Tom.Pettersson60@gmail.com Lean is the Biology

of BusinessSystem Design for Quality

in a Complex

Organization

Learning, Adaptive and Innovative Culture to

Manage Crisis in Healthcare

Mobilize all Individual and Team

Intelligence and Brain Power (IQ +

EQ) in the Organization

If We All Knew What We All Know?

Specialized in seeing

many things at once

Synthesizes

the ”Big Picture”

Emotional, Emphatic,

Visual

Good at recognizes

serial events

Analyzes details

Logic, Abstract

A Whole new Mind: Why Right-brainers will rule the Future

Left-brainers Right-brainers

What do you see ?

Human Microbiome 2012 Five Horses

Do we see the same ?

Communicate through Dialogue and Active Listening

Learn to see and act ?

Empower, Motivate

See Waste,

Uncover Problems

Eliminate Waste,

Correct Root Causes

Manage Quality

Quality is in the process

F

HA

B

C

DE

GA B C D

Newtonian Linear Process View

Reductionist – Left brain approach

Quantum Complex Process View

Holistic – Right brain approach

ComplexAdaptive System

Linear Flow

Evolution Is

continuous

adaptation

of a

complex

Biological

System

1.Self-creation 2.Self-reflexivity 3.Self-regulation4.Communications among all parts5.Conservation of what works well6.Creative change of what does not

work well.

Culture of a Complex Adaptive Organization

1. Pursue agility and resilience

2. Consciously learn from daily experience

3. Allow solutions to emerge

4. Pull, don’t push

5. Seek healthy mixtures

6. Rely on vision and boundaries

7. Appreciate the messy phases

8. Expect non-linear progress

9. Cooperate to create abundance

10. Promote grassroots initiatives

11. Work in a place designed for humans

Evolution Is

continuous

adaptation

of a

complex

Biological

System

TQMDeming 14 points

”No Waste”

Process design

Scientific method

Project

KaizenA better Life

ISO

CENISO 9001/2008

ISO 17025/ISO 15189

The Toyota WayTPS, TPM, 14 points

”Purpose/People/Process”s

LEAN (1990)

Production

Service

Healthcare (IHI)

Six Sigma

QA/QC

QMS

Franklin Ford Taylor Juran

Deming

Toyoda

Shingo Ohno

ImaiWomack Seddon Jones

Smith Westgaard

The Evolution of Quality

Management in Industry

PresentThe Industrial Management and Quality Maturity Model

”Lean, Six Sigma, ISO Synchronization”

QMS

Sokrates

Lean”Learn to see”

Continuously Improve / eliminate Waste”/ Innovate

Synchronize Flow/ Focus Speed and Customer

Process Quality/ ”Quality by Design” / All Participate

Six SigmaData

Reduce Variation and Errors

”World Class” Product Quality

Design for Six Sigma / Expert Driven

ISODocument

Documentation /Traceability/ Accreditation/ Certifying

Quality Through Control / Regular Audits (internal/external)

Apply to Standards / Weak Focus on Process (traditional)

Tendency to Hamper Improvement Culture

Lean is

Right Brain

Thinking

Six Sigma

is Left Brain

Thinking

Quality is Data driven Improvement

Taiichi Ohno

Father of the Toyota Production System (TPS)

Toyota system is; “profit-making industrial engineering”

Reduce the time from committing money to the raw materials to when collect money from customers“Cash Flow”

”Design for best quality to lowest price”

”Mobilize all intelligence in the organization to meet our purpose”

Lean Heritage from TPS

“Yet the most powerful aspect

of LEAN

is not what participants do to

add to improve a process but what

they remove from the process

to improve it”

Lean Pillars for Lean Culture:

1) Continuous Improvement

2) Respect People

Appreciate peoples brains

Job satisfaction motivates, self

respect reduces

negative Stress

“Lean IS Healthcare”

No Zero Sum but Win-Win !

