Академический Документы
Профессиональный Документы
Культура Документы
GPS
MUDA MUDA
3P:
NVA/VA-
Functions/Mgrs Safety Morale Capacity Tables
Production,
e
p
l Setup Reduction Heijunka Poka-yoke
o Changeover (mistake
y
(Leveling) proofing)
m
e
Preparation,
n Multi-process Continuous
t
Operations Flow Kanban Andon
3P
RPIW Kaizen Kaikuku Prod
Prep
7 Flows
Factory Product/Patient Quantity Analysis
7 Flows
Medicine
Process
• Sweeping
• Sorting 7
4 No’s
• Simplifying 5S • Standardizing
• Self Discipline Wastes
Taiichi Ohno
27 3P v20130529 2 ©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
Mod 27 – 3P
Half of Everything
Lean = ½ Less
½ the human effort.
½ the space.
½ the equipment.
½ the inventory.
½ the investment.
½ the engineering hours.
½ the new product development time.
World-Class Paradigm
The Important Number is Zero
Waste
27 3P v20130529 6 ©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
Mod 27 – 3P
Transportation
Movement
Stock on Hand
Processing
(Inventory)
People Space
Large Machines
A Single Goal: NO WASTE
27 3P v20130529 8 ©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
Mod 27 – 3P
Value
Typical
Added Non-Value Added
Company
Original
Lead Time
Traditional
Improvement VA NVA
Minor
Improvement
Kaizen
Waste VA NVA Major
Reduction Improvement
Time
27 3P v20130529 9 ©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
9
Mod 27 – 3P
Value Stream Network
VSM
Mapping
Health Care Enterprise
Kanban
Hospital
3P
Kanban Standard
Work: SW
Right Size
Kaizen
Equipment
OR
3P
Steps SW
to customer’s customer
Kaizen Kaizen
4. Remove waste
5.Pursue perfection
VSM
What is 3P?
The model process for designing quality services
and appropriate production processes while best
embracing Rapid Process Improvement culture.
Q D T
The Best Quality At The Demand Proper Timing
Service Volume (TAKT Time)
Proper Cost
is a by-product of these other factors.
Medications
Instruments
Inspection Systems
Applying the
Principles of Simple/Flexible
U-Shaped Cells
Takt Time
Rapid Process Pull Ergonomics
One-Piece-Flow
Improvement Jidoka Poka-Yoke
Waste Elimination
Rectified Flow
HON INDUSTRIES
To Our Services
To Our Processes
27 3P v20130529 13 ©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
13
Mod 27 – 3P
Non-Value 194
Added Time minutes
52 minutes -73%
Distance
Traveled
748 feet 181 feet -76%
27 3P v20130529 15 ©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
Mod 27 – 3P
Why Do 3P?
DEVELO P EFFECTIVE SERVICES AND PROCESSES
Improvement
Kaizen - Evolutionary Change
Kaikaku - Revolutionary Change
Time
27 3P v20130529 17 ©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
Mod 27 – 3P
When is 3P Used?
Production
Changes Preparation Process
In Process Design
Demand Changes
3
Assured Quality
Product Development
TAKT Time
2 Ease of Service
Delivery
1. Determine Function
What is the Theme & Scope of Your Event
Product Process
HON
Allstee
Post on Wall/Board
Clamp
spin
turn K
E WORDS
Y
staple slide
Attach Cling
Move Shear
Spin
Adhere
Cover
Grip
Attach Cling
Float
Shear
Do Your Homework
Sketch the Examples
Attach Hinge
Nature
105 degrees
rotation
What is now
Force uniform
happening or must 48- 94 degrees flex
Fly
Seven Proposals
Be Creative.
Do NOT Be Afraid to Propose Anything!
27 3P v20130529 26 ©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
Mod 27 – 3P
190
PROOF
MOONSHINE
Document
Collect Real Data
The Data
#3
Even Though Your Model is NOT Perfect, it will Give
You Valuable Data on How to IMPROVE Your Design.
27 3P v20130529 28 ©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
Mod 27 – 3P
Established
Criteria
Design
Design #3
Evaluation
Demo/Explain
Design Top 3 Designs
Improve Designs
If Problems Arise...
