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
- 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
Bob Sproull
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