5s And Gemba Walk (final) 3x3652

Lean Tools and  Methods:  5S Jamie Harkins, RN, BSN, MBA, HQ Manager Clinical Operations

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Objectives State the key elements of 5S

Describe the value of implementing 5S

Obtain the knowledge needed to implement 5S in your organization

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Vascular Access Cart Wasted Time Spent Searching for Needed items – Anything Missing?

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How’s This? Would you know if a supply needed re-stocked?

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5S  A strategy that helps to keep our workplace safe and organized 

Sort



Set/ Simplify



Sweep



Standardize



Sustain/ Self-Discipline

5S is a foundational element of Lean Hospitals 7

5S  Removes waste, including:       

Excess inventory Out-of-stock supplies Searching for supplies Walking for supplies Wrong and outdated parts Non-value added setup and cycle time Moving parts around workspaces

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Benefits of 5S  Assists in the elimination of waste  Improves work flow  Reduces employee stress  Provides a systematic process for continuous improvement  Focuses on the process and not the person

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5S at Work

Blood Sugar Supplies

Crash Cart Medications

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27

30

51

62 23

47 40

10

58

79

13

11

Mark 1-49

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30

23

47 40

10 13 12

Sorted / Mark 1-49

Numbers from 1 to 49 10 13

27

23

30 40

47 13

27

30

Standardize/ Mark 1-49

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62 23

47 40

10

58 13

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79 Find missing #s

Numbers from 1 to 49 10 13

27

23

30 40

47 15

Find missing #s

5S Implementation: 1.

Determine the space and scope for the 5S activity

2.

Identify teams and team leaders

3.

Involve as many team as possible

4.

Document the current state with photos

5.

Measure current inventory levels

6.

Use visuals/photos to describe current state to team

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5S:   Sort  Sorting separates necessary from unnecessary 

Most critical of the 5S steps



Objective evaluation of all materials in the 5S area

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Identifies additional required supplies

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Identifies proper par levels

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Document key information

 Consider: 

Supplies are neat, but are par levels connected with use?



What do you do when there is excess inventory? 17

5S : Sort

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5S:   Set/Simplify Makes Places for Necessary Items

Implement Set/Simplify

 Correlate location of supplies with their use  Place higher use items closer to the point of use  Makes unnecessary items visible  Enables the team to see what is out of place

 Place most frequently used items within reach  Ensure less frequently used items are still accessible  Label items that are mobile  Label items that are not familiar to all team  Remove excess stock

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5S:   Shine/Sweep Form of Inspection that Ensures Everything is Returned to its Proper Place

Implement Shine/Sweep

 Remove and replace broken equipment  Replace missing equipment/ expired supplies  Clean area  Makes it obvious when things are out of place  Avoids the need for ‘cleanup’ events

 Include scheduled sweeps with your eyes  Determine the appropriate sweep frequency  Determine the elements of a complete sweep

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5S:   Standardize Creates a Standard Agreement and Communicates it to the Team

Implement Standardize

 Define teams and roles for each team member  Specify training/ orientation expectations  Define standards for personal items  Specify standards for visual controls  Specify standards for disposing unneeded items

 Complete team agreement  Update kanbans to signal for replenishment  Document and post a visual map of the work area  Document and post pictures of new current state  Develop task sheet for each 5S area 21

5S:   Sustain/Self Discipline Maintains Standards Through Training, Empowerment, Commitment and Discipline

Implement Sustain/Self Discipline  Managers should do visual 5S sweeps at least daily  Audit the area against the 5S achievement template regularly to maintain the gains & improve  All team must participate - Set time aside to ensure workspace is functional, orderly  Acknowledge gains

 Often the most difficult of the 5S steps  Seeks to ingrain desirable behaviors  Consistency and repetition need to become habitual

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5S Example COLLEEN’S HARD WORK Before

http://runningahospital.blogspot.com/2009/10/5s-projects-arespreading.html?m=1

After

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5S

S Cusanza, AONE 2010

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5s

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Cleanliness problem areas are identified and mess prevention actions are in place

Map created for each item in storage room showing general location and layout of materials and can be retrieved quickly with minimal effort

Potential problems are identified an countermeasures are documented

Reliable methods and standards are shared throughout similar work areas

Root causes are eliminated and improvement actions focus on developing preventive methods

Work area has documented housekeeping responsibilities and schedules, and the assignments are consistently followed

Items rotating from storage and use, create visual control to identify point of use

Inspection of area occurs daily and work areas and equipment are restocked and organized

Reliable methods and standards are adhered to by all of the work group

Sources and frequency of problems are documented as part of routine work, root cause of noncompliance are identified and corrective action plans are developed

Initial cleaning has been completed; items disposed of according to auction disposition

Needed items are outlined, dedicated locations are properly labeled and required quantities are determined

Visual controls and indicators are established and marked for the work area equipment, files and supplies

Documentation for all visual controls exist

Work group routinely checks are to maintain 5S agreements

Level II Focus on Basics

Needed and notneeded items are identified and those not needed are removed from work area

Needed items are stored and organized according to frequency of use

Work group has agreed on items to be checked and acceptable performance levels documented

Work group has documented agreements for needed items, organization, and work area controls

Documentation of completed 5S is posted in work area; 5S is incorporated into new staff orientation

Level I Just Beginning

Necessary and unnecessary items are mixed together throughout the work area

Items needed are located in various places throughout the work area

Key work items are missing and current location is not known

Standards for work area organization are not followed or documented

Work area checks are not done regularly and there is no visual measurement of 5S performance

Sorting

Simplifying

Standardizing

Self-Discipline

Level V Continuously Improve

Level IV Focus on Reliability

Level III Make it Visual

Sweeping

Summary of Key Points  Disorganization is a barrier to work flow!  To “set” means to place higher use items closer to the point of use.  5S assists in the elimination of waste, improves work flow, reduces employee stress, and provides a systematic process for continuous improvement.

