program.

It was amazing to me how quickly the manager was able to restore order. With a very methodical approach, she began directing the team to alleviate the bottle-necks in the process from the back of the line to the entry point. I began to observe her correct subtle deviations from standard process that had been abandoned in the chaos. Her actions were focused, directed, and confident. It was clear, that she had been here before and knew exactly what was required. This seemed to have a calming effect on both the staff and the patrons. It was a magnificent example of service recovery.

Naturally, as both a lean healthcare coach and as a life-long and avid student of human behavior the opportunity to observe this left me with a lot to ponder. Within nearly all healthcare institutions there are completely analogous breakdowns and recoveries that occur on a regular basis. This is especially true in services that encounter significant variability in demand. The two questions I was left pondering were: 1.) Why did it take a service breakdown to pull the manager from the back-office? 2.) Why was the manager able to restore order so quickly but the team could not? They are a lot of contributing factors that could be considered. I would propose that the primary concept for consideration in this case is the Andon.

So what’s an Andon? In the Toyota Production System (TPS) an andon is an indicator of status. This indicator is usually visual, at times audible, and is used to prevent a breakdown in process. These are often associated with highly automated processes but most definitely have their place in a lean healthcare setting. In fact, the essential concepts associated with andons are not new to healthcare and, collectively, are often referred to as a system of thresholds, triggers, and responses. So let’s apply the andon concept to the service breakdown described above and use the example to translate the concept to healthcare.

The first concept associated with the andon is that of a threshold. This is some visual indicator that helps the team to understand that a potential problem exists. In our case study above, the andon was a complaint reaching the manager’s office. Not the best possible andon, but an andon. In healthcare, one example of a threshold associated with an andon may be the number of patients within a waiting or service area; where an exceeded threshold serves as an indicator of abnormally high volume. The idea is to make this visual to the team to drive a change in behavior.  This leads to the second concept associated with andons, the trigger.

Who has the authority to pull the trigger? For the andon to be fully functional, authority to pull the trigger must reside in the individual(s) best positioned to observe that the threshold has been exceeded. In many healthcare institutions, as in the case study above, the ability to pull the trigger lies exclusively with the manager. In our case above, only the manager had the authority to pull the trigger; to initiate a change in directed action. The down-side to this was that the team floundered until she was roused from her office by the complaint(s). Managing under these circumstances becomes habitual fire-fighting. Implementing a well designed system of andons removes the manager from the fire-fighting role into a coach and resource allocator role. This leads us to the final concept associated with andons, the response.

Once the trigger has been pulled, proactively and in advance of service failure, a systematic and well defined set of actions are executed in response to the trigger to prevent service failure. In our case study, the manager’s approach to service recovery was focused, directed, and confident. It was clear, that she had been here before and knew exactly what was required. However, the team did not have a common understanding of her method and, basically, just followed her lead. Sound familiar?  After-all wasn’t it her experience that landed her in the manager role? The success of her actions in restoring service, however, is not unique. They are, in fact, possible to duplicate, document, and coach. It is, often, the fundamental failure to duplicate (test), document, and coach that inhibits the team from being able to proactively anticipate and course correct.

Returning to the original questions my experience left me to ponder: 1.) Why did it take a service breakdown to pull the manager from the back-office? 2.) Why was the manager able to restore order so quickly but the team could not? Consider the following:

• Andons are informal and undocumented versus andons are well defined, documented, trained, coached and evaluated on an ongoing basis.
• Thresholds are intangible and not easily identified versus thresholds are defined and easily observed.
• Triggers are informal, not clearly visible and only invoked by management versus triggers are defined and visible with authority delegated to resources best positioned in the service process to observe and invoke.
• Thresholds and triggers predict and prevent service failure versus thresholds and triggers are in response to service failure.
• Responses are informal, undocumented, understood by few versus responses are well defined, documented, trained, coached and evaluated (tested) on an ongoing basis.

The above list is not intended to be exhaustive, but rather, thought provoking. If the experience described in the case study above is frequently analogous to experiences within your department, a well designed and implemented system of andons may serve to empower the team to course correct independently while simultaneously transitioning managers out of the fire-fighter role and into a coach / resource allocator role. 

