Housestaff Lean Academy
Module 1: Lean Principles for Physicians
Robert Martin, PsyD
Performance Excellence
UCLA Health
1
Where does this module fit into the curriculum?
Module #
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)
2
Module 1 Agenda…
Physician Process
vs. Lean Process
Important
Concepts
Lean Origins
Physician Process
vs. Lean Process
Origins
Important Concepts
Post Questions
Post Questions
3
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
Lean Process
Notes
Conduct Health & Physical
Understand Scope (Charter)
Neither process jumps to
solutions
Develop Initial Diagnosis
Develop Problem Statement
Both processes involve the
patient
Order Tests
Conduct Observations &
Collect Data
Analyze & Understand Data
Analyze & Understand Data
Develop Treatment Plan
Develop Improvement Plan
Try, Measure, Adjust It
Try, Measure, Adjust It
Physician Process
vs. Lean Process
Lean Origins
Both processes use data
Both processes use the
Scientific Method
QI & Lean call “The Scientific
Method” PDCA (Plan-DoCheck Adjust/Act)
Important Concepts
Post Questions
4
Lean is a modern term, but the origins are not…
Venetian Arsenal
American Meat Packers
• 1 Warship/day
• Standardized Parts • Conveyor belts to
steadily remove
• Use of canals to flow
carcasses past workers
galleys to workers
after meat removal
through assembly
phases
1500s
1780s 1880s 1890s
French Army Ordinance
• Concept of
interchangeable parts
for muskets (precursor to high-volume
flow production
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
Toyota > GM (2007)
• Toyota becomes the
world’s largest
automaker
Mission,
Vision, Values,
Commitment
Performance
Improvement
and Management
Takt Time
• German aircraft industry Deming Prize
pioneers use takt time • Japanese Union of
Scientists and
for synchronizing
Engineers creates
movement of aircraft
Deming Prize for
• Mitsubishi brings idea
statistical quality and
back to Japan where
PDCA
Toyota embraces it
1902- Present
1930s
1908-1926
Scientific Management –
Frederick Taylor
• Scientific study of tasks
• Employee development
and training
• Managers use principles to
plan work and workers
perform tasks
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
1940s
1960s
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
UCLA
Operating
System
Strategies
Objective Mgt:
Goals,
Operating Plans,
Dashboards
UCLA Operating System
Established by Amir Rubin
1980s - 2009
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)
5
Physician Process
vs. Lean Process
Lean Origins
Important Concepts
Post Questions
Lean is based on a few important concepts…
Value
Waste
Lean is more than a collection of tools….
Scientific
Method
(PDCA)
It is about creating a culture based on a few important concepts.
There are more- but these are sufficient for now!
Empowered
Staff
True North
Alignment
Physician Process
vs. Lean Process
Origins
Important Concepts
Post Questions
6
Lean is based on a few important concepts…
Value
Waste
Scientific
Method
(PDCA)
Empowered
Staff
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
True North
Alignment
Physician Process
vs. Lean Process
Origins
Important Concepts
Post Questions
7
Lean is based on a few important concepts…
Value
Activity (Individual or self-organized)
Waste
Scientific
Method
(PDCA)
• Spend a few minutes to discern what your
patients value
• Group Discussion
Empowered
Staff
True North
Alignment
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
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
9
Lean is based on a few important concepts…
Value
Waste
Scientific
Method
(PDCA)
Empowered
Staff
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
True North
Alignment
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
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)
True North
Alignment
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
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!)
True North
Alignment
Physician Process
vs. Lean Process
Origins
Important Concepts
Post Questions
12
Lean is based on a few important concepts…
Value
What would happen if all staff was trained in PDCA, engaged and
empowered without alignment to the organization’s goals?
Waste
Scientific
Method
(PDCA)
Empowered
Staff
• 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
True North
Alignment
Physician Process
vs. Lean Process
Origins
Important Concepts
Post Questions
13
Post Questions & Next Module Preview…
Module #
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
14
15