Fix Them Right on the Spot, Don’t Talk About Them.
Keep TRY-storming....NOT Brainstorming.
27 3P v20130529 30 ©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
Mod 27 – 3P
Quality
Patient Flow
Material Control
Information
Hospital Layout System
Safety
Evaluation Committee
Have Models and Data Prepared for Viewing By Evaluation Committee.
These are Your Customers...They have to Buy the Designs From You
27 3P v20130529 31 ©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
Mod 27 – 3P
3P Results
GI 60 58 89 52.4 GI 60 58 45 26.5
IR 15 15 180 26.5 IR 15 15 60 8.82
Bronch 3 3 89 2.62 Bronch 3 3 45 1.32
EP 11 11 142 15.3 EP 11 11 62 6.69
Cath 13 13 143 18.2 Cath 13 12 63 8.03
total 102 114.98 total 102 51.33
Assumptions for space were made for each area based on Takt Time. Note many of the calculations are based on
current lead time. Assumptions with decreased lead times are noted
1. Direct Admit Pt Calculation assumptions:
TT = 279’ LT = 6192 Demand: 1885 Time Available = 24 hrs/day
Functional Units – 22 beds
2. ED Patient Flow: Peak time 1100 – 2100
TT = 8’ LT= 190’ Time Available = 600 minutes (peak 10 hours of the day)
Functional Units = 25 rooms (* at current lead time at 50% improved lead time = 11 – 12 rooms), X-ray (plain) –
need 2.7 machines, CT scanners 2, Chemistry TT 11.5, Heme 3.
Adjacency: Radiology and lab in ED, parking, food services for patients and families, elevators for moving pts and
supplies Flexible monitored rooms for procedures, overnight stays. Supplies and equipment dropped down from
the ceiling
•TT = 600/102 = 5.8 min. •TT = 600/102 = 5.8 min.
Functional Units: LT/TT = 114.98/5.8 = 19 •Procedure Rooms: LT/TT = 51.333/5.8 = 8.9 rooms for current
rooms (current state lead time) volumes (future state)
Reductions in Travel-Distance-Based
Flows in New Locations are:
Flow Before After % Change
Provider 1696 feet 442 feet 74 %
ED Patient w/CT scan 1208 feet 460 feet 62 %
Cardiac Cath Patient 580 feet 403 feet 30 %
Inpatient Surgery Patient 1180 feet 740 feet 37 %
Clinic Patient Admit 1050 feet 680 feet 35 %
Supplies 45,000 feet 3750 feet 92 %
Innovative concepts:
“Library Walls”– to expand and contract co-located spaces with utilities in the ceiling to allow for inexpensive cell
changes.
Flexible space based on “grid” delivery of power, medical gases, air, etc., from the ceiling using “quick connect”
connections. Get plumbing and electrical out of cement to keep the lower space maximally flexible for the
future.
“Lunchable” supplies for surgical/procedure kits. Drop into the room from above and then “drop” in the floor
(chutes and ladders) for disposal.
Design a bed that has all the information attached –Cerner connection, equipment etc.
1000 Madison Future ideas: Looking to the Horizon for our Future:
Retail (food service) to support staff/patient needs/amenities and local neighborhood needs/amenities.
Health/wellness center (Spa).
Below grade parking with access to ED.
Migrating OP Services here with above and below grade access.
Reduce Walking:
50% reduction for patient in maternity department.
50% reduction for patients in pediatrics department.
Reduce Storage:
Reduce Intrapartum ward storage by 65%.
Reduce administrative/office areas by 50%.
Albert Einstein
MUDA MUDA
Module 22
n Multi-process Continuous
t
Operations Flow Kanban Andon
3P
RPIW Kaizen Kaikuku Prod
Prep
7 Flows 7 Flows
Factory Product/Patient Quantity Analysis Medicine
• Sweeping
• Sorting 7
4 No’s
• Simplifying 5S • Standardizing
• Self Discipline Wastes
7 Flows of Medicine
1. Flow of Patients
2. Flow of Family
3. Flow of Providers
4. Flow of Information
5. Flow of Supplies
6. Flow of Medications
7. Flow of Equipment
27 3P v20130529 60 ©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
Mod 27 – 3P
1. Flow of Patients
A. No patient waits.
B. Minimize patient walking; bring the
services to the patient.
