Issue 2 • January 2011
Sustaining Improvement - training
Sustaining is all about management. It has nothing to do with concepts and technology. It is about persistence, consistency, and tenacity. Refuse to fail!
Before you can begin to sustain, you must improve. Before you improve, you must stabilize your organization. Stability begins with visual management. An organization should stabilize Manpower, Methods, Machinery/Equipment, and Materials. Until you are able to utilize basic standards of operation and achieve and maintain consistency in these areas, improvement will be difficult.
Assuming you have stabilized the organization, you can now deploy your lean techniques to deliver improvement. Implement lean techniques such as Flow and Pull in all of your work areas. Strive for zero defects, and manage the results visually. Finally, adapt a culture of kaizen. Strive for improvement every day!
Some of the common lean approaches to sustaining improvement include Gemba Walks, leadership standard work, and Kamishibai (audit).
When you get to a point where you have standard work, good 5S, and visual management of both process and results, you can actually improve incrementally each and every day.
Imagine an environment where every day you leave the work place better than when you arrived. That would be special indeed. This concept is known as managing for daily improvement, or MDI.
Now go and change the world, one team at a time!
Breakthrough Highlights from York Central Hospital
The Surgery Program at York Central Hospital is continuing the journey to provide excellent and compassionate care to our patients. Over the past few years we have achieved many improvements that have positively impacted the quality of the surgical service, including:
- attracting, hiring, and retaining great nurses, support staff and physicians,
- decreasing surgical wait-times and increasing available OR time,
- receiving over $1.0M in capital equipment of instruments and other OR equipment,
- installing Minimally Invasive Surgery Suites, and
- renovating CPD to bring the Department up to standards and beyond.
Although much has been accomplished, there is much more work to be done such as reducing the cost per case, reducing wait-times, increasing volumes, improving patient, staff and physician satisfaction and ensuring the right bed is ready for the right patient at the right time.
To move us towards our goal, we have embarked upon a significant quality improvement project using the Lean methodology. This process allows us to recognize wastes within all parts of the peri-operative continuum and then identify ways to remove this waste and thereby improve efficiencies. In June, the Surgery Program Value Stream Analysis was completed and we have since completed Kaizen events in Pre-Admit Clinic, Chart Prep, Pre-Op Day Surgery, OR, PACU, and Post-Op Day Surgery as well as a Kanban event in the Sterile Core/Central Processing Department.
In a very short-time, we have realized positive results which are measurable and considerable, such as:
- 16% decrease in the OR cost per case,
- Increased OR cases by 21% over budget,
- Increased prime time Pre-op Day Surgery, PACU, Post-Op Day Surgery capacity by 30% thereby reducing overtime expense,
- 80% reduction in the labour cost of managing direct orders,
- Decreased rush order freight costs to $0, and
- Improved OR on-time start times and decreased overtime for all staff
Although this initiative has been time and energy intensive, the results are worth the investment. We continue to focus on sustaining the achievements to date, pressing to realize further improvements and continuing to apply many of the learned tools of visual management and standard work to all parts of the peri-operative continuum.
Is your strategic plan deployment ready?
A well articulated Strategic Plan not only sets the key directions for an organization over the coming years, it also creates the opportunity for the organization and its stakeholders to define a future that is both under its control and achievable.
>How do the Mission, Vision and Values, environmental scan, consultation and intense dialogue translate into action and results for sustaining purpose, quality and improvement? The answer is by creating a plan that is deployment ready.
A deployment ready plan:
- Has a manageable number of strategic directions – three to four at most!
- Includes strategic directions that are measureable - one to two performance targets for each direction and associated targets for sustaining and improving performance
- Allows for clear accountabilities at all levels of the organization for achieving objectives and targets
- Supports information flow to the front line and back up to the Board for celebration and course corrections
- Speaks to all members of the organization such that each person knows their role in achieving the vision
A Strategic Plan that is not ready for deployment can be made ready through more rigorous priority setting, clarifying objectives, defining clear targets, integrating improvement and assignment of responsibility for outcomes.
Is your strategic plan deployment ready?
Gemba Walking - training
It seems that in lean most people are quite fond of that that little word, "gemba." It's simple and has a touch of charm to it. People throw "flow and pull" around like it's candy, only to be topped by the use of "standard work." Management usually isn't fully aware of the significance and what's involved to achieve these lean concepts. Gemba, though, brings with it a simple definition of "the workplace": it is "the source of truth" and "where value is created." In other words, a place we should hang out more often.
That being the case, lean takes the concept of gemba a step further and suggests gemba walks. We encourage every senior leader, starting with the president, to commit to doing weekly gemba walks. One argument for this is that following an improvement we're going to ask...expect:
1) That staff follow standard work each time
2) That managers and leads check progress (planned to actual) and standard work hourly
3) That mangers check the standard work and progress frequently
That being the case, it only makes sense for leaders to exhibit the same type of discipline and commit weekly to a gemba walk.
A gemba walk thus begins with a short desktop talk on gemba walks and then deciding one or two lean principles selected as themes for the walk. Through this we want the leader to start grasping a better understanding of lean principles through discussion and by learning to evaluate behavior based on the principles.
The first part of a gemba walk is sometimes awkward as in, "Ok....what do we do now?" After a few minutes though, the workplace started to reveal itself and the leader will start seeing opportunities for improvement based on lean principles we are focusing on. We encouraged the leader to study behavior and to think about the culture. We talk about what “good” looks like regarding our selected themes.
Gemba walks help leadership understand lean principles. They serve as a bit of a litmus test regarding their commitment to the lean improvement. It provides an opportunity for dialogue on each visit to address concerns or misunderstandings about lean and the journey. Gemba walks are invaluable to a lean learning and culture development.
