Lean Tools Implementation

Lean Process Improvement Memory Jogger
GE Healthcare Confidential and Proprietary Information The information contained in this document is disclosed in confidence and is subject to a confidentiality agreement between GE Healthcare and the customer. It is the property of GE Healthcare. This notice shall appear on any reproduction, in whole or in part. The information contained herein should not be used by others, or disclosed to others, without the express written consent of GE Healthcare.
Copyright GE All Rights Reserved. GE Healthcare Performance Solutions Northern Europe Rev2008.01KE
2/ Performance Solutions/ 26/02/2009
GE a Global Company
Operations in over 100+ countries 300,000+ employees worldwide Manufacturing facilities in 40+ countries
Industrial NBC Universal
Commercial Finance
Infrastructure Healthcare
Consumer Finance
GE is a family of businesses aligned with our customers needs and acting as one company to drive growth.
GE Healthcare
GE Healthcare brings the world medical science and technologies that are helping to transform healthcare. We are working with our partners in healthcare to help them predict, diagnose, inform, and treat disease earlier than ever.
90+ years in Healthcare
Continuing Innovation
By inventing the high vacuum x-ray tube in 1913, we enabled the first modern x-ray tube. Throughout the past century we've led medical breakthroughs, such as the recent creation of the first all-digital hospital, with real-time electronic patient records and medical images accessible to doctors worldwide
MOLECULAR MEDICINE Combining today's sophisticated diagnostic imaging with an increasing understanding of both the human genome and the body's chemistry, GE is helping to transform after-the-fact treatment to before-onset care
Diagnostic Imaging Interventional Cardiology & Surgery Clinical Systems Healthcare Information Technologies Services Life Sciences Medical Diagnostics
Performance Solutions Formula for Success

Our Team
Formula for Success
Healthcare Management Consultin g Experts Quality Lean Six Sigma & Acceptance & Accountability Change Acceptance Process & Work-Out Performanc e Manageme nt & Effective Leadership
GE Lean Six Sigma & Change Acceleration
Clinically Trained Healthcare Experts
Success Factors Based on our extensive experience of delivering programmes of transformational change in the NHS, we know there are three things critical for success: Solid and deep methodology, tailored to the NHS and needs of particular trusts Clinical engagement and acceptance of change Accountability supported by strong leadership
Sustainable Impact Performance Culture
GE Healthcare are not like other consultants, they use these tools internally as well, in one of the worlds largest and most successful companies. James Barbour, CEO NHS Lothian
Capabilities and Application areas

GE GE Capabilities Capabilities Hospital Hospital areas areas
Market Market Leader Leader in in Healthcare Healthcare

A&E Diagnostics
Value Chain
Treatment Discharge Recovery
Performance Performance Improvement Improvement
Outpatients
Theatres
Clinical Clinical engagement engagement
Project Project Team Team

Key areas for improvement
Discharge points Value Stream Management Scheduling Booking Bed Discharge Management Planning
Leadership Leadership
Training Training & & Education Education
We We bring bring experience experience and and understanding understanding of of delivering delivering process process transformation transformation in in healthcare healthcare
Our Delivery
Key Offerings
Performance & Process Improvement Change Acceleration & Management Productivity Improvement Initiatives Cultural Change Leadership Development Six Sigma Black Belt & Lean Leader Development Management & Leadership System Resource Development Coaching & Mentoring
Examples of Projects
Cancer Pathways Pharmacy Trauma Mental Health Cardiac Theatres A&E Skills Transfer Business Planning
Examples of clients
Components for Effective Change

Six Sigma Work -Out
Quality
Lean
X Acceptance Accountability
=
Change Acceleration Process
Effective Results
Project Framework
Quality x Acceptance x Accountability = Effect Results
Lean Principles
1 Specify Value
5 Work to Perfection
Lean
2 Map the Value Stream
Thinking
4 Implement Pull 3 Establish Flow
Lean is based on 5 Principles which form the foundation for all of the tools and structures within the Methodology
Benefits of Lean
Lean eliminates or minimises waste / non value add activity within a process which either shortens the overall cycle time or allows for more quality value add activities to take place or both.
Lead Time / Cycle Time
Before
Work . . . Value Add Time Wait / Waste . . . Non Value Add Time
After
Lean attacks waste here

