Can

Lean improve your laboratory?

Immunology

The Management of Change

"Lean is about continuously developing people and improving processes to create and flow value to customers using the least possible resources required."

“Here is Edward Bear, coming downstairs now, bump, bump, bump, on the back of his head, behind Christopher Robin.  It is, as far as he knows, the only way of coming down-stairs, but sometimes he feels that there really is another way, if only he could stop bumping for a moment and think of it.”

Unconscious incompetenceConscious incompetenceConscious competenceUnconscious competence

• Lean tools

• Developing people

“When a company engages its people in problem solving as part of their daily work, they feel more motivated, they do their jobs better, the organization’s performance improves, and a virtuous cycle starts to turn”.

A lean transformation must keep an even balance…..

‘Tools’

TECHNICAL

‘People’

CULTURAL

Too much emphasis on tools and methods….

Extensive use of “tools”Use of Japanese terms and conceptsSome processes made more efficientLean belongs to a few enthusiasts

TECHNICAL

Failure to embed or spreadResistance to changeResults not sustainedNo overall transformation

CULTURAL

If Cultural concerns predominate….

Failure to establish flowLack of rigour in use of toolsLean “speak” without true understandingFull potential not realised

TECHNICAL Temporary feel good factor createdBetter teamworkIncreased levels of involvementBut hard to sustain without results

CULTURAL

Continuous Improvement Toolbox

Value Stream Mapping

Pull Systems

5S System Layout

Setup Reduction

Teams

Visual Controls

POUSStandardized Work

Quality at the Source Continuous Flow

Work Cells Performance MeasurementTPM

Batch Size Reduction

Lean

Too

ls

Batch logic v Flow Logic

SPF

Ba

tch 1

2

3

3

2

1

Assumptions:• 3 Operators• 3 processes• 1 min per process• 0 min Move Time• 10 specimens

10m 20m 30m

Batch21”30”

SPF 3”12”First

resultLast result

Band 6 microtomy

Trust objectivesManagement reviewObjectivesAnnual AppraisalDaily huddlesSuggestions

Alig

nmen

tA

lignment

Directorate of Laboratory Medicine Cellular Pathology Page 1 of 1 Cell-Path-Appraisal-003 Revision Version: 3

Professional and Leadership Behaviours

Appraisal self-assessment form Name: ................................................ Date of IPR: ............................................ Return form to: ................................................ By: ............................................ VALUES BASED PERFORMANCE MANAGEMENT POINTS FOR DISCUSSION Please complete the following statements reflecting on your overall performance throughout the period under review. Use 1 for Always Use 2 for Most of the time Use 3 for Rarely Use 4 for Never

Our Values

Quality

Motto

Employee Promise

Declaration

Doing the RIGHT thing

the

RIGHT way

at the

RIGHT time

Quality is doing it right when no one is looking

Continually striving for

ZERO DEFECTS

to be the

BEST in CLASS

LABORATORY

in the world

Together we will strive

for

PERFECTION

by applying principles of mutual respect,

integrity, understanding, cooperation and

effective communication

I am

EMPOWERED

to work with my

colleagues to make changes, based on Lean principles, to

make things right for ourselves, our

clinician customers and our patients

• Involve operators in improving their workplace

• ‘We make people before we make reports’• Every lab is different but all human beings

share the same capabilities and potentials• Develop problem solving in every person –

not apply lean tools to every process

• Zero quality control• Zero defects• Enable employees to do quality work and

ensure perfection every time

Never accept, make or pass on a defect

• Need FACTS to make decisions

• ‘If you can’t measure it, you can’t improve it’

• ‘100 audit’

Service Improvement Team• Reps from each section and grade 2/52• Sub groups – small and focussed

• use PDCA, DMAIC, A3• report to main group to…

– show progress – seek authorisation– share the gain

4.14.4 Staff suggestions

Patient Safety

Briefing

1. Avoid reliance on memory2. Make things visible3. Review and simplify processes4. Standardise common processes

and procedures5. Routinely use checklists6. Decrease the reliance on vigilance

Apply human factors thinking to your work environment

“Problems”Or is it… “Issues” or “Opportunities”?

• Engagement; what’s in it for me?• Not lean from my perspective• Right first time. Better slower and correct

than have to solve error, correct and rework. ? = license to under perform.

• “When everyone’s super – no one will be.” - Team not individual

Can Lean improve your laboratory?

LeadershipAwareness of toolsEmployee involvementSet cultureAMRObjectivesAnnual AppraisalSuggestionsDaily huddles

Go see, ask why?

respect people

Go see, ask why?

respect people

Questions?Terry.coaker@nuth.nhs.uk

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Average of TAT Receipt to stain

Issue

Average of TAT Stain Issue to

AuthAverage of Total

Tat

2010-05 13:17:08 61:51:31 150:34:15 225:42:542011-05 15:36:30 51:23:08 145:12:50 212:12:282012-05 13:31:56 48:57:02 117:20:27 179:48:192013-05 9:07:54 51:26:46 171:28:50 232:03:302014-05 10:23:39 52:32:24 148:42:33 211:38:362015-05 11:19:56 55:28:57 158:57:13 225:46:05