C. Problems must force the process to stop.
D. Patient flow is in only one direction with
successive steps in order of processing.
E. Incorporate quality checks at each step of
the process with mistake-proofing
methods.
F. If there is single-piece flow,
schedulers/planners are not needed for
the process.
G. Understand Takt Time – meeting the
demand.
H. Use “between processes” time to
complete indirect patient care tasks.
27 3P v20130529 61 ©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
Mod 27 – 3P
2. Flow of Family
A. Family and important relationships are
defined by the patient.
B. Family travels with the patient where
appropriate and as the patient desires.
C. Family is a respected part of the
patient care team.
D. Family concerns stop the process until
addressed.
E. Family is a respected source of
information about the patient.
F. Information should flow to the family
throughout the process as desired by
the patient.
3. Flow of Providers
A. Understand Takt Time and cycle times of the
work.
B. Look for standard work – it is critical to people
flow.
C. Do not isolate people in “islands.”
D. Understand people movement especially if
across several process steps.
E. People are part of the process – when they
stop, the process should stop.
F. All supplies, instruments and materials should
be as close to the provider as possible.
G. Examine motion of hands, feet, and eyes.
H. Stand when possible – do not use chairs!
I. Do not tolerate rework!
J. Avoid unreasonableness (i.e., Muri).
27 3P v20130529 63 ©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
Mod 27 – 3P
4. Flow of Medications
A. Single-piece flow with signal/pull from
provider.
5. Flow of Supplies
A. Do the supplies flow to point of use?
B. Just in Time – only material on-hand needed at
the right place and at the right time.
C. Make the flow visual for simple control.
D. Introduce min/max, or “2 bin” strategies to re-
supply point of use.
E. Presentation of materials and sequencing is key.
F. Quality is critical.
G. Inventory reduction strategies – use kanban for
total inventory reduction.
H. Think of flow upstream – to suppliers – is it Just
In Time? (JIT)
6. Flow of Information
A. Information travels with patient.
B. When information flow stops, the process stops.
C. When designing the process, consider how
information flows.
D. Only the minimum information necessary to
perform the process should be released.
E. Introduce mistake proofing and go/no go gauges
to ensure the flow of correct information.
F. Information can come in many forms – signals,
lights, sounds, music, spaces, etc.
G. Information must facilitate pull processes, not
push.
H. “Open room” arrangements facilitate the flow of
information between providers and staff.
27 3P v20130529 66 ©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
Mod 27 – 3P
7. Flow of Equipment
A. Arrange equipment in a sequence that facilitates
the flow of patients, providers and information.
B. Separate people from machine work (i.e., Jidoka).
C. Use equipment with narrow frontage. Think
“townhouse” not “ranch house.”
D. Operation in front – maintenance in back.
E. Right-sized, small, economical equipment on
wheels that is home-made.
F. “No money” and “no time” are just excuses.
G. Use of small, single-purpose machines with
in-process checks.
H. “No roots, no ivy, no anchors.”
I. Equipment must facilitate flexible arrangements
as demand and processes change.
J. Is there wasted machine movement?
27 3P v20130529 67 ©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
Mod 27 – 3P
# IN EXP.
ITEM COST STOCK DATE
Implant Hospital/
Cochlear $50K ea 15 2008 Factory Clinic
Implant
No Excess Just-in-Time
Inventory Supply
Why? Why?
Why?
6
8
1 2 3 4 5 6 7 8 9 10
TODAY
2025
Yes!
I document
after each
patient visit
blah
blah
MACHINES
3
P
Machines
Pulling
Pushing
Which is Smoother?
Spaced far
apart Closely Spaced
Machines Machines
CO$T Q
D
T
16 Catchphrases
1. Production Preparation should be lightning fast.
2. Equipment construction and layout should permit easy material flow.
3. Build additive equipment; no battleships.
4. Build equipment to allow easy changeovers.
5. Make equipment easy to disconnect and relocate.
6. Make versatile equipment that can easily be reconfigured.
7. Make operator stations narrow; deep is acceptable.
8. Both the equipment and layout should allow the operator to move easily. Open
room concept allows operators to see the big picture.
