Synchronous Flow Workshop by BsAi21Pn


									Going with the flow
The Journey to Continuous
   Synchronous Flow
     Harvard Business Review

“Medical treatment has made astonishing
  advances over the years. But the
  packaging and delivery of the treatment
  are often inefficient, ineffective and
  customer unfriendly.” HBR, 2007

“Systems designed for manufacturing are
  fully applicable to health care.” HBR, 2005

              Today’s Objectives

•   What is Synchronous Flow?
•   How does it work with Lean Healthcare
•   Kaizen Blitz Events
•   Synchronous Flow Timeline

                     Where People Come First…

• Our mission is to excel at providing
  personalized, quality care; where people
  come first.
• Our vision is to be the provider of choice by
  creating a professional environment where:
  – patients want to receive care
  – clinicians want to practice medicine
  – employees want to work

                    Where People Come First…

We will accomplish this by:
• empowering our caregivers with education,
  technology, and personal and professional
• creating an environment which builds collaborative
  relationships among physicians, staff and patients,
• providing our communities with the educational
  resources and support to enable individuals to make
  informed decisions and play an active role in
  managing their own health,
• offering safe, personalized, high quality care.
A Synchronized System:
   What does it take?

    Synchronous Management

• A management approach that views
  resources in a system as elements of an
  interdependent network
• all of which can be synchronized to a
  strategically selected control point
• in such a way as to optimize the
  performance of the entire system.
• Rooted in the concepts of Constraints
    The Synchronous approach

• A “Control Point” is selected, optimized and
  finitely scheduled at the desired Throughput
• All other functions strive to serve the Control Point
• Predetermined inventory “ Buffers” are
  strategically placed to protect the Control Point
• Buffers are proactively managed daily
• New Patient release is metered to control WIP
  and lead times.

                    Drum, Buffer, Rope

      Gate                                                  CP      Exit    Service
      Input                                                        Output

                                           Constraint Buffer
 Time                              Process Flow

Processes from the Gate to the Exit are divided into zones and managed continuously

     Synchronous Flow Elements

• Relentless efforts to reduce all waste that is of
  no value to the patient experience
    – More time dedicated to patient care
    – From about 40% to at least 70%
•   Work release – Input / Output model
•   Standard work practices
•   Productive capacity and Protective capacity
•   Buffer Management logbook for each process
•   Buffer Analysis systems for each process
•   Focus Meeting script.                             -10
             Process Failures

• Errors – incorrect execution of a task when
  everything needed is available
• Problems – Disruption of a worker’s ability to
  execute a prescribed task as planned
  – Clear, complete and timely information unavailable
  – Some tool or resource needed is unavailable
  – Something is present that is not necessary
Synchronous Flow procedures differentiate
 and track each.
              Problem Solving

• Level One Problem Solving
  –   Worker compensates for the failure
  –   The underlying cause is not addressed
  –   Worker does not want to “make waves”
  –   Can actually be counterproductive
• Level Two Problem Solving
  – Worker addresses the immediate issue
  – Actions taken to identify and address the core causes
  – Willingness to “make waves” is encouraged by
  – Organizational improvement occurs
Improvement Requires Change

   Your existing system is designed
        to give you the results
       you’re currently getting.
    If you want different results,
     you must change the system!

occurs only with

The Opportunity for Change

            Knowledge             Change
            What is it?

     Desire             Skill
   Why should I?      How do I?
      Heart            Hands

The Synchronous Flow Focusing Steps

Three necessary conditions
•    Define the system
•    State the purpose
•    Decide how to measure it

Five Focusing Steps
1.   Identify the system’s Control Point (s) (Constraints)
2.   Decide how to exploit the system’s Constraints (s)
3.   Subordinate everything else to the above decisions
4.   Elevate the system’s constraint
5.   When a constraint is broken, return to step one. Do not
     allow inertia to become the system’s constraint.

                A Constraint is...

Anything that limits an organization’s higher performance
relative to its goals
• Can be internal or external
• Can be a process, a policy or a paradigm.

The Control Point is…
• The location within the scope of the system on which we
       choose to focus
• The point upon which operational measures are based.

               A Bottleneck is...

•   A temporary limitation caused by Murphy
•   The effect is an intolerable situation
•   Something that we want to defeat
•   Something we respond to with urgency
    – Prioritized according to the relative threat to the
      Control Point.

    Productive Capacity

• The capacity required to meet the
  overall demand
• Largely determined by the constraint
  of the system
• This is the Drum of the process.

         Protective Capacity

• Additional capacity

  required on all resources
  to overcome...              6

   – Murphy (statistical      4

     fluctuations)            2

   – Resource contention      0

• Establishes an
  unbalanced system
• Generally available with
  existing resources.
         A Closer Look

• The are anything that limits performance
• They’re not necessarily bad things
• Every system has at least one
• They determine your system’s capacity
• They are your system’s most valuable
• Choosing to manage them is better than
  chasing Murphy
• Focusing attention on them simplifies life.
        Buffer Management
Purpose: to identify and record buffer problems
  and assign responsibility to fix them
• Meetings are held at least once per day at a
  designated time and place for a maximum of
  15 minutes
• Everyone is on time and prepared
• Actions items and person responsible for
  each is communicated
• The essence of proactive management.


• Common practices lead to
  balanced capacity
• Balanced capacity systems are
  unstable and under-productive
• Unbalanced capacity systems
  are stable, with increased
  velocity and predictability
• Constraints hold the key to
  focusing improvement activities.

               What is Lean?

