Change Agent Training

Day 1

Objectives of the course

Apply the Lean methodology to the workplace Apply practical principles through simulations Use knowledge gained to develop a Lean

investigation in your own area Provide a network of support for each other

Agenda

09:15 Lean Simulation

10:30 Coffee

11:15 Transformation Approach Parts 1 and 2

12:00 Lunch

12:45 Transformation Approach Part 3

14:00 Coffee

16:30 Close

Reflection from Half Day Session Any thoughts you’d like to share with the group?

Lean Flow Game

Game Number 1!

Learning Points from Flow Game Types of ‘Waste’ what were they?

Transportation Waiting Re-work Motion

Kanban Flow Value Stream Single Piece Flow – no batching

Transformation Approach

1. Preparation Voice of the Customer

Defining Value

Project Scoping

Voice of the Customer

“Lean thinking …must start with a conscious attempt to precisely define value…. Through a dialogue with customers”

James P. Womack & Daniel T. Jones

Who are the customers? Who are the users of the service..

people upstream and downstream of you that receive what you deliver (patients are our customers)

payers/manager of the services provide the Voice of the Business

VoC and VoB can give rise to conflicting requirements

Can you identify your customers?

How would you identify what ‘value’ means for your customer?

Project Scoping A Project Charter is a simple tool for formalising

the nature and boundaries of the project.

It allows clear communication to all project team members and stakeholders.

No matter how small a project/idea its always good to draw up a project charter so everyone knows the scope

1. Preparation Voice of the Customer

Defining Value

Project Scoping

2. Value Stream Analysis Data Collection

Pareto Analysis

5 Whys

Value Stream Mapping (process mapping)

Data Collection Before you start any project you must look at

where you are now i.e. baseline measurement

What data do I need, where do I start?

Microsoft Excel Worksheet

Pareto Principle (80/20 rule) Italian economist Vilfredo Pareto observed that

for many events, roughly 80% of the effects come from 20% of the causes in 1906 he found that 80% of the land in Italy

was owned by 20% of the population

Pareto analysis is a very simple technique that helps you to focus efforts on the problems that offer the greatest potential for improvement.

Pareto Principle Pareto's principle, the 80/20 rule, should serve

as a daily reminder to focus your time and energy on the issues that really make a difference.

80 per cent of a nurse's time is spent on 20 per cent of the patients

80 per cent of the decisions made in meetings come from 20 per cent of the meeting time

When to use Pareto? A Pareto Chart breaks a big problem down into

smaller pieces, identifies the most significant factors, shows where to focus efforts, and allows better use of limited resources

A Pareto Chart is a good tool to use when the process you are investigating produces data that are broken down into categories

A Pareto diagram puts data in a hierarchical order, which allows the most significant problems to be corrected first.

Pareto Chart Exercise 1 Draw a Pareto Chart

Analysing the Data Ask the 5 whys

1. Why do TTAs take a long time to get to the ward?

Because pharmacy don’t get the list of TTAs in time for discharge 2. Why? Because doctors don’t order the TTAs in time 3. Why? They batch them up and do them at the end of the day 4.Why? TTA pads are at the nursing station and not used during the ward

round 5. Why? Because it’s always been done that way

Value Stream

“Wherever there is a product or service for a customer, there is a value stream. The

challenge lies in seeing it”

Value Stream Mapping What is Value?

In NHS terms – Value is any activity which improves the patient’s health, well being and experience

Why Value Stream?

Identifies the core set of actions required to deliver value for patients

Why Value Stream Analysis?

To align healthcare processes to facilitate the smooth flow or patients and information

Eliminate stop – starts and identify ‘hand-offs’

Value Stream Mapping

Value Stream Mapping

Value Stream Mapping

Value Stream Mapping Exercise You are an event organiser and have been

asked to organise a picnic for 10 clients in a week’s time.

This is the first time you’ve organised a picnic so you want to document the current state (what happens now) and test out the process with this client. Start of value stream: Client requests the picnic End of value stream: Deliver picnic to venue

Value Stream Mapping Analysis Step 2 Once you’ve mapped the process identify

the following; Who is the customer? Identify the value added and non value added

steps for the customer What’s the elapsed time? Min and max What’s the value added time?