BusinessValue

“(Cost)”

Quality in

Process

“(Quality)”

Customer Value

“(Delivery) “

Staff Value

“(Motivation)”

Input - Process - Output• Quality in raw material/sample

• Quality in process

• Product Quality

Allways improved Quality/Value to

Lower Price

Do not sell

out Quality

Kaizen

Board

Process VSM 5S 5W PDCA/A3

JITDayly

SteeringTakt time

Spagetti

map

Onepiece

Flow

Flow Mäta Transformation Team Pull

MuraMuda Muri Root Cause

Initiate first

Kaizen

feeling among

staff

”Lean Thinking”

<”Lean Toolbox”

First Kaizen Culture then Tools

Initiate first

Kaizen

feeling among

staff

”Lean Thinking”

<”Lean Toolbox”

First Kaizen Culture then Tools

Initiate first

Kaizen

feeling among

staff

”Lean Thinking”

VSMSpagetti map

5S/5W

PDCA/A3

Flow

Measure

<”Lean Toolbox”

First Kaizen Culture then Tools

Selected

Tools

Abandon Command and Control Culture (No Blame)

Cease dependence on inspections for quality

Empower people to continuously improve quality

Establish Lean Coach, Facilitator, Change Agent

Pull according to Need - do not Push !

First Kaizen Culture then Tools

Lean Design Healthcare

Enterprise

Integrated Delivery System

1. Understand ”Big Picture”

2. Utilize Industrial Maturity Model for Management Quality,

Competence and Skills

3. Design Education and R&D for right Knowledge, Science

and improvement Culture

4. Lean Value Stream Design all interconnected Processes

involving all Stakeholders (Extended Value Stream)

5. Deliver right Care and Health/Wellness Support

Design System for Value and Flow

Industrial Quality and Management Maturity

1 Sokratic direction

”Dialogue”

2 B Franklin ”No waste”

3 F Taylor ”Scientific

Management”

4 H Ford ”Assembly line –

Process for

Massproduction”

5 E Deming – Total Quality

Management”

6 J Juran ”The Quality

Triangle”

7 Toyoda – ”TPS . Toyota

Production System”

8 Womack/Jones/ Seddon –

”Lean Production /

Services”

9 B Smith, “Six Sigma”

10 JH Holland ”CAS Biology

Systems Thinking”

11 “CEN- ISO regulation”

Global/Individual

Patient need of

Medical Cure

Global/Individual

Patient need of

Health - Wellness

MedicalDiagnostics

Academia

R & D for

New Biology

Knowledge

Medical

Applications

Academia

Education for

Adequate

Practice

Focus on Relevant

Knowledge, Dismiss

Irrelevant Knowledge

Pharma

Industry

Medical Devise

Industry

In Vitro

Diagnostic

Industry

IT/ICT/IST

Indsutry

Health

Wellness

Industry

Understanding the Big Picture and NeedsIdentify relevant Problems to Solve

Base Decisions on Data

Add Resources

Act

Clinical Specialities

People

Processes

Purpose

Waste

Out

Waste

Ou

t

Waste

Ou

t

The Lean House

of

Individual/Global

Healthcare

Design for Flow

Manage all Parts that Interact

Look for waste !

”Best Care at Lower

Cost”

Report IOM USA

2012

Category Sources Excess CostsUnnecessary Services 210 billion US

Inefficiently delivered Services 130 billion US

Excess Administrative Costs 190 billion US

Prices That are Too High 105 billion US

Missed Prevention Opportunities 55 billion US

Fraud 75 billion US

Total 765 billion US

5 202 000 000 000 Skr

Science and Technology

Revolution

New Possibilities – New

Demands

Intuitive Healthcare

Empirical Healthcare

Precision Healthcare

Patient Participation

The Ecological Approach

”The New Biology”

Health, Food, Energy, Environment

Medical Diagnostics support Integrative and

Functional MedicinePersonalized Medicine, Pharmaco- and Nutrigenomics

New Business Paradigm

Power through Collaboration

In Complex Organizations Capability

and Capacity depends on

Relationship Management and

Collaboration in Multifunctional

Teams

Extended Value Stream

The intelligent PatientThe well informed PatientPatient Health AwarenessPatient as Health ConsumerPatient as a Healthcare Professional

Doctor as ConsultantHealthcare professional Team effort

Changing Roles in Healthcare –Customer Always in Focus

New Roles

Access Healthcare Information

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Patient Mobilisation

Lean Design and

Innovation

Medical Diagnostics

Common Purpose

Lean HealthcarePatient Experience/Flow/Security/Medical and Operational Excellence

Customer/Patient level

Radiology”Imaging”