This leads to: Improved customer satisfaction Better quality of service delivered Reduced cycle times More efficient delivery More capacity Increased Productivity
10 / Performance Solutions/ 26/02/2009
VA vs. VE vs. NVA

VALUE Start to look at processes from the patients point of view!
1 VA = Value-Added
Lean defines a value from the patients point of view.
Value-Added work are all processes ..which add direct value to the patient. ..All contact with a clinician is considered .. value Examples: Consultant talking to a patient a nurse taking blood radiologist looking at X-ray scans surgery
2 VE = Value-Enabling
No Value in the patients eyes but necessary for the process
Value-Enabling steps are steps which the patient would not be willing to pay for but cannot be deleted from the process Steps regard to work which have to be done because of laws and regulations.
Examples: Check in at reception booking and scheduling anaesthetic Reporting regulations Data collection
Pt recovery at natural rate
3 NVA = Non-Value-Added = Waste

Most important vocabulary in Lean issues. NVA work is waste. All processes and steps without direct Value to the patient are Waste.
Types of Waste (Muda)

Any wasteful activity or any obstruction to the smooth flow of an activity
1.Waiting
Time that passes while a step or activity ends until the next step can start
=> Examples: Waiting for an exam, waiting in a queue
6. Excessive processing
Not necessary or duplicated processes
2.Transportation
Unnecessary transportation while providing a service direct to the patient
=> Examples: patient repeatedly asked for their details
7. Under utilization
Staff working on processes under their specific
=> Examples: Bring wheel chair patient to skill wrong treatment room, multiple be moves => Examples: Doctors transporting patients to treatment rooms
3.Inventory
Everything that ties up resources
=> Examples: Batching blood samples
8. Defects
A mistake in the process => very dangerous in healthcare
4.Motion
Not optimized and standardized processes creating unnecessary motion
=> Examples: giving patient wrong injection

* NVA = Non-Value Add
=> Examples: Transportation of patient files
5. Overproduction
Producing more to the patient than required or needed
=> Examples: MRI scan that could have

been done with X-ray
Value Stream
Visualize your processes and find the waste
A Value Stream Map is a pictorial view of Value-Added and NonValue-Added activities that are required to bring the patient through the whole process A Value Stream is the set of activities that convert patients needs into delivered services
Home/
Admitted
iPAS
Opera
KAIZEN!
KAIZEN! KAIZEN!
I
Reception
I
Ward Assessment Holding Bay Anaesthetic Room OR Recovery
I 6 149 Minutes 89 Minutes 149 Minutes 89 Minutes
VA* 4 Minutes NVA* 13 Minutes
17 Minutes 39 Minutes
Patient
Transport
1 operators
Number of
Patient inventory
Movement of Patient Electronic Information Flow
Pull of Patient Manual Information Flow
Care Provider
Data System
Phone Call
*VA = Value Add *NVA = Non Value Add
Flow
Let processes flow like water => find the easy way!
One continuous flow of a patient or material. One at a time
Why
Have a Lean look on movement (flow) of products, services and information down the value stream
Target
Create a continuous flow as product, service and information is transformed by continuously adding value
How
Flow is created by eliminating queues and stops, and improving process flexibility and reliability
In Healthcare:
An example of flow is the patient journey
Patient is booked in at Reception Patient arrives in Hospital Patient is brought to Ward Patient has Surgery Patient recovers on ward Patient leaves hospital
Pull
When the Flow is determined by pull from further down the Process. As opposed to being pushed through the process To produce only requested amounts
Why
To create processes where only the required amount is taken
Target
No action is taken until the downstream process initiates it
How
Let the end customer pull the product/service through the value stream. => Each step pulls the product/transaction when needed from the preceding step
In Healthcare:
an Example of Pull
When a patient is called by theatres to an operation. It is theatre who determines the rate of flow and that only the required amount of patients are pulled into the next step
The Perfect Process

