Learning Lean (HCH)

Learning Lean

He karakia whakatimatanga – Opening karakia Tūtawa mai i runga Tūtawa mai i raro Tūtawa mai i waho Tūtawa mai i roto Kia tau ai Te mauri tū, Te mauri ora Ki te katoa Haumi e. Hui e. Tāiki e!

I summon from above - from below - from the surronding environment and from within The universal vitality and energy To infuse and enrich all present Enriched, unified and blessed

PG X | SECTION X

Workshop Aims: • To provide both an introductory overview and a practical toolkit to support HCH practice teams to implement Lean Methodology and thinking • To strengthen the capacity of general practice teams to become more lean and stay lean • Where to start and how to make it stick

Programme Time

What

1.45pm-2.00pm

Welcome & Introductions

2.00pm-3.00pm

Workplace Organisation

3.00pm-4.00pm

Visual Workplace

4.00pm-5.00pm

Continuous Improvement

5.00pm-6.00pm

Lean Leadership

6.00pm-6.30pm

Debrief/Wrap Up

Lean Tool

Focus Areas o o

Workplace Organisation o

Visual Workplace Visual management, standardisation

Continuous Improvement

Lean Leadership Structured Problem Solving (Plan Do Check Act)

5S events (facility and electronic filing systems) Huddles – Agenda’s, tips for huddle chairs and action note taking. What is value add in the huddles, how do you get it and keep it ?

Flow initiatives – when and how to use this tool

o o o o o

Team Boards - making them work for you One Point Lessons – what is the value add of OPLs? Checklists andFlow charts Stock and inventory areas labelled Kanban inventory system

o o o o o

Process mapping Creating Lean Teams Professional development opportunities/initiatives Suggestion Boxes/Ideas Boards Daily Lean, Project Lean and Lean Culture improvement Gemba walks/Rounding Leading Lean – top tips of how to lead Lean Implementation of Root cause analysis Tracking and measuring and feeding back of PDCA cycle

o o o o

How

∞ • • •

Overview of the tool Purpose of the tool Application of the tool

?

• • • • •

What is working What are our challenges What are others doing How are we measuring How does PDCA fit into al of this

Key elements of the HCH model

Urgent and Unplanned Care

Proactive Care

Routine and Preventative Care

Business Efficiency

Urgent & Unplanned Care

Proactive Care for High Needs

Routine and Preventative Care

Business Efficiency

What is Lean?

Philosophy of Kaizen ‘Everything can be improved’ • Clarence W Barron

Change

for the Better‌ everybody every day everywhere

Kai = Change

Zen = Good (for the better)

What is Lean (Kaizen)?

• A business culture characterised by the endless pursuit of the elimination of waste • Comes from the Toyota Production system • Continuous improvement • Respect for people

5 key principles of Kaizen

1.

2.

3.

4.

5.

Value – what your customers value Value stream –value delivered to the customer Flow – removing barriers to deliver value Pull – triggered on demand from the customer Perfection – continuous improvement

The ultimate goal of Lean is to To eliminate: 1.Overburden - muri 2.Uneveness - mura 3.Waste - muda

Kaizen Lean foundations Create Customer Value

Value-added activities

Non-value added activities

transform materials & information into products or services the customer wants/needs

consume resources without contributing to the product or service

We want to develop processes & facilities that streamline the 7-Flows of Healthcare: • Patients

• Providers/Staff • Medications • Supplies • Information • Equipment • Patient Families

Kaizen Foundations CREATE CUSTOMER VALUE

PULL & FLOW

ELIMINATE WASTE

PROCESS & RESULTS

ENGAGE (RESPECT) PEOPLE

MANAGE VISUALLY

GO AND SEE

Who is the customer?

Patient

Workforce

Business / or System

Break out exercise – What does good look like?

The Lean tools…

“Give a man a fish feed him for a day, teach a man to fish feed him for a lifetime” - Chinese Proverb

7 wastes of a process value-added transportation defects/ rework inventory/ WIP

overproduction

motion overprocessing waiting

Prepare proposal for new prospect

In s id e Sales Rep

Selecl proposal

len-olat.

liJraty

CuSIOmiZll Boilerpla.'s text

Salos RoptOSentat ve

Sales Manager

VP Sa e s

lnside sales Manager

Director

Proposal

1o"'!ll•t•

Salos Aclm ln

L

Write new pro!JOsal text

5S events, Huddles, Flow initiatives

5S – Workplace Organisation

5S in action

Red Tag Files!

Before

After

5S Events

“Red Tag“

Why is 5S so important?

• Minimises & prevents waste • Underpins FLOW of…

• information, services, materials, products • Engages people o o o o

Pride Loyalty Commitment Discipline

• Helps to create, sustain and improve standards • Makes problems obvious

versus

Team Boards, One Point Lessons, Checklists and Flow Charts, Stock and inventory areas labelled, Kanban inventory system

Visual Management - Can everyone see it?

