A
A3
The A3 Event report is a communication tool following a logical and standard structure. The A3 document tells the story of each event:
- The purpose of the event
- Baseline measures - what it is like now
- Aims - what trying to achieve
- What was done in the event, tools used
- What was achieved during the week
- Next steps - project plan
- Lessons learned
Andon
Andon is a term referring to a system to notify management, maintenance, and other workers of a quality or process problem. It gives the worker the ability to stop the process when a defect or problem is found, and immediately call for assistance.
B
Batching
Items are pre-made, just in case - not on demand, creating piles, delays and overproduction. Batching is not Lean - it is the opposite to one piece flow.
BICS
Bolton Improving Care System is the hospitals name for the improvement programme of work using Lean methodology.
BICS Academy
A structured learning and development programme to support improvement work, using lean methodology. There are different levels of training/awareness within the programme:
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BICS Green Level Awareness
Green is the introductory level, which is now mandatory for all staff. The session is a basic introduction into the theory behind Lean methodology, history as to how and why Bolton became involved, in addition exercises and practical examples. This has been reviewed and incorporates the best of both from the community arm training. This training has been externally accredited by the RCN.
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BICS Bronze Level Certification
Bronze level aims to give a better understanding of BICS Philosophy and the use of some tools, in particular: Problem Solving, A3 Thinking, Seeing Waste. This is the second level of certification in the BICS academy, aimed at Departmental Managers and others, including Clinical Leads and identified Improvement Leads who will lead Teams, (with the help of a BICS Facilitator) on BICS Events and those who wish to use BICS principles in their everyday working. This is externally accredited by the RCN.
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BICS Silver Level Certification
The course aims to equip candidates with a better understanding about the BICS philosophy and build on experience of using BICS tools. Also to explore leading in a BICS environment and understanding the role of a leader embedding BICS within the Trust. In particular:
- Value Stream Analysis
- Elements of a Cell - Flow, Pull, 6S, Standard Work and Visual Management
- Leading in a BICS Environment
- Policy Deployment
This is the third level of certification in the BICS Academy aimed at Departmental Managers and others, including Clinical Leads and identified Improvement Leads who will lead Teams, (with the help of a BICS Facilitator) on BICS Events and those who wish to use BICS principles in their everyday working.
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BICS Gold Level Certification
Gold is the fourth level of the BICS Learning and Development Academy and aims to build candidates understanding about the BICS philosophy. Linking improvement to strategy, using advanced tools for eliminating waste across the value stream and further developing your leadership and facilitation skills. In particular:
- Understanding Customer Value
- Data Analysis for Quality Improvement
- Product and Service Development
- Breakthrough Thinking
- Improving flow to eliminate waste
- Programme Management and Sustainment
- Leading Lean Transformations
- Facilitation and being a Sensei
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BICS Platinum Level Certification
Platinum is the fifth level of the BICS Learning and Development Academy, which aims to equip participants with the knowledge to apply transformation thinking and how to apply the technique to each improvement tool and the ability to mentor rapid redesign at all levels
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BICS Academy 6S Training (Well Organised Working Environment)
6s training will assist with the improvement work being carried out as part of the Exemplar Programme and Productive Community Services and is also suitable for those who wish to practically improve their environment.
These 6s sessions will help to equip participants with the knowledge to get the best out of this aspect of improvement work, suitable for all levels of staff working in the area identified for improvement.
C
Current State
A Value Stream Mapping(VSM) tool. Showing how the process is currently.
E
Essential but Non Value Added
Any activity that does not add value to the customer, but is required to deliver the product / service to the customer. E.g. in air travel, essential but non value added activity would be security checks.
EVSA (Visioning Event)
Enterprise wide Value Stream Analysis is a visioning event to decide the Trust way forward using Lean methodology – the following are covered in an EVSA event:
- Why we need to change using BICS and Lean methodology
- What is the Trust like now "current state"
- What is the Trust aiming for "future state"
- How the Trust plans to achieve this
F
5 Million Lives Campaign
The 5 Million Lives Campaign is a voluntary initiative to protect patients from five million incidents of medical harm over the next two years (December 2006 - December 2008). The 5 Million Lives Campaign is the next step from the 100,000 lives campaign, which Bolton originally became involved in Lean methodology.