The perfect process is a continuous flow of customer value add, without interruption
Valuable - Would the customer be equally happy if the step was left out? Capable - Can it be conducted with the exact same result every time? Available - Can it be performed whenever it is needed? Adequate -Can it be done exactly when required Flexible - Can it shift quickly between different requirements? Flow - Does the product Flow from one step to the next with no delay?
Next Future State
Future State
Current State
Original State
HEALTHCARE EXAMPLE
Current State 23 Days
Future State 14 Days
5S
1. Sort 2. Set in Order 3. Shine 4. Standardise 5. Sustain
to separate the needed items from the un-needed items which are then removed to a "red-tagged" location
SAFETY IN EVERYTHING
to arrange in a way for how the remaining items will be used to maintain the work area for the already sorted and set-in-order items to ensure sort, set-in-order, and shine are consistently followed across all users to maintain and improve sort, set-inorder, shine, and standardise
May need to Define or Scope the area before initiating 5S
Spaghetti Map
A diagram that shows the motion and transportation of the patient / family / caregiver / supply throughout the care experience or process
Visualize transportation and motion
How
Draw a layout from the birds eyes perspective of the focus area Observe a patient/family/caregiver while doing their job and draw it on the layout by not lifting the pencil from the paper
Paper Referral Trail in Booking Centre
Why
Creates a better understanding an overview of the whole process Visualizes waste in transportation and motion like no other lean tool Quantifies travel time/ distance elimination
KEY = paper referral = Cancer urgent TL = TeamLeader CI = Cancer Intray
Implementing Lean Improvements
Lean Event Key Phases

Project Timeline
Pre Work
incl. Training 3 4 Weeks
QxA=E
VSM KAIZEN Sustainability

3days 1 Week 30 Days
Key Reporting Points
Reporting Point Deliverable(s)
VSM
Current & Future State Value Stream Map. Quick Win actions. Prioritised options for focus of RIE
RIE
Implemented improvements. Success Metrics. Ongoing tracking mechanism. Sustainability Plan. Further Action Plan
Sustainability
Success Metrics. Further improvements implemented. Feedback from team & staff. Further opportunities identified
KAIZEN: Its not a spectator sport

Rapid Improvement Event or KAIZEN
KAI-ZEN
Organise Event
Try-Storming Very Hands On try new ways, stop at any issues, solve them and continue Continuous evaluation & tracking Communicate & Celebrate successes
Mobilise Team
Communicate & Celebrate

Useful Telephone Numbers
Creative Support - 01204 366347 Patients Council - 01204 546088 BAND - 01204 546070 BEST - 01204337523 MHIST - 01204527200 Age Concern - 01204 382411 Housing Benefits - 01204 331590
Dont Forget!!!
Trystorm Improvements
Useful Telephone Numbers

