Overview of

LEAN Management
精益管理概略

Timothy WONG, SNO / KH

Based on Mr. Simon CHENG and Ms Ivy CHEUNG

HOHR T&D Teaching Material on Lean Management 1
Content
What is LEAN ?
Two key themes
Five principles of Lean Thinking
Traditional approach to improvement
A basic cell of Lean
Lean toolbox

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What is LEAN ?

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What is LEAN ?
Commonly associated with
Japanese manufacturing -
Toyota Production System (TPS)
TPS : Improving the production process and
building quality into the product in the first
place

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TPS 14 Principles…
1: Base Your Management Decisions on a Long-Term Philosophy, Even at the
Expense of Short-Term financial Goals
2: Create Continuous Process Flow to Bring Problems to the Surface
3: Use “Pull” Systems to Avoid Overproduction
4: Level Out the Workload (Heijunka)
5: Build a Culture of Stopping to Fix Problems, to Get Quality Right the First Time
6: Standardized Tasks Are the Foundation for Continuous Improvement and
Employee Empowerment
7: Use Visual Control So No Problems Are Hidden
8: Use Only Reliable, Thoroughly Tested Technology That Serves Your People and
Processes
9: Grow Leaders Who Thoroughly Understand the Work, Live the Philosophy, and
Teach It to Others
10: Develop Exceptional People and Teams Who Follow Your Company’s Philosophy
11: Respect Your Extended Network of Partners and Suppliers by Challenging Them
and Helping Them Improve
12: Go and See for Yourself to Thoroughly Understand the Situation (Genchi
Genbutsu)
13: Make Decisions slowly by Consensus, Thoroughly Considering All Options;
Implement Decisions Rapidly
14: Become a Learning Organization Through Relentless Reflection (Hansei)
and Continuous Improvement (Kaizen) 5
Lean is …
A management strategy to do with improving
process
Applied as health care system holds a series
of process and sets of actions intended to
create value
Focused on distinguishing value-added steps
from non value-added steps, and eliminating
waste (muda)

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Two Key Concepts …

Continuous elimination of waste

Respect for people & staff engagement

(not for headcount reduction)

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5 Principles of Lean Thinking
Value – Customer defined, satisfying their needs
Value Stream – Alignment with patient “Care Paths”
Flow – Process, no gaps between value added steps
Pull – Triggering from actual demand
Perfection – Continuous improvement forever

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Traditional Approach to Improvement

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A Basic Cell for Lean

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8 Types of Waste : DOWNTIME

D efects T ransportation
O ver Production I nventories
W aiting Motion
N ot Utilizing E xtra Processes
Resources
Effectively

Consume resources but create no value for the customer

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Examples of “DOWNTIME”
Defects Medication errors; Wrong site surgery

Over-production Unnecessary tests and x-rays

Waiting Patients on waiting list and queuing in
hospitals/clinics
Not utilize resources Staff in wrong posts / roles
effectively
Transportation Excessive movement of patients and
equipment
Inventories Unnecessary high levels of ward stocks

Motion Staff walking miles to carry out tasks

Extra processes Multiple history taking

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Flow : One Piece vs. By Batch
Process A Process B Process C

10 min.
10 min. 10 min.
1st need
Flow time : 30 min for total order
21 min for the 1st need

Process A Process B Process C

1st need 12 min for total order

3 min for the 1st need

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Benefits of One Piece Flow

 Improves safety
 Builds in quality
 Improves flexibility
 Reduces inventory
 Improves productivity

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Pull vs Push
Pull : service triggered by demand
e.g. vending machine

Push : service triggered by own schedule

without considering the demand and readiness
of “next process”
e.g. supply of old hospital notes

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Pull : Kanban and 2 Bins

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Lean Toolbox
Lean is a process improvement methodology
A set of techniques for solving problems

Lean Toolbox

Qualitative Quantitative

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Data Collection is Important

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Qualitative Techniques

Questionnaire Focus Group Interview Complaints

Lean
Patient Association/Group
Toolbox Go to Gemba

Fishbone
Analysis

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GEMBA (現場)
Gemba Walk
 Going to workplace to look for wastes &
opportunities

Let me go to gemba!

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5-Whys

Helps in revealing root cause of problems

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5-Whys
I can’t submit the proposal on time overdue

 Some details in the proposal have not yet

1st Why?
been ready.
 2nd Why? The graphs and charts are constructed slowly.
 3rd Why? I need at least 2 hours to compose one
graph/chart.
 4th Why? I need to draw the graphs/charts by hand.
 5th Why? I don’t know how to use computer software to do
it.

Avoid assumptions
Trace the chain of causality from a surface cause to a
root cause

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5-Whys
1st

2nd

3rd

4th

5th

Backward : If you
1, 2, 3…..
have done so, then… 23
Fishbone Diagram (Ishikawa Diagram)
Show causes of a certain event

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Quantitative Techniques

Lean
Toolbox

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Pareto Chart – Medication Errors

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Spaghetti Diagram

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Spaghetti Diagram – What is it?
It is a useful visual overview of the geography of the
process.
Help you establish the optimum layout for a department /
ward based on observations of the distances travelled by
patients, staff or products e.g. x-rays.
A great tool for exposing inefficient layouts and identifying
large distances travelled between key steps.

Remarks
• Forget about drawing neat straight lines
• No need to draw things to scale
• Keep track of the number of trips made to remote
locations and note the reasons why

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 Hand Off Chart

1. An analysis and communication tool

2. Involved offices identified on the circle
circumference
3. Who is involved, upstream and downstream
stake holders, Intra-, Inter-, external flows
4. Current and future state comparison
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Pick the Right Problem Solving Tools

GEMBA Identify wastes or opportunities

5-Whys
Cause & effect analysis
Fishbone Diagram
Relative importance of factors
Pareto Chart
Spaghetti Diagram Work flow, Layout efficiency

Lean
Toolbox

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5S + 1S = 6S

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6S - Color & Labeling

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6S

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Visual Management
Visual management
- Tell us at a glance how work should be
done
- Whether it is deviating from the standard

 To catch people’s attention and

communicate important information
by means of
 signs, lights, notice boards, paint, graphic
displays, etc

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Visual Management

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ANDON

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Value Stream Mapping

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Value Stream Analysis - Timeline

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Current Value Stream Map

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Lean Project Process

Define Measure
Measure Analyse
Analysis Improve
Improve Control
Control

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Lean Process Tools
Define 4W1H, Project Charter
Measure Gemba, Interview, Survey, Spaghetti
Diagram, Pareto Chart
Analyse 5 whys, Fish Bone Diagram, VSM
Improve Intervention with time frame, Visual
Control, One piece flow, Pull System,
6S
Control Data collection, Observations,
Regular progress review / reporting 44
WISER

Cluster lean management structure and

projects Steering group
W I S E R – developed by UK visit
delegates, “We Innovate, Services Excel
Rapidly”
KCC, NTEC …

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THANK YOU

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