Mr. Potato Head: A LEAN,
Mean Quality
Improvement Teaching
Machine!
Beth Murphy, MD
Ambulatory Block
QI Session #2
2013-2014
Mr. Potato Head Facts
• Created by George Lerner in Brooklyn, NY
– Jumble of accessories meant to pierce a real potato
– Sold idea for $5000 to a cereal maker in 1951
• 1952- Rights acquired by “Hasbro”
• 1952-First toy advertised on TV and the first marketed directly to kids
• 1987-“Spokes spud” for ACS Great American Smokeout
• Resurgence in 1990’s with Toy Story Movies/Disney
• 2000-RI State Family Travel Ambassador & License Plate
• > 100 million have sold over past 60 years
Source: Yankee Magazine, Dec 2012
Mr. Potato Head
LEAN Simulation Exercise
• A fun, interactive, innovative way to demonstrate:
– Quality Improvement concepts
– Patient Safety/Medical Errors
– LEAN Process Management
– Teamwork
– Communication
• Can do with 4 to >100 learners
• Can do with learners of all levels and disciplines
Mr. Potato Head has Traveled
California Adventure
Anaheim, CA
Downtown Disney
Orlando, FLA
Mr. Potato Head
•
•
•
•
•
Created by Eric Dickson, MD
UMMHC President and CEO
ER physician
Professor of Emergency Medicine
Institute for Healthcare Improvement
Lean Process Management
•
•
•
•
•
Derived from Toyota Production System
Efficiency and Quality are both important
Every step in process should add “VALUE”
Eliminate all “WASTE” from the system
EVERY member of the team is valued for
their contributions to the process AND their
ideas for improving the system/insuring
safety
“At Toyota we get brilliant results from
average people managing a brilliant
process. Others get average results from
brilliant people managing broken
processes.”
--The Toyota Motor Company
Even Mr. Potato Head has Gone
“Lean”
BEFORE
A Slimmed Down Spud
LEAN BELT PROGRESSION
BLACK BELT=PROJECT LEADER
GREEN BELT=USES TOOLS
YELLOW BELT=SOME TRAINING
WHITE BELT=AWARENESS
Value
• What do your patients value?
• What do you value as an employee?
TYPES OF WORK
Value-Added Work
Work/Service the patient cares
about and is willing to pay for
 Face time, Diagnosis, Treatment
Required Non-Value Added Work
No value in the patient’s eyes,
but can’t be avoided
o Billing, Regulatory tasks
Value
Non-Value Added
Added
(Required)
Pure WASTE – Non-Value Added Work
Consumes resources but doesn’t add value.
o Looking for supplies
o Patient/Staff waiting
o Re-work, redundant paperwork
Non –Value
Added
PURE WASTE
Forms of Waste: DOWNTIME
•
•
•
•
•
•
•
•
Defects
Overproduction
Waiting
Not Utilizing the Creativity of all Employees
Transport
Inventory
Motion
Extra-processing
There’s been a terrible accident!
The Situation…
• A bus filled with 16 Potato Head family
members is in a terrible crash!
• EMS arrives at the scene to find only
potato body parts scattered about.
• Luckily, there is an electronic medical
record showing what each family member
looks like.
The Game
• Your “team” is the Trauma Team in the ER
• The goal of the game is to accurately
assemble as many “patients” as possible
in 7 minutes
The Rules
1. Only 2 people from each team can
physically implant the Potato Head body
parts (”Implantation Specialists”)
2. Completed “patients” must be inspected.
3. There are no other rules.
Before we start…
We need 3 brave volunteers
Systems & “Waste”
System 1
System 2
System 3
First Lessons Learned
• Quality is influenced more
often by the SYSTEM than
the individual players
• How much “waste” is
actually in “the system”
• Think LEAN!!
ASSEMBLE YOUR TEAMS
• Choose your 2 “Implantation Specialists”
• Patient photos in the bag
• Bring assembled patients to
Check Out
• You have 2 minutes to plan
your team’s “system”
• You have 7 minutes to
process all 16 patients.
TAKE A FEW MINUTES..
Take 2 Minutes to
plan your team’s
system.
Inspection Stations
Bring completed
patient AND
photo to your
designated
inspection
station
7 Minutes!
• http://www.online-stopwatch.com/full-screen-stopwatch/
• Why did we pick 7 minutes?
– If it takes 20-30 seconds to correctly assemble one
Potato Head with no waste in the system, it should
take maximum of 8 minutes to assemble all 16 if only
1 assembler. You have an entire team!
