Prof Pract iRA #2: The Promise of Lean in Health Care

Lean is primarily about "____________," that is, performing many small tasks better and creating value through the cumulative effect of small improve- ments.

"MAJORING IN MINORS" Lean is primarily about "MAJORING IN MINORS," that is, performing many small tasks better and creating value through the cumulative effect of small improve- ments.

Lean is an operating system composed of _______ principles that constitute the essential dynamic of Lean _______.

6 MANAGEMENT Lean is an operating system composed of 6 principles that constitute the essential dynamic of Lean management.

Value stream mapping requires _________; each discrete step in a process should be captured on the map.

ATTENTION TO DETAIL Value stream mapping requires ATTENTION TO DETAIL; each discrete step in a process should be captured on the map.

The goal of this article is to provide a _______ for health care leaders to use in considering the implementation of the __________ OR in assessing the current state of implementation in their organizations

TEMPLATE Lean MANAGEMENT SYSTEM The goal of this article is to provide a TEMPLATE for health care leaders to use in considering the implementation of the Lean MANAGEMENT SYSTEM OR in assessing the current state of implementation in their organizations

T/F: the underlying goal of Lean in healthcare is to improve value for patients. Doing so (i.e.; improving the value for patients) should ALSO benefit OTHER STAKEHOLDERS (e.g.: fewer medication errors, faster operating room turnover time)

TRUE the underlying goal of Lean in healthcare is to improve value for patients. Doing so (i.e.; improving the value for patients) should ALSO benefit OTHER STAKEHOLDERS (e.g.: fewer medication errors, faster operating room turnover time)

T/F: Making NEW STANDARDS can begin with flexible regimentation

TRUE Making NEW STANDARDS can begin with flexible regimentation

T/F: there is an urgent need to improve quality and efficiency of American health care while controlling costs

TRUE An urgent need in American health care is improving quality and efficiency while controlling costs

T/F: at Lean tracking centers the information is dynamic and directly relates to what staff are thinking about in terms of how best to provide what patients need and want.

True at Lean tracking centers the information is dynamic and directly relates to what staff are thinking about in terms of how best to provide what patients need and want.

_______ in health care has been conceptualized as health outcomes per dollar spent AND outcomes per dollar spent OVERTIME

VALUE VALUE in health care has been conceptualized as health outcomes per dollar spent AND outcomes per dollar spent OVERTIME

__________ are a principal Lean tool used to distinguish between discrete steps in a process that do or do not contribute value. A team close to the work creates a visual map of each step in an existing process to better understand it (ie, the current state).

VALUE STREAM MAPS VALUE STREAM MAPS are a principal Lean tool used to distinguish between discrete steps in a process that do or do not contribute value. A team close to the work creates a visual map of each step in an existing process to better understand it (ie, the current state).

_________ exist in numerous locations within a Lean hospital or clinic. These ~things~ are information displays mounted on the walls in staff-only areas.

Visual tracking centers Visual tracking centers exist in numerous loca- tions within a Lean hospital or clinic. These tracking centers are information displays mounted on the walls in staff-only areas.

Visual tracking center information is ________, and thus it is common practice to use erasable marking pens, pencils, or sticky notes to present it.

ever-changing Visual tracking center information is ever- changing, and thus it is common practice to use erasable marking pens, pencils, or sticky notes to present it.

Standard work is best described as ________, a phrase coined by Robert Wil- son, MD, a ThedaCare cardiologist.

flexible regimentation Standard work is best described as flexible regimentation, a phrase coined by Robert Wil- son, MD, a ThedaCare cardiologist.

VALUE in health care has been conceptualized as: _________

health outcomes per dollar spent VALUE in health care has been conceptualized as health outcomes per dollar spent AND outcomes per dollar spent OVERTIME

Leading a Lean transformation from the top of the organization demands ________ (because setbacks are inevitable as are pockets of resistance) and ______ (because Lean exposes many problems, some of which are caused by the senior leaders themselves).

perseverance humility Leading a Lean transformation from the top of the organization demands PERSEVERANCE (because setbacks are inevitable as are pockets of resistance) and HUMILITY (because Lean exposes many problems, some of which are caused by the senior leaders themselves).