Council Tax Benefits - 01204 331599 PALS 0800 587 4793 Citizens Advice Bureau - 0844826907 Council Housing - 01204 335811 MIND - 0161 953 4006 Benefits (DWP) - 08456088510 Samaritans - 08457 90 90 90
Track Success
ACTION PLAN
Task No. Category Transition to In-Pt Ward 2 Transition to In-Pt Ward 3 Transition to In-Pt Ward 4 Transition to In-Pt Ward 5 Transition to In-Pt Ward 6 Transition to In-Pt Ward 7 Transition to In-Pt Ward 8 Transition to In-Pt Ward 9 Transition to In-Pt Ward 10 Transition to In-Pt Ward 11 Admission Support 12 Admission Support 13 Admission Support 14 Admission Support 15 Admission Support 16 Monitoring staff take-up and use of new obs forms Examining feasibility of staff scanning forms (worker allocation, exit and entry, level 3 obs, handover) and saving electronically - discussion with Anne Warburton/ward managers Observing handovers and obtaining feedback from staff. Responding to staff feedback and amending handover sheet as indicated A Denham/B Earp 11-Apr 9-May Complete Ratify Role of shift co ordinator Ensuring information packs (basic black and white format) are on K2 Examining feasibility of double-sided colour printing on K1 for future stocks of information packs and alternatives if required Undertaking weekly evaluation of new admissions on K2 Amending patient information based on evaluation and informal feedback from patients/staff Angela Murphy S Johnson 11-Apr 11-Apr 9-May 18-Apr Complete
30.00
Task Implementation of Discharge Coordinator / Bed Manager as pilot Implementation of Discharge Coordinator / Bed Manager as Acting up opprtunity Re affirmed shift coordinator allocated through the duty rota Re affirmed A&Eliason Nurse allocated through the duty rota Sectorisation of Crisis Teams Qualified Practioner Teams Launch Role of the bleep holder Review Operational policy Adult inpatients from feedback Review operational policy Maple House From feedback Review operational policy CRHT team
Owner Debs Horrocks /Angela Murpy Angela Murphy Angela Murphy Angela Murphy Angela Murphy Sharon.Morrison Sharon.Morrison Sharon.Morrison Angela Murphy Paula Solomon
Date Assigned 11-Apr 11-Apr 11-Apr 11-Apr 11-Apr 11-Apr 11-Apr 11-Apr 11-Apr
Target Completion 9-May 9-May 9-May 9-May 9-May 9-May 9-May 9-May 9-May
Status Complete Complete Complete Complete Complete Complete In progress In progress In progress
40.00 100.00 90.00 80.00 70.00 60.00 50.00 Average of LoS
Directorate Bolton Salford Trafford
Complete
20.00
S Johnson S Johnson S Johnson/K Cooper
11-Apr 11-Apr 11-Apr
18-Apr 9-May 9-May
In progress Complete Complete
10.00 0.00 7-2007 8-2007 9-2007 10-2007 11-2007 12-2007 1-2008 2-2008 3-2008 4-2008 5-2008 6-2008
Discharge period
Admission Support 17 Admission Support 18 Admission Support 19
S Johnson/B Earp B Earp B Earp
11-Apr 11-Apr 11-Apr
18-Apr 9-May 9-May
In progress Complete Complete
The House of Lean

Lean Transaction House of lean Production System Just-in-Time Jidoka Heijunka
Single Piece Flow Pull Production TAKT Time Production
Autonomation Stopping at Abnormalities
Level Loading Sequencing

Lean Transaction Production System JIDOKA JUST-IN-TIME HEIJUNKA
Jidoka
One of the 3 main principles of Lean
1) Stop at an Abnormality:
Stopping the process when an abnormality has been detected Countermeasure implemented to prevent repeat occurrences
2) Autonomation:
Building human intelligence into machines or software giving automation the ability to make a decision to shut down automatically in the case of an abnormality in order to stop defective products from flowing into the next process. Example: Automatic loom can detect a broken thread
Healthcare Example:
Impact: Visual Timeline Highlights delays Prompts action Instant Progress Snapshot for all Clear plan to meet Estimated ..Discharge Date
Poka Yoke Mistake Proofing

POKA - inadvertent errors YOKERU - to avoid
Why
People and equipment will always be prone to making mistakes. Processes should help them do it right, not help them make mistakes. Poka Yoke will help people and equipment "do it right the first time Not only is the product right the first time, the rate of the process is increased
Benefits
Poka-Yoke supports efforts to eliminate MUDA/ waste: Waiting Inventory Quality Transportation Motion Excess Processing Over Production People's Skills
Applications
Poka Yoke can be used wherever something can go wrong. It is a technique, a tool that can be applied to any type of processes
Healthcare Example:
Cat scan placed wrong way around on an X-ray viewing box = doctor performs surgery on the wrong side of the brain POKA YOKE: Mark patient side of brain to be operated on in advance Design a X-ray box where the scan can only be placed on correctly
JIT Just In Time

Just-in-Time provides the Customer what is needed when needed, without excess, the amount needed
3 Main Elements must work together to achieve JIT

Single Piece Flow Process 1 task at a time and check at the end of process. Ensures defects are detected and not passed on. The basis for Jidoka Pull A system where each process step takes product or knowledge it needs from the proceeding process when needed, in the proper amount Takt Time Derived from Heijunka plan. Establishes the pace the system will operate at Takt Time = Available Time/ Customer Demand
Heijunka
A Methodology to establish stability in a System where Customer Demand is erratic

