Management for Professionals

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More information about this series at http://www.springer.com/series/10101

Thomas Pyzdek

The Lean Healthcare

Handbook
A Complete Guide to Creating
Healthcare Workplaces

Second Edition
Thomas Pyzdek
The Pyzdek Institute
Tucson, AZ, USA

ISSN 2192-8096 ISSN 2192-810X (electronic)

Management for Professionals
ISBN 978-3-030-69900-0 ISBN 978-3-030-69901-7 (eBook)
https://doi.org/10.1007/978-3-030-69901-7

The first edition originally published as The Lean Healthcare Handbook: A Complete Guide to creating
healthcare workplaces that maximize flow and minimize waste in 2018 by Atlantis Publishing.

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Introduction

There is a better way to lead healthcare organizations: one that makes much more
sense than the traditional methods taught in business schools. The Lean way of
designing work involves all levels of the organization, from the leaders who create a
culture of continuous improvement to the person actually doing the work. This book
covers the following topics:

• The origins and drivers of Lean

• What is value?
• Waste and value
• Value streams, flow, push and pull systems
• Why it is important to move towards perfection
• Improving physical and logical work flow using spaghetti diagrams
• Mapping value streams
• Principles of work design
• Workplace organization and housekeeping
• Changing quickly from producing one product or service to producing another, or
from treating one type of patient to treating another
• Continuous improvement and Kaizen
• Leveraging results

By using the approach described in this book you will be able to produce the same
amount of value while using far fewer resources, which benefits all of your
stakeholders and the environment as well. Or, you can produce much more with
the resources you now have. This improved productivity can, in turn, be used to
expand capacity, capture new markets and increase profitability.
I have seen many value streams that contain as much as 95% non-value added
work, otherwise known as waste. A surprising number of value streams are actually
100% waste! That is, they are duplicating the work of another value stream in the
firm while adding no additional value. For example, a financial company had two
groups in two different locations performing the same audit on the same paperwork.
As you undertake your Lean journey be prepared to be astounded at the amount of
improvement you will see.

v
Contents

Part I Lean Tools and Techniques

1 Introduction to Lean and Muda (Waste) . . . . . . . . . . . . . . . . . . . . . 3
1.1 What Is Lean? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
2 Product Family Matrices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
2.1 What Is a Product Family . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
2.2 Creating Product Family Matrices . . . . . . . . . . . . . . . . . . . . . . 23
2.3 What Makes a PFM Unique? . . . . . . . . . . . . . . . . . . . . . . . . . . 24
2.4 Creating and Using a PFM . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
3 Spaghetti Diagrams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
3.1 What Is a Spaghetti Diagram? . . . . . . . . . . . . . . . . . . . . . . . . . 25
3.2 Creating Spaghetti Diagrams . . . . . . . . . . . . . . . . . . . . . . . . . . 25
3.3 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
4 Value Stream Maps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
4.1 Push Systems and Pull Systems . . . . . . . . . . . . . . . . . . . . . . . . 29
4.2 Why Value Stream Maps Are Important . . . . . . . . . . . . . . . . . . 30
4.3 Value Stream Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
4.4 Example: Emergency Department VSM . . . . . . . . . . . . . . . . . . 31
4.5 What Makes VSMs Unique . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
4.6 How Value Stream Maps Are Used . . . . . . . . . . . . . . . . . . . . . 34
4.7 Creating the Value Stream Map Phase I . . . . . . . . . . . . . . . . . . 34
4.8 Creating the Value Stream Map Phase II . . . . . . . . . . . . . . . . . . 36
5 Lean Value Stream Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
5.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
5.2 Continuous Flow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
5.3 Reasons for Discontinuous Flow . . . . . . . . . . . . . . . . . . . . . . . 42
5.4 Steps Toward Continuous Flow . . . . . . . . . . . . . . . . . . . . . . . . 43
5.5 Supermarkets and Kanbans . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
5.6 Pacemaker Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
5.7 Production Mix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
5.8 Production Volume . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

vii
viii Contents

5.9 Load-Leveling Box (Heijunka Box) . . . . . . . . . . . . . . . . . . . . . 48

5.10 Every Part Every Day . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
5.11 Surgical Procedures Scheduling Case Study . . . . . . . . . . . . . . . 50
5.12 Future State Value Stream Map Case Study . . . . . . . . . . . . . . . 54
5.13 Future State Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
6 Standardized Work Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
6.1 Selecting Subprojects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
6.2 Elements of Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
6.3 What Methods Should Be Used to Accomplish the Goal Using the
Resources that We Have? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
6.4 How Should the Workplace Be Arranged? . . . . . . . . . . . . . . . . 79
6.5 How Many People Are Needed? . . . . . . . . . . . . . . . . . . . . . . . 82
7 5S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
7.1 Sort . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
7.2 Set in Order . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
7.3 Shine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
7.4 Standardized Cleanup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
7.5 Sustain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
7.6 Safety: The Real First S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
7.7 How Can We Continue to Reduce Waste? (Kaizen, Lean) . . . . . 98
8 Fast Work Changeover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
8.1 History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
8.2 SMED for Healthcare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102

