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Developing Leadership Capacity
using Lean Methodology
Heather Camrass BScN, RN MHST
Valerie Graham RN
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Objectives
Review of LEAN Methodology
Leadership from the LEAN Perspective
De-mystifying Kaizen Events
Nursing Admission History Kaizen Event
Emerging Leaders
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What is LEAN?
Lean is a mindset of continuous
improvement
It’s a system that empowers people at all
levels to:
Remove waste
Maximize what is of value to the patient
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What is LEAN?
Toyota Production System
(1940)
Lean Manufacturing
(1984)
Lean Thinking
(1992)
Lean Healthcare
(2002) Auto
Industry
Service
Management
Operations
Management
Hospital
Management
Source: Taking the Pulse of Lean Healthcare by
David Wood: Healthcare Quarterly (Reproduced
with permission from de Souza (2009))
… and where did it come from?
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LEAN in Healthcare
Key Drivers:
Price Pressures and Cost Challenges
Coping with Employee/Physician Shortages
Quality and Safety of Care
Lean Lessons*
Lean started in factories but has proven successful in healthcare
Quality improvements are a means of cost reduction
Improving the system, rather than working harder, is the key to Lean
improvements
To impact the bigger picture, you have to start with smaller steps
* Source:
Excerpt (p. 16) “Lean Hospitals; Improving Quality, Safety and Patient
Satisfaction” Mark Graban
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“The role of leadership is to get people’s brains
working on solving problems every day!”
(Balle & Balle, 2009)
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Foundations of LEAN Management
Lean Management Principles Identifies the gap between actual and expected performance
Encourages point of care workers to look for and implement
improvement opportunities to bring actual closer to expected
performance
Ultimately raise the level of expected performance
Getting to Better!
The role of the Manager is to Manage the people AND
Improve the business
In order to improve the business you need to empower the people
When you empower the people,
they become engaged!
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Engaging the People
1. Foster an environment where point of care workers can identify problems and
design solutions.
2. Utilize LEAN tools to visualize waste and organize the problem solving
process. A3
Current State Mapping
Future State Mapping
Brainstorming
Small tests of change to test possible solutions
3. Support point of care ownership of the change process Championing and coaching colleagues on improvement
Provide local support for the new processes
4. Ongoing monitoring to measure success Completing the feedback to let people know if the improvement is achieve the expected
outcome
Real time information that makes sense to the people doing the work and living the change.
Engaging the people helps leaders emerge!
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Kaizen?
Structured team activity to create
value with less waste
Patient focused
Quick implementation of improvements
to address a specific issue
Incremental
Rapid tests of change using PDSA
cycles
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The value of the Team Approach
Changes don’t happen in isolation – there
is impact across an organization
Success is more likely when you bring
a diverse group of people from different
facets of the organization together
Each person has a stake in improving
the process but they each bring a
unique perspective to the table
Teamwork breaks down the vertical silos –
levels the playing field
There is greater buy in for the change
when the ideas are generated from the
people who do the work.
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What was the Issue?
Nursing Admission Assessment
Process was inefficient and inconsistent
Admission Assessment was on paper
The Nursing History was electronic
Varied between nurses and units.
Multiple printed forms some of which duplicated the information
obtained in other parts of the chart.
There were no links to patient care planning
The interdisciplinary team did not value the information.
It was a task that had to be done
There was no value to the patient
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Desired Outcomes
We wanted to …
• Streamline the Nursing Admission History assessment and process
– Give time back to nurses
• Complete a Nursing Admission History on all patients
• Utilize the admission assessment to inform patient care
• Enhance the patient experience
– Create a visual plan of care that included the patient/family/team
– Utilize the information obtained at daily bullet rounds
• Utilize point of care expertise to re-design the nursing admission
assessment.
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Mapping the Process
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Current State
Future State
Visualizing the opportunities and seeing waste.
Getting to better!
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Generating Ideas
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Brainstorming
• No idea is too outrageous
• All ideas have merit
• Creativity is key!
Impact/Effort Analysis
• Prioritize the ideas
• Start with high impact/low effort
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Testing the Ideas
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Going to Gemba
• Trial
• Feedback
• Modify
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Solutions
Nursing Admission History Streamlined to reduce duplication
Became outcome driven
Assessment informed the plan of care
Included prompts for therapy referrals based on the
patient’s functional ability.
Identified potential barriers to discharge
Patient bedside boards Re-designed to include the daily plan of care
Goal oriented to improve communication
Developed process for using/updating the boards
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Solutions
Unit Communication Boards Redesigned to reflect the new vision
Emphasized the barriers to discharge
Identified the plan of care developed from the nursing admission
history
Bullet rounds Updated the standard work to reflect the new vision
Nursing participation emphasized
Included the manager’s participation at Bullet Rounds
to support the change
Encouraged to lead the rounds
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Owning the Process
The project team were empowered to
Develop the communication plan
Designed the audit process and tools
Work with their managers to operationalize the roll out plan
5 week plan with one unit adding the new processes each week
As process champions for their home unit they
Educated and trained their peers on the new process
Supported additional champions on each unit to assist with the
roll out
Performed audits to monitor process uptake
Supported the implementation on the next unit
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Our Emerging Leaders
The champions have become our emerging leaders
They continue to problem solve, find solutions and do small tests
of change on their units
Actively participate in new program initiatives
Their willingness to engage in improvement initiatives has
spread to their peers.
Change is now patient focused and there is less resistance to
new ideas.
There’s a thirst for knowledge
Outcome driven and process audits are becoming the norm.
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“Success is not final, failure is not fatal:
It is the courage to continue that counts.” Winston Churchill
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Suggested Reading
• Lean Thinking
James P. Womack & Daniel T. Jones 2003
• Gemba Kaizen
Masaaki Imai 1997
• Lean Production Simplified
Pascal Dennis 2007
• Lean Enterprise Institute
www.lei.org
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