2 key elements:
1. 2. Leveling: Leveling or Level Loading of a process to reduce variation in output Sequencing: Defining the Sequence which work is processed
Takt-Time
The heartbeat of the organization
Specific production time showing the needed completion time of a process to hit customers satisfaction.
How to calculate Takt-Time

calculate your demand for a specific time period (day, week, month) Look at your available working time during that period*
Takt Time =
Available working time* Actual Demand
Healthcare Example:
60 Patients arrive at a X-Ray on a given day and X-Ray dept. is working 8 hours per day => Takt-Time here would be calculated as follows:
Takt Time = 8 hrs. (480min, 28800sec) work per day = 8 min (480 secs)
60 patients per day
Takt time here shows that every 8 min an exam needs to be completed to hit patients demand
* excluding breaks, meetings, etc.
Appendix
5S Action Workout
Building Blocks for process discipline and control; Sort, Shine , Set in Order, Standardize, Sustain. (Kaizen) 3-5 day team based activity focused on quickly solving problems through physical simulation and evaluation. A visual device (light) or pin-pan-pon that operators use to call attention to an abnormality. The use of this is to request immediate attention and action to the problem. The use of machines working independently of manpower. The process of separating the work of man and machine characterized by: work not movement; quality built into the process; and visual management. (see Jidoka) Any machine or process that limits flow or capacity. The optimal physical layout or machines and manpower for a product or family of products that identifies and eliminates waste. A method of conducting single-piece flow in which the operator proceeds from machine to machine (in a counter-clockwise fashion), taking a part from the previous operation and loading it in the next machine. Then taking the part just removed from that machine, checking it and loading it into the following machineetc, Carrying out one-piece-at-a-time production in order to eliminate stagnation of work (queue) in and between processing steps (see Flow) The total time required for a task to be complete. Elements include manual and travel times, automated or machine run time. Defects per unit. Work done simultaneous to or in conjunction with transportation or conveyance. e.g. (1) an assembly is moving down a line while a person is performing work, (2) a person acts as a conveyor carrying a part to the next machine in a Chaku-chaku fashion. The main purpose of flow is to quickly and continuously identify and eliminate waste. Increasing the delivery frequency of parts, such as parts from outside vendors, in order to keep inventory to a minimum. The process of level loading and sequencing the timing of production.
Andon
Automation Autonomation
Bottleneck Cell
Chaku-Chaku
Continuous Flow Processing
Cycle Time
DPU Flow
Frequent Conveyance Heijunka
Jidoka
Machines that have human intelligence built into them, giving them the ability to shut down automatically in the case of an abnormality to stop defective products from flowing into the next process. Jidoka measures are incorporated in the assembly process by use of Andons and Pin-PanPon; stopping when abnormality is detected. (Just in time) theory of production characterized by (1) single piece flow, (2) producing according to TAKT time, (3) pulling of material from upstream process, keeping inventory at minimum, established levels. Change for the better; a process quality tool for improvement involving a series of activities whereby instances of waste are eliminated one by one at minimal cost, by workers pooling their ideas and increasing efficiency in a timely manner. It emphasizes manual work operations rather than equipment. (see action workout) A method/device of pulling from previous processes in order to control material flow, cap inventory levels, and to take pulse of the customer. It serves as: an instruction for when to produce; a tool for visual control against over production and a detection of irregular processing speeds. Kanban can be broadly categorized into 2 categories: Production Kanban and Pick-up Kanban. These can be further stratified into Ordinary, Signal, Transport, and Purchase. Grouping component parts used in a process or build for ease of assembly. ( see material presentation ) The total time it takes the product to go from raw inventory to the finished product. Order to remittance lead time refers to the total time from when an order is placed until the finished product is shipped.
JIT
Kaizen
Kanban
Kitting
Lead Time
Lean AWO Level Production Machine Time
Internally led Kaizen event. Overall leveling in the production schedule of the variety and volume of items produced in a given time period. ( see Heijunka) The time from machine switch on, processing, to machine returning to original position, during which there is no hands-on work by the operator. The hands-on time it takes for the worker to perform a task. Introducing material to the line or cell in a manner that is easy and effective for the operator. Usually broken into 3 categories (1) items that are too large to kit (2) items that are too small to kit (3) items that lend themselves to be kitted.
Manual Time Material Presentation
Mincing Muda
