28
© 2012. Institute for Performance Excellence – All rights reserved Module 11: Implementing & Controlling Improvements; Lean Culture [1] Improve, Implement & Control

Module 11: Implementing & Controlling Improvements; Lean ... · • Understanding your role in Lean culture change [3] ... Implementing Improvements • As we transition from Analysis

  • Upload
    others

  • View
    3

  • Download
    0

Embed Size (px)

Citation preview

Page 1: Module 11: Implementing & Controlling Improvements; Lean ... · • Understanding your role in Lean culture change [3] ... Implementing Improvements • As we transition from Analysis

© 2012. Institute for Performance Excellence – All rights reserved

Module 11: Implementing & Controlling Improvements; Lean Culture

[1]

Impr

ove,

Impl

emen

t & C

ontr

ol

Page 2: Module 11: Implementing & Controlling Improvements; Lean ... · • Understanding your role in Lean culture change [3] ... Implementing Improvements • As we transition from Analysis

© 2012. Institute for Performance Excellence – All rights reserved

The Improve & Implement and Control Phases

[2]

Establish Organizational Goals

Benchmark Performance

Identify Improvement Opportunities

Charter Projects

Organization Wide Planning Framework

Structured (DMAIC) Improvement Process Framework

Page 3: Module 11: Implementing & Controlling Improvements; Lean ... · • Understanding your role in Lean culture change [3] ... Implementing Improvements • As we transition from Analysis

© 2012. Institute for Performance Excellence – All rights reserved

Module 11: Objectives

• Understand how to more effectively implement improvements – communication and change management

• How to assess the impact of the changes/improvements you’ll be making

• How to sustain the improvements • Understanding your role in Lean

culture change

[3]

Page 4: Module 11: Implementing & Controlling Improvements; Lean ... · • Understanding your role in Lean culture change [3] ... Implementing Improvements • As we transition from Analysis

© 2012. Institute for Performance Excellence – All rights reserved

Implementing Improvements

• As we transition from Analysis into Improvement, implementing and controlling improvements will require people to change the way they do their work

• For all types of changes, implementation and success of a change will depend on how well the human aspects of the change are managed

• It’s likely that people will resist the changes, and they have a variety of reasons for doing so

[4]

Page 5: Module 11: Implementing & Controlling Improvements; Lean ... · • Understanding your role in Lean culture change [3] ... Implementing Improvements • As we transition from Analysis

© 2012. Institute for Performance Excellence – All rights reserved

Why People Resist Change • They perceive that the risk of the

change is greater than the risk of standing still

• They feel overloaded and overwhelmed

• People have a healthy skepticism and want to be sure new ideas are sound, or they genuinely believe that the proposed change is a bad idea

• People fear hidden agendas among would-be reformers

[5]

Page 6: Module 11: Implementing & Controlling Improvements; Lean ... · • Understanding your role in Lean culture change [3] ... Implementing Improvements • As we transition from Analysis

© 2012. Institute for Performance Excellence – All rights reserved

Successful Change Management • Overcoming resistance to change requires

communication and engagement; do this as early and as often as possible with stakeholders and process performers

• Communicate openly, listen to their ideas and concerns - include them in all aspects of the improvement methodology

[6]

• People are much more likely to accept a change if their input was integral in defining issues and determining improvements

• Recognize their contributions

Page 7: Module 11: Implementing & Controlling Improvements; Lean ... · • Understanding your role in Lean culture change [3] ... Implementing Improvements • As we transition from Analysis

© 2012. Institute for Performance Excellence – All rights reserved

Successful Change Management Overcoming resistance to change is about effective Communication, you must tell those most affected by the change:

• Why the change is being made – organizational needs/current performance, what’s in it for them, why should they care?

• What the change will be – what is it going to look like, what does it mean for their day-to-day activities? What will not change.

• How and when the change will happen– how will they be supported in the transition to ensure their success?

