Global Lean Healthcare SummitKenilworth, Warwickshire, UK

June 26, 2007

The Next Steps in Lean Healthcare

James P. Womack, Chairman, Lean Enterprise Institute

2

An A3 Analysis for Lean Healthcare• What is the problem we are trying to solve?

• What is the current condition causing the problem?

• What future condition might be able to solve the problem?

• Who will need to do what when in order to achieve and sustain the future condition?

• What will be the evidence that we have succeeded?

3

What Is Our Problem?• We have performed an impressive number of

experiments applying lean techniques to points along value streams (patient pathways, supported by materials and information pathways.)

But…

• We have a hard time sustaining these point improvements.

• We have a hard time creating lean pathways for patient conditions from end-to-end, as they flow horizontally across complex healthcare organizations.

4

What Conditions Cause This Problem?• Confusion about the correct unit of analysis and object of

improvement:

Are we improving individual activities? (Yes.)

Are we improving end-to-end treatment pathways for conditions (product families)? (For the most part, no.)

• Organizational confusion about:

Responsibility for end-to-end pathways.

Horizontal versus vertical priorities.

Best metrics to align everyone touching a pathway.

• Inadequate attention to support pathways for materials, equipment and information that cause waste & instability.

5

What Future Condition Could Help?

• Clear thinking about the correct unit of analysis for each healthcare organization.

• Clear assignment of responsibility for improving and sustaining patient and support pathways end-to-end.

• Alignment on end-to-end metrics for all pathways.

• Agreement on lean management methods (not just lean tools) for healthcare.

6

Who Needs to Do What When?• Strategy deployment exercise by top management to:

Define critical patient and support pathways for the organization (including upstream and downstream organizations?)

Set priorities for horizontal versus vertical.

Assign responsibility for critical pathways.

Align/create end-to-end metrics for pathways (including elimination of many current metrics?)

Define lean management (e.g, ask questions rather than give answers; practice genchi genbutsu rather than manage by PowerPoint from the conference room; use A3 as the standard problem-solving method, etc.)

7

Who Needs to Do What When?• Conduct A3 analysis for critical patient and support

pathways:

Make someone responsible for the transformation!

Form a team of everyone touching the pathway.

Determine the problem with current performance.

Describe the current condition of the pathway causing the problem.

Envision a better pathway.

Determine who must do what when to achieve it.

Specify the evidence that will show that the problem is sustainably solved.

8

Who Needs to Do What When?• Deploy lean management:

Standard management with a standard cadence for monitoring process performance and a standard method of implementing countermeasures and root cause fixes. (To insure that current performance is sustained.)

Standard work for every activity. (To insure that current performance is sustained.)

Standard improvement methods with a cadence for every pathway. (To insure that every process gets continually better.)

9

How Will You Know Problem Is Solved?

• All patients will obtain the best currently-known treatment and achieve the best currently-feasible outcomes!

• Patient time, anxiety, and hassle will be minimized! (No mura or muri!)

• Employee work will be hassle free and rewarding! (No mura or muri!)

• Total cost for a given set of patient outcomes will be minimized! (No muda!)

• We won’t need a lean healthcare movement! (Which is only incidental work if we succeed and muda if we fail!)

10

But Where Do You Begin?

• It depends on circumstances:

With strategy deployment if top management is willing and able.

With A3 analysis for individual pathways if only part of the organization is ready.

With standard management and standard work if individual activities are so unstable that linking them end-to-end is impossible.

11

Wherever You Begin…• There is much that we currently don’t know about

better ways to conduct strategy deployment, A3 analysis, and standard management in a healthcare environment.

When medical scientists don’t know something they perform experiments and widely share the results.

We need to perform a large number of experiments about lean leadership (transformation) and lean management (to sustain and steadily improve further.)

We need to document these rigorously.

We need to share the results widely.

12

What Makes Healthcare Different

• Human lives are at stake in everything you do.

• You therefore have a moral obligation to share findings and offer mutual support.

We hope the Lean Global Network can assist with experiments and sharing.