2. Value Stream Analysis Data Collection

Pareto Analysis

5 Whys

Value Stream Mapping (process mapping)

3. Identify Constraints

Identify Bottlenecks

Root Cause Analysis

Variation

Introduction to Variation The extent or degree to which something varies

Too much variation in the workplace introduces risk, so reducing variation reduces risk. E.g. introduction of the Theatre WHO checklist

The variance is a measure of how far a set of numbers are spread out.

Variation Exercise Airplanes!

Reducing Variation Can you see variation in your work place?

How could you use the airplane principles to identify variation in your workplace? E.g. what could you measure

To understand variation in more detail you can use the fish bone tool

Root Cause Analysis

Problem Statement:

Man Materials Method

Mother Nature

Measurement Machine/Technology

Root Cause Analysis

Problem Statement:Variation in distance travelled by aeroplane

Man Materials Method

Mother Nature

Measurement Machine/Technology

Height and strength

One person throwing all planes

Different paper/texture/size

Same size paper

Different throwing techniques

Standardised operating instructions

Air pressure of room

Maintain temperature

Not clear what we were measuring

Measure and scale agreed in advance

Could we have used technology in this process

Technology to be investigated

3. Identify Constraints

Identify Bottlenecks

Variation

Root Cause Analysis

Human Dimensions of Change Circle of influence

Role of a Change Agent

Killer Phrases

Belbin

What is a change agent? Facilitator Continuous Improvement facilitator Service Improvement facilitator Champion of Change Internal or Lean Champion Other?

What is a change agent? A person within an organisation who has the requisite

knowledge, skills, desire and motivation to make improvements happen through change

Usually not in a position of authority within the areas of the organisation over which they make these improvements happen

Someone who achieves improvement results with and through other organisational members and stakeholders

Change Agent Experience

Planning your project Spend the next 20 minutes thinking about your

next steps Use the project charter template to think about a

problem and the desired solution

If you have already started a project think about which lean tools you might apply to the project

Summary of Learning – Day 1

Change Agent Training

Day 2

Overnight thoughts

Transformation Approach

Waste Walk In pairs visit each others department and

observe.

Note any of the 7 wastes using the waste template

When you introduce yourself to the department please say that you are observing the process not the people

Waste Walk De-Brief

4. Future State

Other Problem Solving Techniques

Ideal Future State

Future State Map

Motion Analysis

Exercise Draw a spaghetti diagram for round 1

Carrying out a Spaghetti Diagram Obtain department/hospital plans from Facilities Agree what you’re going to measure Agree on your measurements and scale You will need;

Red pen or pins and string Stop watch Pedometer Tape measure or measure wheel

Getting to the Ideal Future State“Think Different”

Steve Jobs (Apple’s CEO from 1996 – 2011) along with advertising executives coined the slogan ‘Think Different’.Converted the phone into a centre for music, film, photography, communication etc. Turned Apple into the most valuable public company in the world

Creative Thinking Divergent

Ideas generation

Convergent What will we test and how will we do it?

Exercises House

Paper Clip

Tools to think differently (Convergent Thinking)

Random Pictures

Random Words

Look to other industries

What’s the worst thing to do

Exploring an Issue RUH North

The RUH want to create an innovative and exciting space to house the new cancer centre

How creative are you?!

Look at the pictures and note what you see (outside of the obvious!)

Designing the Future State (Divergent Thinking)

What ideas could you realistically take forward?

Be achievable in 6 to 9 months (medium term) 12 months + (long term) balancing long term actions with quick wins

Designing The Future State Design a value stream for an outpatient

appointment within your new Cancer Building

Start: Patient enters the RUH End: Patient leaves having attended their

appointment

Think about pull, flow, value added and 7 wastes

4. Future State

Ideal Future State

Visual Management

Future State Map

5. Implementation Plan Action Plan

Deliver Findings

Effort Impact Analysis

Effort

Low High

Impact

Low

HighLow hanging fruit!

May not be worth investing the time

Delivering your Findings Project Team Meetings Communications Board Newsletter – Departmental Bulletin Intranet Show information collected – before and after

project – visual impact

Next Steps Define your project (using the project charter)

Talk to key stakeholders Get to a shared purpose

Start to gather evidence of current practice Speak to Lisa/Tricia or any of the change agents Plan your value stream mapping event (if

applicable)

Please complete your feedback sheets, we need to hear from you!

Feedback 2 mins feedback on your next steps

Summary of Training

QUIZ!

Any Questions?