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Improve Your Lean Management System With a Simple Chart

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"Extended Cut" version of a Shingo Virtual 2020 Talk

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Improve Your Lean Management System With a Simple Chart

  1. Mark Graban www.MarkGraban.com www.LeanBlog.org Improve Your Lean Management System With a Simple Chart Slides & More: www.MarkGraban.com/Shingo2020
  2. Scientific Problem Solving
  3. Better Understanding Cause and Effect Relationships in Systems
  4. We Need to Avoid Making Bad Conclusions “The average patient satisfaction increased from 87.2 to 89%” 86% 87% 88% 89% 90% Before After
  5. Two Data Points are NOT a Trend
  6. Do We Hear (or Say) This in Meetings? “Look at that positive trend!” Narrator: It isn’t a trend
  7. “Does Toyota use Six Sigma?” v “No, but we teach everybody the seven basic Q.I. tools” (including “control charts”)
  8. A Control Chart for Performance Measures - 10 20 30 40 50 60 70 80 90 100 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Rate this Facility - % of Patients Giving “9” or “10” Upper Limit = +3 sigma Lower Limit = -3 sigma Average • “SPC Chart” (Statistical Process Control) • “Control Chart” • “XmR Chart” • “Process Behavior Chart”
  9. My Most Favorite Business Book Ever
  10. Don Wheeler Says: “SPC is a way of thinking, with some tools attached.”
  11. • One goal is reducing waste • This includes “management waste” • Wasted motion • Overprocessing A Lean Management System Looking for a root cause that isn’t there
  12. “Visual Management” or Just “Visual”? “Management by Emoji”
  13. One Data Point is NOT a Trend
  14. 1. Are we achieving our target or goal? 2. Are we improving? 3. How do we improve? Three Key Questions
  15. OK, How About More Numbers?
  16. "Bowling Chart” or “Bowler”
  17. 1. Are we achieving our target or goal? 2. Are we improving? 3. How do we improve? Three Key Questions
  18. 1. Which of these numbers (if any) suggests that the system has changed significantly? 2. Which of these merit reaction, investigation, or explanation? 3. How do we prioritize? Three More Questions
  19. #PlotTheDots
  20. “Visual Trend Charts”
  21. There is VARIATION in Every Metric • The question is “how much variation is routine?” • Personal examples: • Body weight • Resting heart rate • Commuting time 60 65 70 75 80 1-Jul 3-Jul 5-Jul 7-Jul 9-Jul 11-Jul 13-Jul 15-Jul 17-Jul 19-Jul 21-Jul 23-Jul 25-Jul 27-Jul 29-Jul 31-Jul 2-Aug 4-Aug 6-Aug 8-Aug10-Aug12-Aug14-Aug16-Aug Run Chart (Mark's Resting Heart Rate) 180 181 182 183 184 185 186 187 188 5/27/16 5/29/16 5/31/16 6/2/16 6/4/16 6/6/16 6/8/16 6/10/16 6/12/16 6/14/16 6/16/16 6/18/16 6/20/16 6/22/16 6/24/16 6/26/16 6/28/16 6/30/16 7/2/16 7/4/16 Run Chart (Weight)
  22. Signals vs. Noise “While every data set contains noise, some data sets may contain signals. Therefore, before you can detect a signal within any given data set, you must first filter out the noise." "Process Behavior Charts"
  23. #PlotTheDots — Hospital Covid-19 Dashboard - 5 10 15 20 25 30 35 40 12-M ar 13-M ar 14-M ar 15-M ar 16-M ar 17-M ar 18-M ar 19-M ar 20-M ar 21-M ar 22-M ar 23-M ar 24-M ar 25-M ar 26-M ar 27-M ar 28-M ar 29-M ar 30-M ar 31-M ar 1-Apr 2-Apr 3-Apr 4-Apr 5-Apr 6-Apr 7-Apr 8-Apr 9-Apr 10-Apr 11-Apr X Chart (Number of Employees Out Sick) Chart Courtesy of Memorial Health System (Marietta OH) Goal: Avoid Reacting to Every Up & Down
