Transcript Synchronous Flow Workshop
Going with the flow
The Journey to Continuous Improvement Synchronous Flow
Harvard Business Review
“Medical treatment has made astonishing advances over the years. But the packaging and delivery of the treatment are often inefficient, ineffective and customer unfriendly.” HBR, 2007 “Systems designed for manufacturing are fully applicable to health care.” HBR, 2005
-2
Today’s Objectives
• • • • What is Synchronous Flow?
How does it work with Lean Healthcare Kaizen Blitz Events Synchronous Flow Timeline
-3
Where People Come First…
• • Our mission is to excel at providing personalized, quality care; where people come first. Our vision is to be the provider of choice by creating a professional environment where: – – – patients want to receive care clinicians want to practice medicine employees want to work -4
Where People Come First…
• • • • We will accomplish this by: empowering our caregivers with education, technology, and personal and professional development, creating an environment which builds collaborative relationships among physicians, staff and patients, providing our communities with the educational resources and support to enable individuals to make informed decisions and play an active role in managing their own health, offering safe, personalized, high quality care.
-5
A Synchronized System: What does it take?
-6
Synchronous Management
• • A management approach that views resources in a system as elements of an interdependent network • all of which can be
synchronized
to a strategically selected control point • in such a way as to optimize the performance of the entire system.
Rooted in the concepts of Constraints Management.
-7
The
Synchronous
approach
• A “Control Point” is selected, optimized and finitely scheduled at the desired Throughput amount • All other functions strive to serve the Control Point • Predetermined inventory “ Buffers” are strategically placed to protect the Control Point • Buffers are
proactively
managed daily • New Patient release is metered to control WIP and lead times.
-8
Drum, Buffer, Rope
Rope Gate Input RM Buffer Time Process Flow
CP
Exit Output Medical Service Demand Constraint Buffer Time Processes from the Gate to the Exit are divided into zones and managed continuously
-9
Synchronous Flow Elements
• Relentless efforts to reduce all waste that is of no value to the patient experience – More time dedicated to patient care – From about 40% to at least 70% • Work release – Input / Output model • Standard work practices • Productive capacity and Protective capacity • Buffer Management logbook for each process • Buffer Analysis systems for each process • Focus Meeting script.
-10
Process Failures
• •
Errors
– incorrect execution of a task when everything needed is available
Problems
– Disruption of a worker’s ability to execute a prescribed task as planned – Clear, complete and timely information unavailable – Some tool or resource needed is unavailable – Something is present that is not necessary Synchronous Flow procedures differentiate and track each.
Problem Solving
• Level One Problem Solving – Worker compensates for the failure – The underlying cause is not addressed – Worker does not want to “make waves” – Can actually be counterproductive • Level Two Problem Solving – Worker addresses the immediate issue – Actions taken to identify and address the core causes – Willingness to “make waves” is encouraged by management – Organizational improvement occurs
Improvement Requires Change
Your existing system is designed to give you the results you’re currently getting.
If you want different results, you must change the system!
13
Implementing Change
“Improvement occurs only with change.”
-14
The Opportunity for Change
Knowledge What is it?
Head
Change
Desire Why should I?
Heart
Skill How do I?
Hands
-15
The Synchronous Flow Focusing Steps
• • •
Three necessary conditions
Define the system State the purpose Decide how to measure it
Five Focusing Steps
1.
Identify the system’s Control Point (s)
(Constraints)
2.
Decide how to exploit the system’s Constraints (s) 3.
4.
5.
Subordinate everything else to the above decisions Elevate the system’s constraint When a constraint is broken, return to step one. Do not allow inertia to become the system’s constraint. -16
A Constraint is...
• • Anything that limits an organization’s higher performance relative to its goals Can be internal or external Can be a process, a policy or a paradigm.
• •
The Control Point is…
The location within the scope of the system on which we
choose
to focus The point upon which operational measures are based.
-17
A Bottleneck is...
• A temporary limitation caused by
Murphy
• The effect is an intolerable situation • Something that we want to defeat • Something we respond to with urgency – Prioritized according to the relative threat to the Control Point.
-18
Productive Capacity
• The capacity required to meet the overall demand • Largely determined by the constraint of the system • This is the
Drum
of the process.
-19
Protective Capacity
• Additional capacity
required
on all resources to overcome...
– Murphy (statistical fluctuations) – Resource contention • Establishes an
unbalanced
system • Generally available with existing resources.
8 6 4 2 0
-20
A Closer Look
Constraints
• The are anything that limits performance • • They’re not necessarily
bad Every
things system has at least one • They determine your system’s capacity • They are your system’s most valuable resources • Choosing to
manage
chasing Murphy them is better than • Focusing attention on them simplifies life.
-21
Buffer Management
• • • •
Purpose: to identify and assign and record buffer problems responsibility to fix them Meetings are held at least once per day at a designated time and place for a maximum of 15 minutes Everyone is on time and prepared Actions items and person responsible for each is communicated The essence of proactive management.
-22
Remember!
• Common practices lead to balanced capacity • Balanced capacity systems are unstable and under-productive • Unbalanced capacity systems are stable, with increased velocity and predictability • Constraints hold the key to focusing improvement activities.
-23
What is Lean?
