1. Lean Management & The Lean In Daily Work Model
Foundations for Successful Leadership
Lean Management & The Lean In Daily Work Model

2. Learning Objectives
Gain a foundational understanding of Lean Thinking & Concepts
Understand the difference between Traditional Management and Lean Management
Become familiar with the Lean In Daily Work Model – including the important role of the supervisor within the model
Learn how to support your staff in surfacing waste and addressing problems on a daily basis
Recognize the true value managers can provide to their teams through the application of leadership standard work

3. What is Lean Thinking?
“The endless transformation of waste into value from the customer’s perspective”.
---Womack and Jones,
Lean Thinking

4. The Objective of Our Lean Work
To increase Value Added Work and reduce Waste to Increase Throughput, Lower Cost and Improve Quality
Lead Time

5. Waste only adds cost & time to a process
What Is Waste?
Any element of the process that adds no value to the final product or service
Waste only adds cost & time to a process
Waste can be found:
In areas with lots of rework
Areas experiencing long wait times
Process steps requiring multiple reviews and revisions
Areas where multiple handoffs occur within & across depts.
Explain to group, that is section (while redundant to the lean tool day, is intended to act as a refresher for them)…Include a comment around how different consultants, hospitals, usually end up with 7 or possibly 8 wastes and the terms they use to describe them may differ. That is okay, as the definitions around waste is always the same…

6. How Does Waste Affect Me?
Causes physical fatigue
Causes emotional fatigue
Increases frustrations
Increases stress
Causes you to blame others
Steals your time

7. Built-in Quality Just-in-Time
Safe – Effective – Patient Centered – Timely – Efficient - Equitable
Built-in Quality
Just-in-Time
Error Proof
Surface Problems
Stop and Respond to Abnormalities
Solve Problems at Root Cause
Pacing by Demand
Continuous Flow
Pull Systems
Customer Defines Value
Foundational Stability
Leveled Workload
Mutual Trust
Continuous Improvement
(P-D-C-A) and Learning
Visual Mgmt
Standard Work
Make Value Flow by Eliminating Errors and Waste
Health Care House – Sources: J. Shook, J. Billi, J. Liker, S. Hoeft, J. Womack, Park-Nicollet. Revised 5/09 W. Walters

8. Lean is a system... Visual Mgmt Standardized Work Andon System 5S
Flow &
Pull Systems
Problem Solving &
Value Stream
Mapping
Load Leveling
Error
Proofing
Quick
Changeover
These all tools that we use to implement…but in order to use them effectively we need to have the right culture in place, with appropriate lean management
Notes:

9. The Flip Side Of Lean Management

10. Traditional vs. Lean Structure
Traditional Team Structure
In a traditional team structure, Leadership is often looked at as the ultimate customer and employees primary duties are to carry out the wants and needs of management. There is usually very little input from the employees on how business operations can be improved.
Leaders
Team Members
Lean Thinking
Team Members
The Lean Leadership model is often described as an inverted triangle with team members as the largest base on top all the way down to Leadership supporting the team members on the bottom. It is a true servant leadership approach where Leaders develop the capacity to support team members in improving what needs to be done.
Leader

11. Create a Fear-Free Environment
Makes people defensive
Keeps issues submerged for years
Creates a crisis orientation
Use information to drive improvement
NOT pass judgment

12. How can we create (liberate) “20,000 problem solvers”?
Help each worker take initiative to find and fix causes of problems he/she faces daily
This means each of us has two jobs:
Do the work
Improve the work
Leaders’ role:
Support improvement work (time, mentoring)
Align improvements so value flows to the customer
Modified from John Shook

13. Value Creating Work of Management
Gain agreement on what is important.
(which must be to solve customer problems)
Engage and mentor workers to be problem solvers (through performing the above work in dialogue)
Create brilliant process to achieve what is important
Create stable process and continuously improve
Adapted from Womack on Lean Management
Presented by LEI

14. The Lean In Daily Work Model: Standard Work for Daily Problem Solving
Key Metrics: Define, Measure, & Display
Routine Interactions to Identify Problems
Assessment of Problem Complexity
Problem Solving Approaches
Transfer Knowledge for Shared Learning
*Links to strategic deployment
*Part of daily standard work
*Takes place in the gemba
*Design and run experiments
*Share across organization
Daily team huddles at
visual board
“Just Do It”
no written plan needed
Hourly / daily
key operational metrics and targets
Problems
Low
Daily leadership walks in the gemba
(also wkly/mthly)
Problems
Triage based
on problem complexity
Med.
Share learning
from experiments across UMHS
“Everyday Lean Ideas”
structured form
(8.5”x11”)
Problems
High
Daily / weekly
cumulative
counts of
complex
problems
Monthly review &
problem prioritization
by team leads
“A3 Problem Solving”
structured form
(11”x17”)

