1. A3 Training DGSOM BEI HR Sphere

2. Agenda Topic Duration 10 min Intro to Lean 5 min Project Charter
Total: 60 min
Topic
Intro to Lean
Project Charter
Plan
Clarify the Problem
Analyze the Current State
Develop Goals
Analyze Root Causes
Lean as an Integrated System: Mindset, Management, Methods
Waste Walk Activity should be ~15 minutes

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…
“I’ve got too much work to do to stop and listen to you”
“The Tools Are Available”
Use for ice breaker conversation.
There are tools to assist us in helping us to more efficiently do our jobs but we must stop to learn.

5. Lean Definition What is Lean? Lean is Not: Discuss 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
Team Discussion
This is the first opportunity to break them out into teams so they can begin to get to know each other a little better
Lean brings together three inextricable components: mindset, management and methods, with respect for people at the center of everything.
Emphasize management system, culture and elimination of waste to deliver value.

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

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? What are the Benefits of Lean?
Facilitator’s Guide – Toyota Business Practices
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
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
Ask for examples from audience. . .
Eliminates roadblocks
Reduces errors
Reduces wait times
Allows for focus on clinical care
Allows for collaboration
What are some more examples? In your area?

9. How we teach lean at UCLA Health
Understand Value, Waste, & PDCA
Current State Analysis
Root Cause Analysis
Implement & Sustain Improvements
SIPOC
Effective Solutions
Pareto
Process Mapping
Standard
Work
Fishbone
Last week we learned about:
Understanding Value vs. Waste
What does Value-Added mean? Why is it important?
What is the difference between Non-Value Added and Incidental Work? Why is this important?
Should Non-Value added or Incidental Work be eliminated first? Why?
Categorize Waste
Present your homework (choose the best examples for each category). What did you learn?
How was it useful to categorize waste?
Would it have been different if we had just asked you to find waste? 5S
Remind us what the 5S’s are, what order we do them in, and why?
How is 5S different than housekeeping or cleaning?
How is 5S related to the Waste Categories?
Why is 5S foundational to the improvement process?
Standard Work
What is standard work?
What do we do after the work is standardized? Are we finished?
What happens if you don’t standardize an improvement?
Present and explain the chart from training.
Time Obs.
Active Daily
Management
Daily Huddles
Operational
Planning
Change Mgmt
PDCA / A3 Methodology Do
Check
Act
Plan
Spaghetti
Diagram
5 Why

10. Seeing With New Eyes
Lean helps us to question and take a deeper look at the situation at hand.
Lean helps us to see beyond the immediate.
As mentioned earlier, when we apply the tools and approaches of Lean to our work, we begin to see and understand our world in new and different ways, and begin “seeing with new eyes.” Let’s explore this concept using some other examples of how things we see and think are correct turn out to be something very different when we have additional information about the situation at hand.
Example #1
Click to display the Panda Bears picture.
Ask: “What do you see in this picture?”
Likely Responses:
2 pandas eating bamboo
Ask: “Please look more closely. Are there just two pandas?”
There seem to be panda faces embedded in various places in the picture
Ask: “How many pandas do you see now? And why did we miss the other panda images initially?”
Like Responses:
We missed the other images initially because they were not as obvious and were “embedded” in other parts of the picture
somewhere between 2 and 9 total
Say: “Lean provides us the tools and approaches to help us see situations from a different point of view. It gives us the tools to strip away waste that prevent us from seeing the true picture.”
Example #2
Click to bring up the second picture.
Ask: “From a distance, and at first glance, what do you see in this picture?”
A female figure reading a book- she could be pregnant and a drape in the background
The profile of a man with a mustache and goatee that looks kind of sinister
Both of these responses are correct. We may see either image depending on our perspective.
Say: The mind, through prolonged inspection of a subject, becomes bored with it and will explore alternative ways of perceiving it by decomposing the whole into parts and looking for the interesting parts. In the early steps of this process, the effects of these changes remain below the level of awareness. After a while, you become aware of them.
Lean helps to see our world differently. 5S provides a system and tools for literally stripping away what’s not adding value, what’s not being used, to see what lies below. And when we do that, we lay the groundwork for applying an array of other Lean and tools. In the end, we are striving for Visual Management, i.e., knowing that when we look at something, we’re seeing the truth or reality as we know it at that point, and whether or not we’re on track to achieve our goals.