This week’s blog was written by Bradley Schultz, a director and consultant for HPP. Before joining HPP, Bradley was serving as Vice President of Operations & Quality for Infinity Resources Inc. where he pioneered the application of Lean, Six-Sigma, Work-Out™, and CAP (Change Acceleration Process) in the retail market sector. Bradley’s educational background includes: a Bachelor of Science degree in Business Administration from Cardinal Stritch University in Milwaukee, Post Graduate Certification in Quality Engineering from Milwaukee School of Engineering, a Master of Arts degree in Business Administration from Marquette University in Milwaukee, Six-Sigma Master Black Belt Certification from General Electric, and Front-Line Leadership Development Certification from Achieve Global.

First, let’s start with the basics.  Without spiraling into a discussion of Net Present Value (Google it if you don’t know about NPV), the textbook method for calculation of ROI would look like this: 

(Profit – Investment)/ Investment

It simply answers the question of will we make (or did we make) money on an investment.  It can be used when making business decisions such as whether to purchase a new piece of equipment.  Will it make us more profit than it costs us?  Or in other words, what is the Return on Investment?

However, ROI calculations for Lean Implementation can be incredibly complex because of the many variables on both the Profit and the Investment (expense) side of the equation.  In healthcare organizations, employee expenses (fulltime and supplemental labor) make up a significant percentage of the expense side of the equation.  In fact, full time and contract labor can make up between 50 – 60 percent of a hospital’s expenditures. 

Hospitals under considerable financial strain have traditionally looked at their largest expense category, labor, to identify savings.  With a short-term focus on cash, organizations may be cutting short the true benefits of Lean Healthcare implementation.  For example, under a Lean Healthcare program we look to identify and eliminate wasted time, effort, and resources.  The CFO rightfully questions,”Where are my savings? “  Unfortunately, it is not that easy.  I have reviewed many healthcare income statements and have yet to see where “wasted time” is captured on the current list of expenses.  Waste is hidden.  It is woven into the fabric of the organization.   So if waste is eliminated, where can we carve out savings from the P&L?  No savings = no ROI, right?

Not so fast.  A long-term view of Lean Healthcare implementation would see that additional service growth can only come from additional capacity.  By eliminating wasted time, effort, and resources through Lean Healthcare, we effectively increase an organization’s capacity.  In fact, it is the lowest cost capacity because we are already paying for it!  If we can do more procedures with the same staff without people feeling like they are working any harder, then we can show significant returns on the waste elimination efforts.  Service is better, patients are happier, and profits grow with increased volume flowing through the existing cost structure.

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 share lean principles through hands-on learning. 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.

When asked about their Lean Healthcare journey, most leaders will begin the conversation by describing the amazing improvements in both process and people that they have witnessed in the past few months or years.  They recognize the value that Lean Healthcare has brought to their organization but many have seen other initiatives with just as much promise lose traction quickly once the “new wears off”.  They have already begun to see that there are “outside forces” in their organization acting on this “object” or Lean journey that they have worked so hard to build. 

Some of these forces, like gravity, are naturally occurring and are found to act in consistent ways across almost all organizations.  As leaders, you have confronted them in every role you have held throughout the years.  These forces include a natural resistance to, or fear of change.  Because any change (even good change) involves a loss of some kind, this force will remain intact just as gravity is always at work in the natural world.  The good news is, once we know the force that we are encountering and its predictable behavior, we can counter it.  Just as we’ve developed tools, methods or machines to “cheat gravity” (i.e. airplanes) or harness  gravity to our advantage (the free fall ride at Disney World) we should use Leadership Standard Work (the defined routines and processes that leaders fulfill in managing the Lean system), Daily Management (the process level daily routines & metrics that front line supervisors use to drive standard work), Daily Problem Solving & Coaching to combat these forces and “keep the ball rolling”.  Just as working in the gym allows us to jump higher and higher (some of us at least), these countermeasures put in place a structure that allows the organization to work against naturally occurring resistance that will always be present.

