Sts plus lean pt2 final

STS Plus LeanAn Integrative Learning Exercise

WHAT CAN STS DESIGN LEARN FROM LEAN

&

WHAT CAN LEAN LEARN FROM STS

09/09/2013 LAWRENCE M. MILLER 1

Lean is “Integrative Learning”

09/09/2013LAWRENCE M. MILLER 2

Lean/TPS is an evolution of work systems that have been evolving for thousands of years.

09/09/2013LAWRENCE M. MILLER 3

Quick Case Study: The Marysville PlantYou see the physical system, but it doesn’t work without the

social system

09/09/2013LAWRENCE M. MILLER 4

Lean/TPS Principles

1. Lean is a culture of continuous improvement practiced at every level of the organization and by every team.

2. Lean is the application of the scientific method of experimentation and study of work processes and systems to find improvements.

3. Lean is respect for people. It is respect for the voice of the customer and it is respect for those who do the work, who are “on-the-spot” and are, therefore, the “world’s greatest experts” in their work.

4. Lean is the elimination of waste in all its forms. Lean is the ability to distinguish between work that actually adds value to your customers and work that does not. By eliminating waste, you free resources to devote to value-adding activity that serves your customers.

09/09/2013 LAWRENCE M. MILLER 5

Lean/TPS Principles

5. Lean is a work environment that assures the quality and safety of all work for both customers and staff.

6. Lean is a focus on improving the work process and not on blaming people or creating fear.

7. Lean is a culture of teamwork, shared responsibility and ownership that cuts through organization walls or silos.

8. Lean is a culture that returns the joy to work. Honda speaks of the three joys of buying, selling and making the product. We do our best work when we have joy in our work.

9. Lean is flow. Lean is an interruption free process that flows from beginning to end without interruption.

09/09/2013 LAWRENCE M. MILLER 6

Lean Culture is……a journey we have been on for 40 years.the inclusion and engagement of every employee in continuous improvement.

LAWRENCE M. MILLER 709/09/2013

Lean Culture is…

LAWRENCE M. MILLER 8

• the knowledge of customers, suppliers, and processes by every employee.

• every team having a “charter” that defines their responsibilities.

• every team owning a process and being empowered to improve that process.

09/09/2013

Lean Culture is…

LAWRENCE M. MILLER

9

• data driven!• keeping score on performance by

every team.• the visual display of performance by

every team.

09/09/2013

Lean Culture is…

LAWRENCE M. MILLER 10

• Flow in the “value-stream”• mapping of every key work

process by every team at every level.

• the elimination of waste from every process.

09/09/2013

Lean Culture is…

LAWRENCE M. MILLER 11

• the analysis and reduction of variances in quality, cost, and from principles or cycle time.

09/09/2013

Lean Culture is…

LAWRENCE M. MILLER 12

..a change in culture from traditional management styles to high participation – high ownership.

09/09/2013

Lean Culture is…

…continuous improvement at ALL levels, in ALL functions using the PDCA cycle.

LAWRENCE M. MILLER 1309/09/2013

Lean Culture…

Experimentation leads to Standard Work and Leader Standard Work

An essential component of “lean” organizations is defining standard ways of doing things. This reduces mistakes and facilitates learning through planned experimentation, rather than constant re-learning.

LAWRENCE M. MILLER 1409/09/2013

How Much Time is Devoted to Standard Work?

LAWRENCE M. MILLER 15

This is a possible, or typical, percent of time devoted to LSW. However, this is not meant to be a “rule.” Each organization and each position is different and will have some unique requirements.

09/09/2013

All Work Systems are Social-Technical Systems

09/09/2013LAWRENCE M. MILLER 16

Even Toyota Redesigned their “whole-system.”

“Facing up to the labour shortage and to the exhaustion of the whole work force, the management and the union at Toyota began to question the production system and the method of managing work. They concluded that a radical resolution of the crisis of work could only be found in a reorganization of the production system to make work more attractive, for they were in agreement that the cause of the labourshortage was the nature of assembly line work and the Toyotaist method of managing work.”

By investing massively to improve working conditions, by developing a new conception of the production line, by allowing segments of the line to keep buffer stocks, by making social relations of work more equitable and rational, Toyota has changed the rules of the game. For Toyota, ‘lean production’ appears to be the model of the past, because it placed too much pressure on people. The new strategy at Toyota is to give a more humane dimension to its production system but without hindering productivity; even if progress remains slow, and is held back by the old Toyotaism.”

“In terms of team work, four production workers form a work team which is responsible for a segment composed of a series of connected tasks (three or four tasks). The work team takes responsibility for the quality of its tasks, whereas on traditional lines, each person is responsible individually.”

“Humanization of the production system and work at Toyota Motor Co and Toyota Motor Kyushu.” By Koichi Shimizu, In Enriching Production: Perspectives on Volvo’s Uddevalla Plant as an Alternative to lean production. Sandberg, Ake, Editor, Digital Edition, Stockholm. 2007. P. 398.