[7]

Page 8: Module 11: Implementing & Controlling Improvements; Lean ... · • Understanding your role in Lean culture change [3] ... Implementing Improvements • As we transition from Analysis

© 2012. Institute for Performance Excellence – All rights reserved

How to Overcome Resistance to Change

Cause of Resistance: The risk of the change is greater than the risk of standing still Articulate the need for the change and how the

status quo is not sustainable

[8]

Cause of Resistance: They feel overloaded and overwhelmed Understand and accommodate

what’s already on people’s plate and implement accordingly, set them up for success

Page 9: Module 11: Implementing & Controlling Improvements; Lean ... · • Understanding your role in Lean culture change [3] ... Implementing Improvements • As we transition from Analysis

© 2012. Institute for Performance Excellence – All rights reserved

How to Overcome Resistance to Change

Cause of Resistance: Healthy skepticism, not sure new ideas are sound, or genuinely believe a proposed change is a bad idea Run pilot studies or small, low risk tests of

change to ensure that your ideas work and to address people’s concerns

Cause of Resistance: People fear hidden agendas among would-be reformers Always document and share your work with

stakeholders so that your contexts, objectives, actions, results and conclusions are clear to everyone – this allows them to follow your purpose and logic, keeping them engaged and driving consensus

[9]

Page 10: Module 11: Implementing & Controlling Improvements; Lean ... · • Understanding your role in Lean culture change [3] ... Implementing Improvements • As we transition from Analysis

© 2012. Institute for Performance Excellence – All rights reserved

The Implementation and Control Phase • Purpose: plan and

implement improvements, assess their impact, and sustain the gains over the long term

• The expectation is to have an Implementation and Control (Follow-Up) Plan consisting of:

• Communication to and Education of stakeholders and process performers

• Process monitoring, reporting and intervention procedures that are easy to perform and understand

[10]

Page 11: Module 11: Implementing & Controlling Improvements; Lean ... · • Understanding your role in Lean culture change [3] ... Implementing Improvements • As we transition from Analysis

© 2012. Institute for Performance Excellence – All rights reserved

Training for & Implementing Standard Work

• Once created, Standard Work must be relayed to all the people who will perform the work so that they are knowledgeable about the new work standards

• This can’t be left to chance, it requires effective instruction that communicates not only the what, who, when, where, and how, but the why. This

[11]

• Imparts process knowledge • Ensures staff understand why

they will do what they do and the cause-and-effect relationships therein, so that problems can more easily be corrected when they occur

Page 12: Module 11: Implementing & Controlling Improvements; Lean ... · • Understanding your role in Lean culture change [3] ... Implementing Improvements • As we transition from Analysis

© 2012. Institute for Performance Excellence – All rights reserved

Standard Work Template and Training

[12]

Training for Standard Work involves 4 steps: 1. Tell and show each process step and its respective

elements noted in the template 2. Have trainees try the process while you review/correct 3. Have trainees explain each process step and its

respective elements noted in the template 4. Repeat, correct, check on their progress, encourage them

and coach to stability

Process Owner Date, Version #

# Process Step Resources Needed Detailed Steps/Key Points (what, who, where, when, how)

Reason Expected Outcomes (quality) & Time Needed

Key Variables/ Cause-Effect Relationships

What is the main process step?

What information, material, equipment, a supply etc. are needed to successfully perform this step?

What are the detailed steps?

Who performs them?

Where and when is the step performed and how?

Why are the steps important? What do they accomplish for the patient/customer, the process?

What does this step produce, what are the characteristics of that product?

How long should this step take to complete?

What are the key factors that affect the consistency of the outcomes of this process step?

May include process maps, diagrams, photos etc. to better depict the Standard Work

Page 13: Module 11: Implementing & Controlling Improvements; Lean ... · • Understanding your role in Lean culture change [3] ... Implementing Improvements • As we transition from Analysis

© 2012. Institute for Performance Excellence – All rights reserved

Implementation & Control (Follow-Up) Plan - Checklist

All issues identified in Define /Measure/Analyze phases have countermeasures to address root causes.

All countermeasures/improvement actions have owners, timelines and data-based checks for effectiveness – small, low risk tests of change, pilot studies.

Standard Work has been created/updated to resolve issues/root causes. Stakeholders are informed and trained, new standard is part of everyday activities. [13]

Page 14: Module 11: Implementing & Controlling Improvements; Lean ... · • Understanding your role in Lean culture change [3] ... Implementing Improvements • As we transition from Analysis

© 2012. Institute for Performance Excellence – All rights reserved

Implementation & Control (Follow-Up) Plan – Checklist (continued)

Procedures to monitor, report and intervene in process performance exist e.g. recurring metrics, periodic audits. Control procedures are easy to perform and understand.