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Resources and References  Executive Lean Training at Virginia Mason. 2013.

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Lean Tools and  Methods: Gemba Walk Judy Krempin, MS, HQ Manager Quality, Safety, Performance Improvement

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Objectives Be able to define Gemba

Describe the value of being at the Gemba – for RIE, for Kaizen

Know your role at the Gemba

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The place where work is done

What is  the  Gemba?

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The place the truth is found

Show  Respect

Ask Why

Go See 33

Walk from start to end of the value stream Focus on:  The purpose of work  The process we undertake  Engaging people who touch the process

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RIE Team: To gemba before mapping the value stream & before identifying solutions

When do  I go to  Gemba?

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Who goes to Gemba for a  Rapid Improvement Event (RIE)?

All of Improvement Team – before solution is determined

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Gemba Walk for RIE

RIE Purpose:  Understand the current state -- identify barriers to flow

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Gemba Walk for RIE

Actions:  Observe  Draw the current process  Talk to the people doing the work  Agree on the source of the problem  Measure time for process steps

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When do  I go to  Gemba?

Kaizen A Leader goes to Gemba regularly

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Who goes to Gemba? CEO – monthly or more Chief Quality Officer - weekly Managers and Directors - daily Supervisors – every shift 40

Kaizen Purpose:  Be a keen observer – what questions can be asked to help people see barriers and improve the process

Gemba walk for Kaizen

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Actions:  Review the PI Board  Observe  Understand the workflow  Target the improvement plan  Coach

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Gemba walk for Kaizen

Leader Standard Work: Regular Gemba Walks

Create a “no meeting” zone

The first six visits, observation only

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Learning from Toyota Gurus

Toyota managers should be sufficiently engaged on the factory floor that they have to wash their hands at least three times a day. --Taiichi Ohno

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Gemba Walk as Part of Kaizen

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2

See the facts at the source. Become familiar.

Adapted

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Agree on the nature and cause of the problem (before debating solutions).

Teach problem solving.  Why do you think that happened?

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Assess gap between current and target state.

Look for leadership and cultivate.

 Why do you think those conditions exist?

from: Michael Balle’s “Go and See” presentation. Lean Enterprise Institute. 45

What happens first? Senior Leader Gemba Walk  Greet people in the area  Meet with the department leader

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Review the Performance Improvement Board priorities and metrics



Gemba Walk together

1. Focus on the current improvement topic.  See the facts at the source.  What results are required of this process? What do we need to learn?

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2. What is the current problem? Does everyone agree on the source of the problem? What does the person responsible for the process think?

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3. Teach problem solving.

Why do you think this is happening? What do we need to do to change the current conditions?

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4. Assess gap between current and target state.

How do we • If we are on target, compare what has helped us against the succeed? goal for • If we are not reaching this our target, why? process?

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5. Look for leadership and cultivate.

Does this department leader understand the purpose and goal? Does this leader collaborate well within and across settings of care? 51

Coaching at the Gemba Traditional Coaching for Correction

Lean Coaching for Development

 Specify the process deficiency

 Let the staff person own the problem

 Get agreement that problem exists

 Let them think  Help them see

 Give

 Force reflection

 Provide suggestions about how the process should go  Agree on next steps

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Practice Coaching  Find a partner 

Partner should be someone you do NOT work with currently

 First person: Describe a process challenge at work 

Describe for 30 seconds

 Second person: Ask open ended questions to help the other person think through that problem  

Do not use questions that can be answered “yes/ no” Practice for 3 minutes

 Switch roles 53

Gemba Observer Goals

Develop keen

Develop better

observation skills

engagement and discussion skills

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Effects of Showing Respect at the Gemba Discretionary Effort “You hire my time and are due a full day and good effort. You can define my responsibilities, program my activities, and evaluate my performance. You can control what you see. But I can decide how far I go beyond that, and for what.”

From David Verble’s LEI presentation May 2013

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Summary of Key Points  When the Gemba walks are introduced, observe the work for several weeks to become familiar with the process – no tampering with the process or asking questions except to understand the steps.  When coaching at the Gemba, let the staff person own the problem, let them think, help them see, force reflection.

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Resources and References  Michael Balle’s “Go and See” presentation. Lean Enterprise Institute.  David Verble’s Coaching presentation at Lean Enterprise Institute. May 2013.

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Getting Started – First Six Gemba Walks in Each Value Stream

Schedule

Observe PI Board & Process

Say “Thanks!”

Reflect

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Routine Gemba Walks to  and Coach

Schedule

Observe PI Board/ Process & Reflect

Thank Staff

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Coach & Reflect

Starter Manager coaching questions: Coaching the staff closest to the process How is this (process) going?

If it did not go as designed, “what is happening in the environment?”

If it went well, great, “how do we know we were successful?” Identify objective data, proof of success

“What do you think you would do next time?”

If we don’t know why a process failed, “how might we learn more?”

If remedial approach is not going to be effective, say “Good idea, but you may want to think about this…” 61

Starter Senior Leader coaching questions: Coaching the manager/ director How is this (process or staff development work) going?

If it did not go as designed, “what is happening in the environment?”

If it went well, great, “how do we know we were successful?”

Identify objective data, proof of success

“How might you coach staff differently next time?” If remedial approach is not going to be effective, say “Good idea, but you may want to think about this…..” 62

If we don’t know why a process failed, “how might we learn more?”