15. Baseline Lean Culture Survey
This survey is taken prior to implementing the Lean In Daily Work Model and again, a few months or so after the team has built the model into their daily work
Employees
Management
Employees
We talked about how important the lean culture is to support lean transformation…here is where we build that in…
Mgmt

16. Value Metrics
To be successful, we must base all of our improvement efforts on what our customers value most
By clearly defining this value (as a metric), it will serve as the compass to tell us when we are on course & when we need to improve
Value Metrics Need To Be…
High-level enough to represent the over-arching Value we deliver
Allow us to surface many different problems related to the Value Metric (vs. focusing on a specific problem)
Without clearly defined Value Metrics,
it would be impossible for us to continuously improve

17. Value Metric Traits Traits of Value Metrics:
High level enough to represent the over-arching Value we deliver
Are best measured in small increments – by hour, by day, etc.
Do not require intense, pain-staking review in order to measure
Connect directly to what our customers tell us they value
Connect directly to departmental and institutional priorities

18. Value Metric Examples What do all of these examples have in common?
Patient Relations -
Customer: Patients and Patient’s Families (External)
Customer’s Value: Timely & successful resolution of grievances
Value Metric: “Successfully resolve 80% of all patient grievances within 10 days”
Cardiac Procedures Unit –
Customer: Patients (External), Ordering Physicians & Clinical Units (Internal)
Customer’s Value: Timely & accurate completion & interpretation of ordered Surface ECHOs
Value Metric: “Complete, Read & Accurately Interpret 100% of all inpatient Surface ECHOs ordered before 10 am – before the end of the business day”
Urology Taubman Clinic–
Customer: Patients (External), Physician (Internal)
Customer’s Value: Having the right records available during the clinic visit
Value Metric: “100% of outside New Patient records received, reviewed, and imaged prior to clinic visit”
Pro Fee Payment Posting –
Customer: Patients (External) & Clinical Departments (Internal)
Customer’s Value: Timely posting of payments
Value Metric(s): Post 100% of payments within 3 days of receipt
Orthopaedics Surgery Clinic –
Customer: Orthopaedic Patients (External)
Customer’s Value: Expeditious clinic visit (while still meeting needs)
Value Metric(s): 80% of patient visits to be completed within 1 hour

19. Brainstorm Possible Team Value Metrics - Team Activity
2 Teams – Team Lead Scribes – We Facilitate….30 minutes
Process Check At 20 Minutes

20. Visual Management Attributes of visual management tools:
Create “status at a glance” – enabling quick and simple detection of normal vs. abnormal operating conditions
Provide clear information actionable at the point of communication
Be maintained by those carrying out the work
Those performing the work are the first to detect abnormalities
Provide a clear and common understanding of goals & measures
Allows employees to align their actions and decisions with the overall strategic direction of the department

21. Visual Management - Example
Baseball Scoreboard
The scoreboard provides real-time information about important game parameters to be monitored
What is the score of the game?
What is the batting avg. of the hitter – should we pitch differently to him based on it?
What inning is it?
What is the count?
Was that a ball or strike?
How many hits, errors?
How are the other teams in the league performing today?
The scoreboard answers important questions about the status of the game – it tells us how our team is doing in relation to the Goal…Namely to win the game!!!

22. Developing LIT’s Level 1 - Visual Management System
Questions to be answered:
What will the visual display look like?
How will it display the Value Metric and the current status?
How will problems be captured?
Where will the visual board be located?
Who will maintain it?
How often will the Value Metrics be updated?
Identify how the team might respond (Andon) to surfaced problems?
Develop action plan for implementation of the visual display
Who, What, By When
2 Teams – One working on institutional board, other the patient…Report out – get feedback with changes – agree on what they want to do…

24. Urology Adult Clinic Visual Board
Ongoing Visual
Monitoring
Of Value Metrics

27. Value Creating Work of Management
Gain agreement on what is important .
(which must be to solve customer problems)
Engage and mentor workers to be problem solvers (through performing the above work in dialogue)
Create brilliant process to achieve what is important
Create stable process and continuously improve
Adapted from Womack on Lean Management
Presented by LEI

28. Why Huddle?
Make Our Customers The Focus Of Our Improvement (Through Our Value Metrics)
Builds Stronger Staff Morale
Improves Communication
Gives Everyone On The Team The Ability to Surface “Waste” & Solve Daily Problems As A Team

