Core Values (Ground Rules: What We Value)
Across all Lean training, a consistent set of values is emphasized:
Integrity: Being “honest and authentic” and “accountable for your own learning.”
Equity: Ensuring “everyone has a chance to speak, listen to their opinions,” and accepting “that people may have different views and see value in them.”
Caring: Being “in the moment with the people around you” and showing “curiosity and compassion for others.”
Excellence: “Work hard today! Put forth extra effort to get the most out of your learning” and “Exhibit your best ‘learning self’ and help others learn, too.”
Safety: Being “courageous in sharing so that others feel safe in sharing with you.”
The 5S System: Organizing for Efficiency
The 5S system is presented as a foundational element for a “safe and efficient workplace,” organizing “the workplace from the functional to the physical aspect.” It aims to reduce waste, optimize productivity, and promote safety and quality.
The 5S Steps:
The “5S’s that outline the 5S journey” are:
Sort: “Identify and eliminate unneeded items.” This involves a “RED TAG’ Process,” where a bright, visible red tag signals that an item should be removed from the work area. Disposition guidelines include disposing of obsolete or defective items, relocating unneeded items, and storing useful items based on frequency of use (Daily, Weekly, Monthly, Seldom Used).
Set in Order: “Organize for safety and efficiency.” This step emphasizes “A place for everything…and everything in its place!” It includes using labels, separators, and pictures. Items used daily should be kept close, weekly used items in a local location, and monthly/seldom used items in a remote location.
Shine: “Regular Cleaning and Inspection.” The principle is, “When an area is clean…you can see when its dirty!”
Standardize: “Regularly identify and remove unneeded items, cleaning schedule, standards in place for maintaining order (color code, labels, other).” This step is about making the first three S’s into rules for how and when tasks are performed, ensuring “Everything in a state of readiness.” An example is the “5-minute 5S” checklist, where zone owners complete and initial tasks daily.
Sustain: This is crucial because “5S will not work for long without a commitment to sustain.” It involves creating a “culture of 5S,” making it part of “Standard Work and address it at huddles,” engaging the “whole team,” conducting “Gemba walk with teams,” and recognizing/celebrating sustained efforts.
5S Benefits:
Safety: Reduces “lost time accidents, worker’s compensation claims and work-related injuries, illnesses and exposures.”
Quality: Eliminates the “possibility of using incorrect materials/tools/information” and assures “compliance to standards.”
Productivity: Eliminates “wasted time searching for tools/supplies/information,” reduces “process time,” and reduces “equipment downtime through regular cleaning and inspection.”
Observed Problems (Current State) and Countermeasures:
Common issues addressed by 5S include:
Problems: Outdated forms, handwritten notes, redundant info/materials, unorganized spaces, searching/motion waste, and “hiding” places.
Root Causes: Lack of ownership for information/common areas, no established locations, no regular purging, and no established maintenance routine.
Countermeasure: “Initiate this workplace organization system (5S) at Workstations, Labs, Exam Rooms, Offices…really anywhere!”
Future State: Reduced searching waste, improved workflow efficiency, a safer workspace, and process transparency & stability.
The 8 Wastes (DOWNTIME): Learning to See Value
Lean aims to eliminate “Waste,” defined as “Non-Value-Added Activities.” It’s noted that “Most tasks contain up to 90% non-value added activities.” The “DOWNTIME” acronym helps identify these wastes:
Defects: “Inaccurate/ Incomplete work units; Rework.” Example: “Surgical case cart missing an item; wrong medicine or wrong dose administered to patient.”
Overproduction: “Producing faster, earlier, or in more quantity than needed.” Example: “Doing unnecessary diagnostic procedures.”
Waiting: “Idle time when information/people/materials/equipment are not ready.” Example: “Employees waiting because workloads are not level; patients waiting for an appointment.”
Non-respectful Behaviors: “Behaviors that do not contribute to Respect for People or utilize employees’ skillsets.” Example: “Employees get burnt out and quit giving suggestions for improvement.”
Transportation: “Handoffs & movement of patients/customers.” Example: “Poor layout, such as the catheter lab being located a long distance from the ED.”
Inventory: “Excessive/Inadequate stock of work units, supplies, etc.” Example: “Expired supplies that must be disposed of, such as out-of-date medications.”
Motion: “Movement of staff or organizational resources.” Example: “Lab employees walking miles per day due to poor layout.”
Excess-processing: “Unnecessary activities within the process itself.” Example: “Time/date stamps put onto forms, but the data are never used.”
The “Waste Wheel” is a tool to help teams identify and categorize waste within their work, fostering problem-solving by considering the root cause before creating countermeasures.
Visual Huddle Board Training
Huddle Boards are a key tool for “Engaging our Colleagues in what matters most” and running effective daily management. The objective is to enable participants to “Understand the 3 sections of the Lean Visual Management Huddle Board,” “Be able to return to your department and run a huddle,” and “Learn strategies to engage our colleagues in continuous improvement.”
Why Huddle?
The goal is to drive “Sustainable results require a culture in which every person is involved in making improvements everyday” (Shingo Model). Huddles facilitate open communication, problem identification, and collective problem-solving.
The 3 Sections of the Huddle Board:
Communication Section:
Recognition: Starting with recognition fosters a positive environment and encourages engagement.
Announcements: Sharing critical updates (e.g., “Schedule changes,” “Staffing updates,” “Safety considerations,” “Barriers to providing care/services”).
Daily Playbook: Customizing daily information relevant to the group’s needs.
Standard Work Observation: Used to “validate what?” is being done. This involves observing adherence to standard work processes (e.g., work instructions, SOPs, videos). If no changes are observed, mark with a check; if changes, mark with a delta and discuss. The focus is always “on the process, not the people.” “Without standards, there can be no improvement.” – Taiichi Ohno.
Driver Section (Heart of the Huddle Board):
Driver Header: Provides a “Clear, Fast, Visual!” overview of whether target goals were met (Green = met, Red = not met).
Trend Chart: Visualizes performance over time to identify trends. It prompts questions like “How are we doing?” and “Do you see any trends?”
Root Cause Frequency Chart: If a target is missed (RED), this section helps identify “Why?” by asking staff for their input on “your biggest barrier to success.”
Countermeasure Newspaper: Brainstorms and records “ideas you have to fix the root cause,” again, soliciting staff input.
Improvement Section: This section systematically addresses identified opportunities for improvement. The order of discussion is specific:
Just Do It’s (JDI’s): Quick, immediate actions.
A3’s: More complex problem-solving initiatives (a Lean tool).
Submitted Opportunity Cards: Tracking and reviewing new ideas.
PICK Chart: A tool for prioritizing improvements based on Impact and Effort.
Monitoring: Tracking progress of ongoing initiatives.
Learning Moments: Sharing new knowledge, policies, procedures, or customer experience tips.
Achievements: Celebrating “Completed Opportunity Cards” and other successes, reinforcing positive behaviors and team morale. This section is vital for ending on a positive note.
Interconnectedness and Continuous Learning
The Lean principles and tools (5S, 8 Wastes, Huddle Boards) are interconnected. For example, 5S is a “Standard” to “reduce waste,” which directly relates to identifying and eliminating the “8 Wastes.” Huddle Boards provide the daily forum to discuss performance against targets, identify root causes for unmet goals, and implement countermeasures, thereby driving continuous improvement, which is a core tenet of Lean (”Lean is about Respect for People and Continuous Improvement”). The emphasis on “Respect for People” is woven throughout, from the ground rules to encouraging staff input in waste identification and problem-solving during huddles.
