Level 2- Lean Practitioner in Healthcare Course Workbook...

Level 2- Lean Practitioner in Healthcare Course Workbook Part 4 – Step 3

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© Radical Transformation LLC www.radical-transformation.com Rev 0

Table of Contents

Introduction. ................................................................................................................................................ 3

Course Objectives. ..................................................................................................................................... 4

10 Steps to become a Lean Enterprise. ................................................................................................. 5

Take the 30 Second Challenge. ............................................................................................................... 6

Step 3 – Workplace Organization. ........................................................................................................... 8

The 5S Levels of Achievement. ............................................................................................................. 10

The 5S Audit Sheet. ................................................................................................................................. 11

Documents List ......................................................................................................................................... 15


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Introduction. Welcome back to our online training course. This training module is the continuation of our “10 steps to become a Lean Enterprise” Lean Practitioner in Healthcare online course series. We continue with this training module “Lean Practitioner – Part 4 – Step 3.” Let’s continue the Lean journey!


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Course Objectives. Here are the course objectives for the Lean Practitioner – Part 4 – Step 3. We continue to share the necessary information so anyone can gain a better understanding of what it takes to become a Lean Enterprise. Upon completion of this course, you will be able to:

• Describe Step 3 - Workplace Organization

• Describe each of the five elements of 5S

• Describe the 5S levels of achievement

• Understand the purpose of a 5S audit

As you work through the training modules, you will see a screen with an outline of the course objectives. These objectives are the steps a learner needs to fully understand and be able to apply to achieve the overall training goal for each course.


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10 Steps to become a Lean Enterprise. In our previous training modules, Lean Practitioner – Part 1 and 2, we introduced you to some of the important components required to develop the right type of culture for a Lean Enterprise. In the Lean Practitioner Part 3, you completed the following steps:

Step 1 Strategy Deployment. Step 2 Value Stream Mapping.

In Lean Practitioner – Part 4 we are going to discuss Step 3 of the “10 steps to become a Lean Enterprise” program:

Step 3 Workplace Organization. Remember: Each step is an important part of the Lean Enterprise model. If any one of the 10 steps is not applied as described, an organization will find it difficult to become a Lean Enterprise.


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Lean Practitioner in Healthcare Part 4

5©2011 Radical Transformation LLC – All rights reserved

Can you find what you need to do your job in 30 seconds or less?

If you can’t, you’re not being productive when you have to stop your work to go search for supplies, patients, equipment, information, etc.

Take the 30 Second Challenge. As an active part of the workplace organization training, I like to ask everyone to participate in what I call the “30 second challenge”! I ask them a simple question. Can you find what you need to do your job in 30 seconds or less? You probably need a moment or two to think about it! What do you think? Is it possible? What is your answer? Is it “Yes” or “No”? If your answer is “Yes”, then you and your healthcare management team is doing a great job in supporting you to keep doing your job, being productive and creating value for the patient. If the answer is “No”, then your healthcare management team is encouraging you to add cost to patient services by participating in wasteful practices. Why is this? It is because they are choosing to have employees search for medical supplies, patients, equipment, information, etc. You may not believe it but these activities increase costs and reduce value for the patient. Eventually, it affects the bottom line and reduces profits. When healthcare employees are searching for any of these items, they are not involved in the direct delivery of the healthcare services to the patient. While searching for items, they are not being productive, they are unproductive. There is a necessity for medical staff to replenish their work areas but this makes it difficult to stay focused on the task. This can create distractions which can lead to problems in the quality of patient care. The consequence of doing this on a continuous basis is medical errors, extended care, longer turnaround times, excessive waiting for patients, repetitive interruptions in the delivery of service, etc.


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The goal of workplace organization is to create an environment where the items needed to do the job are available in the work area, at any time when they are needed. This will require a paradigm shift in the way the medical staff thinks about their work areas and patient services. They must move from a process focused method to a patient focused system.


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Integration of 5S and Visual Management

5S is five activities:

1. Sort

2. Set in Order

3. Shine

4. Standardize

5. Sustain

A place for everything and everything in its place.

Visual Management is used to differentiate between an abnormal and normal condition in a work area.

