The lean enterprise focuses on the basics… keep it simple and do not try to overly complicate. Remember… common sense always prevails. Lean is really all about applying fundamental principles that can have a tremendous impact on the speed that a business can deliver results to the customer, reducing costs, and improving quality.
- SPEED: Speed is accomplished by eliminating wasteful activities that add meaningless time (nonvalue added) to a process. Value added time is any time spent on activities that transform a product or service in ways that add to the customer’s value. Nonvalue added time comprises of everything else. You will have a much greater impact on speed if you first focus on removing nonvalue added time.
- Value-added (VA): Any activity or process the customer will be willing to pay for. VA work needs to be optimized and improved upon.
- Nonvalue added (NVA): Any activity or process the customer would not want to pay for if they knew you were doing it. NVA work needs to be eliminated.
- Business-value-added (BVA): Any activity or process the customer would not want to pay for, but which cannot be eliminated. These processes need to be rationalized, then minimized, and automated where possible.
- COST: Cost is reduced by remembering that a business is nothing more than a series of processes. We must eliminate the processes that do not add value in our customer’s eye and, therefore, serve only to increase our costs.
- QUALITY: Quality can be improved if we focus on the quality at the source – doing everything possible to make sure that work gets done right the first time, every time, and catching mistakes so they do not turn into customer defects. We must ensure that we have quality at the source and that mistakes are not passed down the supply chain.
- Patient safety is most important… all employees should have that in the foreground of their thought at all times with everything that they touch
- Employees need to feel that they can critique others or processes and feel like they have the ability to impact change
Before you can focus on speed, cost, and quality you need to emphasize one of the lean fundamentals which is a respect for the people. Solutions to our business problems typically come from the people who live with the problems every day. Additionally, people want to work in a safe environment and they want to feel that they are helping solve problems. People want the opportunity to use their minds on the job and feel like they are making a difference. I would say that this is true for everyone but this is especially important for the millennial generation, which is expected to represent 49% of the workforce by 2020. Based on recent studies, the millennial generation especially thrives on feeling purpose in their activities and feeling like they are making a difference.
The first fundamental principle of lean is respect for the employee. The second fundamental principle of lean is reducing waste. Waste, in lean thinking, is defined as: all activities that do not add value from a customer perspective and that can be removed. A lean organization produces what is needed, when it is needed, with the minimum possible amount of waste. This now leads us to understanding the three M’s. Muda, muri and mura are called "the three M's." All three M's must be eliminated to create a sustainable lean process.
THE 3 M’s of LEAN
- MURA (the Waste of Unevenness): the waste of unevenness or inconsistency. Mura creates many of the eight wastes and Mura drives Muda. By failing to smooth our demand, we put unfair demands on our processes and people and often create waste.
- MURI (the Waste of Overburden): Muri causes overburden and gives unnecessary stress to our employees and our processes. This is caused by Mura and other failures in systems such as lack of training, unclear or no defined ways of working, the wrong tools, and ill thought of measures of performance.
- MUDA (The Eight Wastes): any activity or process that does not add value, a physical waste of your time, resources and ultimately your money.
- Transportation: the movement of product between operations or locations (Ex: moving patients, lab tests, information)
- Inventory: Anything that we spend resources on – supplies, materials, facilities, equipment, information, people – to hide the flaws in a process
- Motion: All motion that does not add value to the product or process (Ex: walking waste can arise from poor design of the working area)
- Waiting: All things that cause waiting or hinder our work (Ex: patient wait times)
- Overproduction: Building or buying more than is needed or earlier than is needed
- Over-processing: Doing more than is required to meet the needs
- Defects: rejects and rework within your processes, doing things over because they were not done right the first time (Ex: poor labeling of tests, incomplete information in patient charts)
- Human Potential: Waste and loss due to not engaging employees, listening to their needs, and making them feel a sense of purpose
While the two fundamental principles of lean are respect for the people and reducing waste, there are supporting principles as well that are just as important. These help define what lean is all about, and when an organization transitions to this type of “lean thinking” then a lean culture can truly exist. The supporting principles are:
- Lean is an attitude of continuous improvement. Lean is about finding a better way to get things done and promoting an attitude that what exists can likely be improved.
- Lean is value-creating. Remember… the underlying goal of lean in healthcare is to improve value for patients.
- Lean is a unity of purpose. Properly executed, lean clarifies priorities and guides staff in improvement accordingly.
- Lean is respect for the people who do the work. Lean allows the front-line workers to innovate and encourages an environment of support and trust.
- Lean is visual. Visual tracking centers exist through a Lean hospital or clinic, presenting daily and trend performance data on key metrics.
- Lean is Flexible Regimentation. The essence of lean is to improve processes and then continue to improve the improvements. The key to improvement is determining the root cause for performance shortfalls and then ridding the process of the cause through redesign.
We have now discussed the principles of lean but why stop there? While it is very important to understand the principles, there are also some fundamental group rules that when followed can produce tremendous results. Let’s take another minute to look at the group rules of lean.
FUNDAMENTAL GROUP RULES OF LEAN:
- Improvements are always cross-functional
- This involves everyone so cross-functional impacts can be understood and the upstream must know the impact on downstream
- Conduct improvements incrementally
- Don’t try to do it all at once or it can be overwhelming. If you implement improvements incrementally then you are positioning yourself for success.
- Single-tasking is better than multi-tasking
- 100% done with one item is better than 50% done with two items and multi-tasking can often be the root cause for many errors
- Lean does not promote overtime work
- Lean does not want employees to have to work over 8 hours each day as exhaustion is the root cause for many errors
- Work must be standardized
- Standard work is easier to improve all at once. Remember… non-standard work can be the root cause for many errors and often leads to confused patients and employees.
Today we discussed the fundamental principles of lean, the 3 M’s, and the group rules of lean. Hopefully, this information helps get you one step closer to “lean thinking” and creating a lean culture. At IPeople, we are working hard to live these principles every day and we are seeing great results that extend to our customers… you! Recently, we have been focused on reducing waste and the results really have been tremendous. We just completed a Kaizen event for improving one delivery process that previously took two full days to complete… now the improved process can be completed in two hours and the work has been standardized. Additionally, we focused on another process that went from six hours to 45 minutes with much less room for human error. And we are just getting started… we will continue to improve on the improvements! By living the principles and following the group rules, your organization can implement radical improvements that can truly have a positive impact on both your patients and your staff.