From the Boardroom to the Patient Room: Alignment through...
Transcript of From the Boardroom to the Patient Room: Alignment through...
![Page 1: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/1.jpg)
From the Boardroom to the Patient Room: Alignment through
Lean Management Systems
![Page 2: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/2.jpg)
What is Lean?
![Page 3: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/3.jpg)
Why Lean?
![Page 4: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/4.jpg)
Start from need.
![Page 5: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/5.jpg)
What problem are we trying to solve?
![Page 6: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/6.jpg)
What is Lean?
![Page 7: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/7.jpg)
![Page 8: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/8.jpg)
5S
Value Stream Maps
Standardized Work
Kanban
Visual Management
A3s
![Page 9: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/9.jpg)
Management System
Philosophy
Culture
Thinking
Mindsets
![Page 10: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/10.jpg)
![Page 11: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/11.jpg)
Iterative PDSA Improvements
One improvement often leads to another
Source: Healthcare Kaizen
Ideas
Improvements
![Page 12: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/12.jpg)
What is TPS?(The Toyota Production System)
![Page 13: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/13.jpg)
![Page 14: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/14.jpg)
What is TPS Philosophy?
• Customer first– Provide customers with what they want, when they want it,
and in the amount they want it
• People are the most valuable resource– Deeply respect, engage, and develop people
• Continuous improvement (kaizen)– Engage everyone each and every day
• Shop floor (gemba) focus– Go to where the work is done to find & solve problems
![Page 15: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/15.jpg)
What’s a Management System?
• What are leaders expected to do?
• How are leaders expected TO BE?– Is there clear alignment? Are there gaps?
– Or "just get results"???
• How is this taught, modeled, and reinforced?– What happens when there are gaps?
![Page 16: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/16.jpg)
Why a Lean Management
System?
![Page 17: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/17.jpg)
Creating a Lean Culture
• What are the gaps? How large are they?
• How long to close the gaps?
– In culture & performance?
![Page 18: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/18.jpg)
Strategy Deployment in Healthcare(Scott & White)
![Page 19: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/19.jpg)
Pascal Dennis Books
![Page 20: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/20.jpg)
What is Strategy Deployment?
• Aka "Hoshin Kanri"– Hoshin = "compass"
– Kanri = "management" or "control"
• "A process for embedding strategy and aligning an organization toward common goals"
• Developed by Dr. Yoji Akao– (Yokogawa Hewlett-Packard)
![Page 21: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/21.jpg)
Strategy Deployment Process
1. Study the situation
2. Focus on vital few priorities
3. Ask employees to develop plans for how to close gaps
4. Specify means and measures to close gaps
– Link metrics through the organization
5. Make cause and effect relationships visible
6. Iteratively zero in on strategic objectives (PDSA)
Source : The Management Compass, Bechtell
![Page 22: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/22.jpg)
Strategy Deployment = PDSA
• Using PDSA cycles to:– Create goals
– Choose measurement points
– Link daily activities to high level goals
– Drive results & learning
![Page 23: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/23.jpg)
NOT "Goal Deployment"
• Management by Objectives
– Top down (unidirectional)
– Focuses on rear-view mirror results
– Little effort to understand or improve the system
– Often used as threat to improve performance (or else!)
– Often unlinked (department budgets not tied to overall plan)
Source : The Management Compass, Bechtell
![Page 24: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/24.jpg)
"Catch Ball"
Source: Lean Hospitals, Graban
![Page 25: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/25.jpg)
The Role of Leaders
• Define purpose clearly
• Identify the biggest obstacles
• Create an atmosphere conducive to initiative and creativity
• Reduce hassle
• Lead by example! Model behaviors. Teach
Source (1-4): Andy & Me and the Hospital (Dennis)
![Page 26: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/26.jpg)
"True North"
• Broad goals and direction
– "Brief expression of direction, purpose, commitment, and values"
– "What we should do, not what we can do"
– Speaks to the heart
![Page 27: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/27.jpg)
"True North" Statements• "No wait, no harm."• "Eliminate all unnecessary death or illness."• "Measurably better value."• "To provide high-quality healthcare to all, regardless of
their ability to pay."• "____ will care for patients the way we want members of
our own families to be treated, while advancing humanity's ability to alleviate human suffering caused by disease. We will provide the right care in the right environment and at the right time, eliminating waste and maximizing value."
![Page 28: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/28.jpg)
Strategy Deployment Questions
• What metrics (<10) are the best indicators of organizational health and progress toward True North?
• Where are the biggest gaps in performance?– Where do we need to raise the bar?
• What are doing to close those gaps?
