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A3s (18) Show All »
Welcome to the MTL A3 Dojo
By: Shook, John | February 9, 2011
A3s; Columns
Welcome to this MTL-mini site within www.  lean.  org a destination for thought leadership in lean management in general, "managing to learn" and the A3 process in particular.  The goal of this site is to narrow the gap between reading about how to create an A3 and actually doing A3 management. This site within a site is meant to be a shared space for A3 thinking, a place for you to engage with others on the nitty-gritty daily challenges of your specific problems. Even for you to create an A3 and own it in the process.  This mini-site emerged out More »
Detailed A3 Template (from Managing to Learn)
By: Shook, John | July 19, 2010
A3s; Forms and Templates
A PDF of the A3 template provided in the book Managing to Learn. More »
Audio (16) Show All »
The Gold Mine (Audiobook - CD)
By: Freddy Ballé and Michael Ballé | November 9, 2010
Audio; Books
An unabridged audio version of The Gold Mine: A Novel of Lean Turnaround, a Shingo Research Prize recipient in 2006.    More »
St. Joseph Health System: Taking it to the next level
October 7, 2010
Audio; Images
Mary Kingston, Vice President for Performance Improvement at St. Joseph’s Hospital, talks about the first three years of the lean journey at St. Joseph's in California. She is interviewed (available in audio and text format) by the Association for Manufacturing Excellence in advance of their November conference, where St. Joseph's will be presenting.  From the interview:"One of the things I thought was really intriguing was the whole idea of capturing knowledge which I really hadn't thought about. We use A3 Thinking and our last box is called insights. What I've learned through this conference is that we've been very superficial More »
Case Studies (39) Show All »
Lean Design and Construction Project an Extension of Lean Commitment at Akron Children's Hospital
By: Vinas, Tonya | May 21, 2013
When the Ambulatory Surgery & Critical Care Tower opens in 2015, it will represent a three-year lean design and construction collaboration among builders, architects, trade contractors, healthcare provides, patients, and patient families. The design of both the facility and future operations is being shaped directly by patients and those who care for them. Input from nurses, doctors, therapists, technicians, and patient parents heavily influenced design decisions—from incorporating emergency room hallways that protect the privacy of abused children to the number of electrical outlets in each neonatal intensive care room.    More »
Lean Thinking Helps City of Chula Vista with Budget Crunch
By: Bartholomew, Doug | February 22, 2012
After laying off 350 employees and still facing a continuing budget shortfall, the City of Chula Vista, Calif.  , faced a seemingly impossible dilemma: how to maintain basic services without resorting to further cuts in the workforce. More »
Columns (290) Show All »
Do As I Say, Not As I Do
By: Erin Urban | October 21, 2014
"What the leader demonstrates as important is what the team will focus on," writes Erin Urban. "If we are to be the change we wish to see and model the behavior we teach, we must be cognizant that we are not sending the wrong message by our actions.  " More »
Lean Thinking for Warehousing and Distribution: How to Know Your Business
By: Chet Marchwinski | October 17, 2014
"The vast majority of warehouse or distribution center managers have nowhere near the level of detail about the business that’s needed for a lean transformation," says lean veteran David Graham. Learn what kind of knowledge and data you need and how to get it. More »
Events (12) Show All »
2014 Lean Healthcare Transformation Summit
January 10, 2014
June 4-5, 2014 - Los Angeles, California. Two days when you can learn directly from the lean healthcare leaders who are making real change and getting real results in how we deliver and pay for healthcare. More »
2014 Transformation Summit
October 21, 2013
March 5-6, 2014 - Orlando, Florida. Improve the work, develop the people - the building blocks for continuous innovation. More »
Outside Resources (3) Show All »
"Training Within Industry" Program Resources for Healthcare
August 20, 2009
The "Training Within Industry" program was a U.  S. government program during World War II that focused on ramping up war production. The methodology for creating job instructions, managing continuous improvement, and training employees became the foundation for Toyota's approach to Standardized Work as it was taught to them after the war.  The TWI approach was also used in healthcare during the war. The approach is being utilized today in a growing number of hospitals as that history is rediscovered.  The TWI Institute has resources and historical documents about TWI in healthcare. More »
Links to Hospital Lean Websites
By: Compiled by the Lean Enterprise Institute | August 14, 2009
Here is a list of healthcare organizations that have their own website about Lean:Virginia Mason Medical Center (WA)Avera McKennan (SD)Beth Israel Deaconness (MA)PRHI Perfecting Patient Care (PA)Seattle Children's (WA)  Univ. of Michigan Quality System (MI)ThedaCare Improvement System (WI) More »
Research (5) Show All »
Use of Lean Six Sigma Methodology to Improve Operating Room Efficiency in a High-Volume Tertiary-Care Academic Medical Center
By: Cima, Robert R. MD, MA, FACS, Michael J. Brown, MD, James R. Hebl, MD, et al | March 21, 2011
Abstract from the Journal of the American College of SurgeonsBackgroundOperating rooms (ORs) are resource-intense and costly hospital units. Maximizing OR efficiency is essential to maintaining an economically viable institution. OR efficiency projects often focus on a limited number of ORs or cases. Efforts across an entire OR suite have not been reported. Lean and Six Sigma methodologies were developed in the manufacturing industry to increase efficiency by eliminating non−value-added steps. We applied Lean and Six Sigma methodologies across an entire surgical suite to improve efficiency.  Study DesignA multidisciplinary surgical process improvement team constructed a value stream map of the entire More »