9. Eliminate machine waste; kaizen the motion of the machine.
10. Build equipment to fit into small, swift vertical flow lines.
11. Eliminate horizontal flow…this creates batch processing.
12. Production should be pulled along at Takt Time. Do not allow room or capability for
batching.
13. Build tooling/machines for rapid setups and quick changes.
14. Link machines to make work flow smoothly and avoid excessive WIP.
15. Use multiple lines to avoid constructed flow.
16. Continue pursuing the steps of jidoka by spiraling upward, continuously separating
machine tasks from human tasks.
16 Catchphrases
1. Production Preparation should be lightning fast.
16 Catchphrases
2. Equipment Construction and Layout should permit easy material flow.
Standard Work
①
②
③
④
Entry
Exit
Materials
27 3P v20130529 108 ©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
Mod 27 – 3P
16 Catchphrases
3. Build additive equipment. No battleships.
16 Catchphrases
4. Build equipment to allow easy changeovers.
Change-over Flowing gap Old product New product
5 4 5 4
A 3 F 3
RM 2 RM 1 2
5 4 4
B 3 E 3
RM 1 2 RM 1 2
5 4 5
C D 3
RM 1 2 RM 1 2
27 3P v20130529 110 ©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
Mod 27 – 3P
16 Catchphrases
5. Make equipment easy to disconnect and relocate.
Machines
16 Catchphrases
6. Make versatile equipment that can easily be reconfigured.
Big Dedicated
Machines
16 Catchphrases
7. Make operator stations narrow. Deep is acceptable.
Ranch
Style
Layout
Principle of Townhouse
Verticality Style
Reduced Layout
Footprint Narrow but Deep
Reduced Walking
1 step - station to station
27 3P v20130529 113 ©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
Mod 27 – 3P
16 Catchphrases
8. Both the equipment and layout should allow the operator to move easily.
Open room concept allows operators to see the big picture.
Fixed
Layout
16 Catchphrases
9. Eliminate machine waste. Kaizen the motion of the machine.
1. Switch on
2. Air cutting down (Muda)
3. Drilling
4.Air cutting up (Muda)
Air
cutting MUDA
16 Catchphrases
10. Build equipment to fit into small swift vertical flow lines.
16 Catchphrases
11. Eliminate Horizontal Flow. This creates batch processing.
Horizontal
Press Press Press Press Handling
NO FLOW
Process
Paint Paint Paint Paint
A B C D
Products
16 Catchphrases
12. Production should be pulled along at takt time.
Do not allow room or capability for batching.
1 1
Day Day
16 Catchphrases
13.. Build tooling/machines for rapid setups and quick changes.
Ease of positioning
16 Catchphrases
14. Link machines to make work flow smoothly and avoid excessive WIP.
Whoa!
NO MORE WIP
Five pieces
is Standard
16 Catchphrases
15. Use multiple lines to avoid constructed flow.
F1
Model A
A1
Model B B1 F2
P1 A2
Model C
Model D B2 F3
F4 A3
16 Catchphrases
16. Continue pursuing the steps of Jidoka by spiraling upwards,
continuously separating machine tasks from human tasks.
Jidoka
7 Quality Check (Poka-Yoke)
6 Part Removal (Hanedashi)
5 Autonomation of Returns
4 Automation of Stops
3 Autonomation of Feed
2 Automation of Holding
1 Autonomation of processing
QUESTIONS?
3P Contract
3P Architect Contract
The 7 Ways
Process-At-A-Glance Sheet
Product Design Evaluation
3P Process Evaluation Checklist
3P Project Form
3P Target Sheet
The No’s of Health Care
Construction / Building Supplies as Directed by JBA
27 3P v20130529 124 ©1996-2013, John Black and Associates LLC
Licensed Materials – USA Copyright Laws Apply
Mod 27 – 3P
3P Contract Contract
To give full play to my team’s creativity
Creativity comes into existence by removing the hurdles in the way of
Each team member signs a creative thinking and idea generation.