Part II Continuous Improvement and Kaizen

9 Introduction to Continuous Improvement . . . . . . . . . . . . . . . . . . . . 115
9.1 Kaizen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
10 Process Mapping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
10.1 Activity Maps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
10.2 Opportunity Maps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
10.3 Deployment Maps (Swimlane Maps) . . . . . . . . . . . . . . . . . . . . 128
11 Statistical Thinking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
11.1 Enumerative Studies (Classical Statistics) . . . . . . . . . . . . . . . . . 133
11.2 Analytic Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
11.3 Operational Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
12 Descriptive Statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
12.1 Properties of Distributions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
12.2 What Does s Mean? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
13 X-Charts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
13.1 Sampling for Process Control . . . . . . . . . . . . . . . . . . . . . . . . . . 151
13.2 Control Charts for Process Metrics . . . . . . . . . . . . . . . . . . . . . . 152
13.3 Equations for X-Charts (Optional Material) . . . . . . . . . . . . . . . . 154
Contents ix

14 Pareto Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157

14.1 How to Perform Pareto Analysis . . . . . . . . . . . . . . . . . . . . . . . 157
14.2 The Graphical Story of Me . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
15 Graphical Data Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
15.1 Correlation Analysis Using Scatter Plots . . . . . . . . . . . . . . . . . . 165
15.2 Histograms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
15.3 Example of a Histogram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
16 Problem Solving Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
16.1 Cause and Effect Diagrams . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
17 Project Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
17.1 True North Projects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
17.2 Project Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190
17.3 Project Charter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
17.4 Project Planning and Scheduling . . . . . . . . . . . . . . . . . . . . . . . 194
17.5 Failure Mode and Effects Analysis (FMEA) . . . . . . . . . . . . . . . 198
17.6 Risk Assessment and Contingency Planning . . . . . . . . . . . . . . . 202
18 Kaizen Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
18.1 Scheduling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
18.2 Two Months Before The Event . . . . . . . . . . . . . . . . . . . . . . . . 207
18.3 Event Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
18.4 Sustain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
19 A3 Thinking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
19.1 What Is the A3 and A3 Thinking? . . . . . . . . . . . . . . . . . . . . . . 223
19.2 A3 Content and the A3 Thinking Process . . . . . . . . . . . . . . . . . 227

Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
Lean Six Sigma Lexicon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
List of Figures

Fig. 1.1 Value stream mapping as A3 thinking . . . . . . . . .. . . . . . . . . . . . .. . . . . . . . 8

Fig. 1.2 Value stream map of an emergency department process
before applying Lean . .. . . . . . . . . . . .. . . . . . . . . . . . .. . . . . . . . . . . .. . . . . . . . . . 9
Fig. 1.3 Spaghetti diagram before Lean . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Fig. 1.4 Spaghetti diagram after Lean . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Fig. 1.5 Elements of Lean production . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Fig. 2.1 Product family matrix—surgical/out-patient treatment . . . . . . . . . . . . 22
Fig. 3.1 Example of Spaghetti diagram before Lean . . . . . . . . . . . . . . . . . . . . . . . . 26
Fig. 3.2 Spaghetti Diagram with Numbered Stops . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Fig. 3.3 Using Spaghetti Diagram to Help Validate Product Families . . . . 28
Fig. 4.1 Illustration of push versus pull pharmacy value streams . . . . . . . . . . 30
Fig. 4.2 Value stream map symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Fig. 4.3 Preliminary sketch of a value stream . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Fig. 4.4 Data box symbol .. . .. . .. . .. . .. . .. . . .. . .. . .. . .. . .. . .. . . .. . .. . .. . .. . .. . . 37
Fig. 4.5 Worker/operator symbol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Fig. 4.6 Inventory symbol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Fig. 4.7 Electronic information symbol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Fig. 4.8 Manual information symbol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Fig. 4.9 Push symbol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Fig. 4.10 Timeline symbol . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . 39
Fig. 4.11 Example of completed timeline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Fig. 5.1 Pacemaker process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Fig. 5.2 Pacemaker placement for custom production . . . . . . . . . . . . . . . . . . . . . . 45
Fig. 5.3 Load leveling symbol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Fig. 5.4 Example of using load leveling icon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Fig. 5.5 Load-leveling box (Heijunka box)
(http://en.wikipedia.org/wiki/Heijunka_box. In this illustration,
each time period builds an A and two Bs along with a mix of Cs,
Ds, and Es. What is clear from the box, from the simple repeating
patterns of Kanbans in each row, is that the production is smooth
for each of these products.) ............................................. 48