09/09/2013LAWRENCE M. MILLER 17

VON Case Study: An Example of Lean/STSA Charitable organization, about 5,000 employees, providing home nursing care and home support workers as well as other community based health services.

September 9, 2013Lawrence M. Miller 18

VON Learned that…

09/09/2013 LAWRENCE M. MILLER 19

• Their organization is a “whole-system”• Social, technical and economic systems

must be aligned to customer/client needs

• The process of change must reflect the desired culture – the “Habitat for Humanity” principle.

What data did we have before redesign?

September 9, 2013Lawrence M. Miller 20

In addition:• VON was losing money and contracts• Managers were frustrated and wasting time• Staff were frustrated with communications• CCAC case managers wanted one point of

contact

VON Design Charter

PURPOSE:

The purpose of the HomeCare Service Delivery Redesign Team is to ensure that our service delivery to clients and customers (funders) meet or exceed their expectations in a manner that will maximize the probability of customer, client and service provider loyalty and acquisition of additional contracts. The design should improve financial performance as well as customer and client performance.

OBJECTIVES:

Timelines

1. One (Nursing) will focus initially on designing the nursing service process, while another (Home Support) will focus on designing the home support delivery process.

2. By November 1st, 2011 present initial recommendations for a redesign of the work flow.

3. By November 15th present initial recommendations for changes to systems, structure, decision-making, responsibility or other factors that may enhance performance to customer expectations.

4. By January 1st begin implementation of those recommendations.

September 9, 2013Lawrence M. Miller 21

Deliverables

1. Reduce the number of process steps by at least 50% in order to reduce potential for errors, delay and rework.

2. It currently requires an average of five hours from acceptance of referral to the scheduling of a visit. The goal of the design team should be to reduce this to one hour.

3. A customer or client or service provider must be able to reach someone who can respond to their concerns 24/7.

4. The redesign should result in a missed visits rate below CCAC targets.

5. The redesign should result in a referral rate to exceed CCAC targets.

6. The redesign should result in continuity within CCAC targets.

7. The redesign should result in a reduction in ORTS (complaints) by 75%.

8. The redesign will ensure there is a focus on the quality of care delivered to the client. It will ensure that managers are able to facilitate necessary clinician education, supervisory visits and practice learning teams. This will be measured by up-to-date performance review practices for new and existing employees (as per policy) and by nurse satisfaction that learning needs are met.

9. Reduce billing rejections to a rate of less than .05 percent.

10. Quality feedback loops will be built into each process so they can monitor in real time effectiveness.

11. The design team will calculate the cost of planning and scheduling of visits to be less than five dollars per visit.

12. The design team will define productivity measures at the primary care provider team level and at the district level. These measures will align financial improvement measures at all levels.

September 9, 2013Lawrence M. Miller 22

VON Design Charter

The Design Teams

September 9, 2013Lawrence M. Miller 23

2 Design teams met for 12 weeks, 3 days a week

September 9, 2013Lawrence M. Miller 24

Each process step was analyzed for speed, value-adding, causes of variances

09/09/2013LAWRENCE M. MILLER 25

We Redesigned the Work Flow to Eliminate Waste

• Steps in the process were cut by more than half

• Scheduling time went from an average of five hours to 5-10 minutes.

• Technology was employed to create daily huddles (15minutes), data review, self-scheduling.

The Structure was redesigned

09/09/2013LAWRENCE M. MILLER 26

“Oblatonyangpi”Square People and Round People

Each District Design Team built their own structure to optimize the flow of the work

09/09/2013 LAWRENCE M. MILLER 27

09/09/2013LAWRENCE M. MILLER 28

The redesigned VON

• Each District designed their own structure to their realities.

• They have redesigned as they have experimented

Alignment of National Functions

09/09/2013LAWRENCE M. MILLER 29

Creating a Culture for Future Capabilities

Implementation included training of all teams

09/09/2013 LAWRENCE M. MILLER 30

• Decision processes were define in terms of command, consultative and consensus decisions

• Key data variables and data feedback was designed for each team.

• A competency model was developed for each position.

Final Presentation to SMT

September 9, 2013Lawrence M. Miller 31

VON Results: Scheduling from five hours to five minutesProductivity improved by 25%

09/09/2013 LAWRENCE M. MILLER 32

09/09/2013LAWRENCE M. MILLER 33

Pre

Rede

sign

Sur

vey

Post

Red

esig

n Su

rvey

CCAC Customer SatisfactionProductivity (visits/FTE) is up 25% across all districts

Exercise

1. How were the Lean and STS approaches combined? Was this effective or not?

2. What are the lessons you take from this case for your practice or for your company?

3. What questions do you have for the consultants in these cases?

09/09/2013 LAWRENCE M. MILLER 34