Lean requires new HABITS, new SKILLS, and often a new ATTITUDE throughout the organization from _____ to _______

senior management TO front-line service providers Lean requires new HABITS, new SKILLS, and often a new ATTITUDE throughout the organization from senior management to front-line service providers

Per Lean Principle #3 (Unity of Purpose): Specific improvement projects (the "_______") move the organization forward in its prioritized goal categories (the "_______"). Management uses a process called "________."

specific improvement projects = the HOW prioritized goal categories = the WHAT CATCHBALL Per Lean Principle #3 (Unity of Purpose): Specific improvement projects (the "HOW") move the organization forward in its prioritized goal categories (the "WHAT"). Management uses a process called "CATCHBALL."

A common sight in a Lean health care facility is staff meeting in front of a _______ with the meeting leader continually refer- ring to the posted information. This practice is referred to as "________"

tracking center working the wall A common sight in a Lean health care facility is staff meeting in front of a tracking center with the meeting leader continually refer- ring to the posted information. This practice is referred to as "working the wall."

What is helpful in cultivating Lean principle #1 (attitude of continuous improvement)? Clinical and non-clinical staff members are given the ______, ______, and _____ to make meaningful improvements and how the work is done

ENCOURAGEMENT, TRAINING, TIME Clinical and non-clinical staff members are given the encouragement, training, and time to make meaningful improvements and how the work is done

T/F: All health care personnel at any institution encounter the same version of Lean

FALSE Healthcare personnel have encountered various versions of Lean (some institutions have 5 day workshops; some have "a whole system culture change")

T/F: Lean is a program; Lean is a set of quality improvement tools

FALSE Lean is NOT a program; Lean is NOT a set of quality improvement tools; Lean is NOT a quick fix Lean is NOT a responsibility that can be delegated

T/F: A Lean leadership and management system is a hierarchical system in which higher-level managers and supervisors tell lower-level personnel what to do and how to do it.

FALSE A Lean leadership and management system differs from a hierarchical system in which higher-level managers and supervisors tell lower-level personnel what to do and how to do it.

T/F: Lean is not a quick fix; However, it is a responsibility that can be delegated

FALSE Lean is NOT a quick fix Lean is NOT a responsibility that can be delegated

T/F: Patients view VALUE the SAME as health care views value (the health outcomes per dollar spent thing).

FALSE (typically) Patients, however, typically view value more broadly as benefits received for burdens endured (Reminder: VALUE in health care has been conceptualized as health outcomes per dollar spent AND outcomes per dollar spent OVERTIME )

Per Donald Berwick, MD: "the only way we can rescue American healthcare is to _______ it..... We know what to do--better care, better health, lower cost"

IMPROVE Per Donald Berwick, MD: "the only way we can rescue American healthcare is to IMPROVE it..... We know what to do--better care, better health, lower cost"

Creating a culture of Lean is to create an insatiable appetite for _______; there is no turning back

IMPROVEMENT Creating a culture of Lean is to create an insatiable appetite for improvement; there is no turning back

Lean = a quality ________ and a _________ originated by the Toyota Motor Company

IMPROVEMENT PHILOSOPHY SET OF PRINCIPLES Lean = a quality improvement philosophy and a set of principles originated by the Toyota Motor Company

The Deming Cycle is the foundation of _________, a central tenet of Lean.

PDSA (plan-do-study-act) The Deming Cycle is the foundation of PDSA, a central tenet of Lean.

What does PDSA stand for?

PDSA = Plan-Do-Study-Act (a central tenant of Lean) (the PDSA approach is a SCIENTIFIC METHOD APPLIED TO DAILY WORK)

Process outcomes are sometimes so variable that they first must be ______ before they can be ______.

STABILIZED before they cam be STANDARDIZED Process outcomes are sometimes so variable that they first must be stabilized before they can be standardized.

NAME THAT PROCESS (involved in Lean principle #3): Management uses a process called "_________." From chief executive officer to front-line supervisor, a series of conversations is constantly occurring. These conversations are documented on a single sheet of paper and changed each time different team members' ideas are gathered. On the single sheet (called an A3 simply to denote paper size), background and current conditions are documented for the strategy being studied. A strategy statement is developed and goals are established. The opportunities in the marketplace the strategy is attempting to address are identified and countermeasures are suggested. Finally, a plan is established. Through the ________ process, it is not unusual to have 15 drafts of the A3, indicating that many people have been involved in defining the new strategy. This communication back and forth in the organization builds consensus, understanding, and engagement around the priorities.

