A3 Training DGSOM BEI HR Sphere

1. A3 TrainingDGSOM BEIHR Sphere

2. Agenda Duration 10 min 5 min 45 min Total: 60 min Topic • Intro to Lean • Project Charter • Plan • Clarify the Problem • Analyze the Current State • Develop Goals • Analyze Root Causes

3. Learning Objectives • At the end of the session you should be able to: • Broad understanding of key principles and tools • Be able to use the DOWNTIME model to identify waste • Develop a project charter with your team • Explain why PDCA is an effective method for problem solving • Understand the components of PDCA • Document your PDCA process on an A3

4. “The Tools Are Available” Taking a Different Approach… “I’ve got too much work to do to stop and listen to you”

5. Lean Definition What is Lean? • A management systemand culture designed as a way we work by adding value for our patients and eliminating waste, where every employee is empowered to continuously improve their processes Lean is Not: • The flavor of the month • Concepts that apply only to manufacturing • A collection of tools and methods • Discuss what is lean

6. History of Lean Early 1900’s Frank & Lillian Gilbreth (Time & Motion Study/ Process Mapping) 1950’s Taiichi Ohno (Toyota Production System) 2009 UCLA Operating System Late 1800’s Frederick Taylor (standard Work) 1930’s Kiichiro Toyoda (Just in Time) 1950’s W. Edwards Deming (PDCA) Late 1800’s Early 1900’s 1930’s 1950’s 2009 1950’s Shigeo Shingo (SMED, ZQC) 2009 Mark Graban Shingo Research Award Lean Hospitals 1950’s Joseph Juran (TQM) Early 1900’s Henry Ford (Flow Production)

7. UCLA Health Operating System Mission- Delivering leading edge patient care, education and research Vision-Healing humankind one patient at a time, by improving health, alleviating suffering, and delivering acts of kindness Values-Compassion, Respect, Excellence, Discovery, Integrity, Teamwork

8. Lean Benefits How Will Lean Help Me? • Solving problems and recognizing lasting results • Establishes an environment that has controlled process, repeatable outcomes and delighted staff/patients What are the Benefits of Lean? • Higher quality,safety & efficiency • Giving patients what they want when they want it • Increased staff satisfaction • More time with patients and business growth • What are some more examples? In your area?

9. How we teach lean at UCLA Health Effective Solutions Standard Work SIPOC Pareto Process Mapping Fishbone Time Obs. Active Daily Management Daily Huddles Operational Planning Change Mgmt Spaghetti Diagram 5 Why PDCA / A3 Methodology

10. Seeing With New Eyes

11. Seeing with new eyes requires an understanding that activities either add value or waste… Why? • Activities that are Wasteful (any can be true) • The patient is not willing to pay for • That do not move the care process forward • That are not done right the first time • Waiting in general • Waiting for orders to be written • Late/missing callback for tests • Clinical or operational errors • Unnecessary documentation • Unnecessary approvals WASTE This allows you to focus your resources (to eliminate waste, increase value, or support value) VALUE • Comforting a patient • Examining a patient • Diagnosing a patient • Treating a patient • Educating a patient • Activities that add Value (all must be true) • The patient is willing to pay for • That moves the care process forward • That are done right the first time

12. Value-Added & Non-Value Added Example Value-added Actions 1 3 Pt receives AVS and schedules f/u appt if necessary 8 Pt checks in, pays co-pay MA takes vitals and rooms pt MD completes consult 5 Pt waits in waiting area Pt waits for MD in room Pt waits nurse/MA to come and complete visit 7 Pt waits to checkout 6 2 4 Non-Value-added Actions

13. Waste models can help you identify/find waste For “non-value added” activities, next you find/identify waste; this is made easier by using a model such as DOWNTIME* • D efects • O verproduction • W aiting • N ot utilizing Talent • T ransport • I nventory • M otion • E xtra Processing Mistakes, errors, resulting rework - Producing too much, too soon, or excessive setup - Actual downtime (patient, service, or production) - Poor use of skills and talents, knowledge loss - Moving things around - Too much inventory, or too little - People moving around, searching, etc. - Duplication, unnecessary: refinements, approvals - • *Different systems classify wastes into different amounts of categories. Most use 7 (same as above but without N) or 8 but some use up to 11! • ** There are different types of waste – Type 1 and Type 2. Type 1 adds no value and can be removed easily. Type 2 adds no value but is necessary in the current system and/or is very difficult to remove. This distinction will become more important when focusing on solutions

14. Eight Wastes in Ambulatory Processes… Defects Overproduction Not Utilizing Talent Waiting • Numerous ideas are “lost” only to be rediscovered later • MD/Nurse time spent on clerical tasks • Pt waits in exam room for MD • Incomplete Specialty referrals • Full sheet of labels printed when only one is needed Motion Inventory Extra-Processing Transport • MA/Nurse spends time looking in multiple places for a particular supply • Expired supplies because of excess ordering • Patients asked the same questions multiple times • Patients are taken from waiting room -> vitals intake -> waiting room -> exam room

15. Waste Waste

16. A3s and A4s are used to communicate progress

17. We will be working with A3s today

18. Project Charter

20. PDCA – Continuous Improvement • A structured guide and method for problem solving • The way by which we should be practicing continuous improvement in our daily work Plan Do Check Act Step 5 Implement Solutions Step 4 Analyze Root Cause Step 3 Develop Goals Step 6 Evaluate Results Step 1 Clarify the Problem Step 7 Adjust, Standardize & Sustain Step 2 Analyze Current State