My project was to help develop a Lean Quick Reference Guide. The main goal was to organize the tools and resources of lean methodology into a logically flowing format so that the lean certification participants (LCPs) and the rest of the network’s employees may better solve problems through the knowledge and practice of lean techniques.
In addition, I edited the lean certification link on SharePoint and created a survey for the LCPs as a way to gauge interest in the creation of the guide and to help access the course. The survey revealed that a Quick Reference Guide would be useful for at least 85% of the LCP respondents. It also gave a lot of important detail and feedback for use by the lean department in their continuous improvement education efforts.
Lean is a philosophy, or a way of thinking, for how a company can efficiently and effectively have better outcomes through standardization and simplified processes. It is largely derived from the Toyota Production System. Toyota developed a hyper efficient way to manufacture cars, where waste was significantly reduced along the supply chain and focus was put on activities that exceeded expectations of customer value.
Lean tactics are now applied to many types of businesses around the world and with a more difficult economy and the passing of the Affordable Care Act, it has become crucial for healthcare to adopt lean. By helping companies to eliminate waste across the board, lean improves quality, reduces costs, increases patient satisfaction and allows for operational excellence. It is imperative that all members of an organization participate in lean methodology in order to sustain results. Employees that are aware of these processes realize that it improves their workplace through increased cooperation, communication, focus, knowledge and improves the overall work environment.
The leader in lean implementation in the healthcare industry is Virginia Mason Hospital, located in Seattle, Washington. The hospital’s continuous improvement techniques using lean are now referred to as the Virginia Mason Production System – “the leading methodology for innovations in healthcare” (www.virginiamasoninstitute.org). Virginia Mason has “been applying lean principles to increase patient safety and quality of care, while reducing costs.” (www.virginiamasoninstitute.org). The LVHN’s mission along with its lean department is to get to a level similar to that of Virginia Mason’s over the next few years.
Virginia Mason started looking into the Toyota Production System when they realized that waste was too common in the hospital. It didn’t make sense to give patients any other experience than what they expected – on-time, efficient and effective care that increased patient satisfaction on multiple levels. So, Virginia Mason developed the Virginia Mason Institute that focuses solely on its own version of the Production System and has not only helped improve its own hospital, but many others across the country.
The purpose of the Lean Quick Reference Guide is to provide a thorough, all encompassing guide of lean tools and resources as were learned in the lean certification class to the gamut of employees in an easy to read and portable format so that they may utilize it quickly and at any time. It was initially intended to benefit the participants of the class and it will be distributed to the rest of the network at some future date through different mediums. The hope for the completed guide is that employees will understand lean methodology and use it for process improvement in the network.
In creating standardization in the lean department in terms of the documentation, I revised the SharePoint format. The SharePoint site contains all of the class materials for the lean certification class along with handouts, articles, and important templates used for the class and during any lean management work. It is imperative that the LCPs can easily access these tools, therefore, editing the SharePoint site further adds to the goals of the lean department and its mission. The goal was to organize the tools needed for LCPs so that they may be better, more effective employees as well as organize it for the lean coaches.
The survey we developed will hopefully give the lean department feedback as to how the LCPs felt before and after the class and will give insight into what specifically should be included in the classes’ curriculum or further clarified in the Lean Quick Reference Guide. This will provide some insight into what should be taught in the classes, where more emphasis should be placed, what tools are most important to teach and the results may also affect the layout of the Lean Quick Reference Guide, SharePoint, and lean Intranet website when everything is finalized.
Lean aligns with the goal of continuous improvement. My project relates to all three aspects of LVHN’s Triple Aim. Lean most aligns to Better Cost because the root of lean is to identify and remove wastes. Wastes can be from waiting, too much inventory, inefficient or slow transportation, incorrect work or defects, overproduction, issues during processing or unused human potential. Waste is very prevalent in areas that haven’t implemented lean techniques and can significantly harm the bottom line.
Lean also aligns with Better Care and Better Health because many of the lean techniques will be applied to standardizing and removing waste from primary patient care areas. For example, LVHN has saved a few hundred dollars per surgery through time and energy by standardizing surgical tray setups, which gave both the nurses and doctors more time to spend with the patient; this eliminated waste and improved patient satisfaction. Additionally, switching just one type of pill from brand name to generic throughout the hospital and changing medical supplies has saved millions of dollars for the network. Situations like this in turn encourage Better Care and Better Health.
A survey was created to gain feedback from the lean certification Participants and to gauge interest and need for creating the Lean Quick Reference Guide. It targeted the entire population of LCPs across the entire duration of the program (which was started in January 2013 and had its most recent session this past month). The survey was created using www.qualtrics.com, a common survey site used throughout the network, and was sent out in an email asking participants to respond as soon as possible. The survey included the questions on specific tools taught and used during the class and if/how they were used by the participants, in addition to the standard questions used by the Department of Education.
The Lean Quick Reference Guide information drew from the lean Intranet website, the “lean 101: Identifying Waste” and “lean 101: Removing Waste” TLC modules, documents and PowerPoints from the SharePoint “lean Certification” site as well as from lean department employees’ stand alone documents. I used these sources as a way to educate myself on what lean is and how to apply it to healthcare, and they make up much of my knowledge on lean. The layout of the guide mimics the format of the A3, a single-page document used as the preferred problem-solving tool in the LVHN. The guide follows this format by using the same headers as well as including explanations of all the documents and tools used under each heading. The guide will also help to standardize the SharePoint site, lean Intranet website and lean certification class layout, and vice versa. The goal is to have the guide, SharePoint, Intranet website and class identically laid out.