Step 3 – Workplace Organization. The purpose of workplace organization is to identify and eliminate waste. In addition to this, it is to create a visual workplace because it is much easier to manage. Workplace organization is the integration of two systems, 5S, and Visual Management. A 5S program consists of five separate activities each starting with the letter “S”.

1. Sort - Separate necessary and unnecessary items.

2. Set in Order - Designate a specific location for all necessary items.

3. Shine - Inspection of the work area through cleaning.

4. Standardize - Implement standardized 5S practices in all work areas.

5. Sustain - Integrate 5S into the daily work activities.

The 5S mantra is “A place for everything and everything in its place”. An organization that cannot implement a robust 5S process does not have the level of discipline to become a Lean Enterprise. Sort: Involves identifying which items are necessary and unnecessary. Necessary items will remain in the work area. If an item is not used on a regular basis, it should be stored in a location outside of the work area. It is unnecessary to have it in the work area until it is needed. Unnecessary items are red tagged using a label or tape to identify them. Unnecessary items that are red tagged will be entered into a red tag log and then moved to a red tag area. These items will remain there for at least a week waiting for a disposition. These items will be scrapped, sold, or utilized by another work area. Set in Order: Involves creating a defined location for all necessary items that will remain in the work area. Set in Order is focused on moving an organization from


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optional to required behavior. This is done using a combination of three things - signs, labels and lines. We all experience these three things every day, whether we are parking our car (parking lines), driving along the highway (speed limit signs) or navigating our way to find a file on a computer (folder and file labels). It is necessary to establish the discipline to create a specific location, and then place an item back into its defined location, every time. Without this level of discipline a 5S process will not work effectively. Shine: Involves establishing an orderly and clean facility by inspecting the work area through cleaning. As the area is being cleaned, it is scanned to ensure that everything is in its place and it is safe to use e.g. supplies, medications, documents, equipment, etc. A healthcare organization with work areas that are not maintained in a clean and orderly fashion will never become a Lean Enterprise. Standardize: Involves establishing the best practices and implementing them throughout the entire facility. Each employee will need to follow the same best practices and this will become the standardized procedure for establishing the 3S’s – Sort, Set in Order and Shine. Sustain: Involves establishing a feedback procedure for all work areas to ensure that all standardized 5S methods are being followed and maintained over time. One method of achieving this is to implement a 5S auditing procedure. A work area is assessed using the standards established when the 5S process was implemented. The standards could be a document, a picture of the work area or a workplace layout. The results of the 5S audits are presented to the management team during their continuous process improvement update meetings. Visual Management is a process of implementing visual cues to support the 5S activities. It uses visual methods to give instructions and communicate to healthcare employees about the actual status of a process. It is a great technique to help identify and eliminate waste. The primary goal of Visual Management is to make a non-conformance immediately obvious. The visual management system must be able to differentiate between an abnormal and a normal condition in the workplace. An example would be using a color coding system to determine if medical supplies are located in their correct storage locations. An item with a yellow label in a cabinet designated for items with a green label would be recognized instantly.


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SORT SET IN ORDER SHINE STANDARDIZE SUSTAIN

LEVEL 5Focus on Prevention

Employees are continually seeking to find opportunities for improvement

A dependable standard documented method has been implemented and established to provide a continual evaluation of the process for improvement.

Area employees have devised a dependable standard documented method of preventative cleaning, inspection and maintenance.

Everyone is continually seeking the elimination of waste with all improvements documented. Information is shared throughout the organization to establish best practices.

There is a general appearance of a confident understanding and adherence to the 5S principles. 5S is fully integrated into the work practices

LEVEL 4Focus on Consistency

A dependable standard documented method has been established to keep the work area free of unnecessary items.

A dependable standard documented method has been established to recognize in a visual sweep if items are out of place or exceed standard quantity limits

5S cleaning and inspection agreements are evident in the work area. They are understood, applied and documented continually.

Substantial standard process documentation is available, followed and updated on a regular basis.

Follow-through with 5S agreements and safety practices is evident throughout the work area.

LEVEL 3Focus on

Visual Controls

Unnecessary items have been removed from the workplace.

Designated locations are marked to make workplace organization more visible and visual.

Work/break areas and equipment are cleaned on a daily basis. Visual Controls have been established.

Working environment changes are being documented. Visual Control standards for labeling and quantity levels have been established.

