LEAN FOUNDATIONS
These 5 principles — Value, Value Stream, Flow, Pull, and Perfection — form the backbone of Lean thinking.
What are the 5 Lean Principles?
A Japanese word meaning 'the real place' — where value is created and work is done.
What is Gemba?
The person who signed the preface — President and CEO of the New York City Health and Hospitals Corporation in January 2013.
Who is Alan Aviles?
The glossary term for any operation or activity that takes time and resources but does not add value to the product or service. Also called Muda.
What is Waste?
The preface says HHC began its Lean journey in this year — describing themselves as 'hopeful, excited, expectant, and sinfully ignorant.'
What is 2007?
This 6-step framework — Sort, Straighten, Scrub, Safety, Standardize, Sustain — is used to create a safe, efficient, and organized work area.
What is 6S?
The preface admits HHC had previously tried many health care improvement methods and still could not solve the challenges of this — the ability to spread change and keep it going.
What are spread and sustainment?
The 8 wastes of Lean are captured in this handy acronym — spelled out as: Defects, Overproduction, Waiting, Not best use of talent, Transportation, Inventory, Motion, Extra processing.
What is D.O.W.N.T.I.M.E.?
Three health care pioneers that HHC looked to as early Lean adopters in health care — one partnered with Boeing, one with Ariens, and one created an advisory board with Ritz-Carlton and FedEx.
What are Virginia Mason, ThedaCare, and Denver Health?
This Lean tool is a 4.5-day team-based rapid improvement event used to apply Lean tools for seeing waste and making change during the event itself.
What is an RIE (Rapid Improvement Event), also called Kaizen?
While HHC implemented Lean across its entire system, the book focuses on Lean in one area and one hospital. Name the area and the hospital.
What is behavioral health at Kings County Hospital Center?
This Lean tool resembles a fish skeleton and is used to establish direct and root causes of a problem — with branches representing categories like people, method, machine, and materials.
What is a Fishbone (or Ishikawa) Diagram?
The preface describes this as Lean's ultimate reward — not just revenue, but also this quality in staff that comes from being empowered to solve problems.
What is staff engagement (or empowerment)?
This A3-based tool is the executive-level road map for transforming a business over a defined period of time. Its acronym stands for Transformation Plan of Care.
What is a TPOC?
In 2013, despite 6 years of Lean behind them, the preface describes HHC's Lean effort as still being in this stage — with a 'long, long road ahead.'
What is its infancy?
This practice involves asking 'why' five times when a problem is encountered — to identify the root cause so effective countermeasures can be developed.
What is the Five Whys?
According to the preface, HHC made this specific commitment to its board of directors when it launched Lean — and received 'not insubstantial budgetary approval' in return.
What is a promise of substantial change?
This person — also called a Mizusumashi or water spider — moves quickly from place to place to deliver materials to flow cell members, taking non-value-added work away from the primary worker.
What is a Water Strider (or Water Spider)?
The preface describes Lean as helping the organization see through 'fresh eyes' and reach inside for reserves of these three qualities — long 'depressed by crisis management and an abundance of waste.'
What are innovation, patience, and purposeful compassion?
This vertical bar graph displays data in descending order of frequency — graphically demonstrating the Pareto Principle, also known as the 80/20 rule — used to find the 'vital few vs. the trivial many.'
What is a Pareto Graph?