Owners of improvement and sustainment actions understand and accept their responsibilities.

Reflect on performance/improvement to expand learning and share best practices across the dept/organization (PDCA cycle). [14]

Page 15: Module 11: Implementing & Controlling Improvements; Lean ... · • Understanding your role in Lean culture change [3] ... Implementing Improvements • As we transition from Analysis

© 2012. Institute for Performance Excellence – All rights reserved

Implementation and Control (Follow-Up) Plan

Additional important points for implementing and controlling improvements:

• There has to be a clear hand off with accountability to the process owner

• Clarify roles and responsibilities of staff in maintaining the improved process

• Add the new process to orientation procedures • Post monitored results for staff to see, discuss

performance, its causes, and follow up actions needed and respective responsibilities

[15]

Page 16: Module 11: Implementing & Controlling Improvements; Lean ... · • Understanding your role in Lean culture change [3] ... Implementing Improvements • As we transition from Analysis

© 2012. Institute for Performance Excellence – All rights reserved

Sustaining and Continuing Improvement • Sustaining & continuing the

improvement requires a (Daily) Management System that engages all levels of the unit/work area using the Plan-Do-Check-Act (PDCA) approach

[16]

Page 17: Module 11: Implementing & Controlling Improvements; Lean ... · • Understanding your role in Lean culture change [3] ... Implementing Improvements • As we transition from Analysis

© 2012. Institute for Performance Excellence – All rights reserved

A PDCA (Daily) Management

Do

Check Act

Plan

1. Clear Standard: Defined roles & responsibilities, expected performance levels e.g. quality levels, cycle times

2. Perform the daily tasks/activities as per Standard Procedures/Work

3. Compare actual vs. expected performance, determine causes for differences & define countermeasures needed

4. Enact countermeasures, assess their efficacy, revise Standard Procedures/Work as needed. Share learning. [17]

Page 18: Module 11: Implementing & Controlling Improvements; Lean ... · • Understanding your role in Lean culture change [3] ... Implementing Improvements • As we transition from Analysis

© 2012. Institute for Performance Excellence – All rights reserved

Updating Project Progress, Closing Projects

When do you update an A3 Report? • When new relevant information has been discovered

and needs to be shared with stakeholders • When project schedule points/milestones have been

reached e.g. end of data collection and analysis phase, or meeting of performance targets

When do you close projects? • When you have reached your exit criteria as defined

in your Project Charter e.g. a standardized procedure with trained personnel and well defined performance review process in place [18]

Page 19: Module 11: Implementing & Controlling Improvements; Lean ... · • Understanding your role in Lean culture change [3] ... Implementing Improvements • As we transition from Analysis

© 2012. Institute for Performance Excellence – All rights reserved

Implementing and Controlling Countermeasure Improvements

• If you have determined your countermeasures, define the respective implementation and follow-up plan, including • The small, low risk test of change/pilot studies you

will use to test and prove your ideas • How and when the results of the

tests/pilots/countermeasures will be assessed, and by whom

• Standard Work that has to be created/updated – to develop the Standard Work, use Standard Work template provided

• Owners and due dates of all project team actions

[19]

Page 20: Module 11: Implementing & Controlling Improvements; Lean ... · • Understanding your role in Lean culture change [3] ... Implementing Improvements • As we transition from Analysis

© 2012. Institute for Performance Excellence – All rights reserved

Steps 6,7,& 8 of the A3 Report: Implementing and Controlling (Following Up on) Improvements

• If you have not determined your countermeasures, continue working on them and/or their prerequisites i.e. data/root cause analysis

• Depending on the detail and complexity of your work, document the above in your A3

• What do you need to do next as a team to move your project toward completion?