xi
xii List of Figures

Fig. 5.6 Current state value stream map . . . . .. . . . . . .. . . . . . .. . . . . . .. . . . . . .. . . . . 55

Fig. 5.7 Continuous flow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Fig. 5.8 Build to supermarket . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Fig. 5.9 Takt time versus cycle time . .. . . .. . . .. . .. . . .. . . .. . . .. . .. . . .. . . .. . .. . . 59
Fig. 5.10 Future state value stream map with Kaizen burst symbols . . . . . . . . 60
Fig. 6.1 Subproject loops . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
Fig. 6.2 Value creation hierarchy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Fig. 6.3 Production capacity for instrument cleaning process . . . . . . . . . . . . . . 71
Fig. 6.4 Crib assembly instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
Fig. 6.5 Manufacturing standard operations bulletin example
(Kanban Just-in-Time at Toyota (1989), Productivity
Press, Portland, OR. P. 114.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Fig. 6.6 Standard operations bulletin example
(surgical instruments cleaning) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Fig. 6.7 Paper Kaizen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Fig. 6.8 Cause-and-effect diagram template . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Fig. 6.9 Air ambulance work cell layout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Fig. 6.10 An ambulance as a work cell . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Fig. 6.11 Material storage in an ambulance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Fig. 6.12 Instrument cleaning work cell layout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Fig. 6.13 Instrument cleaning work flow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Fig. 6.14 Cross-training chart . .. . .. . .. . .. . . .. . .. . .. . .. . .. . .. . .. . .. . .. . .. . .. . .. . . 86
Fig. 7.1 5S surgical instruments organizer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
Fig. 7.2 Pots and pans outlined on pegboard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Fig. 7.3 Engine assembly line in Poland with color-coded overhead
tools on retractable cords . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
Fig. 7.4 Simulated workplace . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Fig. 7.5 Location indicator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Fig. 7.6 Lean aisle marked with colored tape . . . . . . .. . . . . . . . .. . . . . . . . .. . . . . . . 94
Fig. 7.7 5S job cycle chart . . .. . .. . .. .. . .. . .. . .. . .. .. . .. . .. . .. . .. . .. .. . .. . .. . .. . 96
Fig. 7.8 5 Minute 5S signboard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Fig. 8.1 SMED method illustrated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Fig. 8.2 Four successive runs using SMED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Fig. 8.3 SMED data recording form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
Fig. 8.4 SMED with multiple operators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Fig. 9.1 Kaizen responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Fig. 9.2 Kaizen versus innovation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Fig. 9.3 PDCA improvement cycle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
Fig. 10.1 Standard flowchart symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Fig. 10.2 Activity map example . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Fig. 10.3 Make a copy as-is process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Fig. 10.4 Opportunity map example (Gray activities are NVA) . . . . . . . . . . . . . 127
Fig. 10.5 Future state process map example . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
Fig. 10.6 Deployment (swimlane) map example . . . . .. . . .. . . . .. . . .. . . .. . . . .. . . 129
Fig. 10.7 Vertical deployment map of process with a problem . . . . . . . . . . . . . . 130
List of Figures xiii

Fig. 11.1 Why you need to plot the data! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134