• Guinness Book of World Records’ fastest assembly of a
Mr. Potato Head: Samet Durmaz of Turkey.
6.62 seconds!
Tracking Your Data/Progress
PDSA 1
Team 1
Team 2
Team 3
# built
# errors
# started
Time to 1st
assembly
PDSA Cycle #1
• How many patients did you treat
correctly during this cycle?
• How many errors did your team
make?
• How long did it take you to
complete first one?
• What changes will your team
make for next cycle to eliminate
waste and improve both quality
and efficiency?
Sharing Best Practices
• Team with Most #
Patients Seen
• Team with Least #
Errors
PDSA CYCLE
TYPES OF WORK
Value-Added Work
Work/Service the patient cares
about and is willing to pay for
 Face time, Diagnosis, Treatment
Required Non-Value Added Work
No value in the patient’s eyes,
but can’t be avoided
o Billing, Regulatory tasks
Value
Non-Value Added
Added
(Required)
Pure WASTE – Non-Value Added Work
Consumes resources but doesn’t add value.
o Looking for supplies
o Patient/Staff waiting
o Re-work, redundant paperwork
Non –Value
Added
PURE WASTE
Forms of Waste: DOWNTIME
•
•
•
•
•
•
•
•
Defects (Medical Errors)
Overproduction (Unnecessary testing)
Waiting (Patients and Employees)
Not Utilizing the Creativity of all Employees
Transport (Moving patients)
Inventory (Equipment, Discharge delays)
Motion (Physical Plant/Flow)
Extra-processing (Retesting, Readmissions)
BACK TO YOUR TEAMS
Take 2 Minutes to
discuss how your
team will improve
the quality and
efficiency of your
patient care.
Start PDSA CYCLE #2
• Switch Bags!
– You don’t see the same patients every day!
• Notice there are many differences in each
body part (i.e. ears, eyes, mouths)
– Demonstrates how each patient is unique!
• You have 7 Minutes!
7 Minutes!
• http://www.online-stopwatch.com/fullscreen-stopwatch/
PDSA Cycle #2
• How many patients did you treat
correctly during this cycle?
• How many errors did your team
make?
• How long did it take you to
complete your first patient?
• How would you plot your data?
• What changes will your team make
for next cycle to eliminate waste
and improve both quality &
efficiency?
Tracking Your Data/Progress
PDSA 2
Team 1
Team 2
Team 3
# built
# errors
# started
Time to 1st
assembly
RUN CHART: Plotting Your Data/Progress
16
# Patients Assembled
14
12
10
Team 1
Team 2
8
6
4
2
0
PDSA 1 PDSA 2 PDSA 3
For PDSA Cycle #3
• There’s been a change at work.
• Your Implantation Specialists have
decided to work for your
competing medical system across
town and you now have Locum
Tenens MDs filling in.
• Implantation Specialists must
switch tables!
BACK TO YOUR TEAMS
Take 2 Minutes to
discuss how your
team will improve the
quality and efficiency
of your patient care
with NEW TEAM
MEMBERS!
Start CYCLE #3
• Switch Bags Again!
• You Have 7 Minutes!
• http://www.online-stopwatch.com/full-screenstopwatch/
Review PDSA Cycle #3
• How did your new team
do?
• How did having new team
members effect your quality
and/or efficiency?
• Did you change your
system?
If we did PDSA Cycle #4…
• Unfortunately, Federal Budget
cuts continue and
reimbursements from Medicare
and Medicaid are down
substantially.
• We have to lay off one team
member from each team…
• The tallest person on the team
has to step away from the table
and observe
Team Outcome Review
What I learned from Mr. Potato Head:
1.
2.
3.
4.
5.
6.
7.
8.
The system is the critical determinant of performance.
Good communication is essential for a high-functioning
team.
Good ideas for improvement can come from anyone on
the team.
Data is essential to drive improvement efforts.
Repeating PDSA cycles is a valuable process.
Efficiency is enhanced when value-added work is
increased and waste is reduced. (LEAN)
With very simple changes in system, you can improve
quality, efficiency, and safety!
QUALITY IMPROVEMENT CAN BE FUN!
MEDICINE IS A TEAM SPORT!
Remember…There are “Different” ways
to achieve the same goals…
Suitcase of Tools
Thank you for participating!
Be sure to take these tools
back with you to your clinics,
wards, ward/ICU teams!
With very small changes, you
can make BIG differences in
both safety and efficiency!
Questions/Comments?