[20]

Page 21: Module 11: Implementing & Controlling Improvements; Lean ... · • Understanding your role in Lean culture change [3] ... Implementing Improvements • As we transition from Analysis

© 2012. Institute for Performance Excellence – All rights reserved

Culture Change and Your Individual Role

[21]

Page 22: Module 11: Implementing & Controlling Improvements; Lean ... · • Understanding your role in Lean culture change [3] ... Implementing Improvements • As we transition from Analysis

© 2012. Institute for Performance Excellence – All rights reserved

Culture Change and Your Individual Role • You are a select group of employees –

you were offered this training because you are • Interested and engaged in delivering greater

value to the organization • A formal or informal leader in your department or

the broader organization who can enact positive change

[22]

Page 23: Module 11: Implementing & Controlling Improvements; Lean ... · • Understanding your role in Lean culture change [3] ... Implementing Improvements • As we transition from Analysis

© 2012. Institute for Performance Excellence – All rights reserved

Culture Change and Your Individual Role • We are trying to change the way people

think and act towards solving day-to-day and organizational problems

• You are the ones who can promote and demonstrate this change in mindset by your actions

“It is easier to act your way into a new way of thinking than to think your way to a new way of acting”

• So what is the culture that we are trying to achieve?

[23]

Page 24: Module 11: Implementing & Controlling Improvements; Lean ... · • Understanding your role in Lean culture change [3] ... Implementing Improvements • As we transition from Analysis

© 2012. Institute for Performance Excellence – All rights reserved

Lean vs. Traditional Organizational Culture

[24]

Lean Culture

Traditional Culture ► Command & Control ► Workarounds ► Blame

Page 25: Module 11: Implementing & Controlling Improvements; Lean ... · • Understanding your role in Lean culture change [3] ... Implementing Improvements • As we transition from Analysis

© 2012. Institute for Performance Excellence – All rights reserved

[25]

Traditional Command & Control Culture

Lean Culture

Results-Only Orientation Focus on final result, not the problem solving process

Process & Results Orientation Focus on the means to achieve great results

Fragmented Thinking Fragmented actions, silos, lack of organization-wide strategy

Systems Thinking Processes and people aligned to achieve organizational goals

Command & Control Approach Metrics/status reports are primary management tool, defer to highest ranking person

Leader as Teacher Approach Go see, don’t just delegate. Mentor people to develop problem solvers

Defensive Mindset Failure is not allowed. Employees feel need to justify their actions, blame - someone else caused the problem, rationalization of data

Internalized Mindset Create an environment where it’s ok to test and fail, but there is also individual and collective responsibility to learn from the failures and overcome them

Knower Blanket solutions, use of Improvement specialist to solve organizational problems, not building capability of others, missing learning opportunities

Learners Let’s identify the problem and solve it together, and share what we’ve learned with others

Page 26: Module 11: Implementing & Controlling Improvements; Lean ... · • Understanding your role in Lean culture change [3] ... Implementing Improvements • As we transition from Analysis

© 2012. Institute for Performance Excellence – All rights reserved

So what can you do to change? Problem Workaround Blame Mindset Lean Mindset

Medications are missing/not available in the cabinet

Nurse walks to other cabinet to find medications

“The pharmacy doesn’t help us”

“Why are medications often not available? How can we work together to fix this?”

Labels are crooked on lab tubes

Technician re-labels the tubes properly

“That assistant never gets it right”

“Is the assistant aware of proper labeling practices and their impact on the process?” [26]

Page 27: Module 11: Implementing & Controlling Improvements; Lean ... · • Understanding your role in Lean culture change [3] ... Implementing Improvements • As we transition from Analysis

© 2012. Institute for Performance Excellence – All rights reserved

So what can you do to change? Problem Workaround Blame Mindset Lean Mindset

Medical Records does not have diagnosis code that will get the system paid for a home nebulizer

Billing clerk searches through the medical record to find a way to recode the diagnosis

“The doctor’s office doesn’t know how to code properly”

“Why do multiple offices make the same error? What is the systematic cause?”

Meds are found in the wrong bin

Pharmacy tech puts meds back in the right place

“Other people aren’t careful”

“Why could that pill fall into the adjacent bin?”

[27]

Source:, Graban, 2012

Page 28: Module 11: Implementing & Controlling Improvements; Lean ... · • Understanding your role in Lean culture change [3] ... Implementing Improvements • As we transition from Analysis

© 2012. Institute for Performance Excellence – All rights reserved

Review In this module we learned: •That successful implementation of improvements requires effective communication – engaging stakeholders and including them in all aspects of the improvement methodology •The need for, and elements of, an Improvement Implementation and Control (Follow-Up) Plan •How to sustain and continue improvements through PDCA-based (Daily) Management Systems •About your role in Lean culture change

Sources/References Graban, Mark. Lean Hospitals – Improving Quality, Patient Safety, and Employee Engagement, 2nd Edition. 2012

[28]