Facilitator
Facilitates preparation for events, in week and follow up. Works with Sponsor and Team Lead on 7 week cycles (Minimum). Facilitates all training required by the team and provides detailed knowledge and experience of tools and principles. Maintains an overview of the valuestream. Supports intense sustainment programmes when required
Five How's
Used in conjunction with the (five why's – see below) A simple idea generating method of how to address and solve the root cause of the problem by asking "How" five times. This should then form the basis of an implementation plan.
Five Why's
A simple problem solving method of analysing a problem or issue by asking "Why" five times. The root cause should become evident by continuing to ask why a situation exists.
Fishbone – Practical Problem Solving Tool
Is a tool used to clarify and then define the root cause of the problem (used in conjunction with the 5 whys) and then determine a solution
Flow (see one piece flow)
Future State
A Value Stream Mapping (VSM) tool. The final tool which utilizes the information from Current State and Ideal State An arrival date for Future State is set (usually 6-12 months). Obstacles identified in other exercises are targeted for resolution. An action list which contains Do-Its, Projects and Events is established with a time line and resources. Completion of this list will make the bridge between Current State and Future State.
G
Green Level Awareness (see BICs Academy)
The Trust's programme for staff to introduce them to the basic theory behind Lean methodology
Gemba (Go & See) - Gemba Walk
is a Japanese term meaning "the real place" or where the work or process occurs. The idea of gemba is that the problems are visible, and the best improvement ideas will come from going to the gemba. The gemba walk, is an activity that takes management to the front lines to look for waste and opportunities to practice practical shop floor improvement. if a problem occurs, you must go to the gemba to understand the full impact of the problem, gathering data from all sources.
H
Handoff Diagram
Diagram show the handoff of information between people involved in a process
Hoshin Kanri
see Policy Deployment
I
Ideal State
A Value Stream Mapping (VSM) tool. A virtual place where the Team builds a "sky's the limit" business. In this exercise, business avoids shared resources and has 3 cells maximum per path. All long term obstacles are identified. Done before "Future State".
Institute for Healthcare Improvement (IHI)
American organisation whose focus is to improve healthcare within the USA. In 2005, the IHI launched the saving 100,000 lives campaign - through which Bolton Hospitals NHS Trust first became involved in using Lean methodology to improve our services.
J
Just Do Its
Changes that can be made quickly.
Just In Time (JIT)
A strategy that concentrates on making quality products, in the quantity needed, when it is needed. This strategy exposes waste and makes continuous improvement possible.
K
Kaizen
Japanese for "Continuous Improvement" Based on the philosophy that what we do today should be better than yesterday and what we do tomorrow should be better than today, never resting or accepting status quo.
Kanban
A means of communicating need for products or services. It is generally used to trigger the movement of material where one piece flow cannot be achieved, but is also used to "signal" upstream processes to produce product for downstream processes.
Kamishibai
Visual management load levelling tool, to enable you to see and spread the work load. Kamishibai boards are used in the Trust as method for managing all departmental audits in one place and evening out the work required to do the audits and who is responsible for doing them.
M
Manual Cycle Time (MCT)
(The hand on time in an operation) also called touch time.
Mission Control
The nerve centre of the Trust's transformation – literally the process used to manage the change activity
- Embodies standard work, pull, flow, visual management and PDCA
- Allows you to lead by example
N
Non Value Added (NVA)
Any activity that used time or resources but does not directly contribute to satisfying the needs of the customer. E.g. in air travel, non value added activity would be waiting to check in.
O
One Piece Flow - (one by one)
A system where all the value added steps are put into sequence (no piles, no waiting, continuous flow) E.g:
- Subway sandwiches makes your sandwich fresh, one at a time and fills it by 'flowing' your sandwich along the counter, staff move very little (motion)
- McDonalds pre-make hamburgers in batches and kept warm. Staff have to run around between the burgers, fries and drinks. (motion)
Outbrief
Is a celebration event at the end of each Rapid Improvement week, where all teams come together to feedback on what they have achieved during the week and their next steps. The outbriefs take place at 11.00am on the Friday of the event week and all staff are welcome to attend – please contact the BICS Team for details on dates and venues - BICS@rbh.nhs.uk
P
Paradigm Shift
Paradigm shift is the term used to describe a change in the basic assumptions, or paradigms, that affect the way we behave/operate. Paradigm shift describes a profound change in a fundamental model or perception of events. For instance, at the start of the 20th century no-one thought it would be possible to have telephone in each home, now we have mobile phone technology. Paradigm shift is about changing the perception of what is/is not possible and adjusting accordingly.