• What progress are you making?
• Are you getting the results you predicted?
• What are you learning? How are you adjusting?
![Page 29: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/29.jpg)
Strategy Deployment as a Series of Hypotheses
Hypothesis #1:
If we focus our improvement efforts and close performance gaps in these four (or five) areas, we will therefore perform well as an organization, this year and over the long-term.
http://www.leanblog.org/SD1
![Page 30: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/30.jpg)
"True North" Focus Areas
Source: ThedaCare
![Page 31: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/31.jpg)
SAFETY & QUALITY
PEOPLEPATIENT SERVICE
FINANCIAL
TRUE NORTH WALL
![Page 32: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/32.jpg)
Building Consensus
![Page 33: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/33.jpg)
Lessons Learned
• Don’t copy others’ True North
• Go through the process of gaining consensus around what these should be
• True North must resonate with your people
• "The best strategy deployment system in the world doesn’t make up for the wrong strategy." (Toussaint)
![Page 34: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/34.jpg)
Strategy Deployment as a Series of Hypotheses
Hypothesis #2:
If we can improve and close our performance gaps in these key performance indicators, we will satisfy our need for improvement in our key focus areas, and therefore we will be successful as an organization, overall.
http://www.leanblog.org/SD1
![Page 35: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/35.jpg)
"True North" Metrics
Source: ThedaCare
![Page 36: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/36.jpg)
System Level Metrics
Source: Thinking Lean at ThedaCare (DVD)
![Page 37: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/37.jpg)
Annual PDSA Cycles
• Goals & Metrics
– How did we perform?
– Why did we have that performance?
– Were those the right goals?
– Are these still the right goals?
![Page 38: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/38.jpg)
SAFETY & QUALITY
PEOPLEPATIENT SERVICE
FINANCIAL
TRUE NORTH WALL
STRATEGY A3
STRATEGY A3
STRATEGY A3
a.k.a. "MOTHER"
A3
MEASURE 1
MEASURE 2
MEASURE 3
MEASURE 1
MEASURE 2
MEASURE 1
MEASURE 2
MEASURE 1
MEASURE 2
MEASURE 4
MEASURE 3
MEASURE 3
MEASURE 4
![Page 39: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/39.jpg)
The A3 Management Discipline
Heading
PlanDo
Study Adjust
Footnotes
17"
11"
A3 (PDSA) Story Board
Cycles of learning and continuous process improvementDeveloping people and improving processes
Plan(Hypothesis)
Do(Try)
Study(Reflect)
Adjust(Act/Adjust/Abandon)
Grasp the Situation
![Page 40: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/40.jpg)
Strategy A3
![Page 41: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/41.jpg)
Initial Strategy A3 Work
![Page 42: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/42.jpg)
"Breakthrough A3" - Safety
• Expect 20 to 50% improvement in these breakthrough A3s
![Page 43: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/43.jpg)
True North Can Evolve
11/1/12 Rev: 10
Safety• System Patient Safety Bundle• D.A.R.T
People• Engagement Index• Health Assessment Score
Customer"Lori"
• Customer Loyalty Score
© 2011 ThedaCare
Financial Stewardship• Operating Margin• Productivity
Quality• Preventable Mortality• 30 Day Readmission
&
![Page 44: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/44.jpg)
Align Measures Throughout the Organization
Improve Safety
Inpatient
Med/Surg Telemetry
Outpatient
Clinics
Clinic A
Physician A Physician B
Clinic B
Surgery
Emergency
Dept
Patient & Employee
Sprains & Strains
Patient Falls
![Page 45: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/45.jpg)
Tiered Metrics (3 Levels)
Source: Group Health Cooperative
Office
Clinic
Primary Care Group (26 clinics)
![Page 46: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/46.jpg)
Daily Management Boards
![Page 47: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/47.jpg)
Lessons Learned
• KPI = KEY Performance Indicator– Tracking more metrics isn’t always better
• Don’t copy: gain consensus on the metrics
• Focus on metrics that are best indicators of progress & gap closure
• Is it worth arguing too much over exact goals?
• Get alignment, not everybody measuring the exact same thing
![Page 48: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/48.jpg)
Strategy Deployment as a Series of Hypotheses
Hypothesis #3:
If we actually execute and complete these top X initiatives, projects, events, and A3s, then we will make the greatest strides toward closing the key performance gaps (from Hypothesis #2) and therefore we’ll be more successful in our strategy.
http://www.leanblog.org/SD2
![Page 49: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/49.jpg)
Prioritization is a Must
• What are the "must do, can’t fail"initiatives for our organization?