29. Team Huddles
The team meets at the visual board at a regular frequency (ideally on a daily basis)
The board is reviewed to determine the status of the value metrics
The team documents the waste / problems standing in the way of improving the value metric
An Everyday Lean Idea (E.L.I.) form is initiated for identified wastes / problems the team has influence over and can be easily solved (process description to follow)
A volunteer is identified to take ownership of each E.L.I. with responsibility to report back on progress at the next huddle
The process repeats during the next huddle

30. Everyday Lean Idea (E.L.I.) Process
ELI’s Should Be Initiated Any Time
You Have An Idea, Whether In
Between Or During A Huddle

31. Break-out Activity
Initiate a few Everyday Lean Idea (ELI) on a common everyday problem
Familiarize yourself with the form in order to better facilitate your team’s use back in your home area
Practice completing the form, thinking through the waste and potential solution
Be prepared to report out on one of your Everyday Lean Ideas

32. Leadership Gemba Rounding
“Gemba” is a Japanese term meaning “the place where the truth can be found” – for us this means the actual place where the work is being done

33. Leadership Gemba Rounding
Leadership reviews monthly calendar of standing meetings – seeks to identify up to 3 hours of meeting time per week to be replaced with Gemba time
Leaders create their visual management board (Which Includes):
Leadership Gemba Walk Route & Instructions
Calendar for Leaders to initial upon Walk completion
Leaders’ Open Issues Tracker
Or equivalent form
Everyday Lean Idea Visual Status (ELVIS)
Summary of “What the Patients Are Telling Us”
Direct Feedback During Walk
Survey completed at end of visit
Other input mechanisms
Summary of Key Success Measures

34. Orthopaedic Taubman Visual Leadership Board
Leadership Gemba Walk Standard Work & Layout
Visual evidence of Leadership Gemba Walks
Open Issues Tracker
ELI Feedback
Success Measures
Patient Feedback

35. “Your ears will lie to you, but your eyes never will”
Why Go To The Gemba?
“Your ears will lie to you, but your eyes never will”
Supports Continuous Improvement By Allowing Us To:
Observe the process first hand rather than making assumptions
See the entire value stream
Identify & observe problems & waste
Observe process changes
Monitor sustaining of gains, compliance with standard work, and the determination of root cause for problems that surface
References on Gemba Benefits: Baptist Health Care Leadership Institute

36. “Your ears will lie to you, but your eyes never will”
Why Go To The Gemba?
“Your ears will lie to you, but your eyes never will”
There are many benefits when a Leader adopts regular Gemba Activity as a part of their Leadership Standard Work;
Leader Benefits:
Helps you to better know your staff
Builds relationships / Solicits feedback
Gives you opportunities to teach, train and share information
Engages and empowers your staff
Reveals areas where improvement is needed
Establishes who should be rewarded and recognized
Ensures quality and safety of services provided

37. “Your ears will lie to you, but your eyes never will”
Why Go To The Gemba?
“Your ears will lie to you, but your eyes never will”
There are many benefits when a Leader Includes Regular Gemba Activity Into Their Leadership Standard Work
Staff Benefits:
Emphasizes that the environment is one of open communication
Gives employees increased access to leaders
Enables staff to be recognized for service excellence
Builds trust between staff and leadership
Allows staff to communicate the biggest barriers & challenges
Ensures quality and safety of services provided

38. “Your ears will lie to you, but your eyes never will”
Why Go To The Gemba?
“Your ears will lie to you, but your eyes never will”
There are many benefits when a Leader Includes Regular Gemba Activity Into Their Leadership Standard Work
Patient Benefits:
Observes caring behavior on the part of leadership
Perception of service improves
Feels valued through being given the opportunity to share information
Inspired to loyalty
More likely to recommend the organization to others

40. Leadership Behavior during Gemba Visits

41. Key Questions for Lean Leaders to ASK OFTEN!
What problem are you working on now?
What was the last experiment you tried?
What happened?
What did you learn?
What do you plan to try next?

42. Click for 9 minute video

45. Practice “Asking Effective Questions” Reflection on Exercise
Use Mentoring / Coaching Handout as a guide
- Get in groups of three - Identify a Problem Owner, a Lean Leader, and an Observer - Problem Owner: briefly describe the problem - Lean Leader: practice “asking effective questions” that are framed around “pure inquiry” (use handout as a guide) - Observer: provide feedback on how the Lean Leader did (both positive things and opportunities for improvement) - Switch roles (repeat until everyone has a chance to play each role)
Reflection on Exercise

46. The Lean In Daily Work Model is a System
Visual Metrics in the Absence of Team Huddles & Leadership Gemba Walks Quickly Becomes Wallpaper…
Team Huddles & Leadership Gemba Walks in the Absence of Visual Metrics Quickly Becomes a Social Event…

