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Creating a Culture of Improvement with the Principles of Enterprise Excellence John S. Toussaint M.D.

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Page 1: Creating a Culture of Improvement with the Principles of

Creating a Culture of Improvement with the Principles of Enterprise ExcellenceJohn S. Toussaint M.D.

Page 2: Creating a Culture of Improvement with the Principles of

Catalysis is a not for profit education institute our work consists of:

• Custom Educational Programs• Peer to Peer Learning Networks • CEO/CMO/CNO Forums• Products: Books and White papers• Executive Site Visits• Annual North America Summit and European Summit• Center for Lean Engagement and Research (CLEAR)

with UC Berkeley• Free Resources via createvalue.org

Page 3: Creating a Culture of Improvement with the Principles of

What is the underlying management philosophy of the organization/practice?

Page 4: Creating a Culture of Improvement with the Principles of

What is the basis of the management philosophy?

Page 5: Creating a Culture of Improvement with the Principles of
Page 6: Creating a Culture of Improvement with the Principles of

What are principles

• Universal truths• Based on fundamental scientific or logical “truths” arising

from observation and experimentation• Objective

• Based on logic not emotion. Do not depend on beliefs or feelings

• Govern a consequence• Leads to a predictable outcome: positive or negative

• Predictable

Page 7: Creating a Culture of Improvement with the Principles of

The Ten Shingo Principles

Create Value for the Customer

Create Constancy of Purpose

Think Systemically

Flow & Pull Value

Assure Quality at the Source

Focus on Process

Embrace Scientific Thinking

Seek Perfection

Lead with Humility

Respect Every Individual

Page 8: Creating a Culture of Improvement with the Principles of

Framework for Model Cell

• An inch wide, mile deep experiment• Focused on an important business problem• Creates a new system with standard work• Ties to key organizational performance • Involves and is sponsored by senior

leadership• It is connected to an enterprise wide value

stream

Page 9: Creating a Culture of Improvement with the Principles of

Toyota video

Page 10: Creating a Culture of Improvement with the Principles of
Page 11: Creating a Culture of Improvement with the Principles of

Who’s time? Who’s motion?

Page 12: Creating a Culture of Improvement with the Principles of
Page 13: Creating a Culture of Improvement with the Principles of

Benefits of applying improvement concepts in dentistry

Patient time for complete

treatment

Patient time for complete

treatment Hygienists Assistants Dentists OperatoriesNumber of visits per

Year

Before 99 Days 7 3 5 3 10 7,519

After 10 Days 1.5 2 3 3 6 5,723

Results/ Improvement +90% +78% +33% +40% --- +40% +24%

Page 14: Creating a Culture of Improvement with the Principles of

Too Many Setups SMED: Treatment Room Changeover

Extra Capacity Flow: Dentist Part of TreatmentCross-Training

Hygiene Not IncludedLevelingMixed Treatment

Coordination Problems

Flow Manager Position

Communication Problems

Kanban / Synchronization

Trying One-Piece Flow

CountermeasureBarrier

Continuous Improvement

Page 15: Creating a Culture of Improvement with the Principles of

One appointment

All treatment

All providers

ContinuousTreatment

No interruption

AllProviders

Smooth Succession

No gaps

Everything before patient leaves

All treatment

All support functions

Defining One-Piece Flow: Making and moving one piece at a time.

15

No wait in Chair

Page 16: Creating a Culture of Improvement with the Principles of

Before SMED After SMED

Setu

p Ti

me

Red

uctio

n

Before and after Smed

16

Page 17: Creating a Culture of Improvement with the Principles of

Amount of resources

Overburden

Excess Capacity

10

190

10

190

0Day 1 Day 2 Day 3 Day 4

Num

bero

f Pat

ient

s

Why Leveling (Averaging)? To optimize the amount of resources

Leve

ling

(Ave

ragi

ng)

