Introduction into Lean

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Introduction into Lean

• and the Every Patient Matters Transformation
  Programme

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Introductions/Objectives

• Introduce yourself
• Why have you come along today?

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Objectives

• Explain what Lean is
• Describe the aims of the Every Patient Matters
  Transformation Programme
• Be able to apply at least one Lean technique in
  your workplace

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Introduction into..
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Why do we need Transformation?

• Fire-fighting has become the norm
• Patients are pushed through the system no flow
• Stressed out staff
• Outdated processes

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Previous Change Initiatives
RUH 2010
Productive Leader (on-going)
Orthopaedic Lean Project
Productive Operative Theatre (TPOT)
Productive Ward
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Improving Quality

• Quality, Innovation, Productivity and Prevention
• What are the programme objectives?
• Perception is that its all about efficiency
  savings
• Every Patient Matters falls under the QIPP
  umbrella and reports to PMO (programme management
  office)

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QIPP Projects

• Acute Oncology
• Ambulatory Care
• Emergency Surgery Pathway
• Theatre Scheduling
• Outpatients
• And many more
• Quality and the impact on patient experience is
  the most important factor to consider when
  scoping a project

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Vision for Transformation

• To deliver the best possible care to every
  patient involving all staff in
• developing a culture of
• continuous improvement

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What is Lean?

• What do you think the term Lean implies?
• Lean is not an acronym, it is a collection of
  tools that assist in the identification and
  elimination of waste (e.g. queues, duplication,
  re-work, waits and delays) and focuses on the
  customer/patient

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History of Lean

• Lean thinking, developed from the Toyota
  Production System, has been applied in many
  competitive sectors.
• It is about changing a business from the roots
  up working to a set of principles to produce a
  culture of continuous improvement that will drive
  sustainable results.

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Industry Examples of Lean
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Why use Lean?

• Such thinking is increasingly being applied to
  health services in the UK and overseas to
• improve the quality of patient care
• improve safety
• eliminate delays
• reduce length of stay
• while using no more resources

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5 Principles of Lean
1. Value Specify value, this must be defined by
the customer/patient. Otherwise known as Voice of
the Customer 2. Value Stream Identify the value
stream/patient journey and the processes that
define it. 3. Flow Align healthcare processes to
facilitate the smooth flow of patients and
information 4. Pull Deliver care on demand with
the resources needed for it. 5. Perfection
Develop and amend processes continuously.
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Value Stream Mapping

• Used to identify the processes involved in the
  value stream and which elements had value to the
  customer
• Different from process mapping in that you
  identify value added and non value added steps
  for the customer and quantify time.

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Lean Principles Exercise

• Exercise 1
• In groups look at the value stream in front of
  you and complete the questions in the exercise
  sheet

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5s a simple tool to start with

• 5s is a good first lean technique to use back in
  your work area
• Sort
• Standardise
• Set in Order
• Sweep and Shine
• Sustain

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Before and After pictures
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5s Principles

• Engage others in your workplace with the 5s
• Start small with your own desk!
• Take photos before and after

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Waste

• Waste is anything other than the minimum amount
  of equipment, space, staff time, which are
  essential to add value to the product or service.
• In Lean 7 types of wastes have been identified,
  there may be more that you can think of

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7 Types of Lean Waste
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Waste Exercise

• Exercise 2
• In pairs, spend 15 minutes thinking of NHS
  examples for each of the 7 wastes

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Waste Walk

• Walking the process from beginning to end (or
  end to beginning)
• Walking each step, watching what actually happens
  (as opposed to what you are told that happens or
  what is contained in a process flow chart or
  procedure)
• Talking to the people who undertake each task to
  establish how it happens (and does it happen this
  way each and every time?)
• Observing for wasteful activities
• Developing a shopping list of measures (data)
  required that will inform the investigation
• Photographs anything and everything that appears
  relevant (do you require permission?)

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• Best possible care through lean thinking is not
  a project, it is a fundamental change to the way
  in which the hospital delivers its services to
  patients

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Lean Awareness
200 RUH staff
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Lean Leadership
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Culture and Climate

• Change in an organisation calls for leaders to
  recognise and balance culture and climate
  dimensions.
• Culture can be divides into five components
  values, beliefs, myths, tradition and norms.
• Climate is the label used to describe the
  dimensions of the work environment E.g.
  organisation structure, leadership style,
  communication, historical forces.

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Culture and Climate Exercise

• Do we have a climate and culture that encourages
  change?
• Exercise 3
• Group 1 - Describe the current Culture and
  Climate of this organisation
• Group 2 - Describe what the Culture and Climate
  of this organisation needs to be.

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What do our leaders think?

• Link to chief exec conference culture question
• http//webserver.ruh-bath.swest.nhs.uk/everypatien
  tmatters/Lean/leadership/index.asp?menu_id5

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Factors to achieve desired culture and climate

• 1. Clear Vision
• 2. Set of values in alignment with the vision
• 3. Accountability for both performance and
  behaviours with consequences when standards
  arent met.
• 4. High performing teams that work independently
  and put the needs of the organisation before
  personal needs.
• 5. Value added communication
• 6. Rewards/Recognition

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Next Steps

• Get your colleagues involved in a 5s activity
• Think of a problem that you think you could apply
  some lean principles too
• Book yourself onto the two day change agent
  training
• Discuss location for waste walk

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Lean Change Agent Training

• Two day change agent training follows this half
  day and includes
• Exercises and group work to demonstrate lean
  principles
• Waste Walk in your department
• Process mapping value added, non value added
• Human dimensions of change
• Handbook provided with Lean toolkit incl.
  Transformation Approach
• Please complete feedback sheets be honest as
  you like!

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