Post on 16-Apr-2022
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Creating a Culture of Improvement with the Principles of Enterprise ExcellenceJohn S. Toussaint M.D.
Catalysis is a not for profit education institute our work consists of:
• Custom Educational Programs• Peer to Peer Learning Networks • CEO/CMO/CNO Forums• Products: Books and White papers• Executive Site Visits• Annual North America Summit and European Summit• Center for Lean Engagement and Research (CLEAR)
with UC Berkeley• Free Resources via createvalue.org
What is the underlying management philosophy of the organization/practice?
What is the basis of the management philosophy?
What are principles
• Universal truths• Based on fundamental scientific or logical “truths” arising
from observation and experimentation• Objective
• Based on logic not emotion. Do not depend on beliefs or feelings
• Govern a consequence• Leads to a predictable outcome: positive or negative
• Predictable
The Ten Shingo Principles
Create Value for the Customer
Create Constancy of Purpose
Think Systemically
Flow & Pull Value
Assure Quality at the Source
Focus on Process
Embrace Scientific Thinking
Seek Perfection
Lead with Humility
Respect Every Individual
Framework for Model Cell
• An inch wide, mile deep experiment• Focused on an important business problem• Creates a new system with standard work• Ties to key organizational performance • Involves and is sponsored by senior
leadership• It is connected to an enterprise wide value
stream
Toyota video
Who’s time? Who’s motion?
Benefits of applying improvement concepts in dentistry
Patient time for complete
treatment
Patient time for complete
treatment Hygienists Assistants Dentists OperatoriesNumber of visits per
Year
Before 99 Days 7 3 5 3 10 7,519
After 10 Days 1.5 2 3 3 6 5,723
Results/ Improvement +90% +78% +33% +40% --- +40% +24%
Too Many Setups SMED: Treatment Room Changeover
Extra Capacity Flow: Dentist Part of TreatmentCross-Training
Hygiene Not IncludedLevelingMixed Treatment
Coordination Problems
Flow Manager Position
Communication Problems
Kanban / Synchronization
Trying One-Piece Flow
CountermeasureBarrier
Continuous Improvement
One appointment
All treatment
All providers
ContinuousTreatment
No interruption
AllProviders
Smooth Succession
No gaps
Everything before patient leaves
All treatment
All support functions
Defining One-Piece Flow: Making and moving one piece at a time.
15
No wait in Chair
Before SMED After SMED
Setu
p Ti
me
Red
uctio
n
Before and after Smed
16
Amount of resources
Overburden
Excess Capacity
10
190
10
190
0Day 1 Day 2 Day 3 Day 4
Num
bero
f Pat
ient
s
Why Leveling (Averaging)? To optimize the amount of resources
Leve
ling
(Ave
ragi
ng)
Lean Tracker
17
Multifunction Worker Training Timetable
Name Task
Task
Task
Task
Task
Task
Task
Task
Task
Task
Task
Date
Name
1 Jane Doe
2 John Doe
3 Jane Doe
4 John Doe
5 Jane Doe
6 John Doe
7 Jane Doe
8 John Doe
9 Jane Doe 18
Dr. Bahri built a model cell dental clinic on a set of principles he established• A belief in the power of Plan-Do-Study-Act (PDCA)
and a commitment to completing the whole improvement cycle every time
• Commitment to becoming a teacher who learns and teaches by asking good questions not telling everyone what to do
• Commitment to running experiments• The humility to admit that knowledge is everywhere in
the practice and improvement is temporary
TYPES OF BEHAVIOR
Ideal behavior established by the individual from
exploring their own personal gaps
INDIVIDUAL
Day-to-Day behavior that is specific to the area and job
related functions.
TACTICAL
High-level behavior that is for all leaders, all managers and all front-line employees, regardless of area.
ORGANIZATIONAL
Behavior that is specific to departments and/or designed systems.
OPERATIONAL
BEHAVIOR
specific
broadPRINCIPLE
SYSTEM
What organizational behaviors are important?
Focus on processEmbrace scientific thinking
Flow & pull valueUnderstand & manage variation
Assure quality at the sourceSeek perfection
Break-through Thinking Monitor & Maintain Predictability Adapt & Adjust
Continuously learn by listening, seeing and translating
observations. Support new models of care delivery developed by front line.
Monitor the outputs of each system to ensure stability and a standard outcome. Continuously challenge
the process to identify areas of improvement.
Adapt the tools by making incremental adjustments that
all shifts agree with. Treattools as a countermeasure not a solution. Structurally solve area problems daily.
Create value for the patientCreate constancy of purpose
Think systemically
[leadership] [management] [front-line]
Establish Direction Organizing & Translating Setting & Achieving GoalsDevelop a vision and strategies to achieve that vision. Set high
but reasonable targets. Communicate the direction on
a regular basis.
Establish a structure to achieve the plan. Organize and allocate
resources. Monitor structure to ensure consistency and alignment
to plan.
Identify meaningful goals that can be accomplished in their area that directly affect the overall vision and strategy. Daily report on status and
needed support.
Lead with humilityRespect every individual
Learn continuously
Motivate, Mentor, Inspire Empower, Involve & Coach Develop & ShareEnergize people to develop and
overcome barriers to change. Daily be in the work area to listen to understand. Embrace failure;
celebrate success.
Empower authority within parameters of area to improve and solve problems. Break-down silos
by involving cross-functional teams to solve value stream issues. Coach
problem solving daily.
Be a self-developer. Findopportunities to grow and
develop to better support the organization. Share with
others what is working and what is not working.
Source: Toussaint,J NEJM Catalyst June 20th 2016
ALI
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ENAB
LEIM
PRO
VE
[principles]
Leadership Principles and Behavior
What personal behaviors are required for building an improvement culture?
Reflection
0
1
2
3
4
5Willingness
Humility
Curiosity
Perseverance
Self-Discipline
Go See, Listen & Learn
Asking Questions
Effective ListeningA3 Thinking
Partner, Buddy System
Coach
Leader Standard Work
Senior Leader Behavioral Self-Assessment
1
2
3
4
5Willingness
Humility
CuriosityPerseverance
Self‐Discipline
Reflection
Go See: Listen & Learn
Asking Questions
Effective ListeningA3 Thinking
Partner, Buddy System
Coach
Leader Standard Work
Personal A3 and Self – Assessment Senior Leader Self-Assessment on Fundamental Behaviors