Mixing of products for central services (i.e. heat treat), OV, kits for components and assemblies. Any type of waste elements that add no value to the product: i.e. Waiting, Transporting, Over production, Excess Motion, Inventory Defects, Human Touches. One shop worker operating two or more similar machines that are grouped together. An operator being able to perform more than one process (which may or may not include machines). Broadening a workers skills so that the worker can operate multiple types of equipment and processes in order to facilitate cell development and one piece flow. A product that deviates from drawing or an internal quality system. A product with a defect. Production system in which only one part at a time is processed or assembled and the work is verified before being sent along the production line to follow processes. A form of Andon that is auditoryspecial sounds are designated to certain points on the line. e.g. A pin-pin-pin repeating sound may be associated with power supply installation, calling attention to it when an abnormality has been detected. Mistake proof: usually refers to the use of fail-safe devices in the process in order to prevent defects from occurring and insure quality. When this ingredient is added to automation will yield autonomation. ( see Jidoka )
Multi-Machine Handling Multi-process Handling Multi-skill Development Non-conforming Material One Piece Flow
Pin-Pan-Pon
Pokeyoke
Process Process Capacity Process Capacity Table Process Mapping Process Route Analysis
A series of steps to achieve a desired result. Maximum amount of product that can be produced through a process for a given period of time. Indicates the maximum capacity for parts processing at any one process. Recorded on it are: the amount of time spent in manual work, machine time, setup time, etc. A technique used to follow the detailed flow of a product through a manufacturing cycle. A study of the process and machine sequence for a group of similar parts. It can be used to standardize product flow for ease of cell implementations.
Process Quantity Analysis
A study of the quantities demanded of different products produced at a work location. This picture of the volume and variety of products can be used to identify high impact areas to concentrate efforts or identify the need to use process razing to make products more similar. System of manufacturing in which each process withdraws the parts it needs from the preceding process when they need them, in the exact standardized amount needed. Total customer satisfaction-involves having all employees Customer focused. The time a part sits waiting to be worked on. The order in which the part is processed. The order in which an operator performs a series of repetitive tasks. Machine changeover steps that are performed while the machine is processing parts or off-line from production time. Machine changeover steps that are performed while the machine is stopped during production.
Pull System
Quality Queue Time Sequence of Processing Sequence of Work Set-up, External
Set-up, Internal
Six Sigma SMED
A quality standard of 3.4 defects per million opportunities - used to insure customer satisfaction. Single Minute Exchange Die (i.e., under 10 min) has become a title for the category of improvement devices used in manufacturing to allow for quick change over of machine/fixture set-ups. Statistical Process Control: analysis of variation in a process. Combining people and machines to accomplish production in such a way as to minimize waste. Minimum (and standardized) amount of work in process required to perform repetitive operations economically. Sequence of repeatable tasks that an operator performs. Shows the outline of work for each worker in a cell. Recorded on it are: Takt time, work sequence, standard WIP, quality checks, safety precautions, etc.
SPC Standard Operations Standard WIP
Standard Work Standard Work Sheet
Standard Work Combination Sheet
A table that clarifies how much time is spent doing manual work and traveling at each production process. It is used to examine the range of processes that one worker can take care of within Takt time and the amount of time during which machines are operated automatically. These are recorded to help determine what combination of operations are possible. A visual system that has a predetermined amount of inventory and all facets of 5s in order to detect abnormalities. With this system, the shopper from the downstream process can buy from the supermarket. Once the purchase has been made, and material consumed, a signal can be sent to the upstream process to supply more. (see pull)
Super Market
Takt Time
Available production time / required production (fcst & act demand)..must be like units; e.g., 1 shift = 1980 min/wk
TPM Travel Time
Total Productive Maintenance involves of all employees in a cell to improve the process. The time is takes a worker to move to the next station to pick up or put down parts, tools, etc. May occur during operations as well. The specific activities required to design, order, and provide a product from concept to launch order to delivery raw materials to finished goods. The process of detailing the process of converting raw material to finished goods. This is typically mapped with the 7 flows (info, people, equipment, raw material, sub-assembly, assembly,engineering) one at a time, or in a combination. Refers to the means by which anyone can tell at a glance if production activities are proceeding normally or not. A communication, discipline and pacing tool. Work In Process; inventory of materials that has been already started processing. Rework, set-ups, inspection, repair processing, transportation, unnecessary work to complete of a product. Anything that isnt directly changing the form fit or function of the part. Only necessary direct work to manufacture a product. Anything that the customer is willing to pay for or an operation that changes the form, fit, or function of the part.
Value Stream
Value Stream Mapping
Visual Management WIP Work, Non-value added Work, Value Added
Additional Lean resources