CATCHBALL Management uses a process called "CATCHBALL." From chief executive officer to front-line supervisor, a series of conversations is constantly occurring. These conversations are documented on a single sheet of paper and changed each time different team members' ideas are gathered. On the single sheet (called an A3 simply to denote paper size), background and current conditions are documented for the strategy being studied. A strategy statement is developed and goals are established. The opportunities in the marketplace the strategy is attempting to address are identified and countermeasures are suggested. Finally, a plan is established. Through the CATCHBALL process, it is not unusual to have 15 drafts of the A3, indicating that many people have been involved in defining the new strategy. This communication back and forth in the organization builds consensus, understanding, and engagement around the priorities.

Influenced by the work of Womack and Jones, we define LEAN in health care as "an organization's cultural _______ to applying the _______ to designing, performing, and continuously improving the ______ delivered by teams of people, leading to measurably better ______ for patients and other stakeholders."

COMMITMENT SCIENTIFIC METHOD WORK VALUE Influenced by the work of Womack and Jones, we define LEAN in health care as "an organization's cultural COMMITMENT to applying the SCIENTIFIC METHOD to designing, performing, and continuously improving the WORK delivered by teams of people, leading to measurably better VALUE for patients and other stakeholders."

A paradox of standard work is that the standards established release ________.

CREATIVITY A paradox of standard work is that the standards established release creativity.

Lean is a ______ transformation that changes how a(n) _____ works; no one stays on the sidelines in the quest to discover how to improve the daily work

CULTURAL ORGANIZATION Lean is a CULTURAL transformation that changes how a(n) ORGANIZATION works; no one stays on the sidelines in the quest to discover how to improve the daily work

Continuous improvement has its basis in a principle introduced by Shewhart and refined by quality improvement pioneer Edwards Deming. The _________ is the foundation of Plan-Do- Study-Act (PDSA), a central tenet of Lean.

DEMING CYCLE Continuous improvement has its basis in a principle introduced by Shewhart and refined by quality improvement pioneer Edwards Deming. The Deming Cycle is the foundation of Plan-Do- Study-Act (PDSA), a central tenet of Lean.

T/F: A key senior management role in Lean is to prioritize and clearly communicate a large number of strategic goal categories that are relevant throughout the organization and that have the most promise to strengthen the organization and create stakeholder value. ^^TO DO THIS, SENIOR MANAGEMENT CAN USE A PROCESS CALLED "CATCHBALL"

FALSE; SMALL # of strategic goals! A key senior management role in Lean is to prioritize and clearly communicate a SMALL number of strategic goal categories that are relevant throughout the organization and that have the most promise to strengthen the organization and create stakeholder value. ^^TO DO THIS, SENIOR MANAGEMENT CAN USE A PROCESS CALLED "CATCHBALL"

Per Lean Principle #4 (Respect for the People Who do the work), respect for the potential of _______ doing much of the innovating and managers trusting them to do it and supporting them is part of a Lean leadership and management system

FRONT-LINE WORKERS Per Lean Principle #4 (Respect for the People Who do the work), respect for the potential of FRONT-LINE WORKERS doing much of the innovating and managers trusting them to do it and supporting them is part of a Lean leadership and management system

What must senior management do in order for Lean to take hold in an organization and transform its culture to one of continuous improvement?

For Lean to take hold in an organization and transform its culture to one of continuous improvement, senior management must: relinquish the role of master problem solver to those who are closer to the problems to be solved -- [^^this will:] - to benefit from their knowledge of the focal process, - to give them hands-on experience in using Lean methods and - to see first-hand the performance improvement and teamwork this can create, and -to promote an attitude that what exists can likely be improved

Lean requires new_____, new _______, and often a new _______ throughout the organization from senior management to front-line service providers

HABITS, SKILLS, ATTITUDE Lean requires new HABITS, new SKILLS, and often a new ATTITUDE throughout the organization from senior management to front-line service providers

Per Lean Principle #4 (Respect for the People Who do the work), In Lean organizations, higher-level managers support the "___________" by regularly visiting the worksites (or "________" in Lean parlance) to learn firsthand about problems and barriers to improvement, by becoming teachers and role models of quality improvement, and by investing in the education, skills training, and tools necessary for front-line staff to be effective in improvement work.

