Saturday, October 26, 2013

Focus and Leverage Part 268

I received an email this past week from a reader who asked me to write about how I run an improvement event.  So with this in mind, this posting is my view of how I run an improvement event and some of the techniques I use to arrive at my implementation plan.  As always, feel free to leave comments or questions.

I recently completed two VSA’s for two separate healthcare facilities in two different states.  In both cases significant amounts of waste were found within each of the processes being evaluated. The focus in one event was a surgical clinic for a specific part of the body, while the focus of the other event was a general surgical process.  In both cases the biggest problem facing these two organizations was excessive patient wait times which resulted in both delays and cancellations of scheduled surgeries.  In this posting I want to demonstrate how the teams were able to identify and significantly reduce the apparent waste within their processes.

Both teams were comprised of the true subject matter experts, the people charged with making the process flow.  Neither of the teams had any sort of focused training on improving flow, so there were no preconceived notions about how the event should unfold.  I actually prefer it this way because I have found that more success happens when the team member’s minds aren’t “polluted” with techniques that may or may not work.

I always deliver “Just-in-Time” training to the team which is a blend of Lean, Six Sigma and Constraints Management.  The members learn about the various sources of waste and variation and how to assess the process in question in terms of value-added and non-value-added activities that currently exist.  They also learn about the importance of identifying and focusing on the constraint that always exists.  They learn about the importance of focusing their improvement actions on the constraint first.  They soon become aware, as a team, that if they are to improve the flow of the process, they must focus their efforts on the constraint because the constraint controls the throughput of the process.  They also learn that not all constraints are physical in nature, meaning that many times the constraint is a policy or procedure that limits the flow.

In both events we started by developing Current State Process Maps based upon how the team members believed the process normally flows.  One of the positive side effects of this step is a much better appreciation of each member’s role in the process.  This appreciation has a tendency to create a “bond,” if you will, between the team members and it is this bond that opens up their minds to the true process and a sense of unity of purpose.  In almost every event I have facilitated, it is this bonding that helps develop a true sense of team.  Yes, knowing the details of the process flow is very important, but being able to have the team come together as one is equally important.

Once the Current State Map is complete to the team’s satisfaction, they then assess it by looking at each individual step in terms of its value-added rating.  That is, they rate each step as either Value-Added (VA), Non-Value-Added (NVA) or Non-Value-Added but Necessary (NVABN) and color-code them as Green, Red and Yellow respectively.  One of the really “cool” things about facilitating events like this is the epiphany that always takes place with the team members, meaning that they rapidly become aware of all the waste that exists within their process.  The team members realize that this process, the one that they work in every day, can truly be improved.

The next step is the development of the Ideal State Map.  The Ideal State Map represents the high-level view of the process being improved with much of the waste removed.  Although most Lean Practitioners start this process with a SIPOC, I don’t always do this.  The Future State Map is the end product for these types of event, so depending upon how much time I’m given, dictates whether or not I have the team develop a SIPOC.  I suspect I’ll receive a lot of push-back from some of my blog followers on this point.  The intent of the Ideal State Map is to demonstrate to the team what the “ultimate” process flow would look like.

One technique I use, in the development of the Future State Map and the implementation plan, is to populate the Future State Map with star bursts with each star burst representing a change that must be made in order to achieve the Future State Map.  The figure below is the Current State Map for one of my teams before any changes were recommended.  In this map, the number of Green, Yellow and Red steps were as follows:

# of Greens = 39 # of Yellows = 15 # of Reds = 41 # of Hand-offs = 16

The next figure is the resulting Future State Map that the team developed with the star bursts indicated in yellow.  The most significant changes between the two maps were the number of yellow and red activities.  The current state had a total of 41 reds while the future state had only 1 red activity.  However, the number of yellow steps increased from 15 to 31.  The total number of steps decreased from 95 to 70 while the number of hand-offs decreased from 16 to 8.

# of Green = 38 # of Yellow = 31 # of Red = 1 # of Hand-offs = 8


As mentioned earlier, in this figure each of the yellow entities (star bursts) represents a change that the team believes must take place in order to make the Future State a reality.  In this particular example there were 28 changes that the team believed must occur if this future state is going to work.  For this event, the team used these starbursts to develop their implementation plan and based upon comments made by the team members, this technique made it much easier to develop their plan.

One final thought for this posting is the development of the team’s presentation to the executives.  For me, it is imperative to have the team develop and present it with minimal help from me.  I will develop the Power Point slides for them, but the content must come from them.  It’s important for the listeners (the executives) to not only hear what the team has to say, but to experience the passion within their words.  I typically start the presentation with a listing of the team members, what they were attempting to accomplish and then a lessons learned slide.  In the example above, here were some of the things the team felt they had learned.

- How to analyze a problem
- How to work together to solve a problem
- The realization that there are road blocks in all areas
- A better knowledge and appreciation of each other’s work
- How important accountability is (or lack thereof)
- Unbiased eyes looking at a process is good
- It’s hard to leave our comfort zones
- The importance of constraints management
- The knowledge to use the tools elsewhere in our jobs
- The importance of developing unity throughout

 Only time will tell if this team has successfully diagnosed and created a better process flow.  If you are a leader of an organization, you hold the keys to success in that unless there is a violation of company policy or safety, it is imperative that you not only support what the team recommends, but also break down barriers so that the changes can be made.  If you push back and say something like, “That will never work here….” then your credibility will be damaged and your employees will not feel good about participating on other improvement teams.  It’s up to you……..

Bob Sproull


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