A Quick Summary of Lean Thinking

1. 1 A Quick Summary of Lean Thinking Do our work every day in a standard way that we created Not just the way the work evolved! Be alert to things going wrong They always do! Fix the problem now For this patient or co-worker Find and fix the root causes of the problem So it never happens again! Modified after Spear; Billi Solving problems: 1. Go and See 2. Ask why 5 times 3. Respect people Mr. Cho

2. Michigan Quality System & Lean References Books: Womack J, Jones D. Lean Thinking. (An overview) Liker J. The Toyota Way. Liker J, Meier D. The Toyota Way Fieldbook. Shook J. Managing to Learn. (Best book on leadership in a lean organization and A3 use) Dennis P. Getting the Right Things Done. (Strategy deployment or hoshin kanri) Rother M, Shook J. Learning to See. (Value stream mapping) Baker M, Taylor I. Making Hospitals Work (2009 from Lean Enterprise Academy, UK) Sobek D, Smalley A. Understanding A3 Thinking. (Problem solving and A3 use) Marchwinski C, Shook J, eds. Lean Lexicon. Articles: Kim CS, Spahlinger DA, Kin JM, Billi JE. Lean health care: what can hospitals learn from a world-class automaker? J Hosp Med. 2006;1:191. Bush R. Reducing Waste in the US Healthcare System. JAMA 2007;297:871. Spear S. Fixing Health Care from the Inside, Today. HBR. 9/05. Spear S. Learning to Lead at Toyota. HBR 4/04 Spear S. Decoding the DNA of Toyota Production System. HBR 9/99 IHI Whitepaper: �Going Lean in Health Care� www.ihi.org/IHI/Results/WhitePapers/GoingLeaninHealthCare.htm Web: Michigan Quality System at UMHS: med.umich.edu/mqs Lean Enterprise Institute: www.lean.org webinars, books, meetings� Ideal Patient Care Experience at UMHS www.med.umich.edu/i/acs/ipe.htm Crossing the Quality Chasm (IOM): newton.nap.edu/catalog/10027.html Lean Enterprise Academy (UK): www.leanuk.org National Health Service (UK): www.networks.nhs.uk/networks.php?pid=211 Wikipedia: en.wikipedia.org/wiki/Lean_manufacturing

3. 3 Lean Thinking: Troubleshooting Guide What is the problem? Who owns the problem? What is the plan? What is the current status of the plan? How will it be monitored? What worker training is needed? How does this problem relate to the organization�s most important goals?* What leader development is needed?

4. 4 We know half the plan is wrong, we don�t know which half. We have to watch it unfold, detect normal from abnormal right now, and fix it. Traditional companies think of a plan - as a prediction of what will happen. Lean companies think of a plan - as an experiment to be conducted - to tell us what we didn�t know about the work Paraphrase of Steven Spear , Fixing Healthcare� HBR�05 Plans are useless, planning is essential. (Eisenhower)

5. UMHS Chief Engineer System

7. 7 Lean Thinking is just� �simple and practical, consistently solving real problems in real time, at the source, at all levels. �not jumping to solutions. �fixing the problem now. �hard on the problem, easy on the people. �leader saying, �Follow me. Let�s look at it together�. �leading by being knowledgeable, fact-driven, expert negotiator, strong willed (for organization�s goals) yet flexible; leading by influence and persuasion. �not telling people exactly what to do. �having individual responsibility clear. John Shook

8. 8 How can we create (liberate)�18,000 problem solvers�? Help each worker take initiative to find and fix causes of problems he/she faces daily This means each of us has two jobs: Do the work Improve the work Managers role: Support improvement work (time, mentoring) Align improvements so value flows to the customer

9. 9 Lean Thinking as the Scientific Method Applied to Daily Work Scientific Method Observation Hypothesis Intervention Results/reflection Revise hypothesis New intervention� Structured abstract Lean Thinking Go see, ask why, respect Plan P Do D Check/reflect C Adjust A Repeat PDCA cycle� A3 report, Value Stream Map

10. 10 Lean Thinking: Great Medical Care for Daily Work