Lean transformation finding the balance between tools and people
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27th May 2011. 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

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Lean transformation finding the balance between tools and people

27th May 2011

Lean transformation; finding the balance between tools and people

Cellular Pathology, Royal Victoria Infirmary

Terry Coaker, Histopathology Operations Manager


Cellular pathology rvi newcastle

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


Drivers for change

27th May 2011

Drivers for change

  • Lord Carter 20% reduction

  • Modernising Scientific Careers

  • Private sector

  • NHS Modernisation

  • Improve the service


Lean transformation finding the balance between tools and people

Cytology Improvement Guidehttp://system.improvement.nhs.uk/ImprovementSystem/ViewDocument.aspx?path=Cardiac%2FNational%2FWebsite%2FDiagnostics%2FCytology_14day_TAT.pdf

Cytology 14 day TAThttp://clinicalcytology.co.uk/resources/pdf/14dayturnaround.pdf

27th May 2011


Lean transformation finding the balance between tools and people

HistopathologyImprovement Guidehttp://system.improvement.nhs.uk/ImprovementSystem/ViewDocument.aspx?path=Diagnostics%2fNational%2fWebsite%2fHistology%20Guide%202.pdf

27th May 2011


Lean transformation finding the balance between tools and people

27th May 2011


Lean transformation finding the balance between tools and people

27th May 2011

Unconscious incompetence

Conscious incompetence

Conscious competence

Unconscious competence


Lean transformation finding the balance between tools and people

27th May 2011

Lean Methods

Continuous Improvement Toolbox

Pull Systems

Work Cells

TPM

Performance Measurement

Setup Reduction

Quality at

the Source

Continuous Flow

Batch Size Reduction

Lean Tools

Standardized Work

Teams

POUS

Visual Controls

Value Stream Mapping

5S System

Layout


A lean transformation must keep an even balance

27th May 2011

A lean transformation must keep an even balance…..

‘People’

‘Tools’

CULTURAL

TECHNICAL


Too much emphasis on tools and methods

27th May 2011

Too much emphasis on tools and methods….

CULTURAL

Extensive use of “tools”

Use of Japanese terms and concepts

Some processes made more efficient

Lean belongs to a few enthusiasts

Failure to embed or spread

Resistance to change

Results not sustained

No overall transformation

TECHNICAL


If cultural concerns predominate

27th May 2011

If Cultural concerns predominate….

Temporary feel good factor created

Better teamwork

Increased levels of involvement

But hard to sustain without results

TECHNICAL

Failure to establish flow

Lack of rigour in use of tools

Lean “speak” without true understanding

Full potential not realised

CULTURAL


Peters and waterman 1982

27th May 2011

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”


Nhs improvement

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…

  • Visual Display

  • Daily meetings


People pitfalls

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


The lean leader

27th May 2011

The Lean Leader

  • Go and See

  • Ask Why

  • Respect People

  • Force Reflection


Re organisation of meetings

Spec Rec

Slide

Production

ICC

General

Office

Cytology

27th May 2011

Re-organisation of meetings

Weekly Huddle Review

Histology Performance

? Medical specialty team meetings


Benefits

27th May 2011

Benefits

  • Daily ! Addresses issues immediately

  • Clarifies duties

  • Encourages feedback

  • Staff know more about their role

  • Ownership

  • Motivating and enjoyable!


Visual display

27th May 2011

Visual Display


Slide delivery

27th May 2011

Slide Delivery


Lean transformation finding the balance between tools and people

27th May 2011


Lean transformation finding the balance between tools and people

27th May 2011

A3

  • 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

27th May 2011

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)


A3 problem solving process go see ask why respect people

COMMUNICATE

COLLABORATE

MENTOR & RESPECT

PRESENTING PROBLEM

CLARIFY PROBLEM

WHY?CAUSE

WHY?CAUSE

WHY?CAUSE

WHY?CAUSE

WHY? ROOT CAUSE

Grasp the situation

  • Actual vs standard

  • Actual vs ideal

Understand how the work is done

‘GO SEE’

Establish ‘Point of Cause’

Time and place where events cause abnormality

27th May 2011

AUTHOR:

NAME:DATE:

SPONSOR / MANAGER:

NAME:DATE FINAL A3 APPROVED:

TITLE:

WHAT IS THE PERCEIVED PROBLEM?

IDEALLY FROM A CUSTOMER VIEWPOINT

  • BACKGROUND

  • 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?

  • CURRENT CONDITION

  • 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

  • GOALS & TARGETS

  • WHAT SPECIFIC OUTCOMES ARE REQUIRED?

  • ANALYSIS – WHAT IS THE ROOT CAUSE OF THE PROBLEM?

  • ASK 5 WHYS ?

  • PROPOSED COUNTERMEASURES

  • 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

  • 6.PLAN

  • 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

  • WHAT?WHO?WHEN?OUTCOME

  • 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

A3 PROBLEM SOLVING PROCESS – GO SEE, ASK WHY ?, RESPECT PEOPLE


People attitude curve

Rogers diffusion curve

Early adopters

Early Majority

Late Majority

Innovators

Laggards

20

30

30

20

18th June 2007

People - Attitude curve

Ready for change

“Lets get started!”

Range of attitudes “Wait and see” “Show me”

Resistant to change


Kegan and lahey

18th June 2007

The Lean Champion is a Farmer

Kegan and Lahey

Horses

Sheep

Dogs

Goats

Jackals

Lemmings

20

30

30

20

Ready for change

“Lets get started!”

Range of attitudes “Wait and see” “Show me”

Resistant to change


Issues

27th May 2011

Issues

  • ‘No problems’ – is a problem!

  • Discipline

  • Poor performance – must be addressed – outside the huddle.


Gemba audits what is the problem

27th May 2011

Gemba audits – What is the problem?

  • 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

27th May 2011

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


Gemba audits the future

27th May 2011

Gemba audits – The Future

  • Robust gathering of problems

  • Speedy and binding resolution of issues


Lean transformation finding the balance between tools and people

27th May 2011

TAT February

30

25

20

Days

15

10

7

5

5

3

0

Neuro

Histo

BR

CT

GI

GYN

HPB

Lymph

OA

OR

Paed

RE

SK

UR

Histo

Total

MN

referral

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

95%

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

50%

Team


Lean transformation finding the balance between tools and people

27th May 2011

‘Not everything that counts can be counted,

and not everything that can be counted counts.’

Einstein


Cellular pathology royal victoria infirmary terry coaker

27th May 2011

Thankyou

Cellular Pathology, Royal Victoria Infirmary

Terry Coaker

…any questions ?


Lean transformation finding the balance between tools and people

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?!


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