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Lean transformation; finding the balance between tools and people Cellular Pathology, Royal Victoria Infirmary Terry Coaker, Terry Coaker, Histopathology.

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Presentation on theme: "Lean transformation; finding the balance between tools and people Cellular Pathology, Royal Victoria Infirmary Terry Coaker, Terry Coaker, Histopathology."— Presentation transcript:

1 Lean transformation; finding the balance between tools and people Cellular Pathology, Royal Victoria Infirmary Terry Coaker, Terry Coaker, Histopathology Operations Manager 27th May 2011

2 Cellular Pathology, RVI, Newcastle 1981: RVI 9,700 requests per annum 1995: NGH acute services 1996: NGH histology 1997: Dental Hospital – oral pathology 2002: Freeman histology; muscle & nerve; cytology decant 2005: Histopathology decant – 42,000 pa 2007: Lean tools – examination phase 2007: Lean tools – examination phase 2008: Neuropathology decant 2009: New building (planned 2004) – 47,000 pa 2009: Pre-examination phase 2009: Pre-examination phase 2010: People 2010: People 27th May 2011

3 Drivers for change Lord Carter 20% reduction Lord Carter 20% reduction Modernising Scientific Careers Modernising Scientific Careers Private sector Private sector NHS Modernisation NHS Modernisation Improve the service Improve the service 27th May 2011

4 Cytology Improvement Guide mprovementSystem/ViewDocument.aspx?path=Cardiac%2FNational%2 FWebsite%2FDiagnostics%2FCytol ogy_14day_TAT.pdf mprovementSystem/ViewDocument.aspx?path=Cardiac%2FNational%2 FWebsite%2FDiagnostics%2FCytol ogy_14day_TAT.pdf Cytology 14 day TAT df/14dayturnaround.pdf df/14dayturnaround.pdf df/14dayturnaround.pdf 27th May 2011

5 Histopathology Improvement Guide vementSystem/ViewDocument.aspx?pat h=Diagnostics%2fNational%2fWebsite %2fHistology%20Guide%202.pdf vementSystem/ViewDocument.aspx?pat h=Diagnostics%2fNational%2fWebsite %2fHistology%20Guide%202.pdf 27th May 2011

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7 Unconscious incompetence Conscious incompetence Conscious competence Unconscious competence

8 Lean Methods Continuous Improvement Toolbox Value Stream Mapping Pull Systems 5S SystemLayout Setup Reduction Teams Visual Controls POUSStandardized Work Quality at the Source Continuous Flow Work Cells Performance Measurement TPM Batch Size Reduction Lean Tools 27th May 2011

9 A lean transformation must keep an even balance….. Tools TECHNICAL People CULTURAL 27th May 2011

10 Too much emphasis on tools and methods…. Extensive use of tools Use of Japanese terms and concepts Some processes made more efficient Lean belongs to a few enthusiasts TECHNICAL Failure to embed or spread Resistance to change Results not sustained No overall transformation CULTURAL 27th May 2011

11 If Cultural concerns predominate…. Failure to establish flow Lack of rigour in use of tools Lean speak without true understanding Full potential not realised TECHNICAL Temporary feel good factor created Better teamwork Increased levels of involvement But hard to sustain without results CULTURAL 27th May 2011

12 Peters and Waterman 1982 Managers themselves are the major barriers to high levels of commitment on the part of staff. People come to work motivated and interested but they are soon alienated by the web of rules and constraints which govern their lives. If only management could find ways to release and tap employees creativity for example visa employee involvement, then their commitment to organisational goals would follow 27th May 2011

13 NHS Improvement Were looking for exemplar sites Er, no, not you ! Q. What would make us an exemplar ? A. Staff engagement so… 1. Visual Display 2. Daily meetings 27th May 2011

14 People Pitfalls Managing from the office Managing from the office Use all the brains in the Department Use all the brains in the Department We are different We are different Not invented here Not invented here e.g. COSHH, Quality and Lean 27th May 2011

15 The Lean Leader Go and See Go and See Ask Why Ask Why Respect People Respect People Force Reflection Force Reflection 27th May 2011

16 Re-organisation of meetings 27th May 2011 Weekly Huddle Review Histology Performance Spec RecICCGeneral Office CytologySlide Production ? Medical specialty team meetings

17 Benefits Daily ! Addresses issues immediately Daily ! Addresses issues immediately Clarifies duties Clarifies duties Encourages feedback Encourages feedback Staff know more about their role Staff know more about their role Ownership Ownership Motivating and enjoyable! Motivating and enjoyable! 27th May 2011

18 Visual Display

19 Slide Delivery 27th May 2011

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21 A3 One side of A3 One side of A3 Pencil and eraser Pencil and eraser Root cause analysis Root cause analysis 5 Whys? 5 Whys? Plan, Do, Check, Act Plan, Do, Check, Act 6σ (Sigma) 3.4 defects per million opportunities 6σ (Sigma) 3.4 defects per million opportunities

22 27th May 2011 Six sigma 3.4 defects per million opportunities 3.4 defects per million opportunities One SUI in One SUI in One in (10 years) One in (10 years) One in (20 years) One in (20 years)