• Delivering more Value with Less Investment
• The Toyota Production System (Deming and Ohno)
• Founded upon:
  – Customer focus
  – Respect for humanity
  – Prudent, systematic elimination of waste
• Expected outcomes:
  – Improved customer satisfaction
  – Improved employee satisfaction
  – Improved organizational performance
    Lean Management Defined

a systematic approach to identifying and
  eliminating waste
through continuous improvement,
by flowing the product at the pull of the
in pursuit of perfection.

    Synchronizing the Lean Tools

• Kaizen Blitz Events - Continuous, incremental
  improvement of any activity to create more value
  with less waste
• A focused, team approach toward breaking the
  status quo by making immediate changes

• Applied continuously to exploit the selected control
• Prioritized to establish the necessary protective
  capacity.                                          -26
   Synchronizing the Lean Tools

Value Stream Mapping - plotting all the
  activities necessary for a product family
• Identifies non-value-added activities
• Helps to identify the constraints and Control Point

• Developed to “define the system and its purpose”
• Used during “identify,” “exploit,” and “subordinate”
  to minimize waste and
   to prioritize Kaizen events.
   Synchronizing the Lean Tools

5 S’s - A safe, clean, neat, arrangement of
  the workplace.
• Sort - eliminate the unnecessary
• Straighten - a place for everything and everything
  in its place
• Shine- Clean the workplace
• Standardize - Rules to maintain
• Systematize - Self discipline to sustain

• Prioritized during the “exploit” and “subordinate”
  steps to organize the workplace.                     -28
   Synchronizing the Lean Tools

Pull mentality - A system of operational behaviors
  from downstream to upstream activities
• Schedule for the Control Point is determined from
  market demand
• Release of Raw Materials is determined by
  consumption at the Control Point

• All other activities are Synchronized to Control
  Point via Drum, Buffer, Rope.

       Characteristics of a Lean
•   High value-added - little waste
•   Simplicity and visibility
•   Process standardization
•   Demand based flow
•   Culture
    – Empowered teams
    – Open communication
    – Enforced accountability
• Continuous improvement mentality    -30
                   Lean Principles
1. Specify VALUE

          2. Identify the VALUE

                   3. Make value-creating steps

                                  4. Let patient flow PULL value

                                                  5. Pursue PERFECTION

                                     Lean Thinking, Womack & Jones
   Lean Strategies and Tactics

• System mapping      • Five S's
• Organize for flow   • Visual workplace
• Total employee      • Set up / changeover
  involvement           reduction
• Pull systems        • Total productive
• Quality systems       maintenance
• Institutionalized   • Design out waste
  improvement         • Measure the right
• Standardized work     things
Value Added vs. Non-Value Added

• Value added: An activity that directly
  serves the needs of the patient.
• Non-value added: any other activity

Value Stream
• The specific series of activities required to
  provide a defined service for the customer

   The Seven Types Of Wastes

1. Excess material movement
2. Unnecessary process
3. Unnecessary motion
4. Defects
5. Inventory
6. Delays
7. Over production

Elements of Work
                      At least 30% of
                      skilled nursing
   Work               time is spent
                      doing non-clinical

   Work content


           System Mapping

• Flowchart of value stream activity
• Understand the macro system
• Identify material stream flow, obstacles to
  flow, control systems, inventory locations
• Group knowledge, creativity

Functional Spaghetti Diagram

     1   1       2       2           3       3

     1   1                           3       3

             4       4       4

                                 5       5       5

                   Kaizen Blitz

Trained teams of people empowered to make
  immediate and tangible changes for improvement.

The PCSAM model
• Problem / opportunity identified
• Core causes confirmed and documented
• Solution and plan of action developed
• Aggressive action applied to the solution in 3 to 5 days
• Measurements tracked to assure success

No going from problem to solution in this approach.
           The Kaizen Cycle

Measure results
                                  Problem Identification

                                 Core cause of the issue

             Solution and plan
              Where to Begin
• Identify the system – value stream mapping
• Choose measures, set objectives
• Decide how to exploit the system
   – Flow layout, constraint positioning, inventory
     strategy, cells
• Pull system - synchronized flow
• Kaizen - waste elimination
   – Set-up reduction
   – Standardization
   – Workplace improvement/visual control
        Conditions for Success

•   Senior management understanding
•   Visual and vocal leadership
•   Clear and elevating goals
•   Complimentary measurement system
•   Guiding Coalition – Steering Committee
•   Education and training
•   Make clear - “What’s in it for me”
        Implementation Timeline

•   Educational session for key staff
•   Selection and training of the Steering Committee
•   Identification of Kaizen opportunities
•   Selection and training of Kaizen Teams
•   Development of the Synchronous Flow Model
    – Constraint and Control Point identification
    – Buffer Management
    – Productive / Protective Capacity
• Focus meeting process.
          Process Improvement
• Communicate the basis of needed change to everyone
  in small group settings
• Select a Steering Committee to manage the process
• Select a key group of leaders to participate in the design
  and implementation of a new system for each identified
• PCSAM development
• Kaizen Blitz to aggressively address each opportunity
• Synchronize all activities to support a single selected
  control point
• Make it visible for effective communication
• Practice Buffer Management for effective accountability
• Emphasize that continuous improvement means
  there is no finish line.
      And remember…

When you’re through changing,

       you’re through.

          Thank You !

   Did you know that
   75% of all change
   initiatives fail?

      The 8 Reasons for Failure

•   Complacency
•   Weak Leadership
•   Lack of vision
•   Lack of communication
•   Stopping at obstacles
•   Invisible progress
•   Declaring victory too soon
•   Neglecting to establish change in culture


To top