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LEAN Principles as Management Mindset & Improvement Tool Set. What is Lean?. A system: flow, pull and strive for excellence Not a set of isolated practices A process, a journey Not an end state A thought revolution.

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What is lean
What is Lean?

  • A system: flow, pull and strive for excellence

    • Not a set of isolated practices

  • A process, a journey

    • Not an end state

  • A thought revolution

A philosophy that shortens the time between the customer order and delivery by eliminating waste

Myth or reality
Myth or Reality?

  • It’s more efficient to process in batches

  • Zero defects is not a realistic target

  • End of process inspection will always protect patients from harm

  • A healthy clinical practice has a full waiting room and backlog of patients

  • Standard methods (procedures, protocols, methods) stifle creativity and are not a good cultural fit in medicine

Lean challenges us to cut waste in half today
Lean Challenges Us to Cut Waste in Half Today!

  • Half the errors

  • Half the cost

  • Half the space

  • Half the labor

  • Half the time

  • Half the complexity

  • Half the steps

  • Half the…….

Requires a Horizontal View

Traditional Improvement Approach







Value Stream Approach







What is a value stream
What Is a Value Stream?

Everything, including non-value added activities, that achieves the transformation from raw information/material into what the customer is willing to pay for

Network of processes and operations that make materials and information flow

Includes the communication of current and future demand throughout the value stream

Types of waste
Types of Waste

Value added timeline
Value-Added Timeline

First Unit Dose for Medication on Nursing Unit


To Patient

Dispense In


Write Order

Enter Data

Value-Added (VA)

Non-Value-Added (NVA)

Total time = 70 minutes

VA time = 6.5 minutes

Percent of NVA time = 91%

Travel distance = .25 mile

Number of Process steps = 25

Value-added steps = 4

Number of Inspection steps = 4

Number of queues = 11

Why focus on waste
Why Focus on Waste?

Because most processes are 95–99% non-value-added, a focus on eliminating waste is the best leverage for an improvement effort.

VA 5%

NVA 95%

Requires us to think differently
Requires Us To Think Differently…




Lead Time







With Traditional

Investment Strategy

  • Speed up value added steps

  • Add capacity






Lean Waste




Is it possible to get all the waste out?

Lean methods language
Lean Methods / Language

  • 5S

    • 5S is a visually-oriented system used to create and maintain greater organization, efficiency and safety while reducing training time, search time, wasted time and resources

  • Rapid Process Improvement

  • Value Stream Mapping

Separate the needed from unneeded items

Create a place for everything and a way to keep everything in its place

Visually examine the work area to differentiate normal from abnormal conditions

Document and use consistent work methods

Hold the gains






Tell at a glance if things are normal or abnormal
Tell at a glance if things are normal or abnormal

Rapid process improvement rpi
Rapid Process Improvement (RPI)

  • A fast-cycle METHOD for implementing lean practices within a particular process

  • Modeled after Toyota workshops for suppliers “Five Days and One Night”

Rpi workshops are
RPI Workshops are….

  • Focused, intense one week events

  • Targeted process

  • All areas of process represented

  • Vision developed

  • Changes are identified and made during the workshop

  • Little or no money is spent

Which management problem would you rather have
Which Management Problem Would You Rather Have?

Problem 1

Problem 2



Levels of quality system
Levels of Quality System


Level 5:Eliminate

Opportunities for Errors

Level 5

Detect Errors

Level 4: Self Inspection

Level 4

Level 3: Work Unit Inspect

Level 2: Company Inspects

Level 1: Customer Inspects

Level 3

Check forDefects

Level 2

Level 1

.You have 60 seconds to inspect this document.

.Count the o’s.

.Score the number at the bottom of the page.

To be, or not to be; that is the question:

Whether ‘tis nobler in the mind to suffer

The slings and arrows of outrageous fortune,

Or to take arms against a sea of troubles,

And, by opposing, end them. To die, to sleep—

No more—and by a sleep to say we end

The heartache and the thousand natural shocks

That flesh is heir to—‘tis a consummation

Devoutly to be wished. To die, to sleep.—

To sleep, perchance to dream. Ay, there’s the rub.

adapted from Hamlet, William Shakespeare

____ Total

What did we do
What did we do?

  • 1stImplementation of RPI at VUMC

  • Pre-work with planning team

  • Development of charter

  • 4 day intensive workshop

  • Includes all segments of Department

    • Focus on Transition Bundles

    • Report out to Management Guidance Team

  • Creation of reliable processes

  • Measureable metrics for continual improvement