1. Housestaff Lean Academy Module 1: Lean Principles for Physicians
Robert Martin, PsyD Performance Excellence UCLA Health

2. Where does this module fit into the curriculum?
Module Description 1
Lean for Physicians (Important Concepts) 2
Focusing Improvement Projects/Efforts (Methods Overview) 3
Managing the Improvement Process (PDCA/A3) 4
Understanding the Current State (Process Mapping) 5
Identifying Waste in the Current State (5S, Waste, Standard Work) 6
Analyzing the Current State I (Organizing & Using Data) 7
Analyzing the Current State II (Organizing & Using Data) 8
Identifying Improvements & Actions (A3 Simulation) 9
Working as a Team (Frontline Empowerment & Engagement) 10
Understanding & Leading Change 11
Supporting Infrastructure (ADM, Huddles, A3/A4 Methodology)

3. Module 1 Agenda… Physician Process vs. Lean Process Lean Origins
Important Concepts
Post Questions
Physician Process
vs. Lean Process
Origins
Important Concepts
Post Questions

4. Lean should be a familiar process for Physicians…
Scenario – a patient arrives with a problem (clinic, ED, etc.). What is the Physician’s process?
Physician Process
Conduct Health & Physical
Develop Initial Diagnosis
Order Tests
Analyze & Understand Data
Develop Treatment Plan
Try, Measure, Adjust It
Lean Process
Understand Scope (Charter)
Develop Problem Statement
Conduct Observations & Collect Data
Develop Improvement Plan
Notes
Neither process jumps to solutions
Both processes involve the patient
Both processes use data
Both processes use the Scientific Method
QI & Lean call “The Scientific Method” PDCA (Plan-Do-Check Adjust/Act)
Physician Process
vs. Lean Process
Lean Origins
Important Concepts
Post Questions

5. Lean is a modern term, but the origins are not…
Jidoka (1902)
Sakichi Toyoda invents device to detect broken threads in looms autonomously
Just-in-Time (1937)
Kiichiro Toyoda establishes Toyota, has the idea for JIT delivery of parts
Takt Time
German aircraft industry pioneers use takt time for synchronizing movement of aircraft
Mitsubishi brings idea back to Japan where Toyota embraces it
Venetian Arsenal
1 Warship/day
Standardized Parts
Use of canals to flow galleys to workers through assembly phases
Deming Prize
Japanese Union of Scientists and Engineers creates Deming Prize for statistical quality and PDCA
American Meat Packers
Conveyor belts to steadily remove carcasses past workers after meat removal
Toyota > GM (2007)
Toyota becomes the world’s largest automaker
UCLA Operating System
Established by Amir Rubin
1902- Present
1930s
1500s
1780s
1880s
1890s
1940s
1960s
1980s
Training Within Industry
US Dept. of War introduces Job Instruction, Methods, Relations to teach millions of workers in war industries. Later introduced to Japan after the war
Lean Research
Toyota Production System (1982, Yasuhiro Monden)
The Machine that Changed the World (1990, Womack, Jones, Roo)
Lean Thinking (1996, Womak, Jones)
Learning to See (1998, Rother and Shook)
DNA of the Toyota Production System (1999, Spear and Bowen)
The Toyota Way (2003, Liker)
Shingo Research Award – Lean Hospitals (2009, Mark Graban)
Scientific Management – Frederick Taylor
Scientific study of tasks
Employee development and training
Managers use principles to plan work and workers perform tasks
French Army Ordinance
Concept of interchangeable parts for muskets (pre-cursor to high-volume flow production
Henry Ford
1908 Model T modular car with truly interchangeable parts “there are no files in my factory”
1913 Flow Production Moving assembly line with processing feeder lines
1926 Mass Production with product variety
2009
Mark Graban
Shingo Research Award
Lean Hospitals
Venetian Arsenal -
Frederick Taylor -
Frederick Taylor – was a laborer and machinist at midvale steel, focused on human component of efficiency (machines worked harder than humans
Lilian introduced psychology to management studies, and Frank developed time/motion studies
Ford – integrated people, machines, tooling, producs, and supply chain into a continuous flow
Kiichiro Toyoda – took Toyoda loom works into auto manufacturing
Taiichi Ono and Shigeo Shingo studied Ford’s approach and improved it. They incorporated respect for people and the role of inventory, which eventually became the Toyota Production System.
Lean is not new. It started a long time ago, in America. Ford took all the elements of a manufacturing system-- people, machines, tooling, and products-- and arranged them in a continuous system for manufacturing the Model T automobile and created the first comprehensive Manufacturing Strategy.
Lean has played an integral role in manufacturing, but it’s application in healthcare is relatively new. UCLA wants to position itself as the leading Lean healthcare system and we need your help to do it.
Physician Process
vs. Lean Process
Lean Origins
Important Concepts
Post Questions

