Housestaff Lean Academy Module 1: Lean Principles for Physicians Robert Martin, PsyD
Housestaff Lean Academy Module 1: Lean Principles for Physicians Robert Martin, PsyD Performance Excellence UCLA Health 1 Where does this module fit into the curriculum? Module # Module Description 1 Lean for Physicians (Important Concepts) 2 Focusing Improvement Projects/Efforts (Methods Overview) 3 Managing the Improvement Process (PDCA/A3) 4 Understanding the Current State (Process Mapping) 5 Identifying Waste in the Current State (5S, Waste, Standard Work) 6 Analyzing the Current State I (Organizing & Using Data) 7 Analyzing the Current State II (Organizing & Using Data) 8 Identifying Improvements & Actions (A3 Simulation) 9 Working as a Team (Frontline Empowerment & Engagement) 10 Understanding & Leading Change 11 Supporting Infrastructure (ADM, Huddles, A3/A4 Methodology) 2 Module 1 Agenda… Physician Process vs. Lean Process Important Concepts Lean Origins Physician Process vs. Lean Process Origins Important Concepts Post Questions Post Questions 3 Lean should be a familiar process for Physicians… Scenario – a patient arrives with a problem (clinic, ED, etc.). What is the Physician’s process? Physician Process Lean Process Notes Conduct Health & Physical Understand Scope (Charter) Neither process jumps to solutions Develop Initial Diagnosis Develop Problem Statement Both processes involve the patient Order Tests Conduct Observations & Collect Data Analyze & Understand Data Analyze & Understand Data Develop Treatment Plan Develop Improvement Plan Try, Measure, Adjust It Try, Measure, Adjust It Physician Process vs. Lean Process Lean Origins Both processes use data Both processes use the Scientific Method QI & Lean call “The Scientific Method” PDCA (Plan-DoCheck Adjust/Act) Important Concepts Post Questions 4 Lean is a modern term, but the origins are not… Venetian Arsenal American Meat Packers • 1 Warship/day • Standardized Parts • Conveyor belts to steadily remove • Use of canals to flow carcasses past workers galleys to workers after meat removal through assembly phases 1500s 1780s 1880s 1890s French Army Ordinance • Concept of interchangeable parts for muskets (precursor to high-volume flow production Jidoka (1902) • Sakichi Toyoda invents device to detect broken threads in looms autonomously Just-in-Time (1937) • Kiichiro Toyoda establishes Toyota, has the idea for JIT delivery of parts Toyota > GM (2007) • Toyota becomes the world’s largest automaker Mission, Vision, Values, Commitment Performance Improvement and Management Takt Time • German aircraft industry Deming Prize pioneers use takt time • Japanese Union of Scientists and for synchronizing Engineers creates movement of aircraft Deming Prize for • Mitsubishi brings idea statistical quality and back to Japan where PDCA Toyota embraces it 1902- Present 1930s 1908-1926 Scientific Management – Frederick Taylor • Scientific study of tasks • Employee development and training • Managers use principles to plan work and workers perform tasks Henry Ford • 1908 Model T modular car with truly interchangeable parts “there are no files in my factory” •1913 Flow Production Moving assembly line with processing feeder lines •1926 Mass Production with product variety 1940s 1960s Training Within Industry • US Dept. of War introduces Job Instruction, Methods, Relations to teach millions of workers in war industries. Later introduced to Japan after the war UCLA Operating System Strategies Objective Mgt: Goals, Operating Plans, Dashboards UCLA Operating System Established by Amir Rubin 1980s - 2009 Lean Research • Toyota Production System (1982, Yasuhiro Monden) • The Machine that Changed the World (1990, Womack, Jones, Roo) • Lean Thinking (1996, Womak, Jones) • Learning to See (1998, Rother and Shook) • DNA of the Toyota Production System (1999, Spear and Bowen) • The Toyota Way (2003, Liker) • Shingo Research Award – Lean Hospitals (2009, Mark Graban) 5 Physician Process vs. Lean Process Lean Origins Important Concepts Post Questions Lean is based on a few important concepts… Value Waste Lean is more than a collection of tools…. Scientific Method (PDCA) It is about creating a culture based on a few important concepts. There are more- but these are sufficient for now! Empowered Staff True North Alignment Physician Process vs. Lean Process Origins Important Concepts Post Questions 6 Lean is based on a few important concepts… Value Waste Scientific Method (PDCA) Empowered Staff What is Value? • What patients are willing to pay for • Value must be discerned • Lean systems produce what the patient values What do Patients Value? • “Timely” Nursing & Physician Time • Information to participate in