Lean Tracker

17

Page 18: Creating a Culture of Improvement with the Principles of

Multifunction Worker Training Timetable

Name Task

Task

Task

Task

Task

Task

Task

Task

Task

Task

Task

Date

Name

1 Jane Doe

2 John Doe

3 Jane Doe

4 John Doe

5 Jane Doe

6 John Doe

7 Jane Doe

8 John Doe

9 Jane Doe 18

Page 19: Creating a Culture of Improvement with the Principles of

Dr. Bahri built a model cell dental clinic on a set of principles he established• A belief in the power of Plan-Do-Study-Act (PDCA)

and a commitment to completing the whole improvement cycle every time

• Commitment to becoming a teacher who learns and teaches by asking good questions not telling everyone what to do

• Commitment to running experiments• The humility to admit that knowledge is everywhere in

the practice and improvement is temporary

Page 20: Creating a Culture of Improvement with the Principles of

TYPES OF BEHAVIOR

Ideal behavior established by the individual from

exploring their own personal gaps

INDIVIDUAL

Day-to-Day behavior that is specific to the area and job

related functions.

TACTICAL

High-level behavior that is for all leaders, all managers and all front-line employees, regardless of area.

ORGANIZATIONAL

Behavior that is specific to departments and/or designed systems.

OPERATIONAL

BEHAVIOR

specific

broadPRINCIPLE

SYSTEM

Page 21: Creating a Culture of Improvement with the Principles of

What organizational behaviors are important?

Page 22: Creating a Culture of Improvement with the Principles of

Focus on processEmbrace scientific thinking

Flow & pull valueUnderstand & manage variation

Assure quality at the sourceSeek perfection

Break-through Thinking Monitor & Maintain Predictability Adapt & Adjust

Continuously learn by listening, seeing and translating

observations. Support new models of care delivery developed by front line.

Monitor the outputs of each system to ensure stability and a standard outcome. Continuously challenge

the process to identify areas of improvement.

Adapt the tools by making incremental adjustments that

all shifts agree with. Treattools as a countermeasure not a solution. Structurally solve area problems daily.

Create value for the patientCreate constancy of purpose

Think systemically

[leadership] [management] [front-line]

Establish Direction Organizing & Translating Setting & Achieving GoalsDevelop a vision and strategies to achieve that vision. Set high

but reasonable targets. Communicate the direction on

a regular basis.

Establish a structure to achieve the plan. Organize and allocate

resources. Monitor structure to ensure consistency and alignment

to plan.

Identify meaningful goals that can be accomplished in their area that directly affect the overall vision and strategy. Daily report on status and

needed support.

Lead with humilityRespect every individual

Learn continuously

Motivate, Mentor, Inspire Empower, Involve & Coach Develop & ShareEnergize people to develop and

overcome barriers to change. Daily be in the work area to listen to understand. Embrace failure;

celebrate success.

Empower authority within parameters of area to improve and solve problems. Break-down silos

by involving cross-functional teams to solve value stream issues. Coach

problem solving daily.

Be a self-developer. Findopportunities to grow and

develop to better support the organization. Share with

others what is working and what is not working.

Source: Toussaint,J NEJM Catalyst June 20th 2016

ALI

GN

ENAB

LEIM

PRO

VE

[principles]

Leadership Principles and Behavior

Page 23: Creating a Culture of Improvement with the Principles of

What personal behaviors are required for building an improvement culture?

Page 24: Creating a Culture of Improvement with the Principles of

Reflection

0

1

2

3

4

5Willingness

Humility

Curiosity

Perseverance

Self-Discipline

Go See, Listen & Learn

Asking Questions

Effective ListeningA3 Thinking

Partner, Buddy System

Coach

Leader Standard Work

Senior Leader Behavioral Self-Assessment

Page 25: Creating a Culture of Improvement with the Principles of
Page 26: Creating a Culture of Improvement with the Principles of
Page 27: Creating a Culture of Improvement with the Principles of
Page 28: Creating a Culture of Improvement with the Principles of

1

2

3

4

5Willingness

Humility

CuriosityPerseverance

Self‐Discipline

Reflection

Go See: Listen & Learn

Asking Questions

Effective ListeningA3 Thinking

Partner, Buddy System

Coach

Leader Standard Work

Personal A3 and Self – Assessment Senior Leader Self-Assessment on Fundamental Behaviors


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