Introduction to Lean and PDSA Thinking
- 1. Introduction to Lean and PDSA Thinking
- 2. What is Lean Its about principles, thinking and practices Toyota Toyota Production System Lean management or Lean production Focused on improving the performance of the business by Maximizing value as defined by the customer Reducing waste in work Collapsing time Decreasing spending Increasing market share Creating new products or service lines
- 3. Benefits of Lean Thinking Stability within our work Vitality of our organization Respecting people Creating meaningful work Creating ownership of your work
- 4. How ThedaCare uses Lean TIS 9 Methods to See and Remove Waste in a Process within a Value Stream Adjust Adjust Adjust Adjust Adjust Sequence and Continuity 50,000 ft GROUND LEVEL INCREASING DETAIL STANDARD WORK Adjust 5S SIPOC TAKT TIME FLOW DIAGRAM COMMUNICATION CIRCLE SPAGHETTI DIAGRAM TIME OBSERVATION BAR CHART STANDARD WORK COMBINATION 5SVisual Management Adjust Adjust Continuous Daily Improvement Value Stream Analysis
- 5. What is the scientific method Penicillin Vaccinations Gravity Electricity Genetics
- 6. What is PDSA Lean’s version of the scientific method A document or artifact that represents your thinking, data collection and problem you are solving Its your story Used to gain a shared understanding of an issue to be able to problem solve and get results
- 7. Header • Title should be reflective of problem at hand • Owner – Party x (person who is responsible for the problem / process and accountable to solve the problem) • Coach – is the supervisor of the owner (sets challenge, insures problem is resolved, and responsible for owners development) • Start date – date of initial draft • Revision date and number
- 8. Background Definition: • Helps us understand the extent and importance of the problem, how did we get here today • Why this, why now? Questions: • What is business context? (True north, challenge) • How did you decide to work on this problem? • What is the compelling story or reason for action? Tips: We should not be answering why Brief, one or two bullets
- 9. Current Condition Definition: • What is happening today • Diverge and Converge • Find the patterns Questions: • What should be happening, what is actually happening? What is the gap? • What do you actually know and how do you know it? • Have you engaged other people? • Can you quantify the
- 10. Current Condition Questions, continued… • 4 W’s and 2H’s – Divergent questions What? (is flowing, happening, is the problem…) Where? (in the flow, in the facility, in the region…) When? (is it occurring – all the time, end of shift, middle of day, once a year, seasonal, peaks…) Who? (what role, area, process…) How? (Methods…) How many/often? Consequence? (impact) How will you break down the problem? Tips: We should not be answering why Should be visual (Maps, paretos) Have you gone to see?
- 11. Problem Statement Definition: • Clearly and succinctly defines the actual issue that is being felt • Quantifiable gap Questions: • What is the quantifiable problem? Tips: Just the facts Solve just one problem Watch for solution in problem statement (words like due to, no, isn’t etc)
- 12. Example Problem Statements Daily in the TC ICU, at least 2 RN’s/day out of 23 potential staff are assigned as a resource RN due to the lack of a clinical lead structure which creates a lack of consistent process owners, lack of formal frontline leadership role and variability in staffing decisions and problem solving, thus impacting financial metrics, and people engagement per our true north metrics. Within the TC ICU, when ICU patients meet UWOPO clinical triggers staff is calling statline within one hour 62% of the time from January- Sept 2011, which has resulted in actually missing 1 donation opportunity in 24 months, potentially delaying UWOPO analysis for appropriate candidates, affecting Theda Clark medal of honor recognition, and increased family dissatisfaction with donation process.
- 13. Goals and Targets Definition: • Know that the work has been successful • Goal is a condition of where we want something to be, targets tell us how we are progressing Questions: • Am I using words like reduce, increase, eliminate, decrease, NOT using words like implement, create or establish? • Have you validated your targets with your sponsor? Tips: Make the team uncomfortable with the goals and targets (should be challenging) Should touch all elements of the triangle (do not
- 14. Analysis / Root Cause Definition: • Identify the most significant causes of the problem stated. • Identify the true underlying source(s) of the problem. Questions: • Is there a standard? Is it known and practiced? • Is the process performing at the designed quality level? Cost level? Delivery level? • How do you know you are at a root cause?
- 15. Analysis / Root Cause Tips: Use Fishbone and 5-why’s to root cause if: There is a standard that isn’t being practiced There is a standard and the quality is poor The problem you are solving is at the step level Use 9 Methods to see waste if: There is no standard The problem you are solving involves collapsing time and space at a process level Use Value Stream Analysis if: The problem you are solving involves collapsing time and space at a value stream level Verify the root cause/waste by going to see.
- 16. Countermeasures Definition: Untested actions to remove waste or address root causes (hypothesis) Questions: Do your countermeasures address the root cause(s)? Is there more than one suggested countermeasure for each root cause? Have you created a detailed plan for experimentation? Can you show how your proposed countermeasures will address the waste / root cause? Has your sponsor approved the “Plan” portion of the PDSA
- 17. Countermeasures Tips: Countermeasures should be reductive (do not add complexity) Creativity over capital Bias for action Countermeasures should be within your team’s scope of control/influence Plan should include how to deal with change management
- 18. Experiments Definition: Verify the effectiveness of the planned countermeasures (hypothesis) prior to implementation. Applying the scientific method to allow the effect of the implementation to be simulated. Questions: What is the first thing you need to learn? What is the smallest thing you can do to test this hypothesis? Has the experiment allowed you to reach your goal? How will you track the experimentation process?
- 19. Experiments Tips: Always state what you believe will happen Have a plan Respect the needs of the people performing the work Practice change management When experimentation delivers on the expected results, implement the proven countermeasures.
- 20. Study Definition: Measurement of the performance over time to verify that the targets have been achieved. Reflect on the success / failure of the PDSA process and implemented countermeasures. Questions: Are we able to see if the performance changed upon implementation? Are the countermeasures sustainable, repeatable and measureable? How will you continue to support the people doing the work? How long will I study the countermeasures?
- 21. Study Tips: Make performance over time visual Use Pareto’s to track abnormalities in the new process. Go and see Train to the new standard
- 22. Act / Adjust Definition: Actions required to close the gaps identified in the study phase. Celebration of the success of the improvement effort Questions: Are there other areas that can benefit from this work? What is your next challenge? Will you raise the bar or focus on another problem of consequence? Is the PDSA ready for closure (have we achieved the target performance)? Has the new practice been standardized? Tips: Establish a target completion date Document your reflections
- 23. Do Study Adjust Plan The Real PDSA Wheel… Do Study Adjust Plan
- 24. Additional Resources Lean Production Simplified by Pascal Dennis Managing to Learn by John Shook Article: Origins of Lean Management in America Article Link TIS website Lean.org
Editor's Notes
- #3: Toyota has been instrumental in the creation and improvement of lean thinking and processes Shook Scales Must balance people with process around a common purpose
- #4: The TPS house represents lean practice and thinking. In order to improve there must be stability and then additional pillars and support are added.
- #5: Thedacare uses these tools and methods combined with Lean thinking or theory of lean to solve problems thru Continuous daily improvement Value Stream Analysis Improvement Activities
- #16: There is no one right way to do analysis
- #24: 50% or more of your time should be understanding the problem! Einstein stated if he had one hour to solve a problem he would spend 55 minutes thinking about the problem and 5 minutes coming up with solutions