Physiol. Laboratory Medicine

TissuesCells

Micro-Organisms

Biological Fluids

MoleculesNucleic acids

Biochemistry

Toxicology

Hematology

Coagulation

Immunology

Transfusion Med

Virology

Physiology

Histopathology

Imaging

Cytology

Medical Diagnostics Services Integrated

Lead, Improve, Innovate, Transform, Drive Change

Service level

Integratedinformation

Integrated Production

Level

IntegratedScientificMedical

Knowledge Base

Skills

BacteriologySerology

Diagnostic, Scientific, Operational, Managerial

Pharmacology

1

2

3

4

5

6

7Develope the Medical Diagnostics Knowledge Worker through

Collaboration and Shared Purpose

Core, Rapid Response, POC Functions

Key Qualities

• Integrate

• Consolidate

• Automate

• Share

Knowledge

• Mobilize all

intelligence in

organization

• Continuously

learn

Integrate Diagnostic Services

Design End to End Processes (Lean Six Sigma)

Key Deliveries 1) Order, 2) Sample material, 3) ReportCorrect from me in every step KPIs for Flow, Timing, Continuous improvenet, Team efforts

Improve and

Innovate;• Methods

• Process design

• Flow, Value

• Team

• Autonomate(Instrumentation/IT)

Potential TAT within 24

hours (TAT = Turn Around Time)

Sample

Quality WorkCellFLOW - Autonomate

No

Delay

Lean Histopathology - Model

Repeat

Improve and

Innovate;• Methods

• Process design

• Flow, Value

• Team

• Autonomate(Instrumentation/IT)

Potential TAT within 24

hours (TAT = Turn Around Time)

Lean Bacteriology - Model

Organize for Single Unit Patient Flow !

Lean Healthcare.org

LEAN for the patient

would change

Health Care forever.

Klaus Schipper Med Dr, Viborg, Danmark, 2010

Central vs Decentralized

Patient in real Focus ?

Scientific

Depth

Diagnostic

Excellence

Operational

Excellence

Management

Leadership

The Diagnostic Team

Educate for Team Effort

Basic Common Design

Lean Organization

and

Biological System

Hierarchy of a Biological System

Gastrointestinal Tract

Microbiome, Skin, Environment

Top Brain, Hypothalamus,

Pituitary,

Pineal

MiddleEndocrine

Organs

Front LineOrgans

Tissues

Cells)

Blood

Cells

Plasma

Nutrients

Hormones Interstitial

fluid

O2/CO2

Re/Ox, pH

ElectrolytesProteinsXYZ

Hormones

Vitamins

Metal Ions

Carbohydrates

Amino Acids

Lipids

Complex

Signaling

Complex

Crosstalk

Sensing Environment

Stimulating

Hormones

Releasing

Hormones

Autonomous

Activities

Neural

Signaling

Biological System vs Lean System

Biology

System

Hierarchy

Lean System

Hierarchy

Top Down

Bottom up

Lean Leadership

Transforming Leadership

Traditional

Manager

Future

Leader

The Lean Organisation - Model

Cell

Tissue

Testing

Testing

Biological

Fluids

Cultivation

Blood

Donation

Trans. Med

The Meeting Point

Direction through Why ?

Why ? Identifies Purpose - Sets Direction

Direction through Why ?

5 Why

Why ? Finds the Root Cause

Focuses the Countermeasure

Fractal Thinking

In Depth Analysis

World Class Lean Organization

IT/ HR/Procurement/Accounting

Lean DilemmaLean and Nature Manage

• Need

• Risk

• Damage

• Repair

Traditional Industry Manage

• Financial Bottom Line

Design Lean Healthcare

System

New Roleof Leadership – Quantum Lead

Fronline Autonomy - Sustained Teams

Improve and Innovate Complex Value Streams

System - Synchronization

Core – Discipline Integrated Central Function

RRL – Rapid Response Function

POCT – Function at Point of Decision

System Lean Healthcare

System - Flow

Components of Flow / Lab

Patients

Clinical Information

Sample material

• Biological fluids

• Cultivation

• Tissues

• Nucleic Acids

Deliveries / LabMedical Excellence

Patient security

Data

Information

Knowledge

Fast - Timely

Coordinated

Correct – no Error

Reproducible

Operational Excellence

Medical Excellence

Patient security

Data

Information

Knowledge

Fast - Timely

Coordinated

Correct – no Error

Reproducible

Operational Excellence

Patients

Clinical Information

Sample material

• Biological fluids

• Cultivation

• Tissues• Nucleic Acids

”Lean Management” (System value)