IMPROVERS "Gemba" Per Lean Principle #4 (Respect for the People Who do the work), In Lean organizations, higher-level managers support the "IMPROVERS" by regularly visiting the worksites (or "GEMBA" in Lean parlance) to learn firsthand about problems and barriers to improvement, by becoming teachers and role models of quality improvement, and by investing in the education, skills training, and tools necessary for front-line staff to be effective in improvement work.

A value stream map differs from other mapping by combining _______ flow and ______ and ______ flow; this enables the team to more clearly see a complex system's current state and offers a roadmap for improvement.

INFORMATION FLOW MATERIAL AND PEOPLE FLOW A value stream map differs from other mapping by combining information flow and material and people flow; this enables the team to more clearly see a complex system's current state and offers a roadmap for improvement.

_______ is an operating system composed of 6 principles that constitute the essential dynamic of ____ management.

LEAN Lean is an operating system composed of 6 principles that constitute the essential dynamic of Lean management.

Influenced by the work of Womack and Jones, we define _______ in health care as "an organization's cultural commitment to applying the scientific method to designing, performing, and continuously improving the work delivered by teams of people, leading to measurably better value for patients and other stakeholders."

Lean Influenced by the work of Womack and Jones, we define LEAN in health care as "an organization's cultural commitment to applying the scientific method to designing, performing, and continuously improving the work delivered by teams of people, leading to measurably better value for patients and other stakeholders."

One promising MANAGEMENT APPROACH [to improve quality and efficiency of American health care while controlling costs] implemented by some leading health care institutions is ___________, a quality improvement philosophy and a set of principles originated by the Toyota Motor Company

Lean One promising MANAGEMENT APPROACH implemented by some leading health care institutions is LEAN, a quality improvement philosophy and a set of principles originated by the Toyota Motor Company

Per Lean Principle #3 (Unity of Purpose): _______ clarifies priorities and guides staff in improvement work accordingly. _______ work is focused work; priorities govern investment of improvement resources.

Lean Per Lean Principle #3 (Unity of Purpose): Lean clarifies priorities and guides staff in improvement work accordingly. Lean work is focused work; priorities govern investment of improvement resources.

_________ = a quality improvement philosophy and a set of principles originated by the Toyota Motor Company

Lean _________ = a quality improvement philosophy and a set of Lean originated by the Toyota Motor Company

The Health Care Scenario described below is an example of which Lean Principle? St. Jude Medical Center has defined its true north as "Perfect Care, Healthiest Communities, and Sacred Encounters." Perfect Care is trans- lated into specific initiatives and metrics for inpatient, outpatient, and support areas. The Perfect Care focus on the critical care floor is the elimination of ventilator-acquired pneu- monia. Before conducting a rapid improvement event, critical care staff believed they were doing everything possible to prevent ventilator- acquired pneumonia. The event showed otherwise, and staff implemented a visual management board outside each room of a patient receiving ventilatory assistance. On this board, red and green magnets are flipped every 2 hours as preventable measures are executed. This technique enables staff to quickly determine whether any preventable measure was missed. The care team meets regularly to review clinical evidence and discuss any misses in the prevent- able measures. The critical care unit has had zero preventable cases of ventilator-acquired pneumonia for more than 3 years at this writing, the result of unity of purpose around a true north metric.

Lean Principle #3: Unity of Purpose (specifically, an example of using the True North Framework) St. Jude Medical Center has defined its true north as "Perfect Care, Healthiest Communities, and Sacred Encounters." Perfect Care is trans- lated into specific initiatives and metrics for inpatient, outpatient, and support areas. The Perfect Care focus on the critical care floor is the elimination of ventilator-acquired pneu- monia. Before conducting a rapid improvement event, critical care staff believed they were doing everything possible to prevent ventilator- acquired pneumonia. The event showed otherwise, and staff implemented a visual management board outside each room of a patient receiving ventilatory assistance. On this board, red and green magnets are flipped every 2 hours as preventable measures are executed. This technique enables staff to quickly determine whether any preventable measure was missed. The care team meets regularly to review clinical evidence and discuss any misses in the prevent- able measures. The critical care unit has had zero preventable cases of ventilator-acquired pneumonia for more than 3 years at this writing, the result of unity of purpose around a true north metric.

