Lean and IT

Lessons Learned at the University of Virginia Health System

Sean Jackson, CIO School of Medicine and Physicians Group

• Provide an overview of the Lean transformation of our Clinical Faculty Hiring process.

• Identify and discuss some Lessons Learned.

• Have some fun!

Learning Objectives

Before • Average cycle time: 72

business days • Some candidates lost to

competing institutions during this time

• 130 forms for candidate to complete

• New faculty arrive with a negative impression of the institution

After • Average cycle time: 25

business days • Most candidates sign their

acceptance letter within five business days.

• 30 forms eliminated, single point of data entry to minimize waste

• New faculty arrive with a positive impression of the institution.

Clinical Faculty Hiring involves three separate legal entities: The School of Medicine, the Physicians Group, and the Medical Center (Hospital)

Clinical Faculty Hiring Value Stream

I have a GREAT idea! IT should develop a

system that will track and measure my waste

automatically.

Use data to alert you to problems, but don’t invest in designing software that automates tracking and measuring waste.

I have a GREAT idea! Let’s Web-enable all of

our forms. That way people can complete

them online.

Collect forms and analyze to eliminate redundancies, identify gaps, and identify automation opportunities. Create a single point of data entry for your customers.

Who is our customer and what do they value?

• Identify the customer(s) • Work with the customer(s) to specify value • Set context, Start/End Points • Make the work visible • Go to where value is created • Observe directly and ask questions with respect • Map the value stream • Identify, prioritize, and remove waste using A3 • Design the Future State • Automate value producing steps • Optimize & Leverage Partnerships

Standard Work for IT v. 2.5

Standard Work should be a Work in Process

9

Recruiting

Hiring

Onboarding

• Requisitioning • Sourcing • Response Management • Screening and Assessment

• Offer Packet Generation, Sending

• Acceptance • Credentialing • Provisioning, Privileging

• Orientation • Onboarding

Talent Development

Need Determination

Talent Acquisition

Hiring component of the Talent Acquisition process

End: Clinical Faculty is authorized to bill for patient services

Start: HR approves candidate for hire

Disagreement regarding the current state. Disagreement regarding the desired state. Disagreement regarding how to achieve the desired state.

Using A3 Problem Solving and Root Cause Analysis we can address these three disagreements in a constructive manner.

The Three Disagreements

I have a GREAT idea! Let’s transform my relatively inexpensive and tractable process expense into your relatively intractable and

expensive system expense!

Software can be used to automate both value-added and non-value-added work. Do not automate waste—eliminate it, then automate what remains.

Capacity

Demand Over Time

Muda Wasteful Activity

(Excess Capacity)

Muri Overburden

“Mucha”

We need to pay more attention to Mura and Muri. They are “executive” wastes.

The Three Wastes in Action

• Transportation • Inventory • Motion • Waiting • Over processing • Overproduction • Defects • Unused Employee Creativity

Harm Confusion

Muda at the University of Virginia

Current State

Desired State

Standards

End to End

Work Plan

Value Stream Mapping

Adherence to standards is no guarantee of success. Standards serve as the basis for continuous improvement.

Customer Desire(s)

Standards Help to Bridge the Gap

15 The degree to which we can make the work visible determines the degree to which we can automate that work.

16*22 Validations (from tacit and explicit sources)

16 Poka Yoke: Mistake proof by validating data quality at the time of entry

Ensuring Data Quality is Vital

The Traditional Bacon, Lettuce and Tomato Sandwich

The Deconstructed Bacon, Lettuce and Tomato Sandwich

Workflows

Documents

Business Rules

Templates

Data Curation Collection Transformation Archiving

Know

ledg

e Ba

se

The Deconstructed Application

Software applications often become impediments to continuous improvement because they are not designed to be changed quickly and relatively inexpensively.

Application

Configuration

Kernel

Division of labor and enhanced agility: Solve problems and respond to changes at the appropriate level of impact, complexity and cost.

Highly Configurable Software

Much of the work can be done prior to IT involvement. The final content of the documents can be designed by the SMEs well in advance.

Distribute Work to Appropriate Skill Levels

LOW

HIGH

MED

Microsoft Word Documents

Push Button System Configuration

SQL Validations and Calculations

By Subject Matter Experts

By Project Managers

By Application Developers

Later users of the system receive benefits and lessons learned from early adopters.

Continuous Improvement Through Refactoring

Difficult SQL Validation or Calculation Another Similar SQL Validation or Calculation Another Similar SQL Validation or Calculation

+ +

Opportunity for new Validation or Calculation Type =

Decreases Defects Decreases Code Inventory Reduces Complexity and Skill Level Required To Perform Task

Refactor

• Provide an overview of the Lean transformation of our Clinical Faculty Hiring process.

• Identify and discuss some Lessons Learned • Have some fun!

Learning Objectives

Thank you! Merci Beaucoup!