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“If you have built castles in the air, your work need not be lost; that is where they should be. Now put the foundations under them.” Henry David Thoreau
Lofty Ideas • Great – But…. • How to get buy-in? • How to prove what needs to be done to achieve things like Universal Screening or ONE Plan across systems • How to build a Foundation to work on
Lean / Continuous Improvement“Common sense uncommonly applied.” • A way of thinking • Know your customer (yes government has customers – many in fact) • What does your customer value? • Is the delivery process simple and all steps have value added? • Do “it” right the first time • Involve and empower employees • Continually improve
Lean Concepts • We all have customers • All work is a process • Processes can be defined • Problems happen for a reason • Everything can be improved • Methods can be standardized • Processes can be measured
Lean Concepts • Eliminate non-value-added activities, tasks, steps • Implement low-cost/no-cost solutions • Simplify Process (5 Whys) • Do things only once • Look at the process from the customer point of view
The Eight Wastes • Overproduction • Generating more info than customer needs • Creating reports no one reads • Making extra Copies • Waiting • Transportation • Taking files to another person • Going to get signatures • Non-Vale Added Processing • Repeated manual entry of data • Redundant reviews/approvals • Data entry not performed at the source • Information for decision making not real time • Excess Inventory • Files waiting to be worked on • Emails waiting to be read • Office supplies, piles and shelves of supplies • Errors • Equipment breakdowns • Lost Records • Data Entry error • Excess people motion • Searching for… • Extra clicks or key strokes • Looking through manuals • Handling paperwork • Underutilized people • People with training skills beyond work • Roadblocks
Value Stream Mapping A visual mapping tool that outlines all the steps in a process and helps to identify ineffective procedures and waste, as well as to develop implementation actions plans for making continuous improvements. • The mapping must be done by those intimately involved in the process from every angle. • Purpose: Team members can: • See(and document the process) • Assess • Measure • Change(identify, plan, implement and measure improvements)
Value Stream Mapping Typically a 3-day process, (We adapted this to be 4 days to gain parent perspective) • Day 1 - Identify a current process state • Day 2 - Design the improved future process state • Day 2 and 3 - Prepare a change/action plan to move toward the future state • Day 3 - Implement and monitor the Action Plan
What is a Process • A Sequence of tasks drilled-down to the lowest denominator Example: “Doing the Laundry
Well Child Check Example • Who is the Customer? • What is the Product?
Current State • Visualize the steps and sequence of the process • A step is an ACTIVITY that starts with a verb and includes a noun (walk dog)
NOTES FOR EXAMPLE Blue Post-Its – ANY IDEAS FOR IMPROVEMENT – PUT IT DOWN (one idea per post-it) Yellow Post-Its - Process
Exercise Instructions • Review Charter • 5 minute – Individual Brainstorm • Work individually and silently • One step per yellow post-it • Start with a verb and use a noun • Write quickly • Write BIG • Get Down As Many Steps as you can (remember: someone else will get a step down) • 5 minute – Group Process • Discuss sequence of steps
Loop and Group Report-out Instruction • We are quickly going to collect the data we’ve just generated. We will do this in a round robin fashion. We’ll start to my right, and the first group will place three of their post-its on the wall - read them out loud as you post them. Questions for clarification only as we go. The next group posts three, the next three more – and so on. If there are duplicates, place them on top of the one already there. We will continue round robin until we are out of post-its. If you have no post-its left, just say “pass” If, as we post the steps you have another idea, just write it on a new post it.
Once all Post-Its are up… • Please look at the wall and organize the steps in sequence. • Name the Step Clusters on PLAIN WHITE PAPER • Who performs the activity step? • Elapsed Time vs Task Time • Elapsed Time ( GREEN POST-ITS)
Analyze • What do you see? • Batch, Backlogs and Bottlenecks (MARK PROBLEMS WITH RED DOTS) • What are Critical Value Steps? (MARK WITH ORANGE DOTS)