• Delivering more Value with Less Investment • The Toyota Production System (Deming and Ohno) • Founded upon: – Customer focus – Respect for humanity – Prudent, systematic elimination of waste • Expected outcomes: – Improved customer satisfaction – Improved employee satisfaction – Improved organizational performance
-24
Lean Management Defined
a systematic approach to identifying and eliminating waste
through continuous improvement, by flowing the product at the pull of the customer, in pursuit of perfection.
-25
Synchronizing
the Lean Tools
• •
Kaizen Blitz Events
- Continuous, incremental improvement of any activity to create more value with less
waste
A focused, team approach toward breaking the status quo by making immediate changes • • Applied continuously to
exploit
the selected control point.
Prioritized
capacity.
to establish the necessary protective
-26
Synchronizing
the Lean Tools
Value Stream Mapping
- plotting all the activities necessary for a product family • Identifies non-value-added activities • Helps to identify the constraints and Control Point • • Developed to “define the system and its purpose” Used during “identify,” “exploit,” and “subordinate” to minimize waste and to
prioritize
Kaizen events.
-27
Synchronizing
the Lean Tools
• • • • •
5 S’s
- A safe, clean, neat, arrangement of the workplace.
Sort
- eliminate the unnecessary
Straighten
in its place - a place for everything and everything
Shine
- Clean the workplace
Standardize Systematize
- Rules to maintain - Self discipline to sustain •
Prioritized
during the “exploit” and “subordinate” steps to organize the workplace.
-28
Synchronizing
the Lean Tools
• •
Pull mentality
- A system of operational behaviors from downstream to upstream activities Schedule for the Control Point is determined from market demand Release of Raw Materials is determined by consumption at the Control Point • All other activities are
Synchronized
to Control Point via Drum, Buffer, Rope.
-29
Characteristics of a Lean Enterprise
• High value-added - little waste • Simplicity and visibility • Process standardization • Demand based flow • Culture – Empowered teams – Open communication – Enforced accountability • Continuous improvement mentality
-30
Lean Principles
1. Specify
VALUE
2. Identify the
VALUE STREAM
3. Make value-creating steps
FLOW
4. Let patient flow
PULL
value 5. Pursue
PERFECTION
Lean Thinking
, Womack & Jones
-31
Lean Strategies and Tactics
• System mapping • Organize for flow • Total employee involvement • Pull systems • Quality systems • Institutionalized improvement • Standardized work • Five S's • Visual workplace • Set up / changeover reduction • Total productive maintenance • Design out waste • Measure the right things
-32
Value Added vs. Non-Value Added
• Value added: An activity that directly serves the needs of the patient.
• Non-value added: any other activity
Value Stream
• The specific series of activities required to provide a defined service for the customer
-33
The Seven Types Of Wastes
1. Excess material movement 2. Unnecessary process 3. Unnecessary motion 4. Defects 5. Inventory 6. Delays 7. Over production
-34
Elements of Work
Work
At least 30% of skilled nursing time is spent doing non-clinical activities.
Work content Waste
-35
System Mapping
• Flowchart of value stream activity • Understand the macro system • Identify material stream flow, obstacles to flow, control systems, inventory locations • Group knowledge, creativity
-36
Functional Spaghetti Diagram
1 1 1 1 2 2 4 4 4 3 3 3 3 5 5 5
-37
Kaizen Blitz
Trained teams of people empowered to make immediate and tangible changes for improvement.
•
The PCSAM model
Problem / opportunity identified • • Core causes confirmed and documented Solution and plan of action developed • • Aggressive action applied to the solution in 3 to 5 days Measurements tracked to assure success No going from problem to solution in this approach.
-38
The Kaizen Cycle
Measure results Problem Identification Action Solution and plan Core cause of the issue
Where to Begin
• Identify the system – value stream mapping • Choose measures, set objectives • Decide how to exploit the system – Flow layout, constraint positioning, inventory strategy, cells • Pull system - synchronized flow • Kaizen - waste elimination – Set-up reduction – Standardization – Workplace improvement/visual control
-40
Conditions for Success
• • • • • • • Senior management understanding Visual and vocal leadership Clear and elevating goals Complimentary measurement system Guiding Coalition Education and training Make clear – Steering Committee “What’s in it for me”
-41
Implementation Timeline
• Educational session for key staff • Selection and training of the Steering Committee • Identification of Kaizen opportunities • Selection and training of Kaizen Teams • Development of the Synchronous Flow Model – Constraint and Control Point identification – Buffer Management – Productive / Protective Capacity • Focus meeting process.
-42
Process Improvement
• • Communicate the basis of needed change to everyone in small group settings • Select a Steering Committee to manage the process • Select a key group of leaders to participate in the design and implementation of a new system for each identified target • PCSAM development • Kaizen Blitz to aggressively address each opportunity • Synchronize all activities to support a single selected control point • Make it visible for effective communication • Practice Buffer Management for effective accountability
Emphasize that continuous improvement means there is no finish line.
-43
And remember… When you’re through changing, you’re through.
Thank You !
-44
Change
Did you know that 75% of all change initiatives fail?
45
The 8 Reasons for Failure
• Complacency • Weak Leadership • Lack of vision • Lack of communication • Stopping at obstacles • Invisible progress • Declaring victory too soon • Neglecting to establish change in culture
-46