  24. Process Behavior Chart (10) (5) - 5 10 15 20 25 30 35 40 3/12/20 0:003/13/20 0:003/14/20 0:003/15/20 0:003/16/20 0:003/17/20 0:003/18/20 0:003/19/20 0:003/20/20 0:003/21/20 0:003/22/20 0:003/23/20 0:003/24/20 0:003/25/20 0:003/26/20 0:003/27/20 0:003/28/20 0:003/29/20 0:003/30/20 0:003/31/20 0:004/1/200:004/2/200:004/3/200:004/4/200:004/5/200:004/6/200:004/7/200:004/8/200:004/9/200:004/10/20 0:00 X Chart (Number of Employees Out Sick) Upper Limit = +3 sigma Lower Limit = -3 sigma Average NOISE “COMMON CAUSE” Chart Courtesy of Memorial Health System (Marietta OH) PREDICTABLE SYSTEM
  25. Has the System Changed? (10) - 10 20 30 40 50 3/12/20 0:003/13/20 0:003/14/20 0:003/15/20 0:003/16/20 0:003/17/20 0:003/18/20 0:003/19/20 0:003/20/20 0:003/21/20 0:003/22/20 0:003/23/20 0:003/24/20 0:003/25/20 0:003/26/20 0:003/27/20 0:003/28/20 0:003/29/20 0:003/30/20 0:003/31/20 0:004/1/200:004/2/200:004/3/200:004/4/200:004/5/200:004/6/200:004/7/200:004/8/200:004/9/200:004/10/20 0:004/11/20 0:00 X Chart (Number of Employees Out Sick) SIGNAL “SPECIAL CAUSE” What changed? What is the root cause? Note: The last data point is a hypothetical situation
  26. 3 Rules for Finding a Signal
  27. 3 Rules for Finding a Signal
  28. 3 Rules for Finding a Signal
  29. A PBC for the Toyota Way Fieldbook “Trend Chart” NOISE “COMMON CAUSE” There is NO “root cause” for any of those data points But we CAN improve the system systematically
  30. Process Behavior Charts Help Us Evaluate Improvement Work
  31. We Made Improvements (?) to the System - 10 20 30 40 50 60 70 80 90 100 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Rate this Facility - % of Patients Giving “9” or “10”
  32. We Made Improvements (?) to the System - 10 20 30 40 50 60 70 80 90 100 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Rate this Facility - % of Patients Giving “9” or “10” SIGNAL
  33. We Made Improvements (?) to the System - 1.00 2.00 3.00 4.00 5.00 6.00 January-17 February-17M arch-17 April-17 M ay-17 June-17 July-17August-17 Septem ber-17October-17 Novem ber-17 Decem ber-17January-18 February-18M arch-18 April-18 M ay-18 June-18 July-18August-18 Septem ber-18October-18 Novem ber-18 Decem ber-18January-19 February-19M arch-19 X Chart -- Pain Score (0-10) Caudal Epidural Analgesia in 2017 Pudendal Nerve Block in 2018
  34. We Made Improvements (?) to the System - 1.00 2.00 3.00 4.00 5.00 6.00 January-17 February-17M arch-17 April-17 M ay-17 June-17 July-17August-17 Septem ber-17October-17 Novem ber-17 Decem ber-17January-18 February-18M arch-18 April-18 M ay-18 June-18 July-18August-18 Septem ber-18October-18 Novem ber-18 Decem ber-18January-19 February-19M arch-19 X Chart -- Pain Score (0-10) Caudal Epidural Analgesia in 2017 Pudendal Nerve Block in 2018 NO CHANGE
  35. We Made Improvements (?) to the System - 20 40 60 80 100 120 January-18 February-18 March-18 April-18 May-18 June-18 July-18 August-18 September-18 October-18 November-18 December-18 X Chart (PACU Minutes) (Old Protocol) (New Protocol) NO CHANGE?
  36. Evaluating Clinical Process Change (2) - 20 40 60 80 100 120 January-18 February-18 March-18 April-18 May-18 June-18 July-18 August-18 September-18 October-18 November-18 December-18 X Chart (PACU Minutes) (Old Protocol) (New Protocol) SIGNAL
  37. We Need to Avoid Bad Conclusions “Look at that positive trend!” Narrator: It isn’t a trend
  38. 12 Data Points Might NOT Be a Trend
  39. Process Behavior Chart 78 80 82 84 86 88 90 92 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Patient Satisfaction PROCESS CHANGE SIGNAL Cause & Effect?
