Issue 8 • Jan 2012
Lean Training – Management and Staff Development
One of the primary responsibilities of leadership during a cultural transformation is to develop management and staff. Why do the management and staff need to be developed? Likely many habits exist within your organization. These habits show up in actions that occur daily. An organization really shows its colors when it is placed under stress.
Is lean thinking exhibited, or are traditional solutions employed when problems surface? Even if you are in years 3, 4, or 5 of your improvement journey, when stressed you will consistently see non-lean solutions to problems encountered. Hiring extra people, ordering additional resources, working overtime, purchasing extra equipment, etc. The list goes on.
Does an A-3 get opened or an A-4? Do we practice kaizen? Is our approach to eliminate waste in lieu of adding resources? This is how a lean organization would respond. A kaizen week, for example, might eliminate the need to hire a new staff member that could take up to six weeks.
Our goal is to create a culture of continuous improvement; one that sees and eliminates waste in real-time. To get to this point we have to learn habits that enable excellence. This is why both staff and management need to be developed.
There is very long list of what the staff and management need to know. At a minimum everyone should know the 5 principles of improvement and the 7 wastes. Additionally, I prefer everyone understand A-3 thinking which is the documentation and thinking used to execute the (PDCA) scientific method. Finally everyone needs to know the common tools to see and eliminate waste.
Management needs even more skills. In addition to the skills listed above, management needs to understand problem solving using the fish bone diagram and 5 why skills. Management also needs the discipline of following standard work. They need to hold the staff accountable for their standard work and they need to follow their leadership standard work. Management finally needs some data collection and measurement skills.
This list is not inclusive of all the skills needed, but would be a great place to start. How are your skills?
Kamishibai at Peterborough Regional Health Centre
by Cheryl Johnson, PRHC
Peterborough Regional Health Centre has adopted Lean methodology, a proven performance improvement strategy that focuses on quality and patient safety to drive cultural change.
Lead by the Transformation Office (TMO), the Intensive Care Unit (ICU) was guided through the implementation of a Kamishibai or visual audit system, designed to spread accountability to those doing the work and promote a culture that takes real time corrective action.
The target performance included promoting accountability in the prevention of Health Care Associated Infection through a focus on hand hygiene, the prevention of VAP and CLI and facilitating the spread of the Kamishibai system through the corporation as a method of managing outcome and process quality indicators.
A three day rapid cycle improvement event was held to examine current practices, identify value vs. non- valued added activities and reduce the waste within our processes. A gap analysis was completed to develop solutions and define the action plan.
Visual audit cards were developed by a multidisciplinary team aimed at validating processes critical in the support of providing high quality patient care and improved patient safety outcomes. Cards are designed for frontline staff and clinical leadership working within the ICU, to provide staff visual daily feedback in the success or failure of their performance.
Unit based metrics with clear target outcomes are posted on the unit Performance Board and updated to drive performance within the ICU. Real time corrective action is initiated when failure is identified through this daily audit process.
Weekly performance huddles lead by the TMO and ICU leadership and attended by all available ICU staff allows for the discussion and evaluation of data, the identification of barriers and the development of corrective actions as required.
Key learning’s have been to start small, focusing on the processes and practices that have meaning for staff. Include all staff in the daily audit process to promote accountability and to test each card well for comprehension prior to circulation. Circulating several copies of the same card will validate processes throughout a shift and increase data confidence.
Results have shown an improvement in Hand Hygiene compliance (MOHLTC 4 Moments for Hand Hygiene) and the best practice elements (Safer Health Care Now!) for the prevention of Ventilator Associated Pneumonia (VAP) and Central Line Associated infections (CLI)!
Lean Leadership – Managing the Pace of Change
Every organization has to make the choice of where to spend the critical improvement resources. There are always many good opportunities for improvement, but picking the critical few is the responsibility of leadership.
We want the improvements to align with the strategic focus of the organization. Improving the speed and accuracy of the mail room might be a good improvement project, but I doubt it will help improve your lead-time for products and services, or grow your sales. But we are trading off that decision with creating a culture of improvement. The best way to create a culture of improvement is to get everyone involved.
So the decision to go "deep" implies picking a few key value streams within your organization and transforming these value streams consistent with your strategic plans. The decision to go broad implies using lean thinking in all areas of the organization so everyone can participate.
Leadership has to balance the resources and pace of change in the initial stages of an enterprise wide transformation. Going too deep at the expense of going deep will shut off the balance of the organization from learning lean thinking. Going too wide at the expense of going deep will dilute the focus of improvement, slow the actual transformation, and eventually impact the sustainability of the improvements.
Different third party organizations that you may use to help you in your transformation have different views with respect to which is better and which pace to shift from wide to deep or vice versa. At the end of the day it is the role of leadership, and the steering committee to regulate the pace of change.
While you didn't ask, I always prefer to go deep first, then wide. Everyone really underestimates the effort it takes to make meaningful change. And everyone wants to transform really fast. If I told you transforming your organization was a 20 year journey which model would you pursue first.
Scheduled for March 2012 – Training toward Lean Certification
Lean Certification is an area pursued by many people/ organizations. There is comfort in knowing that you have built internal expertise in improvement and can be recognized for those efforts.
I like to note that Toyota has no “belts” in their organization. No one is classified as “lean certified.” Their entire focus is on daily improvement using repeated cycles of plan-do-study act. Certification is not required to practice PDCA.
However, you can expand and accelerate your learning by becoming exposed to the core knowledge that comprises the Toyota Production System, which you know as LEAN.
On March 7-9, 2012 Breakthrough Horizons will facilitate a public workshop to help prepare people who are interested in pursuing an accredited lean certification. This certification is the recognized world leader in lean certification curriculums. The workshop will be hosted by Rouge Valley Health System in Ajax, Ontario. The workshop will be limited to 30 people to ensure adequate knowledge transfer.
The workshop will cover the core lean content required to pass the body of knowledge exam. Upon successful completion of the exam, candidates submit a portfolio of five projects to a council for review, and may be awarded bronze level certification.
The workshop will be held on March 7, 8 and 9.
Over 200 healthcare professionals have attended this workshop over the last 3 years. This certification is recognized by ASQ, SME, AME, and The Shingo Prize.
