CAPA is Lean

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CAPA is Lean

• Steve Kingsbury and Ann York
• 2010

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CAPA is Lean p198-199

• Toyota mantra
• People Brilliant processes Amazing results
• Always
• Add value
• Smooth flow
• Pull not push
• Make decisions slowly, implement quickly
• Relentless reflection
• Go see for yourself

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Add value

• Only 5 of NHS activity adds value!!
• What in NZ?
• Cut waste (TIM WOOD)
• Transportation-e.g have notes ready
• Inventory- only have what is needed
• Motion- reduce travel
• Waiting-reduce and make active
• Overproduction-not too many appts
• Over-processing-not too many things
• Defects correction- do it right first time

4
Smooth flow p 174-177

• Analyse bottlenecks
• Full booking
• Daily referral screening
• Reduce number of queues with Core work
• Segment similar needs together
• Plan time for admin
• Give families things to do until next step
• HELPFUL Habit

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Pull dont push

• Increase pull- draw resources to the user
• Flex capacity
• Use full booking systems in Choice and
  Partnership
• Specific work bolted on, not another waiting list
• Reduce push systems
• fixed appointments- urgent slots
• Avoid waiting lists
• CAPA

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Toyota Production System
Goal highest value to customer, as fast as
possible
Continuous Improvement
Product Development 14 Principles
Respect for People
Foundation Management applies and teaches lean
thinking
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Pillar 1 Respect for people

• Don't trouble your customer
• Includes the person after you in the production
  chain
• Develop people then build products
• Managers Walk the talk
• They are lean themselves eliminate waste etc
• Develop teams
• Team work not group work
• Teams and individuals evolve their own practices
  and improvements

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Pillar 2 Continuous improvement

• Go see (gengi genbutsu)
• Solve at the source not behind desks
• Kaizen
• My work is to do my work and to improve my work
• Local experimentation
• Continuous improvement
• Value and waste
• Perfection Challenge
• Work towards flow

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14 principles

• Some highlights..
• Use pull systems
• Stop and fix problems (this means attend to
  issues now to save time later
• Visual tools (e.g. not just printed schedule
  information but how to bring the processes and
  info to life in a visual way)
• Decide slowly by consensus, implement quickly
• Time boxing
• Setting small and near time limits to avoid
  outcome delay

10
Lean Thinking

• Is a set of tools and ideas that simplify the
  Toyota Production system
• Largely miss out the first pillar of Respect for
  People
• Effective none the less

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Lean Principles

• Specify Value every step must add value
• Would the customer pay for it?
• (don't forget the customer is also your colleague
  after you!)
• Identify the Value stream
• I.e. what acts add value?
• Make the Process flow
• Create Pull systems
• Pursue Perfection

12
Waste

1. Transportation
2. Inventory (large stock)
3. Motion (having to move to complete tasks)
4. Waiting
5. Over-processing
6. Overproduction
7. Defect Correction

13
Waste exercise (20 mins)

• Separate in small groups of 4-5.
• For each type think about your service
• See if you can find waste of this type
• Meet and discuss the identified wastes
• Longer exercise...
• As a group pick some of the wastes
• Go back into the small groups to think of
  possible solutions
• Meet up again to plan!!

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Push vs pull systems

• Push
• Timing of items flowing through system is based
  on high level commands or schedules
• Up-stream or Top down commands
• Or number of things provided is based upon
  planning
• CAMHS examples? ... Fixed number new patient
  appointments
• Pull
• Capacity provided or movement of items in a
  system based on down-stream requests
• Services or products are pulled to the customer
  by their demand
• CAMHS examples?
• Stock / inventory control examples
• Kanban cards in TPS
• Visual cards that signal a need for restocking (a
  pull request)

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Exercise is CAPA a Lean system?

• Think about the CAPA system and consider which
  bits are pull and which are push
• Think about which steps add value and eliminate
  waste cf traditional CAMHS