The Health Care Scenario described below is an example of which Lean Principle? ThedaCare's true north framework (Figure 2) puts the patient in the middle of a triangle and the strategic goal categories at the tips of the triangle. Two metrics are used to measure progress for each goal category and one for the patient, which is a customer loyalty score. This specific framework appears on improvement work boards in virtually every department and unit throughout ThedaCare's system of hospitals, clinics, and administrative offices. The several teams that conduct 4-day rapid improvement events every week at ThedaCare show how their work supports the true north framework on day 5, when they present their findings at an employee gathering called "Report Out."

Lean Principle #3: Unity of Purpose (specifically, an example of using the True North Framework) ThedaCare's true north framework (Figure 2) puts the patient in the middle of a triangle and the strategic goal categories at the tips of the triangle. Two metrics are used to measure progress for each goal category and one for the patient, which is a customer loyalty score. This specific framework appears on improvement work boards in virtually every department and unit throughout ThedaCare's system of hospitals, clinics, and administrative offices. The several teams that conduct 4-day rapid improvement events every week at ThedaCare show how their work supports the true north framework on day 5, when they present their findings at an employee gathering called "Report Out."

The Health Care Scenario described below is an example of which Lean Principle? Martin Health System, based in Stuart, Florida, had an incident in which an emer- gency department (ED) nurse at its satellite hospital could not quickly locate an intrave- nous (IV) pump for a patient in the ED. To improve, Martin installed "equipment supermarkets" in nursing units. The supermar- kets contained all necessary equipment for specific units, for example, IV pumps, patient- controlled analgesia pumps, feeding pumps, sequential compression devices, and bed alerts. Standard work was developed to facilitate the availability of needed equipment. By improving the use or "turns" of IV pumps, the hospital was able to replace the existing pump inven- tory with 100 fewer units, which yielded a direct savings of $300,000. Total nursing time spent gathering supplies was reduced by 34 hours per day. *********THAT PART: Multiple departments collaborated on developing, testing, and refining the nursing equipment flow process, including nursing, material management, housekeeping, and de- contamination. These staff members became a community of innovators to find a better way to ensure that essential hospital equip- ment was available where and when it was needed while minimizing nonuse of the equipment. One additional outcome at Martin: nurses have stopped hoarding IV pumps.

Lean Principle #4 (Respect for the People Who do the work) Martin Health System, based in Stuart, Florida, had an incident in which an emer- gency department (ED) nurse at its satellite hospital could not quickly locate an intrave- nous (IV) pump for a patient in the ED. To improve, Martin installed "equipment supermarkets" in nursing units. The supermar- kets contained all necessary equipment for specific units, for example, IV pumps, patient- controlled analgesia pumps, feeding pumps, sequential compression devices, and bed alerts. Standard work was developed to facilitate the availability of needed equipment. By improving the use or "turns" of IV pumps, the hospital was able to replace the existing pump inven- tory with 100 fewer units, which yielded a direct savings of $300,000. Total nursing time spent gathering supplies was reduced by 34 hours per day. *********THAT PART: Multiple departments collaborated on developing, testing, and refining the nursing equipment flow process, including nursing, material management, housekeeping, and de- contamination. These staff members became a community of innovators to find a better way to ensure that essential hospital equip- ment was available where and when it was needed while minimizing nonuse of the equipment. One additional outcome at Martin: nurses have stopped hoarding IV pumps.

What is Lean Principle #4?

Lean Principle #4: ("Lean is") Respect for the People who do the work

What is Lean Principle #5?

Lean Principle #5: ("Lean is") Visual; i.e.: Visual Tracking

What is Lean Principle #6?

Lean Principle #6: Flexible Regimentation

The Health Care Scenario described below is an example of which Lean Principle? With standard clinical approaches, patients who deviate from the standard are more easily appreciated, freeing up the clinicians to expend their mental energy on issues and patients. An example at Seattle Children's is the asthma care unit, in which standardization of albuterol therapy has allowed physicians to better iden- tify patients who are not following the typical course. The fact that the standard approach to treatment does not work calls into question the diagnosis of asthma and forces the physi- cian to search for other causes. The specific design of a standard process offers the opportu- nity for focused study and testing. Knowledge work is easier to study once it has been defined as a set of expected activities.

