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A3 Training DGSOM BEI HR Sphere 1. Agenda Topic Intro to Lean Project Charter Plan Clarify the Problem Analyze the Current State Develop Goals Analyze.

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Presentation on theme: "A3 Training DGSOM BEI HR Sphere 1. Agenda Topic Intro to Lean Project Charter Plan Clarify the Problem Analyze the Current State Develop Goals Analyze."— Presentation transcript:

1 A3 Training DGSOM BEI HR Sphere 1

2 Agenda Topic Intro to Lean Project Charter Plan Clarify the Problem Analyze the Current State Develop Goals Analyze Root Causes Duration 10 min 5 min 45 min Total: 60 min

3 Learning Objectives At the end of the session you should be able to: Broad understanding of key principles and tools Be able to use the DOWNTIME model to identify waste Develop a project charter with your team Explain why PDCA is an effective method for problem solving Understand the components of PDCA Document your PDCA process on an A3

4 Taking a Different Approach… 4 “The Tools Are Available” “I’ve got too much work to do to stop and listen to you”

5 Lean Definition What is Lean? A management system and culture designed as a way we work by adding value for our patients and eliminating waste, where every employee is empowered to continuously improve their processes Lean is Not: The flavor of the month Concepts that apply only to manufacturing A collection of tools and methods 5 Discuss what is lean

6 Early 1900’s Frank & Lillian Gilbreth (Time & Motion Study/ Process Mapping) History of Lean 6 Late 1800’s Frederick Taylor (standard Work) Early 1900’s Henry Ford (Flow Production) 1930’s Kiichiro Toyoda (Just in Time) 1950’s W. Edwards Deming (PDCA) 2009 UCLA Operating System 1950’s Taiichi Ohno (Toyota Production System) 1950’s Joseph Juran (TQM) Late 1800’sEarly 1900’s1930’s1950’s Shigeo Shingo (SMED, ZQC) 2009 Mark Graban Shingo Research Award Lean Hospitals

7 UCLA Health Operating System Mission - Delivering leading edge patient care, education and research Vision - Healing humankind one patient at a time, by improving health, alleviating suffering, and delivering acts of kindness Values - Compassion, Respect, Excellence, Discovery, Integrity, Teamwork

8 Lean Benefits How Will Lean Help Me? Solving problems and recognizing lasting results Establishes an environment that has controlled process, repeatable outcomes and delighted staff/patients 8 What are the Benefits of Lean? Higher quality, safety & efficiency Giving patients what they want when they want it Increased staff satisfaction More time with patients and business growth 1.What are some more examples? In your area?

9 Understand Value, Waste, & PDCA Current State Analysis Root Cause Analysis Implement & Sustain Improvements Active Daily Management Daily Huddles Operational Planning Change Mgmt Standard Work PDCA / A3 Methodology Do CheckAct Plan Process Mapping Spaghetti Diagram Time Obs. Pareto Fishbone 5 Why SIPOC Effective Solutions How we teach lean at UCLA Health

10 Seeing With New Eyes 10

11 Seeing with new eyes requires an understanding that activities either add value or waste… 11 Activities that add Value (all must be true) The patient is willing to pay for That moves the care process forward That are done right the first time Activities that are Wasteful (any can be true) The patient is not willing to pay for That do not move the care process forward That are not done right the first time Comforting a patient Examining a patient Diagnosing a patient Treating a patient Educating a patient Waiting in general Waiting for orders to be written Late/missing callback for tests Clinical or operational errors Unnecessary documentation Unnecessary approvals VALUE WASTE This allows you to focus your resources (to eliminate waste, increase value, or support value) Intro Value Analysis Waste Analysis RCA RCA - Causes RCA – Pareto RCA – Cause & Effect RCA – 5 Whys

12 Value-Added & Non-Value Added Example 12 Pt checks in, pays co-pay Value-added Actions Non-Value-added Actions Pt waits in waiting area MA takes vitals and rooms pt Pt waits for MD in room MD completes consult Pt waits nurse/MA to come and complete visit Pt waits to checkout Pt receives AVS and schedules f/u appt if necessary

13 Waste models can help you identify/find waste 13 For “non-value added” activities, next you find/identify waste; this is made easier by using a model such as DOWNTIME* *Different systems classify wastes into different amounts of categories. Most use 7 (same as above but without N) or 8 but some use up to 11! ** There are different types of waste – Type 1 and Type 2. Type 1 adds no value and can be removed easily. Type 2 adds no value but is necessary in the current system and/or is very difficult to remove. This distinction will become more important when focusing on solutions Intro Value vs Waste Waste Analysis RCA RCA - Causes RCA – Pareto RCA – Cause & Effect RCA – 5 Whys D efects O verproduction W aiting N ot utilizing Talent T ransport I nventory M otion E xtra Processing Mistakes, errors, resulting rework - Producing too much, too soon, or excessive setup - Actual downtime (patient, service, or production) - Poor use of skills and talents, knowledge loss - Moving things around - Too much inventory, or too little - People moving around, searching, etc. - Duplication, unnecessary: refinements, approvals -

14 Eight Wastes in Ambulatory Processes… 14 ▪MA/Nurse spends time looking in multiple places for a particular supply Motion ▪Incomplete Specialty referrals Defects ▪Full sheet of labels printed when only one is needed Overproduction ▪Expired supplies because of excess ordering Inventory ▪Patients are taken from waiting room -> vitals intake -> waiting room -> exam room Transport ▪Patients asked the same questions multiple times Extra-Processing ▪Pt waits in exam room for MD Waiting ▪Numerous ideas are “lost” only to be rediscovered later ▪MD/Nurse time spent on clerical tasks Not Utilizing Talent

15 Waste 15

16 A3s and A4s are used to communicate progress 16 A4 Problem-Solving (8.5 x 11)A3-Problem Solving (11 x 17) Everyday problem-solving, consensus & communication tool used by staff Complex problem-solving, consensus, communication tool Known root-causes and solutionsUnknown root-causes and solutions Quick and easy to useRequires Planning (PDCA) and usually data Example: Peanut butter and jelly sandwiches in the RR. Example: A unit wants to improve poor patient satisfaction scores but they do not understand why the scores are so poor or how to improve them

17 17 A4 Problem-Solving (8.5 x 11)A3-Problem Solving (11 x 17) Everyday problem-solving, consensus & communication tool used by staff Complex problem-solving, consensus, communication tool and project management tool Known root-causes and solutionsUnknown root-causes and solutions Quick and easy to useRequires Planning (PDCA) and usually data Example: Peanut butter and jelly sandwiches in the SMH. Example: A unit wants to improve poor patient satisfaction scores but they do not understand why the scores are so poor or how to improve them We will be working with A3s today

18 18 Project Charter

19 19

20 PDCA – Continuous Improvement A structured guide and method for problem solving The way by which we should be practicing continuous improvement in our daily work Step 7 Adjust, Standardize & Sustain Step 6 Evaluate Results Step 5 Implement Solutions Step 4 Analyze Root Cause Step 3 Develop Goals Step 2 Analyze Current State Step 1 Clarify the Problem Act Check Do Plan Do CheckAct Plan


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