PDCA Cycle
Plan-Do-Check-Act. The PDCA cycle, sometimes referred to as the Deming cycle, is an important item for control in policy deployment.
Perfection
Lean is about creating a culture of continuous cycles of improvement. It is not about one-off projects, but eliminating waste and making improvements forever.
Policy Deployment
Derived from the Japanese concept: Hoshin Kanri, Policy Deployment is the Framework to ensure that operational day to day actions relate directly to the achievement of strategic goals. It is a structured process aligning and deploying goals, measures and focus throughout the organisation. Also known as "Strategy Deployment"
Process Owner
The Process Owner may be responsible for all or part of a process within the area of improvement under focus in the event. One Team may have several process owners or just one dependant on structure of the organisation. The Process Owner should participate in events and take responsibility for the agreed improvements in the workplace on a day to day basis ensuring the improvement is sustained, effectively measured and further improved.
Production Control Board
A visual board in each cell with hour by hour planned and actual production levels including comments, problems, and corrective actions.
Pull
A system where you do not start doing a task until you are triggered by demand from the customer E.g.
- Making cup of tea when you are thirsty
- Not making 20 cups of tea in the morning, just in case you feel thirsty throughout the day
R
Rapid Improvement Event (RIE)
Rapid Improvement event focused on one area or issue. They are 5 days long with a 2-3 week preparation period before each event and a 2-3 week follow up period after each event.
Rapid Experiment
A way of trying out ideas and evaluating them to see if they work (PDCA cycle) and making any changes necessary before full scale implementation.
S
6S (Well Organised Working Environment WOWE)
Systematic way of creating a safe, clean and orderly workplace and keeping it that way:
- Most peoples garden sheds or garages
7 Flows
A tool to consider how different components flow through the process - a way of identifying what is needed at each stage of the process - a tool that will help build the 7 ways (beauty contest for future state). The 7 flows are:
- Patients
- Supplies
- Equipment
- Staff
- Information
- Medication
- Technical support
Sensei
An outside master or teacher that assists in implementing Lean practices.
Simpler
Is the consultancy company that Bolton Hospital is currently working with to assist us in using Lean methodology to transform our services.
Spaghetti Diagram
Map of current physical journey - showing the movement of the patient/product and or staff.
Sponsor
The Sponsor has the responsibility and ownership of an event, its impact and realising results. The Sponsor will be involved in preparation for events, introduce event weeks, and be visible in week. They will performance manage to ensure that processes are sustained, continuously improved upon and that measures are achieved and updated accordingly.
- Has process/budget authority
- Empowers team, busts obstacles, Communicates and acknowledges success
- Helps develop the RIE aim and metrics and act on teams recommendations
Commits to active support (kick-offs, updates, briefings) and reports success, Monitors performance, metrics
Stakeholder
A person or group people who are "touched" by a process, either directly or indirectly. These people have a vested interest in a particular process being reviewed by a Kaizen event. Any changes made to the process will affect them.
Standardisation
The system of documenting and updating procedures to make sure everyone knows clearly and simply what is expected of them. Essential for application of PDCA cycle
Standard Work
A prescribed documented method or process that is sustainable, repeatable and predictable. Creation of a system, where it is clear what exactly is needed to do a job, when needed, in the quantity needed, using the best way known to do the job. Standard work is also adjustable over time to ensure that it continually fit for purpose.
Standard Work in Progress (Std WIP)
The minimum amount of material or a given product, which must be in process at any time to insure proper flow of the operation.
T
TAKT Time
The frequency with which the customer wants a product. How frequently a sold unit must be produced. The number is derived by dividing the amount of time available in a shift by the customer demand for that shift. The time required to produce one component based on customer demand.
Takt Time = (available time) / (customer demand)
2 P
A lean tool which designs a process capable of meeting the customers needs. Defect free, On demand, 1 By 1, At Lowest cost. It stands for Process Preparation.
It works by focussing on the needs of the product first - the process is designed around the transformational steps of the process as the ‘product’ progresses through its work sequence.