23 A3 PROBLEM SOLVING PROCESS – GO SEE, ASK WHY ?, RESPECT PEOPLE TITLE: WHAT IS THE PERCEIVED PROBLEM? IDEALLY FROM A CUSTOMER VIEWPOINT 1.BACKGROUND WHY ARE WE TALKING ABOUT THIS PROBLEM? FOCUS ON THE CUSTOMER (Internal or External) BRIEFLY STATE HOW THIS PROBLEM IMPACTS ON THE PURPOSE OF THE ORGANISATION & THE PROCESS GIVE RELEVANT BACKGROUND INFORMATION WHO ARE THE STAKEHOLDERS? 2.CURRENT CONDITION WHERE DO THINGS STAND TODAY? USE DIRECT OBSERVATIONS & MEASUREMENTS GO SEE (where activity actually occurs e.g. laboratory, office etc.) REPRESENT VISUALLY – USE CHARTS, GRAPHS, DRAWINGS, VALUE STREAM MAPS etc. BE OBJECTIVE,THOROUGH & SUMMARISE CONCISELY 3.GOALS & TARGETS WHAT SPECIFIC OUTCOMES ARE REQUIRED? 4.ANALYSIS – WHAT IS THE ROOT CAUSE OF THE PROBLEM? ASK 5 WHYS ? AUTHOR: NAME: DATE: Understand how the work is done GO SEE PRESENTING PROBLEM CLARIFY PROBLEM WHY?CAUSE WHY? ROOT CAUSE Grasp the situation Actual vs standard Actual vs ideal Establish Point of Cause Time and place where events cause abnormality 5.PROPOSED COUNTERMEASURES WHAT ARE THE POSSIBLE MEASURES THAT WILL ACHIEVE THE TARGET CONDITION? ALWAYS CONSIDER A RANGE (OR SET) OF COUNTERMEASURES HOW WILL EACH COUNTERMEASURE AFFECT THE ROOT CAUSE? SELECT A COUNTERMEASURE (S) THAT BEST ADDRESSES THE ROOT CAUSE 6.PLAN IMPLEMENTATION OF CHOSEN COUNTERMEASURE(S) WHAT ACTIVITIES ARE REQUIRED FOR IMPLEMENTATION? WHO IS RESPONSIBLE & WHEN WILL THEY HAPPEN? DEFINE SPECIFIC PERFORMANCE INDICATORS & MILESTONES BE VISUAL – USE TABLES OR GANTT CHARTS WHAT? WHO? WHEN? OUTCOME 7.FOLLOW UP WHAT ISSUES CAN BE ANTICIPATED? CHECK OUTCOMES ARE BEING ACHIEVED. IF NOT, THEN CHECK TO SEE IF CURRENT CONDITION [2] & ROOT CAUSE ANALYSIS [4] WERE CORRECT CAPTURE & SHARE LEARNING – COMMUNICATE STANDARDISE TO MAKE CHANGE TO CURRENT CONDITION – AMEND POLICY, PROCEDURES, SIGNAGE, TRAINING etc REPEAT THE CYCLE - PLAN DO CHECK ACT SPONSOR / MANAGER: NAME: DATE FINAL A3 APPROVED: COMMUNICATE COLLABORATE MENTOR & RESPECT 27th May 2011

24 People - Attitude curve Resistant to change Range of attitudes Wait and see Show me Ready for change Lets get started! Innovators Early adopters Early Majority Late Majority Laggards Rogers diffusion curve 18th June 2007

25 Kegan and Lahey Resistant to change Range of attitudes Wait and see Show me Ready for change Lets get started! Dogs HorsesSheep Goats The Lean Champion is a Farmer 18th June 2007 Lemmings Jackals

26 Issues No problems – is a problem! No problems – is a problem! Discipline Discipline Poor performance – must be addressed – outside the huddle. Poor performance – must be addressed – outside the huddle. 27th May 2011

27 Gemba audits – What is the problem? Issues remain unresolved Issues remain unresolved Not seen as the number one priority Not seen as the number one priority Lack of time to investigate and fix Lack of time to investigate and fix Superficial solutions – sticking plasters are not root cause Superficial solutions – sticking plasters are not root cause No clear ownership No clear ownership Med / tech barrier blocks communication Med / tech barrier blocks communication Performance not reviewed (no huddle) Performance not reviewed (no huddle) What defines a good days work? What defines a good days work? 27th May 2011

28 Gemba audits - Actions Open issues and outstanding CAPAs discuss at histo performance meeting Open issues and outstanding CAPAs discuss at histo performance meeting Add waste walks to PIs Add waste walks to PIs Define checklist of Gemba audits Define checklist of Gemba audits Define dashboard for audit Define dashboard for audit Audit visual display boards Audit visual display boards 27th May 2011

29 Gemba audits – The Future Robust gathering of problems Robust gathering of problems Speedy and binding resolution of issues Speedy and binding resolution of issues 27th May 2011

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31 Not everything that counts can be counted, and not everything that can be counted counts. Einstein

32 Cellular Pathology, Royal Victoria Infirmary Terry Coaker Thankyou 27th May 2011 …any questions ?

33 Also known as… Process improvement Re-engineering Continuous improvement Total Quality Management Six Sigma 3.4 DPMO– Motorola - DMAIC Lean – Toyota Common sense?! 27th May 2011


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