5S agreements and safety practices have been developed and are visually evident in the work area

LEVEL 2Focus on 5S Basics

Necessary and unnecessary items are separated.

A designated location has been established for items.

Work/break areas are cleaned on a regular scheduled basis. Key items to check have been identified.

Methods are being improved but changes have not been documented.

A recognizable effort has been made to improve the condition of the workplace.

LEVEL 1No Awareness

of 5S

Needed and not needed items are mixed throughout the workplace.

Items are randomly located throughout the workplace.

Workplace areas are dirty, disorganized and key items not marked or identified.

Workplace methods are not consistently followed and are undocumented.

Workplace checks are randomly performed and there are no visual measurements of 5S performed.

The 5S Levels of Achievement. In this matrix, on the screen, you can see five levels of achievement for 5S. Below, I give a brief explanation of each level: Level 1 - There is no awareness of 5S throughout the organization.

Level 2 – The focus is on implementing the basic 5S principles.

Level 3 – The focus is to create order by making everything visual.

Level 4 – The focus is to standardize to achieve consistency.

Level 5 – The main focus is to develop prevention awareness.

The purpose of these 5S Levels of Achievement is to bring attention to the different depths and requirements to create a workplace that can easily differentiate between a normal and abnormal situation, at a glance. At this point in the training it is important to get an overview of the processes involved in Workplace Organization. These include the integration of 5S and visual controls and how they are applied in the workplace. We have a complete training module dedicated to Workplace Organization in the Level 3 - Lean Expert training course which is part of the “10 Steps to become a Lean Enterprise” online program.


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5S audit sheet used to qualify & quantify the condition of the workplace.

There are two rows for each 5S activity:1. Sort2. Set in Order3. Shine4. Standardize5. Sustain

There is a definition of the scoring criteria for each 5S element.

Place for giving feedback to employees so they know how to improve their audit score.

Work Area 5S Audit Sheet

The 5S Audit Sheet. On the screen, you can see an example of a 5S audit sheet. Performing 5S audits is part of the “Sustain” activities. An audit is a tool used to qualify and quantify the condition of the workplace. The audits are carried out periodically and the results are displayed on a 5S information board. Many organizations develop a rewards and recognition program to support their Lean implementation process. Their rewards program will include items such as movie tickets, gift cards, t-shirts, pizza, etc. to encourage employees to participate in the 5S process. The team with the best consistent 5S scores during a month or quarter would receive one of these prizes. The business management team will track the 5S audits scores for all departments on a monthly or quarterly basis. The department that achieves the best score will win a prize, which could be anything from a trophy to place in their work area to buying pizza for the team. You can find a copy of the 5S audit sheet in the back of your course workbook. There are ten rows separated into 2 rows for each 5S elements. There is a scoring criterion for each 5S element, which is used by the auditor to determine the score for each element. The scores range from a 1 (poor) to a 5 (excellent). Some organizations will use the 5S Levels of Achievement matrix to help determine their audit scores. The main purpose of conducting the audits is to drive continuous improvement. The auditor will use the form to give feedback to the team in a work area so they understand how they can improve their work area and 5S scores before the next audit.


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Once the auditor has completed the 5S audit of the work area, the scores will be totaled and converted into a percentage (%). These are entered into a spreadsheet to create a bar chart, which is used to compare the audit scores for every work area.


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End of Presentation. Congratulations, you have now completed this presentation, which is Part 4 – Step 3 of your Level 2 – Lean Practitioner in Healthcare online course materials. Please go to Part 4 – Step 4 of your Level 2 – Lean Practitioner in Healthcare online course materials.


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Notes


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Documents List

1. 5S Levels of Achievement Sheet

2. Work Area 5S Audit Sheet

3. Office 5S Audit Sheet


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5S Levels of Achievement

SORT SET IN ORDER SHINE STANDARDIZE SUSTAIN

LEVEL 5

Focus on

Prevention

Employees are

continually

seeking

improvement

opportunities

A dependable

documented

method has been

developed to

provide continual

evaluation, and a

process is in place

to implement

improvement.

Area employees

have devised a

dependable

documented

method of

preventative

cleaning and

maintenance

Everyone is continually

seeking the elimination

of waste with changes

documented and

information shared.

There is a general

appearance of a

confident

understanding of,

and adherence to,

the 5S principles.

