Thursday, June 17, 2010

Behavioral Health Kaizen Two Report Out is Tomorrow/Friday at 10:00AM in the CCRMC Lobby

"We are here to make another world."
- W. Edwards Deming

What is Lean?

There are many different variations of Lean in practice so I offer a very limited and generic overview that is consistent with the overall philosophy and reflective of CCRMC's Lean efforts.

Generally, Lean is centered on creating more value with less work. Lean Management is a process management philosophy derived mostly from the Toyota Production System (TPS) and grounded in W. Edward Deming's System of Profound Knowledge. Lean focuses on reduction of the original Toyota seven wastes in order to improve overall customer value.

Working from the perspective of the customer who consumes a product or service, "value" is defined as any action or process that a customer would be willing to pay for. Value is defined by the external customer and in our case it's always the patient.

Lean manufacturing is a variation on the theme of efficiency based on optimizing flow; increasing efficiency, decreasing waste, and using empirical methods to decide what matters, rather than uncritically accepting pre-existing ideas.

Why Lean and why now?

"The future is already here…it’s just not evenly distributed yet." *

For many of us it is difficult to hear our system described as "financially unsustainable," but that is how our system was described at a board meeting earlier this year. This shouldn't surprise any of us. As a government owned and operated system, we are in fact a reflection of the US Health Care system. I understand many would argue that industry is a better description than system. However you prefer to describe it, we do offer a glimpse of what the nation faces.

Currently health care makes up about 17% of the GDP and is climbing at a steady and very unsustainable rate. In America, we hear daily debates about bailouts, stimulus packages and health reform. Although the solutions are still in the development phase it is clear we must change course nationally and it is just as clear we must do the same here at the local level. Lean Management offers a systematic way of improving efficiency while improving not compromising quality.

What are we doing at CCRMC?

Teams of key stakeholders perform an exercise called value stream mapping. This mapping examines steps in our processes and determines how much value these steps add to the patients experience of care from their perspective. In partnership with users of our health system/community partners, teams then imagine/dream the ideal future state and present that to the system. To begin developing and testing changes to take our system to this ideal future, a series of rapid improvement events or kaizen events (also known as kaizen blitz) are conducted. In these improvement events several small tests and simulations are performed where changes are developed and tested with front-line staff and users of our system. Teams in the site where the work actually occurs then implement changes and continue to refine them on an ongoing/continuous basis, pursuing the ideal future state.

I know this seems like a foreign language, and that's because it actually is!

It feels like so much to learn, but we will learn together. We will take one step at a time. If we fall down seven times, we will get up eight. Please ask questions and keep an eye out for updates. Anyone from the Operations Team can answer your questions so please don't hesitate to ask.

I hope to see you tomorrow.
More very soon.

Click here to go to the Daily Kaizen Update learn more about what this week's team is doing.
Continuous Information for Continuous Improvement...


  1. Bravo Anna. Keep up the good work. Chugachmiut is an Alaska Native non profit organization that began its lean transformation in May of 2004. We have started to write about that transformation at:

  2. Thank you for your kind words. I will pass your comments along to the teams.

    One of the greatest joys in work for the staff and our partners is knowing we are linked to other great organizations in our journey. We will be cheering for Chugachmiut on your transformational journey from Contra Costa and we look forward to learning with you.

    As it turns out, I have had the opportunity to "go and see" Southcentral Foundation (unfortunately not Chugachmiut)in Anchorage during my fellowship at the IHI and I often draw on that experience to describe what it looks like when the community drives the care.

    I have started reading your blog and am learning a great deal. It really puts things into perspective to think your system promotes health not only in the populated regions of your state, but across 10 million acres of Alaskan wilderness. Wow! Now that's a daunting Gemba/shop floor.

    Something that caught my eye in your blog was the movement from "Tool Based" Lean implementation to "Culture Based" Lean implementation in your post, "A hard nut to crack" ( A magnificent and courageous discussion/post and I could not agree more.

    Thank you for sharing.