Redesigning Acute Care Processes In Wisconsin
By: Bielaszka-DuVernay, Christina | March 16, 2011
The journal Health Affairs features the work of ThedaCare's Appleton Medical Center and Theda Clark Medical Center in article about the redesign of acute care.  Cost Savings In the two acute care units where Collaborative Care has been implemented, cost per case has decreased 15–28 percent, and average length-of-stay has dropped 10–15 percent (with an 8.  89 percent thirty-day readmission rate).  Quality Improvement Results The two acute care units in which Collaborative Care has been fully implemented have achieved perfect “medication reconciliation,” which is a formal process for creating the most complete and accurate list possible of a patient’s current medications and comparing More »
Value-Stream Maps (8) Show All »
Value-Stream Map Zones (from Perfecting Patient Journeys)
By: Lean Transformations Group | January 29, 2013
Developing a current-state map creates a common understanding of how things really work today in the value stream (not necessarily what the documentation says or some might believe) so that the stakeholders can work together to identify and address problems and make improvements. Remember, see together, learn together, act together.  All value-stream maps are laid out in a horizontal format. They capture major categories or zones of fact finding. We find it helpful to think about value-stream maps in terms of the following six zones: customer, supplier, processes, information flow, process data, and a timeline and summary.  Perfecting Patient Journeys, More »
Value-stream Mapping Icons for Excel
By: Lean Enterprise Institute | January 1, 2003
At the request of some of our readers we have posted the most commonly used mapping icons so that they can be downloaded for Excel spreadsheets. More »
Workshops (57) Show All »
5S - Visual Workplace
5S methodology helps organizations achieve more consistent operational results through maintaining an orderly workplace. This workshop will introduce you to the 5S methodology and help you learn basic implementation steps including evaluation and audit. More »
A Factory of One: Applying Lean Thinking to Improve Your Personal Performance
As lean moves out of the "tool age," leaders—managers, directors, executives— must invest more time in the critical work of lean leadership: going to the gemba to support value creators in their improvement work and coaching and mentoring teams to develop their problem solving capabilities. This ensures that all organizational processes continuously add value to customers. More »
Articles (585) Show All »
"How to Lead with Respect" -- Follow-Up Q&A to the Webinar
By: Ballé, Michael | September 29, 2014
At the end of the lean management webinar “How to Lead with Respect,” we had a couple of hundred questions left over that presenter and author Michael Ballé didn’t have time to answer.  After reviewing the questions, several main themes emerged. We’ve selected your questions that best represent those themes and present them here with answers from Michael.  Q:Can you give examples of two improvements that can only happen within relationships to help me better understand this concept?A: Teaching lean thinking to the COO of a new company. In shipping, we start with a Truck Preparation Area --  the logistics More »
“How ThedaCare Created Its Own Management System”, Follow-Up Q&A
By: Barnas, Kim | June 2, 2014
Kim Barnas, author of Beyond Heroes: A Lean Management System for Healthcare, answers questions that we couldn't get to during the hour-long webinar on how to create a lean management system at a healthcare organization. More »
Books (183) Show All »
Beyond Heroes: A Lean Management System for Healthcare
By: Kim Barnas | April 22, 2014
Hospitals have long relied on heroics to save the day – on one brilliant nurse or physician to fix the problem at hand. The result is a lot of people rowing in opposite directions, putting safety and quality at risk while increasing costs. This is the story of an organization breaking that habit.   Beyond Heroes shows the reader, step by step, how ThedaCare teams developed their management system, using the stories of its doctors, nurses and administrators to illustrate. The book explores each of the eight essential components of the lean system:Team HuddlesManaging to Established StandardsProblem SolvingTransparencyAdvisory TeamsScorecardsStandard Work for LeadersPhysician’s More »
Lean Lexicon 5th Edition
By: Lean Enterprise Institute, Inc. | January 21, 2014
The fifth edition of the Lexicon, first published in January 2003, is 140 pages, containing 60+ illustrations and 207 key terms from A3 Report to Yokoten. The Lexicon already covers such key lean enterprise terms as jidoka, kanban, kaizen, lean consumption, lean production, lean enterprise, pull production, standardized work, takt time, Toyota Production System, and value-stream mapping. It also has a simple, one-page guide to pronouncing Japanese terms. More »
Charts, Graphs and Diagrams (4) Show All »
Begin from Need
October 28, 2010
"Begin from need" is attributed Taiichi Ohno, a key developer of the Toyota Production System. It means, as shown on these charts, what does the customer (the organization, the worker, the gemba) need right now? It's  another way of articulating the principle of PDCA, plan-do-check-act.    It helps us begin problem solving by grasping the situation, and avoid jumping to conclusions. More »
eLetters (347) Show All »
How is standardized work different from the Taylorist one best way?