Lean Principle #6: Flexible Regimentation With standard clinical approaches, patients who deviate from the standard are more easily appreciated, freeing up the clinicians to expend their mental energy on issues and patients. An example at Seattle Children's is the asthma care unit, in which standardization of albuterol therapy has allowed physicians to better iden- tify patients who are not following the typical course. The fact that the standard approach to treatment does not work calls into question the diagnosis of asthma and forces the physi- cian to search for other causes. The specific design of a standard process offers the opportu- nity for focused study and testing. Knowledge work is easier to study once it has been defined as a set of expected activities.

Lean is a _______, not a _______. Lean has no _____

Lean is a JOURNEY, not a DESTINATION. Lean has no FINISH LINE

Lean is an ________ composed of 6 principles that constitute the essential dynamic of Lean management.

OPERATING SYSTEM Lean is an OPERATING SYSTEM composed of 6 principles that constitute the essential dynamic of Lean management.

when well-executed, Lean transforms how an ______ works and creates an insatiable quest for ______

ORGANIZATION IMPROVEMENT when well-executed, Lean transforms how an organization works and creates an insatiable quest for improvement

Per Lean Principle #4 (Respect for the People Who do the work), how does Lean "turn leadership upside-down"?

Per Lean Principle #4 (Respect for the People Who do the work), Lean "turns leadership upside-down" by: Lean, in a sense, turns leadership upside down, with front-line workers doing much of the innovating and managers trusting them to do it and supporting them. Respect for the potential of front-line workers to have the brainpower and commitment to improve the work must pervade the organization. Respect flows downward, not just upward

Per Lean Principle #4, what is "perhaps the biggest challenge Lean implementation poses in many organizations?"

Per Lean Principle #4, "perhaps the biggest challenge Lean implementation poses in many organizations" IS: A Lean leadership and management system IS NOT a hierarchical system; the people in charge (e.g.: higher-level managers and supervisors) may have to change the most for a Lean culture to develop (if they are used to hierarchy and telling lower-level personnel what to do and how to do it.)

Principle 3 of the Lean operating/management system: ("Lean is...") ______

Principle #3: ("Lean is") UNITY OF PURPOSE

The Health Care Scenario described below is an example of which Lean Principle? When Seattle Children's built its new Bellevue Clinic and Surgery Center, it used Integrated Facility Design, a process based on Toyota's Production Planning Process approach. The Integrated Facility Design process brings a diverse set of stakeholders together for plan- ning before a shovel ever enters the ground. During planning, Seattle Children's brought together nurses, physicians, support staff, patients, architects, designers, and others to help determine the needs, goals, and metrics for the facility and to think through the most efficient flow and use of space. Value stream maps depicting the workflow were developed and agreed on by all vested parties, including patients and families. The value stream maps helped prioritize design requirements that contributed to the facility being built for $30 million less than initial estimates. The mapping allowed the team to see the waste in their existing care process, much of which they removed in designing a new ideal-state care process. The new ideal state was used to design the building space required, which cost less, rather than the space proposed in the original architectural design. The maps are still displayed in the back hall of the building and are regularly reviewed and updated. Metrics for both the clinic and surgery center are displayed in visual tracking centers throughout the facility.

Principle #5: Visual Tracking (i.e.: "Lean is Visual") When Seattle Children's built its new Bellevue Clinic and Surgery Center, it used Integrated Facility Design, a process based on Toyota's Production Planning Process approach. The Integrated Facility Design process brings a diverse set of stakeholders together for plan- ning before a shovel ever enters the ground. During planning, Seattle Children's brought together nurses, physicians, support staff, patients, architects, designers, and others to help determine the needs, goals, and metrics for the facility and to think through the most efficient flow and use of space. Value stream maps depicting the workflow were developed and agreed on by all vested parties, including patients and families. The value stream maps helped prioritize design requirements that contributed to the facility being built for $30 million less than initial estimates. The mapping allowed the team to see the waste in their existing care process, much of which they removed in designing a new ideal-state care process. The new ideal state was used to design the building space required, which cost less, rather than the space proposed in the original architectural design. The maps are still displayed in the back hall of the building and are regularly reviewed and updated. Metrics for both the clinic and surgery center are displayed in visual tracking centers throughout the facility.