11. Seeing with new eyes requires an understanding that activities either add value or waste…
Waiting in general
Waiting for orders to be written
Late/missing callback for tests
Clinical or operational errors
Unnecessary documentation
Unnecessary approvals
Why?
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
WASTE
This allows you to focus your resources (to eliminate waste, increase value, or support value)
VALUE
Work motion example
Main point:
Why do we concentrate on waste? Because we want to eliminate anything which does not add value to the product.
Within any process there are three components:
A) Waste - is within every process we see (man or machine), for example: unnecessary motion, obvious waste, waiting, searching etc..
B) Incidental Work - is work that is required based on the way the current job is done but adds no value to the customer, for example: the loading or unloading of a part into a machine, or positioning of a part into a fixture
C) Value Added - it is often the smallest component of most processes.
By identifying and eliminating waste we can reduce costs, increase quality and productivity.
Tip: Know the audience’s work environment and provide examples of waste within their own work environment or daily life (ie. Standing in lines at the supermarket or in traffic, waste of waiting). Give one example for each of the three components of work motion.
Comforting a patient
Examining a patient
Diagnosing a patient
Treating a patient
Educating a patient
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
Intro
Value Analysis
Waste Analysis
RCA
RCA - Causes
RCA – Pareto
RCA – Cause & Effect
RCA – 5 Whys

12. Value-Added & Non-Value Added Example
Value-added Actions 1 3 8
Pt receives AVS and schedules f/u appt if necessary
Pt checks in, pays co-pay
MA takes vitals and rooms pt 5
MD completes consult
Pt waits in waiting area
Pt waits for MD in room 6
Pt waits nurse/MA to come and complete visit 2 4 7
Pt waits to checkout
Non-Value-added Actions

13. Waste models can help you identify/find waste
For “non-value added” activities, next you find/identify waste; this is made easier by using a model such as DOWNTIME*
Mistakes, errors, resulting rework -
D efects
O verproduction
W aiting
N ot utilizing Talent
T ransport
I nventory
M otion
E xtra Processing
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 -
Work motion example
Main point:
Why do we concentrate on waste? Because we want to eliminate anything which does not add value to the product.
Within any process there are three components:
A) Waste - is within every process we see (man or machine), for example: unnecessary motion, obvious waste, waiting, searching etc..
B) Incidental Work - is work that is required based on the way the current job is done but adds no value to the customer, for example: the loading or unloading of a part into a machine, or positioning of a part into a fixture
C) Value Added - it is often the smallest component of most processes.
By identifying and eliminating waste we can reduce costs, increase quality and productivity.
Tip: Know the audience’s work environment and provide examples of waste within their own work environment or daily life (ie. Standing in lines at the supermarket or in traffic, waste of waiting). Give one example for each of the three components of work motion.
Too much inventory, or too little -
People moving around, searching, etc. -
Duplication, unnecessary: refinements, approvals -
*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

14. Eight Wastes in Ambulatory Processes…14
Defects
Overproduction
Waiting
Not Utilizing Talent
Incomplete Specialty referrals
Full sheet of labels printed when only one is needed
Pt waits in exam room for MD
Numerous ideas are “lost” only to be rediscovered later
MD/Nurse time spent on clerical tasks
Transport
Inventory
Motion
Extra-Processing
Patients are taken from waiting room -> vitals intake -> waiting room -> exam room
Expired supplies because of excess ordering
MA/Nurse spends time looking in multiple places for a particular supply
Patients asked the same questions multiple times
OPTIONAL PAGE: If the option has had a hard time coming up with specific examples for the 8 wastes, you can show this page and show additional examples. This page also offers examples from different areas of the hospital, which might be useful if most of the examples brought up are from the same area of the hospital (e.g. if only the OR or ED folks have been vocal during the discussion)
Discuss the examples of each muda’s and have audience add their own

15. Waste Waste
Have someone in the audience read this cartoon. What is there thoughts?

16. A3s and A4s are used to communicate progress
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 solutions
Unknown root-causes and solutions
Quick and easy to use
Requires 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. We will be working with A3s today
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 solutions
Unknown root-causes and solutions
Quick and easy to use
Requires 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

18. Project Charter

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 Do
Check
Act
Plan
Plan Do
Check
Act
Ask if anyone knows what PDCA means?
*click* (Plan, Do, Check, Act appears)
Ask what stands out? What do they notice?
-Planning has the most steps, otherwise there will be rework in DCA
Step 1
Clarify the Problem
Step 2
Analyze Current State
Step 3
Develop Goals
Step 4
Analyze Root Cause
Step 5
Implement Solutions
Step 6
Evaluate Results
Step 7
Adjust, Standardize & Sustain