Introduction to Lean and PDSA Thinking

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

Benefits of Lean Thinking Stability within our work Vitality of our organization Respecting people Creating meaningful work Creating ownership of

your work

How ThedaCare uses LeanTIS 9 Methods to See and Remove

Waste in a Process within a Value Stream

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Sequence and Continuity

50,000 ft

GROUND LEVEL

INCREASING DETAIL

STANDARD WORK

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5S

SIPOC

TAKT TIME

FLOW DIAGRAM

COMMUNICATION CIRCLE

SPAGHETTI DIAGRAM

TIME OBSERVATION

BAR CHART

STANDARD WORK COMBINATION

5S Visual Management

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Continuous Daily Improvement

Value Stream Analysis

What is the scientific method Penicillin Vaccinations Gravity Electricity Genetics

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

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

BackgroundDefinition:• 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

Current ConditionDefinition:• What is happening today• Diverge and Converge• Find the patternsQuestions:• 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 problem?

Current ConditionQuestions, 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?

Problem StatementDefinition:• Clearly and succinctly defines the actual issue

that is being felt• Quantifiable gapQuestions:• 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)

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.

Goals and TargetsDefinition:• 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 distort it)

Analysis / Root CauseDefinition:• 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?

Analysis / Root CauseTips: 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.

CountermeasuresDefinition: 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

CountermeasuresTips: 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

ExperimentsDefinition: 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?

ExperimentsTips: 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.

StudyDefinition: 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?

StudyTips: Make performance over time visual Use Pareto’s to track abnormalities in the new

process. Go and see Train to the new standard

Act / AdjustDefinition: Actions required to close the gaps identified in the

study phase. Celebration of the success of the improvement effortQuestions: 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

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The Real PDSA Wheel…

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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