By: Ballé, Michael | October 19, 2014
Columns; eLetters
How is standardized work different from the Taylorist one best way? More »
How can I train technical experts who know more about the work than I do?
By: Ballé, Michael | October 6, 2014
Columns; eLetters
Dear Gemba Coach,I understand I have to train people, but I work in a very technical area and they all know far more about their jobs than I ever will. How can I train them if they know more than I do? More »
Forms and Templates (18) Show All »
Problem Definition Worksheet
By: Lean Transformations Group | June 17, 2013
In order to continuously improve, you must be able to find problems in order to solve them.  Once you have found a problem, the first step you must take is to make sure you have properly defined the problem.  One way to look at problems (i.  e.  , gaps) is to think in terms of standards. A gap can exist between current performance and an established standard or a new standard that you are attempting to achieve. A problem also can be unwanted variation in performance even when average performance appears acceptable. When even a single out-of-specification event is a More »
Root Cause Template
By: Shook, John and David Verble | June 13, 2013
When trying to solve a problem, you want to identify underlying causes, which will help you to prevent fires rather than just extinguish them. By identifying the underlying causes down to the root causes, you can reduce the likelihood that a given problem will recur.  The most common root-cause analysis technique in lean is the "Five Why's.  " This is practice of asking why repeatedly whenever a problem is encountered in order to get beyond the obvious symptoms to discover the root cause.  For instance, Taiichi Ohno gives this example about a machine that stopped working (Ohno 1988, p. 17):Why did More »
Presentations (48) Show All »
KATA CASE EXAMPLE - GKN SINTER METALS
By: By Wayne Meyer | July 1, 2014
This month's video is a case example of deploying the Improvement Kata & Coaching Kata. Wayne Meyer illustrates GKN's application, explains how to get an organization to change and provides highly-useful lessons learned. Be sure to watch the final Q&A portion of the video for extra insights. More »
Lean Startup: From Toyota City to Fremont to You
By: Shook, John | February 10, 2014
Speaking at the 2013 Lean Startup Conference, John Shook, CEO of the Lean Enterprise Institute, used his slides to give the audience some background on lean’s development and its key concepts. But he also noted that whether a company is a startup or an established company, lean thinking and practice means:Engage Everyone in Problem Finding and Continuous ExperimentationGive Everyone Permission to Fail and Ability to Succeed More »
Software (1)
eVSM v7 - Electronic Value-Stream Mapping
March 10, 2014
Accessories; Software; Value-Stream Maps
Walking the shop or office floor with a paper and pencil to collect data and observe actual conditions is how value-stream mapping (VSM) is done. But for a long time, members of the Lean Community have been sharing these hand-drawn maps by creating their own electronic templates from scratch in various software programs. eVSM makes the process of turning hand-drawn maps into electronic ones easier and faster.  As a companion – not a substitute – to paper-and-pencil mapping, the software allows lean practitioners to easily create, modify, and disseminate electronic value-stream maps. More »
Videos and Webinars (33) Show All »
Webinar: How to Lead With Respect
September 9, 2014
How to Lead With Respect webinar featuring Michael Ballé More »
Webinar: The Two Basic Forms of Coaching for Lean
May 22, 2014
The Two Basic Forms of Coaching for Lean with David Verble More »