”Lean Operations ” (Process value)

Lean

Customer Service

Lean

Human Resources Lean ITLean

Procurement

Lean

Accounting

Start

Input Output

Medical DiagnosticsRadiology, Physiology

Laboratory Medicine

Goal

System Lean Healthcare

System - Connectedness

Top Down

Bottom Up

System – Diagnostic Work Station – Patient Focus

• Historic• Intelligent• Standardized

EHR, EMR, EPR

RIS/PACS/LIS/LIMS

Disciplin Integrated

Single Patient Flow

”Cloud Computing – abundant but waste free data flow”

”Lean for the Information Age”

System – Access and Share

Manage Change

Responsibility

Accountability

Committed

Respected

“Your vision becomes your beliefsYour beliefs become your thoughtsYour thoughts become your wordsYour words become your actionsYour actions become your habitsYour habits become your valuesYour values become your destiny”

Mahatma Gandhi

The test question is:

Am I working with or against

nature?

Manage Change

Toyota Kata

Nature and Healthcare are Fractal

Autonomous Lean Cell in a Fractal Organization

Autonomation = Automation

with a human touch for a better life

Create the Medical Diagnostic

Konwledge Worker in Team Organization

Balancing left with right

Make it Simple but not Simpler

Lean is the Biology of Business

TPS Approach

Classic Drucker

A Einstein

Learn from Nature - Work with Nature - Altruism - No Ego

Weight 2 - 20 g 50 - 110 kg

Heart size (% wight) 2,43 0,31

Heart beat / min 300 - 1000 70 - 120

Lifetime O2 cons. L / kg 500 000 180 000

Lifespan /years 10 80

Rel. Longevity / kg 200 1

Hummingbird versus Working Man / Team

Lean is the Biology of Business

System design

The Question is How

do we Become more

like Birds ?

Lean Ceases to be Lean when

used for Bad

Biology dies when abused

Business fails when driven by

Greed

Lean is the Biology of

BusinessDesign Pull Systems – Do Not Push !

Tom.Pettersson60@gmail.comContact:

Appendix: Proposed Change Agenda

1. Improve Patient Involvement in Care and Health Process – Individualized / Personalized Medicine – Patient Role as a

Profession

2. Transfer Healthcare / Medical Diagnostics Focus towards Prevention and Culture of Wellness – Integrative and Functional

Medicine shifting Mindset from fragmented (reductionist) to a holistic (quantum) View

3. Foster Healthcare Organization in Continuous Learning, Respect for People and continuous Work Process Improvement for

a better Life – Healthcare Kaizen

4. Design Healthcare / Medical Diagnostic system for Patient Flow and Flow of Work – Lean /Complex Adaptive System (CAS)

oriented Healthcare

5. Design Laboratory Processes for Analytical Material Flow and timely Delivery of Reports through Integration, Consolidation,

Autonomation (= Automation with a human touch) and Multifunctional Operational Teams – Lean Laboratory Medicine

6. Utilize new Technology and Biological Knowledge in Genome, Proteome, Metabolome and Microbiome for new Diagnostic

Applications – The New Biology, Systems Thinking and Science Integration

7. Designing IT / ICT / IST for Process Management, Flow of Data, Access of Information and Knowledge Sharing – Lean

Process Design for Lean IT, Impact of Internet and Social Media

8. Transforming Leadership towards Teaching, Coaching, Motivation and Self-sustaining / Empowered Operational Teams –

Lean Management / Quantum Leadership

9. Shifting Quality Focus from End Product to Process Quality through Continuous Improvement Culture for Medical

Excellence, Operational Excellence and Patient Safety – Lean Six Sigma and ISO Synchronization

10.Shifting Healthcare / Medical Diagnostic Operations towards a Biological Adaptive Business Model generating Power

through Collaboration – Participation, Responsibility, Accountability, Flexibility and Growth

11.Developing Relationship IT / IVD Industry, Medical Diagnostics Laboratory and Healthcare for Innovation - Lean Extended

Value Stream and Innovation Sourcing, Ecological Approach

12.Educational Programs for improving Diagnostic and Scientific Knowledge Base , Operational Management Competence and

Skills for Team Operations, Productivity and Value for Money – Lean / Biological Systems Thinking / Lean Higher Education