Fig. 11.2 Models for forecasting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Fig. 11.3 Process control versus quality control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Fig. 11.4 Shewhart‘s big question . .. . . .. . . .. . . .. . .. . . .. . . .. . .. . . .. . . .. . .. . . .. . . 139
Fig. 11.5 Shewhart‘s big question answered . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
Fig. 11.6 Wrong common cause improvement strategy . . . . . . . . . . . . . . . . . . . . . . 141
Fig. 12.1 Distribution properties illustrated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
Fig. 12.2 Visualizing s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
Fig. 13.1 Example of X chart . . .. . . . .. . . . .. . . . .. . . . .. . . . .. . . . .. . . . .. . . . .. . . . .. . . 153
Fig. 14.1 Newspaper sales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
Fig. 14.2 Newspaper sales rescaled . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
Fig. 14.3 Pareto chart structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Fig. 14.4 Pareto chart of reported problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
Fig. 14.5 Final pareto chart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
Fig. 15.1 Linear relationship . . . .. . . . .. . . . .. . . . .. . . .. . . . .. . . . .. . . . .. . . . .. . . . .. . . . 166
Fig. 15.2 Curvilinear relationship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Fig. 15.3 Structure of scatter plots . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
Fig. 15.4 Excel’s scatter plot . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Fig. 15.5 Range restriction effect . .. . .. . .. .. . .. . .. .. . .. . .. .. . .. . .. .. . .. . .. .. . .. . 170
Fig. 15.6 Scatter plot interpretation guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Fig. 15.7 Histogram structure . .. . .. . .. . .. . . .. . .. . .. . .. . .. . .. . .. . .. . .. . .. . .. . .. . . 172
Fig. 15.8 Example of a histogram . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
Fig. 16.1 Structure of cause and effect diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178
Fig. 16.2 Potential causes of CVC bacteremia infections
(The diagram shown here is based on this NIH article
http://bit.ly/2iznSx4) .. .. . .. . .. .. . .. .. . .. . .. .. . .. . .. .. . .. . .. .. . .. .. . .. . 180
Fig. 16.3 Generic enhanced cause and effect diagram . . . . . . . . . . . . . . . . . . . . . . . 183
Fig. 17.1 Transfer function illustrated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Fig. 17.2 Cascade leaders’ goals to your project . .. . . . .. . . . .. . . . .. . . .. . . . .. . . . 188
Fig. 17.3 Effect ! Cause ! Effect Cascade . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Fig. 17.4 Charter form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192
Fig. 17.5 Work breakdown structure for PDCA project .. . .. . . .. . .. . .. . .. . .. . 196
Fig. 17.6 Gantt chart example . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Fig. 17.7 Gantt chart symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Fig. 17.8 FMEA workbook . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Fig. 17.9 PDPC chart example . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Fig. 18.1 When to use a Kaizen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
Fig. 18.2 Value add, non-value add and wait time . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
Fig. 18.3 Bringing value to the company multi-tasking version . . . . . . . . . . . . . 207
Fig. 18.4 Bringing value to the company focused projects version . . . . . . . . . 207
Fig. 18.5 Sample Kaizen event schedule . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210
Fig. 18.6 Sample graphics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212
Fig. 18.7 The hidden operation is at the bottom of the process map . . . . . . . . 212
Fig. 18.8 Example swim lane process map . . . . . . . . . .. . . . . . . . . . . . . . . .. . . . . . . . . . 214
Fig. 18.9 Sample fishbone diagram . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
xiv List of Figures

Fig. 18.10 Improvement ideas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217

Fig. 18.11 Completed affinity analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
Fig. 18.12 Category names . . . . . .. . . . . . .. . . . . . .. . . . . . . .. . . . . . .. . . . . . .. . . . . . .. . . . . . 218
Fig. 18.13 Benefit/effort/cost matrix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
Fig. 18.14 Sample process control plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220
Fig. 18.15 Kaizen event evaluation form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Fig. 19.1 A3 template with plan-do-check act scientific method . . . . . . . . . . . . 224
Fig. 19.2 Many facetted features of A3 thinking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226
Fig. 19.3 Example of an A3 with 7-step practical problem solving . . . . . . . . . 228
Fig. 19.4 A3 using 8-step practical problem solving . . . . . . . . . . . . . . . . . . . . . . . . . 230
Fig. 19.5 A3 thinking across the A3 tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230
Fig. 19.6 Example of an A3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Fig. 19.7 The problem background step example . . .. . . .. . .. . .. . . .. . .. . .. . . .. . 232
Fig. 19.8 Current condition example . . . . .. . . .. . . .. . . . .. . . .. . . .. . . . .. . . .. . . .. . . . 233
Fig. 19.9 Target condition example . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234
Fig. 19.10 Root-cause analysis A3 example . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236
Fig. 19.11 Countermeasures developed with a future state
Value Stream map . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Fig. 19.12 Cost/benefit matrix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238
Fig. 19.13 Example countermeasure table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238
Fig. 19.14 A3 implementation plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
Fig. 19.15 Example of effect confirmation .. .. . .. .. . .. .. . .. .. . .. .. . .. . .. .. . .. .. . 240
Fig. 19.16 A visual follow-up plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241