Lean Healthcare Gemba Walks
Gemba – The place where work is being done
Lean Healthcare Gemba Videos
Earll Murman, MIT
Lean Healthcare- Uma transformação na saúdeUNICAMP, São Paulo, Brazil
October 14, 2013
UNICAMP 2013 Murman - Slide 2© 2013 Massachusetts Institute of Technolgy
Lean Learning Levels: John Shook
Shook, J., 2011, “Lean Education”, 5th Lean Educator Conference, Huntsville AL, Sept 31, 2011
UNICAMP 2013 Murman - Slide 3© 2013 Massachusetts Institute of Technolgy
Introduction
• Challenge of bringing students to the Gemba• Gemba video project
• Collaboration of Indiana University School of Medicine, MIT and Jefferson Healthcare
• Five 5-9 minute videos produced with accompanying 30-45 min instructional modules
• Videos are teaching supplements, not tutorials• Presentation Plan
• Overview of module contents• Introduce two modules: DMS and A3 Thinking• Seek “testers” for all five modules
UNICAMP 2013 Murman - Slide 4© 2013 Massachusetts Institute of Technolgy
Instructional Modules Have Common Architectures
Several DidaticSlides
2 Context Slides
Gemba Video
Class Discussion
Wrap Up, Reading List, Acknowledgements
Pre/Post Assessment
Learning Objectives
UNICAMP 2013 Murman - Slide 5© 2013 Massachusetts Institute of Technolgy
A3 ThinkingModule: 30 minutesVideo: 4 min 55 sec
5 or 6SModule: 45 minutes
Includes 15 min exerciseVideo: 5 min 13 sec
Rapid Process Improvement WorkshopModule: 35 minutesVideo: 8 min 45 sec
Standardizing WorkModule: 30 minutesVideo: 6 min 44 sec
Daily Management SystemModule: 30 minutesVideo: 6 min 8 sec
Glossary
Speaker Notes
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A3 ThinkingModule: 30 minutesVideo: 4 min 55 sec
Daily Management SystemModule: 30 minutesVideo: 6 min 8 sec
Agenda for Talk
• Not all the module content will be covered• Videos will be shown
Lean Healthcare Gemba Walks
Gemba – The place where work is being done
Daily Management System (DMS)
UNICAMP 2013 Murman - Slide 8© 2013 Massachusetts Institute of Technolgy
Virginia Mason Medical Center World-Class Management
Management by Policy (Hoshin Kanri)Alignment of entire organization to achieve strategic objectives
Cross-Functional ManagementAlignment of separate departments to improve patient care
Daily Management SystemAlignment within each unit to improve coordination, patient care, and achievement of organizational objectives
Adapted from Graban, Lean Hospitals
Patient Care Team
Photo by Earll Murman
UNICAMP 2013 Murman - Slide 9© 2013 Massachusetts Institute of Technolgy
Daily Management System
• At Jefferson Healthcare, DMS focuses on a 5 minute daily meeting in each organizational unit to:• Review previous day’s performance• Transmit any new enterprise directives• Review current day’s plans• Review employee suggestions• Note any special achievements or issues
• Organized and run by unit administrative lead
Photos by Earll Murman
UNICAMP 2013 Murman - Slide 10© 2013 Massachusetts Institute of Technolgy
DMS Tracks Enterprise Relevant Metrics
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Clinic ProvidersYe
ster
day
Clinic Totals
Start of day
End of day
Same day
Double bookNo showOverflow
TodayTomorrowHuddle attendance
Did provider leave on time?
Actual vs Goal
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DMS Gemba Video
UNICAMP 2013 Murman - Slide 13© 2013 Massachusetts Institute of Technolgy
DMS – Summing Up
Daily Management Systems include:• Daily stand-up huddles• Frequent process audits• Tracking of metrics linked to enterprise goals• Employee suggestions for improvements• Recognition of accomplishments
“This approach has been implemented in many hospitals as they begin their journeys, or it has been adopted after struggling with the aftermath of a tools-driven approach to Lean” Mark Graban, Lean Hospitals
Lean Healthcare Gemba Walks
Gemba – The place where work is being done
A3 Thinking
UNICAMP 2013 Murman - Slide 15© 2013 Massachusetts Institute of Technolgy
Structured Improvement
Lean is not a set of tools. It is a continuous improvement mindset using multiple PDSA cycles
PlanSet objectivesCurrent stateDevelop plan
DoExecute planGather dataDocument
StudyAnalyze data
SummarizeReflect
ActNext PDSA?
Standardize? Make changes?
Time
Impr
ovem
ent
Source: LAI Lean Academy® v7.6© 2013 Massachusetts Institute of Technology
UNICAMP 2013 Murman - Slide 16© 2013 Massachusetts Institute of Technolgy
A3 Enables PDSA
A3 is..• Both a way of thinking and a tool• A management process evolved at Toyota• Named for the A3 sheet of paper
(similar to 11” x 17” US Ledger paper)
&
Source: LAI Lean Academy® v7.6© 2013 Massachusetts Institute of Technology
UNICAMP 2013 Murman - Slide 17© 2013 Massachusetts Institute of Technolgy
Title: What you are talking about.
Background
Current Situation
Goal
Analysis
Plan
Follow - up
Why you are talking about it. What is the business context?
Where do we stand?
Where we need to be?
Where we want to be?
What is the specific change you want to accomplish now?
-What is the root cause(s) of the problem?
-What requirements, constraints and alternatives need to be considered?
Recommendations
What is your proposed countermeasure(s)?
What activities will be required for implementation and who will be responsible for what and when?
How we will know if the actions have the impact needed? What remaining issues can be anticipated?
Toyota A3 SheetA PDS
Source: LAI Lean Academy® v7.6© 2013 Massachusetts Institute of Technology
UNICAMP 2013 Murman - Slide 18© 2013 Massachusetts Institute of Technolgy
Jefferson Healthcare Example
Source: LAI Lean Academy® v7.6© 2013 Massachusetts Institute of Technology
UNICAMP 2013 Murman - Slide 19© 2013 Massachusetts Institute of Technolgy
A3 Gemba Video
UNICAMP 2013 Murman - Slide 20© 2013 Massachusetts Institute of Technolgy
A3 Thinking – Summing Up
The thought process used is paramount to the tool (A3 Report)
It is a collaborative problem-solving method
It promotes:• Logical, objective (data-driven) thinking• Results and process• Synthesis, distillation, and visualization• Alignment• Coherence within and consistency across• Systems perspective
References: Sobek, Durward K., Smalley, Art., (2008). Understanding A3 Thinking: A Critical Component of Toyota’s PDCA Management System. Boca Raton: Productivity Press, Taylor & Francis Group
Source: LAI Lean Academy® v7.6© 2013 Massachusetts Institute of Technology
UNICAMP 2013 Murman - Slide 21© 2013 Massachusetts Institute of Technolgy
Wrap Up
• Materials are “open source” under the Creative Commons License• Limited to non-commercial educational uses• No fee• May be used for derivative works
• Testers are being sought to establish educational effectiveness of modules
• Once tested, modules will be submitted to open source, peer reviewed MedEd portal of the American Association of Medical Colleges
UNICAMP 2013 Murman - Slide 22© 2013 Massachusetts Institute of Technolgy
If You Are Interested in Being a Tester…
• Contact Prof. Murman [email protected]• Instructions will be provided for downloading
the modules and videos• You can test the module or video with a class,
and internal training session or another audience
• You will be asked to fill out an online feedback form for each module or video tested for each audience
• If you give permission, you will be acknowledged as a module tester
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