Lean in HealthCare

Helen Zak of the Lean Institute writes about the national healthcare debate and Lean:

“No doubt you've heard and read a lot about the debate in Washington D.C. over healthcare reform.

“Like me, you're probably concerned about the lack of discussion about how to take waste out of healthcare delivery by applying lean principles before any of the proposed solutions are enacted.

“So, the Lean Enterprise Institute and the ThedaCare Center for Healthcare Value have formed a nonprofit partnership to make sure lean thinking is part of healthcare's future.

We are partnering because we believe proposed solutions to the country’s healthcare problems, such as electronic health records and expanded insurance coverage, miss the underlying problem -- healthcare's systemic waste and errors, which drive down quality and drive up costs, producing:

100,000 unnecessary patient deaths annually
15,000,000 unnecessary patient injuries annually
100,000,000 hospital medication errors annually
Escalating costs that now stand at 16.2% of GDP, 50% higher than the next highest country

“We believe the solution is the application of lean thinking to all of the processes delivering care in hospital rooms, clinics, operating rooms, pharmacies, emergency rooms, and outpatient centers. Unless we eliminate the waste and errors, proposed reforms will only be different ways to pay for and perpetuate a broken system.”

Lean does work in healthcare too. For more information about this important subject (Healthcare costs contractors a lot of money!) go to: www.HealthcareValueLeaders.org

Lean Standards

Lean experts always stress the importance of standardization. We often claim it is impossible to standardize construction work. George Hedley, president of a general contracting company doesn’t agree. He makes sure his company is running efficiently because he has set in place the way every job should be run. He says,

“Step one is to have written standardized field systems or procedures for your field team to follow and use. These systems must be written and not just in your head. I call this our "DO" Manual. How we "DO" business on every project, no exceptions! It's a simple notebook that has our company standards and systems written out. There are pictures of what we want and how we want things done. It has checklists and guidelines for the field crews and project team members to follow. Each field employee is issued a company "DO" manual to follow and refer to. It is used for training and as a tool to make sure we all do business the same way. Our "DO" Manual has the following sections:

General Information

• Questions
  
• Problems Issues
  
• Calls To Make
  
• Calendar
  
• Business Cards Phone #'s

Field Systems

• Job Information
• Project Administration Checklist
• Job Start-Up Checklist
• Job Contract
• Job Plans
• Job Specifications
• Subcontractor List
• Subcontracts
• Job Goals Objectives
• Job Budget
• Job Schedule
• Shop Drawing Submittal Log
• Job Daily Activity Reports
• Job Inspection Log
• Job RFI / PCO / CO Logs
  
• Job Meeting Minutes
  
• Quality Punch-list Reports
  
• Job Close-Out Checklist
  
• Company Information
  
• Company Standards
  
• Company Systems
  
• Employee Forms”

Source: George Hedley, Hardhat Hedlines December 2008

Last Planner System (LPS)*

“Exploiting these [Lean] opportunities requires new leadership, thinking and practice at every level of the organization and over the life of every project. While it is possible to implement aspects of lean and to receive some of the benefits, the impact is limited and the practices are soon abandoned. For example, the ability of the planning system to predict the condition of a project one week in advance can be measured and steps taken within current practice to improve. Short-term improvements are real but lost as the initiative veers down one of two unsustainable paths; one leads to crisis, the other to a slow return to current practice.

“The leadership of companies implementing LPS usually see it as an improved way to plan but often do not believe they have an actual problem. The crisis occurs when early LPS implementation reveals significant failures within current practice.

“Failures of administration, the lack of connection of the project plan to action in the field, and the ability of the organization to assure work is ready or the sequence is maintained become painfully obvious. Senior managers are often shocked to discover the magnitude and extent of these problems, even on projects managed by their top teams.

“This realization leads some companies to adopt the LPS across the company.

“In other companies, managers attribute the problems to individual incompetence rather than the inevitable consequence of the current operating systems. In these cases, solid performers may be fired and the lean initiative dies.
“The drift back to low performance is less dramatic. The intention, habits and practices of current project management contradict those necessary to make workflow predictable. Some improvement in reliability is possible by doing more to assure work is ready when assigned. These gains are lost when the habits and practices of centralized command and control are reasserted. The organizations revert to traditional practice when supervisors push each crew to do whatever work they can to assure high labor utilization.

“Taking advantage of the opportunities created by Lean Construction requires a steady, long-term effort to learn and improve. The leadership available limits the speed and effectiveness of lean initiatives. Going lean and transforming an organization is more than hard work. Developing understanding at the highest level is a first order of business as is establishing a strategy to satisfy the organization’s ambition. Study Action Teams provide both the background and opportunity to establish that strategy. Where companies go from their initial exposure and learning depends on how they see their opportunities now and in the future. Early implementation of LPS should be used to discover the changes needed to assure the company becomes a lean organization.

Going lean is hard work. Lean concepts will reshape the structure and practices of project management. Success in this new industry will rest on opportunities not possible in current practice and readily available under a lean operating system for project management.”

Source: “Lean Construction: The past and future” by Gregory A. Howell, P.E.

* Last Planner System is a trademark of the Lean Construction Institute.

Learning Opportunities

You may be interested in attending one of these training seminars:

• Sept. 17, 2009 - Customer Loyalty by Design, – Phoenix, AZ – Sponsor: PIPE & 469 JAC, contact Cathy at pipetrust@qwest.net
• Oct. 6, 2009 - Lean Works in Construction – Milwaukee, WI – Sponsor: Plumbing Mechanical Sheet Metal Contractors Alliance, Contact: Dajen Bohacek at 414/543-7622 or dajen@pmsmca.com Must be a SMACNA member company, associate or sponsored by one to participate.
  
• Oct. 15. 2009 - Introduction to Lean in Service, – Phoenix, AZ – Sponsor: PIPE & 469 JAC, contact Cathy at pipetrust@qwest.net
  Contact Dennis Sowards if you want a customized workshop exclusively for your company.

Other Lean Construction Events:

• July 22, 2009 - Creating a Learning Organization - LCI Los Angeles Area Chapter (Long Beach, CA). Details and registration are at: http://lci-la-07-2009.eventbrite.com
• Aug 6, 2009 - Lean Project Delivery: Present, Contract, and Implement Lean Construction, Cincinnati, OH, Sponsor: The Greater Cincinnati SMPS in association with THE Lean Construction Institute is pleased to welcome a seminar designed for all professionals in the A/E/C industry. Details and registration are at: http://tinyurl.com/nyftse
• August 12, 2009 - Nor Cal Lean Construction Institute Chapter Meeting, Rancho Solano Clubhouse, Fairfield, CA - 6:00 PM-9:00 PM - Pacific Time, Contact: Theresa Robinson at trobinson@tcco.com or 916.554.7944
• Sept. 17, 2009 – Arizona Chapter of the Lean Construction Institute LCI kick-off meeting, details to come.
• Oct. 13, 2009 - Kaizen Events – Improving Your Business’ Efficiency in Just One Week (A New Horizons Foundation Project), 2009 SMACNA Convention, Palm Springs, CA, details at: https://www.smacna.org/events/annualconvention/

A Quick Thought

Don’t focus on the improvements that cost money. Focus on the many improvements that don’t cost a lot. - Bruce Hamilton

For more information about Lean applications to construction and especially the 5S’s contact Dennis Sowards at his office at 480-835-1185 or his cell at 602-740-7271 or at his web site: www.YourQSS.com

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