Keeping with the analogy of a rolling ball, there is another “outside force” to be considered – friction. Unlike gravity, friction is a direct result of the environment and it varies based on the smoothness of the surface that the ball is rolling on.  With respect to Lean journeys, we find that this force varies widely between organizations and facilities.  When encountering this resistance, most leaders initially mistake it for “gravity” in that the natural resistance to change is overwhelming the ability of the organization to change.  On further investigation, we find that these forces are more a function of the specific environment and can be controlled and “smoothed”.  Friction can be generated when support services are not aligned to support improvement efforts (i.e. response time to move a Pyxis station is 30 days vs. 1 day), or communication is unclear around changes/improvements to the work (i.e. the “what” is communicated, not the “why”) to name a few.  A detailed understanding of what is happening at Gemba (the floor) is required to identify these sources of friction, but once seen, they can be managed, if not eliminated.  Often, these issues can be alleviated with a simple change to process or standard work.

There are many factors that can affect the sustainability of your Lean Journey and understanding the “outside forces” that are currently working to slow your momentum is critical to your long term success.  As leaders, it is important to diagnose these factors as either naturally occurring (like gravity) or a product of the environment (friction).  With this knowledge, we can select the appropriate treatment and put in place the structures that will allow for that ever elusive goal of Sustainability.

This week’s blog was written by HPP’s Marshall Leslie. Marshall, a Six Sigma Blackbelt, is the Vice President of Operations at HPP.  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.

Of course, I sanitize this terse response before putting it back to the questioner.  But, the message is always the same.  The key to improvement in 5S performance, like any metric, lies with the staff.  Go to the Gemba and ask them.

Assuming that all the pieces of a 5S program are in place, including a healthy audit system that yields quantifiable, actionable 5S results, leaders are ideally prepared to address 5S performance in the same manner that they might any of the other initiatives they are charged with. 

Leaders often make the mistake of assuming that failure to follow 5S standards is simply, at worst, an issue of non-compliance on the part of the staff or, at best, an issue of lack of training to the standard.  But, the root cause of failing to follow standards is almost always more complex.  Getting to the root cause requires a disciplined approach to problem solving.  The ideal tool to use when seeking to improve 5S performance is the A3. 

In one recent case at a Lean Healthcare facility, a leader noticed a downward trend in one her department’s 5S score.  She scheduled a stand-up meeting with some members of her staff to address the issue.  She chose to use an A3 approach.  She used the data from the department’s recent 5S audits to explain the issue and the background.  After some problem analysis, the team was able to hone in on one source of the point deductions but they still weren’t at the root cause.  They had learned that a consistent problem area is the improper storage of blood pressure cuffs on the headwall.  The standard was for these cuffs to be stored in casework in the exam room.  Further problem analysis, using the “5 Why” tool revealed that the some staff members had begun to store the cuffs on the headwall to avoid congestion.  (The casework is on the opposite side of the exam room, where another member of the team is often blocking access to the cuffs while using the computer to chart at the same time vitals are being taken.) As a countermeasure, the team decided to change the standard so that cuffs are now stored on the headwall.  Appropriate storage, with labeling, has been added. This change has been communicated throughout the staff and the team is no longer having points deducted on its 5S audit. In this case the audit findings pointed to a need to improve the standard.

When 5S performance, as measured by audit results, fall below the acceptable level, employing an A3 approach will help to point the staff to the true root cause and a solid countermeasure.  Nearly every failure to follow a 5S standard should elicit this type of problem solving approach.  Shortly, the failures to follow standards will fall away.  You can be reasonably sure that if your staff is failing to follow standards, it due to a hidden issue that can often be addressed at little or no expense.

This week’s blog was written by Jeff Wilson. Throughout Jeff’s career, he has delivered and applied progressive management and process improvement tools to help organizations reach new levels of performance. The industries span from healthcare to manufacturing, financial consulting and accounting. He has developed Lean transformation plans, facilitated Kaizen events and developed training materials for numerous client companies. Jeff has a Bachelors Degree in Economics from Western Kentucky University. He also holds a Certified in Production and Inventory Management (CPIM) designation.

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.