Issue 13 – Jan 2013


Issue 13 • Jan 2013

Training Toward Lean Bronze Certification

Breakthrough Horizons is pleased to offer another public workshop on training toward Lean Bronze Certification through ASQ, SME, the Shingo Prize and AME.

In sponsorship with Mount Sinai Hospital located in downtown Toronto, ON, This two and half day workshop will be held from 12-14 March 2013 at the Ontario Power Generation Building.

The training is designed to facilitate group discussion, learn the basic fundamentals of lean improvement, and prepare for the body of knowledge of exam necessary to achieve bronze level lean certification. The session will be limited to ~30 participants and will be filled on a first-come first-served basis. (Note: the course is 50% full as of the time of this printing)

Eligible individuals: individuals who want to advance their quality improvement knowledge or others in your organization that have a basic knowledge of improvement methods. (Prior improvement experience is not necessary).

The training will be provided by Ron Bercaw, President and Sensei, with Breakthrough Horizons, Ltd.

Training - Zero Defects

Of all the lean principles, perhaps none is more important than eliminating defects. Human beings, by our design, are prone to make errors. A defect is an error that reaches the customer. Ideally, we seek to be error free, but we can live, short term, with a system that prevents any error from reaching our end customer.

Defects in their minor form, only serve as a nuisance. The ketchup packet left out of your order of fries, or the garment your find without the price tag when you get in a line with many waiting customers behind you. A worse form of defect is that which requires a lot of rework, adding cost and time to your products and services while "eating" at the staff doing the work. In the extreme, defects can cost people their lives; the sign that falls off the building, the wrong medicine given to a patient, or the truck accident leading to a gas fire.

A lean organization seeks to repeatedly design and re-design systems that prevent defects. Preventing defects is not as easy as a memo saying "make no more defects". Process and culture must be changed to create a world class organization that then develops defect free processes. To get started, simply capture and report on errors. In many organizations the staff and the management have only a limited idea of the quantity and source of defects. You can't fix what you can't see. Or as Dr. Phil says, "you can't change what you don't acknowledge."

There are a host of lean tools designed to move processes toward zero defects. The short list includes the following: successive operator checks, mistake proofing (hard and soft), closed loop corrective actions, standard work, recipe cards, andon, 5 Why's , quality at the source , root cause analysis , A4 problem solving, cause and effect diagram, and the 7 Quality Tools.

The key point, regardless of the tools or concepts used, is that for a system to reach its potential, you must develop a way for the work to be done right as it progresses through the value stream. Thinking zero defects and then applying zero defect approaches is a great way to start.

Think about a defect for a second. Think about the wastes that it causes: at a minimum inventory, waiting, and rework. Defects also impact people in a negative way and as such, are disrespectful to the staff. Defects also increase cost since they take time, space, and resources but fail to deliver value to a customer.

Your role is to design processes that are defect free.

Lean - An Enabler to Inter-professional Education and Collaborative Practice - Part 1 of a 2 part Series

Peggy Goff, IA, Lean Bronze
Trillium Health Partners

Health professionals have been educated, and have traditionally worked within specialized “silos”. This has led to fragmented communication, issues of power and hierarchy and limited competencies in inter-professional collaboration. The desired shift from multi-disciplinary silos of practice, to inter-professional collaborative practice, has identified the need for inter-professional education (IPE) opportunities.1 IPE can be defined as “the process by which two or more health professions learn from, with, and about one another across the spectrum of their life-long professional journey, to improve collaboration, practice and the quality of patient centered care”.2

Continuous quality improvement (CQI) has been identified as an enabler for IPE where “learning, from, with, and about one another are an integral part of the process.”3 With many healthcare organizations adopting the Lean approach to CQI, there is a tremendous opportunity to explicitly recognize and leverage the Value Stream Analysis and Kaizen event as opportunities for IPE.

The interactive, multi-disciplinary team based improvement events provide an opportunity to develop the prerequisites of collaborative practice. Event outcomes may include increased knowledge of each other’s roles, good communication and negotiation skills, a willingness to work together, trust and mutual respect, The Kaizen event has the added benefit of empowering the team to develop, test, implement and continually adapt the processes, standard work, visual management, communication tools and leadership practices that will support and drive inter-professional collaborative practice within their specific care setting.

The development of effective interprofessional collaboration is a key factor for timely, safe, effective care within the organization and upon transition to the community. We may want to consider measuring the impact of our events on the development of interprofessional competencies and collaboration.

1. Hall P. Interprofessional teamwork: professional cultures as barriers. J Interprof Care. 2005;19(suppl 1):S188-S196
2. Interprofessional Care Steering Committee, HealthForceOntario. Interprofessional care: A blueprint for action in Ontario. HealthForceOntario Web site. 2007.
3. Hammick M, Freeth D, Koppel S, Reeves S, Barr H. A best evidence systematic review of interprofessional education. Med Teach. 2007;29: 735–751.

Available for Pre-Sale

This book explains how to apply Lean improvement to clinical and non-clinical processes. Written by a Sensei, it delivers valuable lessons learned over the years of providing improvements in the healthcare industry. The text covers the fundamentals of Lean and explains how to link a strategy of continuous improvement to create operational excellence. It also lays out a roadmap for starting your Lean improvement, discusses the leadership behaviors required for success, and describes how to mitigate the risk of failure when undergoing large-scale change.

For more details, please click here.


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