Issue 5 – July 2011

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Issue 5 • July 2011

Lean Training Stability and the 4 M’s

For over a year, you have read about how lean improvement can be applied to any industry through the application of the Toyota Production System. Improvement consists of seeing and eliminating waste through the application of tools. Sustaining improvement involves following disciplined leadership standard work that uses a visual environment to make management by exception possible. Great, but are there any predecessors to improving?

Stability of the 4M's is a requirement to developing a culture of improvement. The 4M's include Methods, Manpower, Machinery, and Materials.

Could we agree that it would be difficult to improve if we did not have a stable workforce? One that shows up for work, does not turnover 30% of its employees each year, and performs to the safety standards of the organization? This is stability of Manpower.

Could we also agree that it would be difficult to improve with untrained staff, following inconsistent work standards with no accountability? This is stability of Methods.

Next, we could agree that it would be difficult to improve with machinery that breaks down frequently, or fails to operate to the appropriate specifications? This is stability of Machinery.

And finally, we could agree that it would be difficult to improve with constant part shortages, and poor quality or obsolete parts? This is the stability of materials.

If you are not seeing improvement in your lean efforts, go back to the four M's and do a quick analysis. You must stabilize the four M's as a foundation for improvement. In order to stabilize the 4 M’s, you must begin with 5S and visual management. These are the first two steps necessary to stabilize your organization.

Lean Profile – Trillium Health Centre

Trillium’s strategic plan identified “Quality by Design” as one of our strategic themes and “quality” as a promise of excellence. One of the specific strategic directions in the plan is to develop and implement an organization-wide quality imperative and approach to reduce waste, drive process improvements and redesign, across Trillium. The Emergency Health System (EHS) was prioritized as the first value stream to apply the Lean methodology. A value stream analysis was held in June 2010 and we have successfully completed nine Kaizen events over the last year to reduce waste within our various processes to improve quality, efficiency, patient flow and staff morale.

Our Kaizen events have included: Triage and Registration, Equipment Repair and Supplies, CTAS 4 and 5, Implementation and Sustainability Event, Patient Assignment and Transfer, Leadership Standard Work, CTAS 2 High Acuity Intake Zone, CTAS 3 Rapid Assessment Zone, Charge Nurse Standard Work.

Patients now flow “first in, first out” from triage to registration and are directed to the most appropriate area inside the emergency department based on acuity and patient need. Standard work, appropriate supplies, clear triggers to pull staff to the area in a timely manner, and visual management of the process have been developed for each of the zones. Charge nurse and leadership standard work events have tied together all of the improvements and this daily focus on process will be critical to sustaining the gains and continuous improvement. The benefits to our patients have been more timely assessment and treatment with a reduction in time spent in the waiting room leading to a reduction in patient risk, and an overall improvement in key metrics.

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The benefits to the ED staff include clear expectations through standard work, consistency and continuity in process, a greater understanding of the various roles and process issues from the perspective of their colleagues, greater understanding of MOH-LTC targets, and empowerment of the staff to redesign the processes within which they work. Over 70 ED staff have actively participated in one or more Kaizen events, which has increased staff buy-in to the changes and feedback has been positive:

“Working on Lean projects allows you to take a step back from your daily work and have a better understanding /appreciation for what can be improved upon “(Kim, RN)

Challenges include ensuring that the right resources are in the right place at the right time to meet the demands of increasing volumes and sustainability of both standard work processes and visual management. Lean has provided the foundation to develop the culture, management system and tools to continually improve and adapt our processes to patient need.

The Shingo Prize Conference

One of the great ways to expand your lean knowledge is by attending one of the annual lean conferences. One of the oldest and most respected lean organizations is The Shingo Prize, an outstanding organization described below with a few words from their web site: http://shingoprize.org.

“The Shingo Prize for Operational Excellence is named for Shigeo Shingo who distinguished himself as one of the world’s leading experts in improving manufacturing processes. The mission of The Shingo Prize is to “create excellence in organizations through the application of universally accepted principles of operational excellence, alignment of management systems, and the wise application of improvement techniques across the entire organizational enterprise.”

Around March each year, the Shingo Prize holds its annual conference. This past year’s program featured keynote addresses from CEOs of leading worldwide organizations, plus a great selection of in-depth knowledge sessions from a variety of industry leaders, authors, and Shingo Prize recipients. It consisted of networking opportunities with speakers and conference attendees in various stages of their lean journeys.

Except for a small staff, Shingo Prize’s site visits and other national activities are conducted by volunteers. Consider attending, or perhaps even speaking at, the May 2012 conference in Atlanta. You’ll return with new knowledge and understanding, names of networking contacts and renewed enthusiasm to drive your organization to the next level. Those involved with the Shingo Prize cite their experiences as key component to enhancing their lean knowledge and growth and I know you’d experience the same.
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Additional Lean Training – A4 Problem Solving

Due to the popularity of the first course, Breakthrough Horizons is pleased to offer a second public workshop on lean problem solving. This course introduces a new lean tool, the A-4. The training is designed to teach participants problem solving based on lean principles. Root cause problem solving eliminates problems permanently.

Included in the workshop are learning key problem solving skills including defining the problem statement, determining the direct cause of a problem, developing soft and hard countermeasures, and tracking the results. The curriculum includes problem solving theory, application and use of the A-4 problem solving tool, and includes hands-on problem solving of actual, clinical and administrative problems.

This lean problem solving training is integral to sustaining improvement and is being offered as is a 2-day program on 11 - 12 October, 2011 in partnership with The Central CCAC. The session will be limited to ~30 participants and will be filled on a first-come first-served basis.

  • Eligible individuals: individuals who want to learn the technique of lean, root cause problem solving. (Prior improvement experience is not necessary). This course will apply to clinical, medical, and administrative associates.
  • The training will be provided by Mike de Graauw, Master Sensei, with Breakthrough Horizons, Ltd.  
  • Included in the cost of the training will be Training hand-outs, lunch and snacks. Training fees for the curriculum will be $590 CAD per participant. Participants are responsible for travel, and for their own lodging if required.

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