Lean transformation; finding the balance between tools and people Cellular Pathology, Royal Victoria Infirmary Terry Coaker, Histopathology Operations Manager 27th May 2011 Cellular Pathology, RVI,
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Lean transformation; finding the balance between tools and people Cellular Pathology, Royal Victoria Infirmary Terry Coaker, Histopathology Operations Manager 27th May 2011 Cellular Pathology, RVI, Newcastle 1981: RVI 9,700 requests per annum 1995: NGH acute services 1996: NGH histology 1997: Dental Hospital – oral pathology 2002: Freeman histology; muscle & nerve; cytology decant 2005: Histopathology decant – 42,000 pa 2007: Lean tools – examination phase 2008: Neuropathology decant 2009: New building (planned 2004) – 47,000 pa 2009: Pre-examination phase 2010: People 27th May 2011 Drivers for change 27th May 2011 Lord Carter 20% reduction Modernising Scientific Careers Private sector NHS Modernisation Improve the service Cytology 14 day TAT http://clinicalcytology.co.uk/resources/p df/14dayturnaround.pdf Cytology Improvement Guide http://system.improvement.nhs.uk/I mprovementSystem/ViewDocument .aspx?path=Cardiac%2FNational%2 FWebsite%2FDiagnostics%2FCytol ogy_14day_TAT.pdf 27th May 2011 Histopathology Improvement Guide http://system.improvement.nhs.uk/Impro vementSystem/ViewDocument.aspx?pat h=Diagnostics%2fNational%2fWebsite %2fHistology%20Guide%202.pdf 27th May 2011 27th May 2011 Unconscious incompetence Conscious incompetence Conscious competence Unconscious competence 27th May 2011 Lean Methods Continuous Improvement Toolbox Lean Tools Pull Systems Setup Reduction Quality at the Source Standardized Work Visual Controls 27th May 2011 Work Cells TPM Performance Measurement Continuous Flow Teams Value Stream Mapping Batch Size Reduction POUS 5S System Layout A lean transformation must keep an even balance….. ‘Tools’ TECHNICAL 27th May 2011 ‘People’ CULTURAL Too much emphasis on tools and methods…. Extensive use of “tools” Use of Japanese terms and concepts Some processes made more efficient Lean belongs to a few enthusiasts 27th May 2011 Failure to embed or spread Resistance to change Results not sustained No overall transformation If Cultural concerns predominate…. Failure to establish flow Lack of rigour in use of tools Lean “speak” without true understanding Full potential not realised 27th May 2011 Temporary feel good factor created Better teamwork Increased levels of involvement But hard to sustain without results Peters and Waterman 1982 “Managers themselves are the major barriers to high levels of commitment on the part of staff. People come to work motivated and interested but they are soon alienated by the web of rules and constraints which govern their lives. If only management could find ways to release and tap employees creativity for example visa employee involvement, then their commitment to organisational goals would follow” 27th May 2011 NHS Improvement “We’re looking for exemplar sites Er, no, not you ! Q. What would make us an exemplar ? A. Staff engagement” so… 1. Visual Display 2. Daily meetings 27th May 2011 People Pitfalls Managing from the office Use all the brains in the Department “We are different” Not invented here e.g. COSHH, Quality and Lean 27th May 2011 The Lean Leader Go and See Ask Why Respect People 27th May 2011 Force Reflection Re-organisation of meetings Spec Rec Slide Production ICC General Cytology Office Weekly Huddle Review Histology Performance ? Medical specialty team meetings 27th May 2011 Benefits Daily ! Addresses issues immediately Clarifies duties Encourages feedback Staff know more about their role Ownership Motivating and enjoyable! 