The Health Care Scenario described below is an example of which Lean Principle? A process based on PDSA known as a rapid improvement event led to changes that include a staff huddle every morning to monitor and discuss the metrics of wait time, call volume, and dropped call rate, among other topics. The staff problem-solves issues from the previous day and anticipates issues for the upcoming day. At any time during the day, any team member can call for a huddle if performance issues arise. Such a huddle enables the staff to quickly identify and resolve problems. Total call volume has increased while wait time has decreased to under 1 minute and the dropped call rate to less than 3% with no increase in staffing.

Principle 1: Attitude of Continuous Improvement A process based on PDSA known as a rapid improvement event led to changes that include a staff huddle every morning to monitor and discuss the metrics of wait time, call volume, and dropped call rate, among other topics. The staff problem-solves issues from the previous day and anticipates issues for the upcoming day. At any time during the day, any team member can call for a huddle if performance issues arise. Such a huddle enables the staff to quickly identify and resolve problems. Total call volume has increased while wait time has decreased to under 1 minute and the dropped call rate to less than 3% with no increase in staffing.

Principle 1 of the Lean operating/management system: ______

Principle 1: Lean is an attitude of continuous improvement

Principle 2 of the Lean operating/management system: ______

Principle 2 of the Lean operating/management system: VALUE CREATION (i.e.: Value-Creating)

________ a process involves finding a short-term method to contain unacceptable results until a standardized solution can be developed.

STABILIZING Stabilizing a process involves finding a short-term method to contain unacceptable results until a standardized solution can be developed.

The essence of Lean: take nonstandard work processes and transform them into ________ that improve performance and then continue to improve the standard work design through ______.

STANDARD PROCESSES PDSA The essence of Lean: take nonstandard work processes and transform them into standard processes that improve performance and then continue to improve the standard work design through PDSA.

The Health Care Scenario described below is an example of which Lean Principle? ThedaCare has a conference room that contains a large, finely detailed map of the patient's experience during a hospital stay. The admission process involves 124 steps, the discharge process 140 steps. This map has been through 7 stages of refinement at this writing. Various interfunctional teams work with different parts of the map in search of measurable improvement. One team, for example, has been working on reducing hospital readmission rates by improving the discharge process. The hospital value stream map room is where dozens of ThedaCare personnel working on various improvement teams seek to deeply understand the hospital care system's current state with the goal of improving the value it deliversdincreasing the benefits and reducing the burdens for all stakeholders.

Principle 2: Value-Creating (i.e.: Value Creation) ThedaCare has a conference room that contains a large, finely detailed map of the patient's experience during a hospital stay. The admission process involves 124 steps, the discharge process 140 steps. This map has been through 7 stages of refinement at this writing. Various interfunctional teams work with different parts of the map in search of measurable improvement. One team, for example, has been working on reducing hospital readmission rates by improving the discharge process. The hospital value stream map room is where dozens of ThedaCare personnel working on various improvement teams seek to deeply understand the hospital care system's current state with the goal of improving the value it deliversdincreasing the benefits and reducing the burdens for all stakeholders.

The Health Care Scenario described below is an example of which Lean Principle? In perioperative services at 8 member hospitals of the New York City Health and Hospitals Corporation, management recog- nized the need for a different infrastructure to support improvement.... During 4.5-day rapid improvement events, teams reviewed the problem; mapped the current and target state; described the ideal state (perfection) and analyzed the gap between the current and target state; developed, tested, and imple- mented successful solutions; and crafted the metrics necessary to confirm achievement of the target state.

Principle 2: Value-Creating (i.e.: Value Creation) [they used the value stream mapping, which is a principal Lean tool used to distinguish between discrete steps in a process that do or do not contribute value] In perioperative services at 8 member hospitals of the New York City Health and Hospitals Corporation, management recog- nized the need for a different infrastructure to support improvement.... During 4.5-day rapid improvement events, teams reviewed the problem; mapped the current and target state; described the ideal state (perfection) and analyzed the gap between the current and target state; developed, tested, and imple- mented successful solutions; and crafted the metrics necessary to confirm achievement of the target state.

A process based on PDSA known as a ___________ led to changes that include a staff huddle every morning to monitor and discuss the metrics of wait time, call volume, and dropped call rate, among other topics.

RAPID IMPROVEMENT EVENT A process based on PDSA known as a RAPID IMPROVEMENT EVENT led to changes that include a staff huddle every morning to monitor and discuss the metrics of wait time, call volume, and dropped call rate, among other topics.

Lean has the potential to turn an organization into a community of innovators. However, this can happen only in a culture of ________.