6. Lean is based on a few important concepts…
Value
Waste
Scientific
Method
(PDCA)
Empowered
Staff
True North Alignment
Lean is more than a collection of tools….
It is about creating a culture based on a few important concepts.
There are more- but these are sufficient for now!
Physician Process
vs. Lean Process
Origins
Important Concepts
Post Questions

7. Lean is based on a few important concepts…
Value
Waste
Scientific
Method
(PDCA)
Empowered
Staff
True North Alignment
What is Value?
What patients are willing to pay for
Value must be discerned
Lean systems produce what the patient values
What do Patients Value?
“Timely” Nursing & Physician Time
Information to participate in choice
A safe and effective Treatment Plan to become healthy, alleviate their pain and suffering, or restore function
To be listened to; Trust and Privacy
Physician Process
vs. Lean Process
Origins
Important Concepts
Post Questions

8. Lean is based on a few important concepts…
Value
Waste
Scientific
Method
(PDCA)
Empowered
Staff
True North Alignment
Activity (Individual or self-organized)
Spend a few minutes to discern what your patients value
Group Discussion
Physician Process
vs. Lean Process
Origins
Important Concepts
Post Questions

9. Lean is based on a few important concepts…
Value
Waste
Scientific
Method
(PDCA)
Empowered
Staff
True North Alignment
Waste is: the opposite of what patients value…
Waste hides in complex systems, and healthcare is complex!
Waste must be understood so that it can be discovered and highlighted as abnormal
Focus on minimizing or eliminating waste:
Waiting for appointments, to be seen, etc
Waiting for physician’s orders to be written
Late/Missing callback for test results
Clinicians who don’t listen, lack of trust, lack of privacy, etc.
Administrative errors
Clinical Errors
Unnecessary documentation protocols & approvals
Physician Process
vs. Lean Process
Origins
Important Concepts
Post Questions

10. Lean is based on a few important concepts…
Value
Waste
Scientific
Method
(PDCA)
Empowered
Staff
True North Alignment
Activity (Individual or self-organized)
Spend a few minutes to discern
What your patients do NOT value (i.e. waste)
Wasteful activities that inhibit your value production
Group Discussion
Physician Process
vs. Lean Process
Origins
Important Concepts
Post Questions

11. Lean is based on a few important concepts…
Value
Waste
Scientific
Method
(PDCA)
Empowered
Staff
True North Alignment
The Scientific Method (PDCA) …
Was discussed earlier!
Is taught to staff so that they can
Use data to solve problems
Support value-added activities
Minimize or eliminate waste
Continuously improve
Also known as Plan-Do-Check-Adjust/Act
(We are going to have a whole class on this)
Physician Process
vs. Lean Process
Origins
Important Concepts
Post Questions

12. Lean is based on a few important concepts…
Value
Waste
Scientific
Method
(PDCA)
Empowered
Staff
True North Alignment
What does Empowered Staff mean? Why is it important?
The best ideas from the smartest physicians often result in:
Passive or Active resistance from staff
Staff who feel disempowered and disengaged
No change
Staff must feel that they “Own” changes which will support value-added activities and minimize/eliminate waste
They are experts in their areas and have great ideas on how to improve
Leaders (Administration & Physician) must engage, empower, and align staff
(We are going to have a whole class on this also!)
Physician Process
vs. Lean Process
Origins
Important Concepts
Post Questions

13. Lean is based on a few important concepts…
Value
Waste
Scientific
Method
(PDCA)
Empowered
Staff
True North Alignment
What would happen if all staff was trained in PDCA, engaged and empowered without alignment to the organization’s goals?
Some improvement certainly!
Likely much silo’d improvement which might sub optimize the system (i.e Schegistration might make their job easier and everyone else’s more difficult!)
Improvement can occur at all levels, but always in consideration of linked-activities in the organization
What is True North Alignment?
A vision or ideal from Leadership that can “rally” the case for change (should be aligned or supports the hospital or SoM vision)
“Minimally sufficient” strategies and initiatives (3 to 5, not 25 to 75) to focus staff effort
The most ideal strategies include participation from all layers of management and staff (i.e. catchball) to ensure that they are realistic
Physician Process
vs. Lean Process
Origins
Important Concepts
Post Questions

14. Post Questions & Next Module Preview…
Module Description 1
Lean for Physicians (Important Concepts) 2
Focusing Improvement Projects/Efforts (Methods Overview) 3
Managing the Improvement Process (PDCA/A3) 4
Understanding the Current State (Process Mapping) 5
Identifying Waste in the Current State (5S, Waste, Standard Work) 6
Analyzing the Current State I (Organizing & Using Data) 7
Analyzing the Current State II (Organizing & Using Data) 8
Identifying Improvements & Actions (A3 Simulation) 9
Working as a Team (Frontline Empowerment & Engagement) 10
Understanding & Leading Change 11
Supporting Infrastructure (ADM, Huddles, A3/A4 Methodology)
Physician Process
vs. Lean Process
Origins
Important Concepts
Post Questions