LEADER STANDARD WORK
June 2016
HealthEast Care System
Didier Rabino, Vice President, Lean Sensei
2 Confidential. For internal use only. Not for distribution.
LEARNING OBJECTIVES:
�Describe relationships between problems, standards
and visual controls
�Develop effective Leader Standard Work
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ABOUT HEALTHEAST
� 14 primary care clinics
� 4 award-winning hospitals
� 7,500 employees
� 850 providers
� Specialty centers, home care,
hospice care
� Comprehensive wellness program
� 1.1 Million residents
� 63 languages
HealthEast is a full-service health care provider serving the Twin Cities East Metro
4 Confidential. For internal use only. Not for distribution.
LEAN JOURNEY AT HEALTHEAST
2006 - 1st Lean flow projects2011 - 1st department with frontline tools2012 - 1st Lean system launched (FMS)
2013 - A3 Thinking & Gemba Walk
2014 - Strategy Deployment
2015 - Kaizen Workshop & VSM
Not a way of life yet
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1 - Identify Value
2 - Map the value stream
3 - Create Flow
4 - Establish Pull
5 - Seek Perfection
LEAN PRODUCTION SYSTEM
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RESPONSE Problem
CORRECTIVE ACTION
SEEK PERFECTION
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STANDARDS: THE FUNDAMENTAL IDEA
� There is no problem without a standard (norm,
expectation, goal, objective, desired condition)
� Any condition that is not meeting the standard is a
problem
� It is a problem when an employee does not meet the
standard
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1
• Difficult to sustain results
2
• Results do not match the expectations
3
• Lack of leadership support and buy in from peers
4
• Lack of necessary resources (people or money)
5
• Reaching a plateau and not able to move beyond it
COMMON CHALLENGES:
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IS THERE A LINK MISSING?
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LEAN LEADERSHIP: A DIFFERENT MODEL
Two Principles:
1. Respect for people
2. Continuous improvement
They translate into:
� Customers always come first
� Employees are the most important resource
� Continuous improvement is a way of life
� Front line focus – everything is grounded to Gemba
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LEAN LEADERSHIP: A DIFFERENT MODEL
The “Leader as Dictator” who tells everyone what to do:
no transfer or cascade of responsibility
The “Leader as Social Worker” who sets “goals” and let
everyone do as they pleased: no focus or direction
The “Lean Leader” who provides maximum flexibility
with maximum control: neither bottom up nor top down
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LEAN LEADERSHIP MODEL
Maximum flexibility: • Do not tell exactly what to do: rely on individual initiative
Maximum control:• Do not allow actions without justifications to the manager
Neither bottom-up nor top-down but:• Emphasize doing the “right thing” / establishing authority• Develop systems in which processes are well defined and
individual responsibility is clear
Lean organizations have evolved from a top-down
cascade of tasks to a cascade of responsibility
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LEAN MANAGEMENT: PRACTICAL APPROACH
3 - Leader Standard
Work
2 - Visual Accountability
1 - Visual Controls
1.Bring the focus on process abnormalities in real time
2.Transform problem identification into assignments for action
3.Help sustain improvements made
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The leader uses visual controls to ensure:
• the execution of the standards
• that gaps are understood
• that appropriate response to gaps
1 – VISUAL CONTROLS
Different levels:1. Provides information (e.g. water level gauge under a
bridge)
2. Shows abnormality (e.g. gauge shows “normal” and
“flood situation”)
3. Indicates response needed (e.g. gauge shows level for
“close bridge”)
4. Display status of response (e.g. gauge with nearby sign
“bridge closed by sheriff on April 7”)
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PROCESS: NORMAL / ABNORMAL?
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Lab only Patients
PROCESS: CLINIC LAB FIFO & WORKLOAD
Process: patient flow in CT room
“Inspect what you expect;
your team members will respect what you expect”
Process: inspect what you expect
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5
4
3
Knowledge and Skills
1
2
4
3
Kaizen Calendar
• Problem statement• Target• Kaizen leader• Executive sponsor• Lean coach• 4 gate process
St. Joseph’s Lab Recognition Board
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2 - VISUAL ACCOUNTABILITY
Transforms problem identification into assignments
for action and follow up to ensure the assignments
are completed
Strategy Deployment Rooms
Accountability Board
• Daily or weekly review
• 30 seconds per person
• May only place tasks on yourself
= Task completed on time
= Task behind commitment
Strategy Deployment Rooms
Task behindschedule
Task on schedule
Project Status
3 – Leader Standard Work
• The strategies to change are different than the strategies
to maintain the change. We fail at maintaining the change
when we don’t have a strategy to continue the change.
• Leader standard work helps sustain improvements made.
Inspect what you expect from Gemba
Coach A3 thinking
Teaching role
Delegate responsibilities
Support the work
Balance maintain & improve
Cascade challenges
Reward & recognize
Staff here
and ready
to work?
Huddle quality?
Coaching kata? Ahead or behind?
Issues identified?
Standard
work
followed?
Support staff
improvement
workBreak start-
stop OK?
Ahead or behind?
Issues identified? Work on my
A3 project
Next day
staffing plan
Go home satisfied!
Go and see
patient
Triple aim
deep dive
The Routine: Leader SW guides the leader to the visual controls
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THE DOCUMENT
Developing new routine
1
2
5
6
7
4
3
31-May-16
Personal Kanban
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IN SUMMARY:
2 SYSTEMS NEEDED1 - Identify Value
2 - Map the value
stream
3 - Create Flow
4 -Establish
Pull
5 - Seek
Lean Production System
LeanManagement System
3 - Leader Standard
Work
2 - Visual Accountability
1 - Visual Controls
33 Confidential. For internal use only. Not for distribution.
Objectives: • Results
• People
• Management system
Methodology:• Monthly learning cycles
Activity to date:• 5 learning cycles
• Encouraging
• Scratching the surface
OUR IMPLEMENTATION APPROACH
THE MODEL CLINIC
Leader Standard Work
Final Questions?
HealthEast Care System
Didier Rabino, Lean Sensei