By editing the SharePoint website, the lean department may now have a better layout to model their website after so that it is easier for them and the LCPs to distribute and access the information, respectively. The SharePoint was edited using knowledge of the class structure after I sat in on lean certification Class #3 and from general learning experiences while working in the lean department.
The survey yielded 65 responses out of about 100 surveyed. There were four key question responses (out of 20 total questions) that I felt provided the most insight for the lean Department.
1) “The activity has improved....”
All five metrics improved almost equally, however, the one that we would want to see improve the most would be “Quality, patient safety or patient health”. The lean certification class may need to emphasize competencies that better align to department and network Triple Aim goals.
Attitudes towards the topic
Job performance and productivity
Quality, patient safety, or patient health
Lean Certification has improved...
2) “Please indicate any barriers you perceive in implementing these changes.” (“These changes” refers to the goals of the LCPs’ projects and application of lean principles in their departments.)
The greatest barrier was for lack of administrative, physician and colleague support. This is crucial because if the entire staff of a department is not on board with making changes using lean, the changes cannot be implemented or carried out and sustained over time. My recommendation for this is to offer large lectures in addition to the lean certification classes so that a large number of people in a short amount of time can become aware of lean practices and understand why it is so important that they engage and support those in the network that are trying to implement it. Additionally, it should be discussed what they can do to support lean and how they can change their behaviors and preconceived notions so that there are fewer barriers for LCPs and others.
A lack of resources, the issues of cost and a lack of time all were significant factors blocking LCPs from implementing lean. Hopefully, once the main issue of a “lack of support” is rectified, these other issues will clear up since they stem from administrative orders.
3) “Which concepts or tools were most difficult to learn?” and “Which tools did you use for your project?”
By surveying the participants to find out which tools they found to be the most difficult to learn and which tools they used in their projects, the lean Coaches will be better able to know which skills they should emphasize in the class and which ones people need to spend more time on. Interestingly, the tools that were implemented were ones that people found easiest to do, aside from the A3, which is a necessary component of any lean project. Since LCPs found the A3 difficult – and it is necessary to use –it can be further discussed in the Lean Quick Reference.
4) Compiled slide of important comments from the open-ended sections of the survey.
From these comments, it appears that LVHN employees want lean to be taught and implemented at every level, from front-line employees to top management. Without a strong basis and support from all sides, the LVHN cannot meet its goals to become lean and people will constantly struggle with barriers. For the lean certification class itself, the lean Coaches can now look into the curriculum and standardize their teaching style and which tools they emphasize as well as perhaps create a lecture series or information session for large numbers of employees so that the lean philosophy is embraced by the entire network.
Eighty-five percent of respondents said that they would like to have a Lean Quick Reference Guide and that they would find it useful, especially the LCPs that complete a project. This metric substantiates the need for the project I have been working on for the duration of the internship.
The Lean Quick Reference Guide is in its beginning stages. It is being created in PowerPoint and so far I have completed 85 slides, which includes background Lauren Ranzino Research Scholars Manuscript information of lean philosophy, multiple tools that were taught throughout the lean certification class, examples of templates that may be used to help implement lean, etc.
The lean department staff will continue to tweak and add slides to the guide over the next few months once they finalize the class curriculum and make any other changes that would affect the contents of the guide. Below, I have selected a sampling of slides from the guide that I find to be of great importance for the LCPs and the rest of the network.
The lean department desires to organize and distribute relevant, helpful information for its LCPs so that the LVHN can have a strong base of people throughout the network who understand the importance and basics of lean management in order to further its goal of becoming a more lean organization. Without a solid foundation of people that have knowledge of lean and are invested in implementing it in their departments, the network cannot achieve its goals. The goal is to disseminate lean philosophy in an easily understood format for the lean certification Participants so that they may utilize the tools during application in their respective departments.
The survey impacted the lean department by providing insight into the lean certification program. This insight will hopefully change the way that the class is taught and on which parts of the curriculum will be emphasized (on theory, hands on activities, or tools, etc.) This will also slightly affect the layout of the Lean Quick Reference Guide, the SharePoint, and Intranet website. My Lean Quick Reference Guide (and the other components of my project) will help forward the goals of the lean department – to cut waste across the board, increase and maintain process improvements, increase employee’s productivity, improve the quality of patient care, reduce wasted time for all employees and patients, etc. In terms of hospital operation, the lean department is of great importance to the running of the LVHN.
Removing waste, standardizing work and engaging all employees in a lean mindset will save a lot of money for the network over time and allow for the network to continue to grow and prosper. My Quick Reference Guide incorporates all of this because it is simply a guide on lean philosophy and how to apply it, but in a tailored version to fit LVHN and healthcare.
I hope that the guide will be of use to everyone and that once it is completed, it will be an all-encompassing guide that can be confidently distributed to the participants and the rest of the network so that they may utilize it quickly and at any time making it easier for everyone. It will be a fantastic source of information that will improve LVHN.
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Published In/Presented At
Ranzino, L., (2014, July, 25) Disseminating Lean Philosophy to the Lehigh Valley Health Network. Poster presented at LVHN Research Scholar Program Poster Session, Lehigh Valley Health Network, Allentown, PA.
Research Scholars, Research Scholars - Posters