RESPECT Lean has the potential to turn an organization into a community of innovators. However, this can happen only in a culture of respect.

_______ refers to developing a common or standard process for performing a specific service based on the best available evidence; _______ refers to ongoing efforts to improve the standard process.

Regimentation flexible Regimentation refers to developing a common or standard process for performing a specific service based on the best available evidence; flexible refers to ongoing efforts to improve the standard process.

In the Lean model, respect flows _____ (upward or downward?)

Respect flows downward, not just upward

The PDSA approach (a "CENTRAL TENANT OF LEAN") is a ________ applied to daily work: defining an explicit and measurable hypothesis about how a process can be improved, objectively testing the hypothesis, and, if improvement occurs, making the improved process "standard work" until such time as further improvement can be demonstrated.

SCIENTIFIC METHOD

Is the following statement T/F regarding how PATIENTS typically view VALUE? (compared to how health care views value, i.e.: VALUE in health care has been conceptualized as health outcomes per dollar spent AND outcomes per dollar spent OVERTIME) Burdens include both monetary costs and nonmonetary costs. The benefits vs burdens conceptualization of value includes medical outcomes and financial costs but extends beyond these constructs to also include patients' perceptions of the overall health care experience.

TRUE Burdens include both monetary costs and nonmonetary costs. The benefits vs burdens conceptualization of value includes medical outcomes and financial costs but extends beyond these constructs to also include patients' perceptions of the overall health care experience.

T/F: Health care cases reveal that Lean is as applicable in complex knowledge work as it is in assembly-line manufacturing; when well-executed, Lean transforms how an organization works and creates an insatiable quest for improvement

TRUE Health care cases reveal that Lean is as applicable in complex knowledge work as it is in assembly-line manufacturing; when well-executed, Lean transforms how an organization works and creates an insatiable quest for improvement

T/F: Lean cannot be rushed, is not easily understood, and requires ongoing, multifaceted investment

TRUE Lean cannot be rushed, is not easily understood, and requires ongoing, multifaceted investment

T/F: Lean uses the scientific method approach to measure whether new process B is superior to existing process A

TRUE Lean uses the scientific method approach to measure whether new process B is superior to existing process A

T/F: Through the CATCHBALL process, having MORE DRAFTS of the A3 indicates that MORE people have been involved in developing the new strategy it is not unusual to have 15 drafts of the A3, indicating that many people have been involved in defining the new strategy.

TRUE Through the CATCHBALL process, having MORE DRAFTS of the A3 indicates that MORE people have been involved in developing the new strategy it is not unusual to have 15 drafts of the A3, indicating that many people have been involved in defining the new strategy.

T/F: Lean at its best: employees keep raising the bar, the organization becomes increas- ingly innovative, more staff want to be directly involved, and an attitude of continuous improve- ment becomes the driving force behind all work.

TRUE employees keep raising the bar, the organization becomes increas- ingly innovative, more staff want to be directly involved, and an attitude of continuous improve- ment becomes the driving force behind all work.

Lean organizations often use the symbolic term _______ and visual expression to communicate and reinforce strategic priorities.

TRUE NORTH Lean organizations often use the symbolic term TRUE NORTH and visual expression to communicate and reinforce strategic priorities.

What 3 things are converging to encourage health care leaders to consider Lean for their institutions? - - -

The 3 things that are converging to encourage health care leaders to consider Lean for their institutions: - The emergence of Lean success stories in health care - A rapidly changing reimbursement environment that necessitates improved quality and efficiency - The trend to public reporting of health care performance data

What are the 6 principles that constitute the essential dynamic of Lean management? 1- 2- 3- 4- 5- 6-

The 6 principles that constitute the essential dynamic of Lean management? (pneumonic: AVU RVF) ("Lean is...") 1- Attitude of continuous improvement 2- Value creation 3- Unity of purpose 4- Respect for front-line workers 5- Visual tracking 6- Flexible regimentation

What is an example of how healthcare personnel are familiar with the scientific method?

an example of how healthcare personnel are familiar with the scientific method: controlled double-blind studies to test new treatments

Per Lean Principle #3 (Unity of Purpose): Lean ____ and ______ in improvement work accordingly.

clarifies priorities and guides staff Per Lean Principle #3 (Unity of Purpose): Lean clarifies priorities and guides staff in improvement work accordingly.