27th May 2011 Visual Display 27th May 2011 Slide Delivery Average number of cases delivered to Dr's Res. 25.10.10-20.11.11 Average number of cases delivered to Dr's Res. 07.03.11-08.04.11 100 100 90 90 80 70 Number of cases delivered Number of cases delivered 80 70 Monday 60 Monday Tuesday Tuesday Wednesday 60 50 50 Wednesday Thursday Thursday Friday 40 40 Friday 30 30 20 20 10 10 0 0 27th May 2011 09:00 09:00 11:00 11:00 13:30 15:30 12:30 13:30 15:30 Delivery time Delivery time 16:45 16:45 27th May 2011 A3 27th May 2011 One side of A3 Pencil and eraser Root cause analysis 5 Whys? Plan, Do, Check, Act 6σ (Sigma) 3.4 defects per million opportunities Six sigma 3.4 defects per million opportunities One SUI in 47 000 One in 470 000 (10 years) One in 940 000 (20 years) 27th May 2011 A3 PROBLEM SOLVING PROCESS – GO SEE, ASK WHY ?, RESPECT PEOPLE WHAT IS THE PERCEIVED PROBLEM? IDEALLY FROM A CUSTOMER VIEWPOINT AUTHOR: NAME: DATE: 1. BACKGROUND 5. PROPOSED COUNTERMEASURES WHY ARE WE TALKING ABOUT THIS PROBLEM? FOCUS ON THE CUSTOMER (Internal or External) BRIEFLY STATE HOW THIS PROBLEM IMPACTS ON THE PURPOSE OF THE ORGANISATION & THE PROCESS GIVE RELEVANT BACKGROUND INFORMATION WHO ARE THE STAKEHOLDERS? COMMUNICATE WHAT ARE THE POSSIBLE MEASURES THAT WILL ACHIEVE THE TARGET CONDITION? ALWAYS CONSIDER A RANGE (OR SET) OF COUNTERMEASURES HOW WILL EACH COUNTERMEASURE AFFECT THE ROOT CAUSE? SELECT A COUNTERMEASURE (S) THAT BEST ADDRESSES THE ROOT CAUSE 2. CURRENT CONDITION TITLE: SPONSOR / MANAGER: NAME: DATE FINAL A3 APPROVED: COLLABORATE MENTOR & RESPECT 6. PLAN WHERE DO THINGS STAND TODAY? USE DIRECT OBSERVATIONS & MEASUREMENTS GO SEE (where activity actually occurs e.g. laboratory, office etc.) REPRESENT VISUALLY – USE CHARTS, GRAPHS, DRAWINGS, VALUE STREAM MAPS etc. BE OBJECTIVE,THOROUGH & SUMMARISE CONCISELY IMPLEMENTATION OF CHOSEN COUNTERMEASURE(S) WHAT ACTIVITIES ARE REQUIRED FOR IMPLEMENTATION? WHO IS RESPONSIBLE & WHEN WILL THEY HAPPEN? DEFINE SPECIFIC PERFORMANCE INDICATORS & MILESTONES BE VISUAL – USE TABLES OR GANTT CHARTS 3. GOALS & TARGETS WHAT SPECIFIC OUTCOMES ARE REQUIRED? 4. ANALYSIS – WHAT IS THE ROOT CAUSE OF THE PROBLEM? WHAT? ASK 5 WHYS ? 27th May 2011 CLARIFY PROBLEM WHY? WHY? WHY? WHY? CAUSE CAUSE CAUSE CAUSE WHY? ROOT CAUSE Understand how the work is done ‘GO SEE’ Establish ‘Point of Cause’ Time and place where events cause abnormality WHEN? OUTCOME 7. FOLLOW UP WHAT ISSUES CAN BE ANTICIPATED? CHECK OUTCOMES ARE BEING ACHIEVED. IF NOT, THEN CHECK TO SEE IF CURRENT CONDITION [2] & ROOT CAUSE ANALYSIS [4] WERE CORRECT CAPTURE & SHARE LEARNING – COMMUNICATE STANDARDISE TO MAKE CHANGE TO CURRENT CONDITION – AMEND POLICY, PROCEDURES, SIGNAGE, TRAINING etc REPEAT THE CYCLE - PLAN DO CHECK ACT PRESENTING PROBLEM Grasp the situation • Actual vs standard • Actual vs ideal WHO? People - Attitude curve Rogers diffusion curve Early adopters Early Late Innovators Majority Majority 20 30 30 Ready for change Range of attitudes “Wait and see” “Lets get started!” “Show me” 18th June 2007 Laggards 20 Resistant to change The Lean Champion is a Farmer Kegan and Lahey Dogs Lemmings Horses Sheep 20 30 30 Ready for change Range of attitudes “Wait and see” “Lets get started!” “Show me” 18th June 2007 Goats 20 Jackals Resistant to change Issues ‘No problems’ – is a problem! Discipline Poor performance – must be addressed – outside the huddle. 27th May 2011 Gemba audits – What is the problem? 27th May 2011 Issues remain unresolved Not seen as the number one priority Lack of time to investigate and fix Superficial solutions – ‘sticking plasters are not ‘root cause’ No clear ownership Med / tech barrier blocks communication Performance not reviewed (no huddle) What defines a good days work? Gemba audits - Actions Open issues and outstanding CAPA’s discuss at histo performance meeting Add “waste walks” to PI’s Define checklist of Gemba audits Define dashboard for audit Audit visual display boards 27th May 2011 Gemba audits – The Future Robust gathering of problems Speedy and binding resolution of issues 27th May 2011 TAT February 30 25 Days 20 15 10 7 5 5 3 0 BR CT GI GYN HPB Lymph Neuro MN OA OR Paed RE SK UR 95% 7.00 18.15 12.95 13.00 22.60 20.10 13.00 21.10 11.00 6.95 24.00 8.00 17.95 13.00 21.25 50% 3.00 3.00 4.00 5.00 7.25 7.00 5.00 9.00 5.00 3.00 7.00 3.00 5.00 4.00 7.00 Team 27th May 2011 Histo Total Histo referral ‘Not everything that counts can be counted, and not everything that can be counted counts.’ Einstein 27th May 2011 Thankyou …any questions ? Cellular Pathology, Royal Victoria Infirmary Terry Coaker 27th May 2011 Also known as… Process improvement Re-engineering Continuous improvement Total Quality Management Six Sigma 3.4 DPMO– Motorola - DMAIC Lean – Toyota Common sense?! 27th May 2011