What is visual management?

• Displaying information to drive behaviour • Helps us…

Standard Agenda 1.

2.

3.

4.

Fixed Meeting time:

People

Continuous Improvement

Performance Compass Health Annual Plan Policy deployment matrix 2016-2017 Q1 Q2 Q3 Q4 Jul-Sep Oct-Dec Jan-Mar Apr-Jun

Comments (if not green)

X

First 90 days onboarding

X

Design standard operating procedures for all team functions

X X

Streamlining room/event use

XXXXXX X X

X

Implement REMWISE

X

X

Implement ASKYOURTEAM

X

X

Coaching model adopted

X

Increase catering efficiency

X X

Skill/Competency & training needs

75%

Pamela Wahlers

<8

PayGlobal 100% accurate

90%

Responsible Team/Person

Success - gain the best value from the resources available

Year to date plan

Empowerment - strengthening general practice capacity and capability Navigation - improve the quality, safety and experience of care

X

Catering costs vs budget

X

Operating procedures for all team functions

X

X

90% of staff with PDRPs

X

Fewer than 8 sick days per annum per employee

Implement the Health Care Home & Health Care Neighbourhood

Empowered patients and whanau

High Performing network & PHO

Targets to improve

X

New improvement ideas

X

Reception

PayGlobal audit Health & Safety plan implemented

Claire Dixon

X

Alice Graham

X

X

Responsibility

Workforce Development Plan

X

Chris Richard

Status

X

Bernie Phipps

Improvement Projects

Roles & Responsibilities matrix

Year to date actual

100% 100%

Annual plan

Wellbeing - improve health and equity for our population

Date as at

How are we doing today?

What does a good day/ week look like?

Just do it

Problem Solving

Daily KPIâ&#x20AC;&#x2122;s (Targets vs. Actual) 1. Perf Reviews completed 1. Perf Reviews completed 2. Payroll re-openings

Rosters, planners

Register of completed ideas What

Who

When

Problem Solving Working Docs

New Std?

define the problem

root cause PLAN

verify

solutions

Action plan

Completed

TROLLEY LAYOUT â&#x20AC;&#x201C; DRAWER 2

Lab Bags =10

Thermoscan Covers =1 box

Specimen Containers: Plain (Yellow) =2 Formalin (Red) =1 Mark Pen =1

empty

Crepe Bandages =1 of each size: 15cm; 10cm; 7,5cm

Eye Pads =1

Crepe Bandage 5cm =1

Cotton Buds = 10 sticks

Triangular Sling =1

Eurofix =1/2 roll each size: 10mx10cm; 10mx5cm

Blood Glucose Meter

Opsite =1/2 roll each size: 10mx10cm; 10mx5m

Micropore Tape =1 of each: 9.1mx5cm; 10mx2.5cm

Leukofix Tape 1.25cmx9.1m =1 2.5cmx5m =1

Standardisation â&#x20AC;&#x201C; enabling personalisation

Purpose of a standard?

Basis for training

Simplifies recurring / routine work

â&#x20AC;Ś in

Maintains existing know how

Guarantees stability in processes and procedures

Prevents defects

Basic for audit or diagnosis

order to do something in the best, simplest and certain way.

Standards: Leave Notification - Doctors Practice Manager

24.3.14

001

A. DOCTOR ON ANNUAL LEAVE Apply these processes at least one week prior to the commencement of your annual leave.

1. Set "Out of Office" assistant on Manage My Health (MMH) This process will inform patients to contact the surgery by telephone as this email will not be replied to.

1. Go to Manage My Health website and log in with your user name.

2. Open your "Inbox".

3. Click on Settings (far right hand tab) and tick "Enable Out of Office Reply" i.e. make sure there is a tick in this box.

4. Write your "Out of Office" message in the bottom box.

5. Click on "Save Settings" to save this (otherwise the out of office reply wonâ&#x20AC;&#x2122;t be activated).

45

One Point Lessons

Cannon Creeks

Staff Portfolio Matrix

Lead

Diabetes B4 School Check-up Immunisations IV Management Cardiovascular Management

Wound Care Infection Control Smears & Womensâ&#x20AC;&#x2122; Health Sexual Health Preceptorship Respiratory, Asthma, CORD MCA Preceptor Employee Health & Drug Testing Plasters / Suturing

Accountable Deputy

Responsible

Process mapping, Creating Lean Teams, Professional development opportunities, Suggestion Box/Ideas Boards, Daily Lean, Project and Lean Culture improvement

Prepare proposal for new prospect

In s id e Sales Rep

Selecl proposal

len-olat.

liJraty

CuSIOmiZll Boilerpla.'s text

Salos RoptOSentat ve

Sales Manager

VP Sa e s

lnside sales Manager

Director

Proposal

1o"'!ll•t•

Salos Aclm ln

L

Write new pro!JOsal text

Gemba Walks, Rounding, Leading Lean

Standard Agenda 1.