![Page 50: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/50.jpg)
A Generalization…
• Most organizations have too many:– "High priority" or
– "Top priority" initiatives / projects
• Does any initiative get rejected or postponed?
• How many of our top priority projects are getting completed??Photo: Dr. John Toussaint
![Page 51: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/51.jpg)
"Deselecting"• Don’t implement every idea at once (Focus)
• Deselect if it doesn’t meet immediate value stream project criteria
Source: ThedaCare
![Page 52: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/52.jpg)
Project A3
![Page 53: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/53.jpg)
BABY A3 #1
BABY A3 #2
BABY A3 #3
BABY A3 #4
BABY A3 #5
BABY A3s
BABY A3 #7
BABY A3 #8
BABY A3 #9
BABY A3 #10
BABY A3 #12
BABY A3 #13
BABY A3 #14
BABY A3 #15
BABY A3 #17
BABY A3 #18
BABY A3 #19
a.k.a"TACTICAL A3"
#20
BABY A3 #6
BABY A3 #11
BABY A3 #16
![Page 54: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/54.jpg)
Nursing Unit Board
Source: Thinking Lean at ThedaCare (DVD)
![Page 55: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/55.jpg)
Six Sigma
Projects
Large
Kaizen
MediumKaizen
Small
Kaizen
LeanEvents
Circle size is meant to roughly represent relative size of effort; Blue = tracked top initiatives ("Baby A3s")
Com
ple
xity
Daily Kaizen
Women
& Children’s
3P
Electronic
Medical
Record
ImplementationNew
Bed Tower
3 Types of Kaizen
![Page 56: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/56.jpg)
Lessons Learned
• Don’t take on too much
• Gaining consensus on this takes a lot of time, too
• Maybe err on the side of "too few" key initiatives?
• Stop jumping to solutions!
• Don’t let "alignment" stifle Kaizen
![Page 57: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/57.jpg)
Strategy Deployment as a Series of Hypotheses
Hypothesis #4:
We actually have the organizational capacity to complete these X top priorities in a year or a given timeframe (and with the right quality).
http://www.leanblog.org/SD2
![Page 58: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/58.jpg)
PDSA Review Cycles
• Using PDSA cycles to:– Check progress on:
• Activity
• Results
• Lessons learned
![Page 59: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/59.jpg)
Mid-Year Review
• Old management approach:
– Get the results, no matter what!
– Get the results, or else!
– I don’t care what you did, I’m happy you got the results
![Page 60: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/60.jpg)
Mid-Year Review
• Lean / S.D. / A3 / PDSA Approach:
– If "Red" (not meeting target), ask:
• Did we do what we said we’d do, but didn’t get results?– Do we understand why?
– What did we learn?
• Did we NOT do what we said we’d do?– Do we understand why?
– What did we learn?
![Page 61: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/61.jpg)
Mid-Year Review
• Lean / S.D. / A3 / PDSA Approach:
– If "Green" (meeting target), ask:
• Did we do what we said we’d do, and got results?– What did we learn?
• Did we NOT do what we said we’d do, but stilll got results?
– Do we understand why?
– What did we learn?
![Page 62: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/62.jpg)
Traditional ApproachGot Results
Didn’t Get Results
![Page 63: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/63.jpg)
Lean Approach
Didn’t follow process Did follow process
Got Results
Didn’t Get Results
![Page 64: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/64.jpg)
Lessons Learned
• Don’t be confused by a single data point versus a sustained trend in results
• Don’t wait until the end of the year to say, "Oops…"
• PDSA – Study capacity and progress– Adjust as needed
• If there’s a new "top priority" initiative, what are you going to deselect?
![Page 65: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/65.jpg)
Our 4 Hypotheses1. We have the right
True North & categories2. We’ve chosen the
right metrics & gaps3. We’ve chosen the
right initiatives4. We have the right capacity
to execute them
![Page 66: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/66.jpg)
S.D. Wall
KPIs
Huddles
Rapid Improvement Events
A3s
Kaizen Board
![Page 67: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/67.jpg)
Management System
Philosophy
Culture
Thinking
Mindsets
![Page 68: From the Boardroom to the Patient Room: Alignment through ...polesante.hec.ca/wp-content/uploads/2016/08/Mark... · – Hoshin = "compass" – Kanri = "management" or "control" •](https://reader035.fdocuments.us/reader035/viewer/2022071005/5fc22fb0ffa61f27cd070415/html5/thumbnails/68.jpg)
Q&A / Contact Info
• www.MarkGraban.com
• www.LeanBlog.org
www.PracticingLean.com