Housestaff Lean AcademyModule 1: Lean Principles for Physicians Robert Martin, PsyDPerformance ExcellenceUCLA Health
Lean should be a familiar process for Physicians… Scenario – a patient arrives with a problem (clinic, ED, etc.). What is the Physician’s process?
Lean is a modern term, but the origins are not… • Jidoka (1902) • Sakichi Toyoda invents device to detect broken threads in looms autonomously • Just-in-Time (1937) • Kiichiro Toyoda establishes Toyota, has the idea for JIT delivery of parts • Takt Time • German aircraft industry pioneers use takt time for synchronizing movement of aircraft • Mitsubishi brings idea back to Japan where Toyota embraces it • Venetian Arsenal • 1 Warship/day • Standardized Parts • Use of canals to flow galleys to workers through assembly phases • Deming Prize • Japanese Union of Scientists and Engineers creates Deming Prize for statistical quality and PDCA • American Meat Packers • Conveyor belts to steadily remove carcasses past workers after meat removal • Toyota > GM (2007) • Toyota becomes the world’s largest automaker UCLA Operating System Established by Amir Rubin 1902- Present 1930s 1880s 1890s 1780s 1500s 1980s - 2009 1960s 1940s 1908-1926 • Lean Research • Toyota Production System (1982, Yasuhiro Monden) • The Machine that Changed the World (1990, Womack, Jones, Roo) • Lean Thinking (1996, Womak, Jones) • Learning to See (1998, Rother and Shook) • DNA of the Toyota Production System (1999, Spear and Bowen) • The Toyota Way (2003, Liker) • Shingo Research Award – Lean Hospitals (2009, Mark Graban) • Training Within Industry • US Dept. of War introduces Job Instruction, Methods, Relations to teach millions of workers in war industries. Later introduced to Japan after the war • Scientific Management – Frederick Taylor • Scientific study of tasks • Employee development and training • Managers use principles to plan work and workers perform tasks • French Army Ordinance • Concept of interchangeable parts for muskets (pre-cursor to high-volume flow production • Henry Ford • 1908 Model T modular car with truly interchangeable parts “there are no files in my factory” • 1913 Flow Production Moving assembly line with processing feeder lines • 1926 Mass Production with product variety 2009 Mark Graban Shingo Research Award Lean Hospitals
Lean is based on a few important concepts… • Lean is more than a collection of tools…. • It is about creating a culture based on a few important concepts. • There are more- but these are sufficient for now!