2.

3.

4.

Fixed Meeting time:

People

Continuous Improvement

Performance Compass Health Annual Plan Policy deployment matrix 2016-2017 Q1 Q2 Q3 Q4 Jul-Sep Oct-Dec Jan-Mar Apr-Jun

Comments (if not green)

X

First 90 days onboarding

X

Design standard operating procedures for all team functions

X X

Streamlining room/event use

XXXXXX X X

X

Implement REMWISE

X

X

Implement ASKYOURTEAM

X

X

Coaching model adopted

X

Increase catering efficiency

X X

Skill/Competency & training needs

75%

Pamela Wahlers

<8

PayGlobal 100% accurate

90%

Responsible Team/Person

Success - gain the best value from the resources available

Year to date plan

Empowerment - strengthening general practice capacity and capability Navigation - improve the quality, safety and experience of care

X

Catering costs vs budget

X

Operating procedures for all team functions

X

X

90% of staff with PDRPs

X

Fewer than 8 sick days per annum per employee

Implement the Health Care Home & Health Care Neighbourhood

Empowered patients and whanau

High Performing network & PHO

Targets to improve

X

New improvement ideas

X

Reception

PayGlobal audit Health & Safety plan implemented

Claire Dixon

X

Alice Graham

X

X

Responsibility

Workforce Development Plan

X

Chris Richard

Status

X

Bernie Phipps

Improvement Projects

Roles & Responsibilities matrix

Year to date actual

100% 100%

Annual plan

Wellbeing - improve health and equity for our population

Date as at

How are we doing today?

What does a good day/ week look like?

Just do it

Problem Solving

Daily KPIâ&#x20AC;&#x2122;s (Targets vs. Actual) 1. Perf Reviews completed 1. Perf Reviews completed 2. Payroll re-openings

Rosters, planners

Register of completed ideas What

Who

When

Problem Solving Working Docs

New Std?

define the problem

root cause PLAN

verify

solutions

Action plan

Completed

Change Management â&#x20AC;&#x153;Change makes people feel uncertainâ&#x20AC;?

Personal Change Curve

The Pit

ADKAR Desire

Awareness

Knowledge

Ability

Reinforcement

Awareness of the need for change Desire to support the change Knowledge of how to change Ability to deliver new skills and behaviour Reinforcement to make the change stick

Why should you care about change management?

• • • • • •

More likely to succeed More likely to make a good return on time and money invested Help ensure a smooth transition to Health Care Home Motivate your practice team Manage resistance to change Lead the way by being a high performing practice

Root Cause Analysis, Plan Do Check Act, Tracking and Measuring

Problem Solving â&#x20AC;&#x201C; problems are opportunities

Breaking down the problem

What happened? Speak with data.

Why did it happen & why is it an issue?

When did it happen? Has it happened before & how often?

root cause

define the problem Who was involved / affected?

Where did it happen?

How did it happen – sequence of events?

PLAN

DO

GET TO THE BOTTOM

BE VERY SPECIFIC

Structured problem solving template

Ask 5 x Why? What is REALLY causing this?

verify What will it look like when it has been fixed?

solutions How can we fix the ROOT CAUSE? Who needs to do what when?

WHAT WILL FIX THE PROBLEM?

HOW WILL WE KNOW IT’S FIXED?

ADJUST CHECK

Ishikawa or fishbone diagram Causes People / manual power Submitting timesheets late

Process / method

Poor planning

Calculating mistakes

Tiredness

Too many drop-off points

Effect or Problem

Long time to approve Price increase

The die is overheating

Trolley is cluttered

Long walk to stock area

Part deliveries

Insufficient RAM

Window is dirty

Running out of stock

Suppliers / material

Equipment & software / machinery

Environment

All possible causes are taken into consideration and assessed with respect to their impact on the problem

Potential solutions Evaluation

Measures

Collect ideas

(implementation)

(brainstorming)

High

Action Plan Solution alternatives

What?

Cost Solution 1

Solution 2

Solution 3

Time

Long

By whom?

By when?

Status

PDCA / SDCA cycles

Start anywhere â&#x20AC;&#x201C; there is waste everywhere!

Start by doing!

Put a good person in a bad system and the system wins every time!

Start by using this type of thinking: • Discard conventional fixed ideas • Think of how to do it, not why it cannot be done • Don’t make excuses – question current practices • Do it straight away, even if for only 50% of the target • Correct it straight away if you make a mistake • Ask why, why, why, why and then why again • Avoid spending money on Lean: ‘wits not wallets’ • Involve people in the area • See the wisdom of 10 people, not the knowledge of one

He karakia whakamutunga – Closing karakia Kia whakairia te tapu Kia wātea ai te ara Kia tūruki whakataha ai Kia tūruki whakataha ai Haumi e. Hui e. Tāiki e!

Restrictions are moved aside So the pathways are clear To return to eveyday activities Enriched, unified and blessed