LEADER STANDARD WORK - Amazon S3€¦ · Develop effective Leader Standard Work. 3 Confidential. ... HealthEast is a full-service health care provider serving ... 2013 - A3 Thinking

LEADER STANDARD WORK

June 2016

HealthEast Care System

Didier Rabino, Vice President, Lean Sensei

2 Confidential. For internal use only. Not for distribution.

LEARNING OBJECTIVES:

�Describe relationships between problems, standards

and visual controls

�Develop effective Leader Standard Work


ABOUT HEALTHEAST

� 14 primary care clinics

� 4 award-winning hospitals

� 7,500 employees

� 850 providers

� Specialty centers, home care,

hospice care

� Comprehensive wellness program

� 1.1 Million residents

� 63 languages

HealthEast is a full-service health care provider serving the Twin Cities East Metro


LEAN JOURNEY AT HEALTHEAST

2006 - 1st Lean flow projects2011 - 1st department with frontline tools2012 - 1st Lean system launched (FMS)

2013 - A3 Thinking & Gemba Walk

2014 - Strategy Deployment

2015 - Kaizen Workshop & VSM

Not a way of life yet


1 - Identify Value

2 - Map the value stream

3 - Create Flow

4 - Establish Pull

5 - Seek Perfection

LEAN PRODUCTION SYSTEM


RESPONSE Problem

CORRECTIVE ACTION

SEEK PERFECTION


STANDARDS: THE FUNDAMENTAL IDEA

� There is no problem without a standard (norm,

expectation, goal, objective, desired condition)

� Any condition that is not meeting the standard is a

problem

� It is a problem when an employee does not meet the

standard


1

• Difficult to sustain results

2

• Results do not match the expectations

3

• Lack of leadership support and buy in from peers

4

• Lack of necessary resources (people or money)

5

• Reaching a plateau and not able to move beyond it

COMMON CHALLENGES:


IS THERE A LINK MISSING?


LEAN LEADERSHIP: A DIFFERENT MODEL

Two Principles:

1. Respect for people

2. Continuous improvement

They translate into:

� Customers always come first

� Employees are the most important resource

� Continuous improvement is a way of life

� Front line focus – everything is grounded to Gemba


LEAN LEADERSHIP: A DIFFERENT MODEL

The “Leader as Dictator” who tells everyone what to do:

no transfer or cascade of responsibility

The “Leader as Social Worker” who sets “goals” and let

everyone do as they pleased: no focus or direction

The “Lean Leader” who provides maximum flexibility

with maximum control: neither bottom up nor top down


LEAN LEADERSHIP MODEL

Maximum flexibility: • Do not tell exactly what to do: rely on individual initiative

Maximum control:• Do not allow actions without justifications to the manager

Neither bottom-up nor top-down but:• Emphasize doing the “right thing” / establishing authority• Develop systems in which processes are well defined and

individual responsibility is clear

Lean organizations have evolved from a top-down

cascade of tasks to a cascade of responsibility


LEAN MANAGEMENT: PRACTICAL APPROACH

3 - Leader Standard

Work

2 - Visual Accountability

1 - Visual Controls

1.Bring the focus on process abnormalities in real time

2.Transform problem identification into assignments for action

3.Help sustain improvements made


The leader uses visual controls to ensure:

• the execution of the standards

• that gaps are understood

• that appropriate response to gaps

1 – VISUAL CONTROLS

Different levels:1. Provides information (e.g. water level gauge under a

bridge)

2. Shows abnormality (e.g. gauge shows “normal” and

“flood situation”)

3. Indicates response needed (e.g. gauge shows level for

“close bridge”)

4. Display status of response (e.g. gauge with nearby sign

“bridge closed by sheriff on April 7”)


PROCESS: NORMAL / ABNORMAL?


Lab only Patients

PROCESS: CLINIC LAB FIFO & WORKLOAD

Process: patient flow in CT room

“Inspect what you expect;

your team members will respect what you expect”

Process: inspect what you expect

12

5

4

3

Knowledge and Skills

1

2

4

3

Kaizen Calendar

• Problem statement• Target• Kaizen leader• Executive sponsor• Lean coach• 4 gate process

St. Joseph’s Lab Recognition Board


2 - VISUAL ACCOUNTABILITY

Transforms problem identification into assignments

for action and follow up to ensure the assignments

are completed

Strategy Deployment Rooms

Accountability Board

• Daily or weekly review

• 30 seconds per person

• May only place tasks on yourself

= Task completed on time

= Task behind commitment

Strategy Deployment Rooms

Task behindschedule

Task on schedule

Project Status

3 – Leader Standard Work

• The strategies to change are different than the strategies

to maintain the change. We fail at maintaining the change

when we don’t have a strategy to continue the change.

• Leader standard work helps sustain improvements made.

Inspect what you expect from Gemba

Coach A3 thinking

Teaching role

Delegate responsibilities

Support the work

Balance maintain & improve

Cascade challenges

Reward & recognize

Staff here

and ready

to work?

Huddle quality?

Coaching kata? Ahead or behind?

Issues identified?

Standard

work

followed?

Support staff

improvement

workBreak start-

stop OK?

Ahead or behind?

Issues identified? Work on my

A3 project

Next day

staffing plan

Go home satisfied!

Go and see

patient

Triple aim

deep dive

The Routine: Leader SW guides the leader to the visual controls


THE DOCUMENT

Developing new routine

1

2

5

6

7

4

3

31-May-16

Personal Kanban


IN SUMMARY:

2 SYSTEMS NEEDED1 - Identify Value

2 - Map the value

stream

3 - Create Flow

4 -Establish

Pull

5 - Seek

Lean Production System

LeanManagement System

3 - Leader Standard

Work

2 - Visual Accountability

1 - Visual Controls


Objectives: • Results

• People

• Management system

Methodology:• Monthly learning cycles

Activity to date:• 5 learning cycles

• Encouraging

• Scratching the surface

OUR IMPLEMENTATION APPROACH

THE MODEL CLINIC

Leader Standard Work

Final Questions?

HealthEast Care System

Didier Rabino, Lean Sensei

LEADER STANDARD WORK - Amazon S3€¦ · Develop effective Leader Standard Work. 3 Confidential. ... HealthEast is a full-service health care provider serving ... 2013 - A3 Thinking

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