3 P
A lean tool which designs a process capable of meeting the customers needs. Defect free, On demand, 1 By 1, At Lowest cost. It stands for Production, Preparation, Process and differs from the 2 P tool by ensuring the right sized equipment is factored in the process.
Team Leader
The Team Lead will work with the Facilitator to ensure all prep and follow up is completed, and lead the team through event week where they will;
- Challenge the team constantly, maintain a 'can do It' atmosphere
- Set direction and focus the team on the specific actions
- Co-ordinate team activities, match people to tasks
- Involve and communicate updates to team
- Go between sub teams if you have them
- Be sensitive about the impact of changes on people who work in the RIE area
- Ensure communication with the wider team takes place
- Communicate with the Sponsor
- Ensure someone writes up what is done each day and set the ‘to do list’ for the following day
- Attend evening out briefs and prepare Friday out brief
- Ongoing responsibility for sustaining improvements
Team Member
- Remain open minded and be prepared to do things differently
- Those from the work area should represent colleagues, communicate to them everyday, obtain feedback and use their comments/ideas. They also have an on-going responsibility to sustain improvements and make more
- Be prepared to brief managers and colleagues
- Members acting as fresh eyes should be prepared to challenge an drive new ways of doing things
Customers and patient members should bring evidence of what customers and patients really require from the service
TPOC
Transformational Plan of Care details the Trust’s strategy regarding improvement encompassed in the Bolton Improving Care System (BICS).
It provides a summary of progress being made towards the Trust’s “future state” (what we want to achieve) and how it is helping to achieve the Trust’s objectives of:
- Best Care for Better Health
- Responsible Use of Resources
- Valued, Respected and Proud – for staff, patients and the public
The TPOC informs the BICS improvement events
True North Goals
The Trust's ultimate aim - what it wants to achieve through using lean Methodology, there are four true north goals:
- Best Care for Better Health
- Responsible Use of Resources
- Valued, Respected and Proud – for staff, patients and the public
V
Value
Value is what the 'customer' perceives to be important to them. Interpretation of value is different for different people. For example:
- What do you value when getting your hair cut? (cost, time surroundings, quality)
- How much would you expect to pay (£5 or £75)
- What would you expect to get? (15 minute appointment with no fuss or 1 our with coffee, magazines)
Value Added (VA)
Any activity that directly contributes to satisfying the needs of the customer. E.g. in air travel the value added activity is actually flying
Value Stream
A Value Stream is how we deliver our work from start to finish. It is how we deliver ‘value’ to the 'customer'
Value Stream Analysis/Mapping (VSM)
The process of recording all the steps in a value stream including inventory, flow time, cycle time, and decision points.
Vertical Value Stream Map (VVSM)
Tool used for projects or product development to show the relationship between the tasks and the resources required to accomplish those tasks. Allows the team to create a plan in the least-waste way.
Visual Management
(Productive Community Services modules refer to this as "Knowing How you are Doing" and "Patient Status at a Glance").
Systems that enable anyone to immediately assess the current status of an operation or given process at a glance, regardless of their knowledge of the process.
- Departure board at an airport
- A white board on a ward with just the patient names on it
W
Waste (Muda)
Waste is all the non value added activities that we currently have in the system that does contribute to satisfying the needs of the customer. Waste is categorised into 8 types:
- Injuries - damage to people
- Defects - ‘stuff’ that is not right and needs fixing
- Inventory - ‘stuff’ waiting to be worked
- Overproduction - too much ‘stuff’
- Waiting - people waiting for ‘stuff’ to arrive
- Motion - unnecessary human movement
- Transportation - moving ‘stuff’
- Processing Waste - 'stuff' we have to do the does not add value
Work in Progress
Amount of "stuff" that is waiting to be worked, e.g. items in an in-tray - typically created in a batching system. Lean methodology aims to make work in progress as minimal as possible
Writing Cell
A method where a document/presentation is created, formatted, tested and reviewed in a structured and limited time scale. Different members of the writing cell take on different roles.
Y
Yokoten
The principles of Yokoten is concerned with shared learning. It is concerned with teams and departments sharing how they have overcome problems with solutions, with the aim of allowing other teams to learn from these solutions and adapt to put in practice. The Trust has a Shared Learning intranet site to provide a place to share good practice and to offer inspiration when looking for ideas to address an issue.