LEVEL 4

Focus on

Consistency

A dependable

documented

method has

been

established to

keep the work

area free of

unnecessary

items.

A dependable

documented

method has been

established to

recognize in a visual

sweep if items are

out of place or

exceed quantity

limits

5S agreements

(such as cleaning

and preventative

maintenance

schedules) are

understood and

practiced

continually.

Substantial process

documentation is

available and followed.

Follow-through

with 5S

agreements and

safety practices is

evident.

LEVEL 3

Focus on

Visual

Control

Unnecessary

items have

been removed

from the

workplace.

Designated

locations are

marked to make

organization more

visible.

Work/break areas

and machinery

are cleaned on a

daily basis. Visual

controls have

been established

and marked.

Working environment

changes are being

documented. Visual

control agreements for

labeling and quantity

levels established.

5S agreements

and safety

practices have

been developed

and are utilized.

LEVEL 2

Focus on

Basics 5S

Necessary and

unnecessary

items are

separated.

A designated

location has been

established for

items.

Work/break areas

are cleaned on a

regular scheduled

basis. Key items

to check have

been identified.

Methods are being

improved but changes

have not been

documented.

A recognizable

effort has been

made to improve

the condition of

the workplace.

LEVEL 1

No 5S

Needed and

not needed

items are

mixed

throughout the

workplace.

Items are randomly

located throughout

the workplace.

Workplace areas

are dirty,

disorganized and

key items not

marked or

identified.

Workplace methods are

not consistently

followed and are

undocumented.

Workplace checks

are randomly

performed and

there are no

visual

measurements of

5S performed.


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Work Area 5S Audit Sheet

Performed by: Area: Date:

# Description Scoring Criteria Rating Scale 1-5 (poor = 1, excellent = 5

Score Notes for next level of improvement.

1 Sort Workstations should be clean, organized and neat with only tools and products necessary to perform tasks.

2 Sort

Control of machines and tools are properly labeled, stored and clearly marked. All calibrated tools are current, and have a home location.

3 Set in Order

All cleaning equipment is available and stored in a neat manner, for when needed. All floors are cleaned throughout the shift as work is performed.

4 Set in Order

Only documents necessary to do the work are stored at the workstations and they are neat and orderly. Bulletin boards are arranged in a straight, neat manner.

5 Shine Floors locations are clearly marked as to where WIP, etc. should be stored.

6 Shine

Nothing is placed on top of machines, cabinets, or equipment. Nothing leans against the walls or columns. All guards and deflectors are in place.

7 Standardize

Tools and equipment are labeled or stored properly and there is a location identified for all tools and equipment, like shadow boards, labeled shelves, bins, etc.

8 Standardize Documents are labeled, clearly as to contents and responsibility for control and revision. Nothing is unlabeled.

9 Sustain

All machines and equipment are painted and kept clean by routine daily care. Cleaning includes all glass and working surfaces are cleaned and polished.

10 Sustain Obvious system of 5S is in place. Everyone in the work area knows what the 5S’s are.

Total Score: = %

Additional comments:


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Office 5S Audit Sheet

Performed by: Area: Date:

# Description Scoring Criteria

Rating Scale 1-5 (poor = 1, excellent = 5 Score

Notes for next level of improvement.

1 Sort

Office/desks are well organized with no unnecessary items. Personal items are stored in one drawer or defined area.

2 Sort All binders, files, etc. are clearly and properly labeled.

3 Set in Order Binders, files etc. are stored in a defined location and easily returned to that location using visual methods.

4 Set in Order Items, equipment and work in progress are stored on the desk in a neat and orderly manner.

5 Shine Office cleaning equipment and materials are labeled and easily available.

6 Shine Floors and furniture are kept free of dust, debris and unused items.

7 Standardize

Documents are labeled, clearly as to contents and responsibility for control and revision. Nothing is unlabeled.

8 Standardize Bulletin boards are arranged in a neat and orderly manner. Nothing is torn or outdated.

9 Sustain

All office furniture and equipment are kept clean by routine daily care. Cleaning includes all glass and working surfaces are polished.

10 Sustain Obvious system of 5S is in place. Everyone in the office area knows what the 5S’s are.

Total Score: = %

Additional comments:

Level 2- Lean Practitioner in Healthcare Course Workbook...

Documents

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