  40. Process Behavior Charts Help Us Evaluate Ongoing Operations
  41. 1. Are we achieving our target or goal? 2. Are we improving? 3. How do we improve? Three Key Questions
  42. Bowling Chart as Run Charts - #PlotTheDots 0% 10% 20% 30% 40% 50% 60% 70% 80% Jan Feb Mar Apr May Jun Jul Aug Sep Run Chart (Team Engagement) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Jan Feb Mar Apr May Jun Jul Aug Sep Run Chart (Recommend) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Jan Feb Mar Apr May Jun Jul Aug Sep Rating 0.0 0.2 0.4 0.6 0.8 1.0 1.2 Jan Feb Mar Apr May Jun Jul Aug Sep Run Chart (Falls w/ Sev Injury) 0.0 0.5 1.0 1.5 2.0 2.5 Jan Feb Mar Apr May Jun Jul Aug Sep Run Chart (CLABSI) 0.0 0.2 0.4 0.6 0.8 1.0 1.2 Jan Feb Mar Apr May Jun Jul Aug Sep Run Chart (CAUTI) WHEN SHOULD WE REACT?
  43. Bowling Chart as PBCs 0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 1.8 Jan Feb Mar Apr May Jun Jul Aug Sep X Chart (Falls w/ Sev Injury) 0.0 0.5 1.0 1.5 2.0 2.5 3.0 Jan Feb Mar Apr May Jun Jul Aug Sep X Chart (CLABSI) 0.0 0.2 0.4 0.6 0.8 1.0 1.2 Jan Feb Mar Apr May Jun Jul Aug Sep X Chart (CAUTI) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Jan Feb Mar Apr May Jun Jul Aug Sep X Chart (Team Engagement) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Jan Feb Mar Apr May Jun Jul Aug Sep X Chart (Recommend) 50% 55% 60% 65% 70% 75% 80% 85% Jan Feb Mar Apr May Jun Jul Aug Sep X Chart (Rating) SIGNAL NOISE SIGNAL
  44. Bowling Chart as PBCs with Red/Green 0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 1.8 Jan Feb Mar Apr May Jun Jul Aug Sep X Chart (Falls w/ Sev Injury) 0.0 0.5 1.0 1.5 2.0 2.5 3.0 Jan Feb Mar Apr May Jun Jul Aug Sep X Chart (CLABSI) 0.0 0.2 0.4 0.6 0.8 1.0 1.2 Jan Feb Mar Apr May Jun Jul Aug Sep X Chart (CAUTI) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Jan Feb Mar Apr May Jun Jul Aug Sep X Chart (Team Engagement) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Jan Feb Mar Apr May Jun Jul Aug Sep X Chart (Recommend) 50% 55% 60% 65% 70% 75% 80% 85% Jan Feb Mar Apr May Jun Jul Aug Sep X Chart (Rating) SIGNAL SIGNAL NOISE
  45. Is our Metric Predictable and/or Capable?
  46. Unpredictable & Not Capable STABILIZE THE SYSTEM! ROOT CAUSE? ROOT CAUSE?
  47. Predictable & Not Capable IMPROVE THE SYSTEM!
  48. Predictable and Capable IMPROVE THE SYSTEM?
  49. Predictable and Somewhat Capable IMPROVE THE SYSTEM! DON'T OVERREACT!
  50. From Not Capable to Capable
  51. Looking for Signals in a Metric That Meets Target SIGNAL WHAT CHANGED?
  52. 1. Are we achieving our target or goal? 2. Are we improving? 3. How do we improve? Three Key Questions
  53. Process Behavior Charts “…will make us more effective at tracking what we improve or don’t improve.” CEO, Health System
  54. Process Behavior Charts “A simple tool that helps drive a mindset change to being more systematic about the success of improvement work.” President, Ambulatory Services
  55. Better Cause-and-Effect Understanding Better Scientific Problem Solving Better Lean Management Systems
  56. React Less Lead Better Improve More
  57. Questions? Mark Graban • Email: • mark@markgraban.com • Web: • www.LeanBlog.org • www.MarkGraban.com Book: www.MeasuresOfSuccessBook.com Slides: www.MarkGraban.com/Shingo2020

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