Title
Lean Thinking
Topic/Focus
Lean Background / Case Studies
Becoming Lean: An inside story of US Manufacturers The Toyota Production System: Beyond Large Scale Production The Machine That Changed The World: The Story of Lean Production Learning to See Mapping Creating Continuous Flow within a cell
Lean Background / Case Studies Lean Background
Origination of Lean outside of Japan Value Stream
Creating flow
Additional Lean resources

Title Topic/Focus
The Goal: A Process of Excellence Ongoing improvement Poke Yoke: Improving Product Quality by Preventing Defects techniques The Toyota Production System
Operational
Implementation of Poke Yoke
Detailed Implementation of TPS Management principles from Toyota Lean thinking beyond the factory floor
The Toyota Way
Lean Solutions

Lean Tools Implementation

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Lean Process Improvement Memory Jogger

2/ Performance Solutions/ 26/02/2009

90+ years in Healthcare

4/ Performance Solutions/ 26/02/2009

Performance Solutions Formula for Success

GE Lean Six Sigma & Change Acceleration

Clinically Trained Healthcare Experts

Sustainable Impact Performance Culture

5/ Performance Solutions/ 26/02/2009

Capabilities and Application areas

Market Market Leader Leader in in Healthcare Healthcare

Treatment Discharge Recovery

Performance Performance Improvement Improvement

Clinical Clinical engagement engagement

Project Project Team Team

Training Training & & Education Education

6/ Performance Solutions/ 26/02/2009

7/ Performance Solutions/ 26/02/2009

Components for Effective Change

Quality x Acceptance x Accountability = Effect Results

8/ Performance Solutions/ 26/02/2009

2 Map the Value Stream

9/ Performance Solutions/ 26/02/2009

Lead Time / Cycle Time

Lean attacks waste here

VA vs. VE vs. NVA

Pt recovery at natural rate

3 NVA = Non-Value-Added = Waste

11 / Performance Solutions/ 26/02/2009

Types of Waste (Muda)

=> Examples: Waiting for an exam, waiting in a queue

=> Examples: patient repeatedly asked for their details

=> Examples: Batching blood samples

=> Examples: giving patient wrong injection

=> Examples: Transportation of patient files

=> Examples: MRI scan that could have

I 6 149 Minutes 89 Minutes 149 Minutes 89 Minutes

VA* 4 Minutes NVA* 13 Minutes

149 Minutes 89 Minutes

Movement of Patient Electronic Information Flow

Pull of Patient Manual Information Flow

*VA = Value Add *NVA = Non Value Add

13 / Performance Solutions/ 26/02/2009

14 / Performance Solutions/ 26/02/2009

The Perfect Process

Future State 14 Days

16 / Performance Solutions/ 26/02/2009

May need to Define or Scope the area before initiating 5S

17 / Performance Solutions/ 26/02/2009

Visualize transportation and motion

KEY = paper referral = Cancer urgent TL = TeamLeader CI = Cancer Intray

18 / Performance Solutions/ 26/02/2009

Implementing Lean Improvements

19 / Performance Solutions/ 26/02/2009

Lean Event Key Phases

VSM KAIZEN Sustainability

Key Reporting Points

Reporting Point Deliverable(s)

20 / Performance Solutions/ 26/02/2009

KAIZEN: Its not a spectator sport

Communicate & Celebrate

Useful Telephone Numbers

Directorate Bolton Salford Trafford

S Johnson S Johnson S Johnson/K Cooper

VA = Value Add NVA = Non Value Add