49. Value Creating Work of Management
Gain agreement on what is important .
(which must be to solve customer problems)
Engage and mentor workers to be problem solvers (through performing the above work in dialogue)
Create brilliant process to achieve what is important
Create stable process and continuously improve
Adapted from Womack on Lean Management
Presented by LEI

52. Over 500 Implemented Ideas To Date
Solving Problems Allowing Rapid Knowledge Spread
Lean Implementation Teams
L.I.T. S.P.A.R.K.S.
Over 500 Implemented Ideas To Date

53. Key Measures of Success UMHS Strategic Alignment
Key Measures of Success / Strategic Alignment
Primary Goals
Key Measures of Success
UMHS Strategic Alignment
Lean In Daily Work Process Sustained
Monthly audits taking place in each Pilot area, surfacing necessary corrective actions
Sustaining Gains
Continuous Problem Solving on Relevant Issues
500+ Everyday Lean Ideas Implemented as of 7/2011 (Many more in queue!!!)
People Development,
Process Improvement, Service Excellence & Lateral Spread
Improvement & Sustaining
of Value Metrics
In excess of 80% Improvement to team’s Value Metrics
Strategic Deployment,
Process Improvement & Service Excellence
Improvement in
Lean Culture Survey Score
51% Improvement In Overall Score
115% Improvement In “Willingness to Recommend”
People Development & Service Excellence
Evidence of Model Spread / Mentoring Relationships
Proactive Mentoring from
Established LIT Teams to New LIT Teams
Lateral Spread

54. Lean Leadership Articles
We will be following up with these two articles
After reading, list specific behaviors that you can practice and that can be observed by others.
Commit to practicing before, during, and after Leadership Walks
Can you think of a way to measure your own personal progress?

55. Focus of Master’s Course (addressing more complex problem)
Creating a Visual Prioritization System for these more complex problems
Building Structured A3 Problem Solving into existing meetings

56. Lean In Daily Work Train the Trainer Sessions Offered
Learning Objectives
Gain a foundational understanding of Lean Thinking & Concepts
Understand the difference between Traditional Management and Lean Management
Become familiar with the elements of the Lean In Daily Work Model – including the important role of the supervisor within the model
Learn how to support your staff in surfacing waste and addressing problems on a daily basis
Recognize the true value managers can provide to their teams through the application of leadership standard work
Lean In Daily Work Train the Trainer Sessions Offered

57. The Virtual Lean Resource Center
The Virtual Lean Resource Center *Many additional resources available, below is a sample of the most utilized resources
Requests for Lean Assistance
Lean Coach Office Hours
(unique ID and level 1 Kerberos password)
Specific websites dedicated to…
Lean in Daily Work ( (unique id and level 1 Kerberos password)
A3 Structured Problem Solving ( (unique id and level 1 Kerberos password)
Value Stream Mapping ( (unique id and level 1 Kerberos password)
In the Planning Phase…
Lean Networking Groups to share improvement work & address common challenges

58.
Click on this to directly link to the MQS Homepage
Click on the Virtual Lean Resource Center

59. Michigan Quality System & Lean References
Books:
Womack J, Jones D. Lean Thinking.
Liker J. The Toyota Way; Liker J, Meier D. The Toyota Way Fieldbook.
Shook J. Managing to Learn.
Dennis P. Getting the Right Things Done.
Rother M, Shook J. Learning to See.
Womack J, Jones D, Roos D. The Machine That Changed The World.
Sobek D, Smalley A. Understanding A3 Thinking.
Marchwinski C, Shook J, eds. Lean Lexicon.
Bahri, S. Follow The Learner: The Role Of A Leader In Creating A Lean Culture
Articles:
Kim CS, Spahlinger DA, Kin JM, Billi JE. Lean health care: what can hospitals learn from a world-class automaker? J Hosp Med. 2006;1:191.
Bush R. Reducing Waste in the US Healthcare System. JAMA 2007;297:871.
Spear S. Fixing Health Care from the Inside, Today. HBR. 9/05.
Spear S. Learning to Lead at Toyota. HBR 4/04
Spear S. Decoding the DNA of Toyota Production System. HBR 9/99
IHI Whitepaper: “Going Lean in Health Care”
Web:
Michigan Quality System at UMHS: med.umich.edu/mqs
Lean Enterprise Institute: webinars, books, meetings…
Ideal Patient Care Experience at UMHS
Crossing the Quality Chasm (IOM): newton.nap.edu/catalog/10027.html
Lean Enterprise Academy (UK):
National Health Service (UK):

60. Questions / Comments?
Contact Information:
Brendon Weil
Lean Coach, University of Michigan Health System
Kevin DeHority