choice • A safe and effective Treatment Plan to become healthy, alleviate their pain and suffering, or restore function • To be listened to; Trust and Privacy True North Alignment Physician Process vs. Lean Process Origins Important Concepts Post Questions 7 Lean is based on a few important concepts… Value Activity (Individual or self-organized) Waste Scientific Method (PDCA) • Spend a few minutes to discern what your patients value • Group Discussion Empowered Staff True North Alignment Physician Process vs. Lean Process Origins Important Concepts Post Questions 8 Lean is based on a few important concepts… Value Waste Scientific Method (PDCA) Empowered Staff True North Alignment Waste is: the opposite of what patients value… • Waste hides in complex systems, and healthcare is complex! • Waste must be understood so that it can be discovered and highlighted as abnormal Focus on minimizing or eliminating waste: • Waiting for appointments, to be seen, etc • Waiting for physician’s orders to be written • Late/Missing callback for test results • Clinicians who don’t listen, lack of trust, lack of privacy, etc. • Administrative errors • Clinical Errors • Unnecessary documentation protocols & approvals Physician Process vs. Lean Process Origins Important Concepts Post Questions 9 Lean is based on a few important concepts… Value Waste Scientific Method (PDCA) Empowered Staff Activity (Individual or self-organized) • Spend a few minutes to discern • What your patients do NOT value (i.e. waste) • Wasteful activities that inhibit your value production • Group Discussion True North Alignment Physician Process vs. Lean Process Origins Important Concepts Post Questions 10 Lean is based on a few important concepts… Value Waste Scientific Method (PDCA) Empowered Staff The Scientific Method (PDCA) … • Was discussed earlier! • Is taught to staff so that they can • Use data to solve problems • Support value-added activities • Minimize or eliminate waste • Continuously improve • Also known as Plan-Do-Check-Adjust/Act • (We are going to have a whole class on this) True North Alignment Physician Process vs. Lean Process Origins Important Concepts Post Questions 11 Lean is based on a few important concepts… Value Waste Scientific Method (PDCA) Empowered Staff What does Empowered Staff mean? Why is it important? • The best ideas from the smartest physicians often result in: • Passive or Active resistance from staff • Staff who feel disempowered and disengaged • No change • Staff must feel that they “Own” changes which will support value-added activities and minimize/eliminate waste • They are experts in their areas and have great ideas on how to improve • Leaders (Administration & Physician) must engage, empower, and align staff • (We are going to have a whole class on this also!) True North Alignment Physician Process vs. Lean Process Origins Important Concepts Post Questions 12 Lean is based on a few important concepts… Value What would happen if all staff was trained in PDCA, engaged and empowered without alignment to the organization’s goals? Waste Scientific Method (PDCA) Empowered Staff • Some improvement certainly! • Likely much silo’d improvement which might sub optimize the system (i.e Schegistration might make their job easier and everyone else’s more difficult!) • Improvement can occur at all levels, but always in consideration of linked-activities in the organization What is True North Alignment? • A vision or ideal from Leadership that can “rally” the case for change (should be aligned or supports the hospital or SoM vision) • “Minimally sufficient” strategies and initiatives (3 to 5, not 25 to 75) to focus staff effort • The most ideal strategies include participation from all layers of management and staff (i.e. catchball) to ensure that they are realistic True North Alignment Physician Process vs. Lean Process Origins Important Concepts Post Questions 13 Post Questions & Next Module Preview… Module # Module Description 1 Lean for Physicians (Important Concepts) 2 Focusing Improvement Projects/Efforts (Methods Overview) 3 Managing the Improvement Process (PDCA/A3) 4 Understanding the Current State (Process Mapping) 5 Identifying Waste in the Current State (5S, Waste, Standard Work) 6 Analyzing the Current State I (Organizing & Using Data) 7 Analyzing the Current State II (Organizing & Using Data) 8 Identifying Improvements & Actions (A3 Simulation) 9 Working as a Team (Frontline Empowerment & Engagement) 10 Understanding & Leading Change 11 Supporting Infrastructure (ADM, Huddles, A3/A4 Methodology) Physician Process vs. Lean Process Origins Important Concepts Post Questions 14 15
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