Therefore, as one who tries to be creative, I do hereby promise to do
contract on Monday of the 3P the following to improve my creativity:
1) I will not judge (good or bad) another person’s idea.
week to ensure full disclosure 2) I will make every effort to overcome the hurdles in my own
thinking in order to generate useful ideas.
of creativity and a non- 3) I will not think in limited ways but will make every effort to
look at the problem from many angles and especially to get
ideas from nature.
judgmental approach to 4) I will make every effort to express my ideas openly and not fear
the laughter of others.
design. 5) I will return to my 12 year old mindset and will use this style of
thinking to generate useful ideas.
Signature:______________________ Date:_______
Each architect signs a The 3P is recognized as the inspired hard work from the participants. Therefore, as
the architect that will convert this creativity into a building, we do hereby commit
to the following:
contract on Monday of the 3P 1) We will hold to the designs created in the 3P.
week to confirm their role in 2) We will not make any changes to the design without the approval of the 3P
participants.
the 3P. Form follows flow, 3) When presenting any changes, no matter what the cause, we will listen to
and engage with the 3P participants always following their direction.
4) We will always respect the patient as the customer in the design process.
and the architect will hold 5) We will build in as much flexibility into the design as possible, understanding
and agreeing that Lean is about continuous improvement.
true to the designs created 6) We will work throughout the design process to reduce or eliminate each of the
seven wastes, working from schematic design into the building details.
by the participants.
Signature:______________________ Date:_______
The 7 Ways
Each member of the team should work
independently, using the ideas from nature 1
to develop seven designs for the desired
function.
Process At A Glance
Name Process-At-A-Glance
___________________. Tact Time
One-Piece-Flow
Date Part:___________________ Process ________ of ________ Pull System
___________________.
Sequence
(1)
Material
Process
Sketch
(2)
Process
Method
(3)
Poka-Yoke
No-Go
Gauge
(4)
Tools
(5)
Jig/Fixture
Hanedashi
(6)
Machine
Design
Proposals
Criteria or Attributes 1 2 3 4 5 6 7
10
11
12
13
14
Total:
Rating: 5 = Excellent; 4 = Above Average; 3 = Average; 2 = Below Average; 1 = Poor; 0 = N/A
Proposals
Production Method Qualifiers 1 2 3 4 5 6 7
S-1 Properly Guarded - Safety devices in place.
S-2 Passes Ergonomic Evaluation (no postural deviations >1).
S-3 Proper waste collection. Maintains clean workplace.
S-4 Low level of regulatory issues (environment, fire, safety, etc.).
Q-1 Quality Requirements known - NOGO gauges.
Q-2 Defects less than .03%.
Q-3 POKA-YOKE built into the process.
Q-4 Level of Autonomation achieved. (Level 7 would be a “5”).
C-1 Capital Investment (less is better).
C-2 Low level of approval to obtain materials to build.
C-3 Known technology.
C-4 Top notch tooling is used in the process.
C-5 Minimum MOONSHINE time is required.
C-6 Smaller and Simpler than current process.
C-7 Maintenance free. Easy autonomous maintenance.
H-1 Ability of the Process to meet TAKT time.
H-2 Creates ONE-piece flow.
H-3 Creates a PULL system.
H-4 MUDA-less process.
H-5 Change-overs (less than one minute).
H-6 Fits the CHAKU-CHAKU concept.
H-7 THROW-IN loading. Max. 2 seconds operator time.
H-8 Space Utilization. Townhouse design.
H-9 Mobility: On wheels. No roots or vines.
H-10 Number of RPIWs conducted on this process (More is better).
Total:
Rating: 5 = Excellent; 4 = Above Average; 3 = Average; 2 = Below Average; 1 = Poor; 0 = N/A
S=Safety; Q=Quality; C=Cost; L=Your “Local” Production System
3P Project Form
This document is a summary of the information contained in the proposal. Its purpose is to give the judicator an “at a glance” look at the
proposal being evaluated. It contains summaries of the following documents contained in the proposal.
Roles and Participants: These are the core people and stakeholders involved in the event from the role of sponsor, team
and sub-team lead, project manager, audit leader and KPO support down to the content experts and participants including
patients and the architect.
Takt Time Calculations: Multiple Takt Times will be determined based on services provided and forecasted demands
spanning from 5 – 20 years.
-3P Workshop Project Form-
Process Flow: The patient flow the 3P is focusing 3P Project# & Project Name: Date:
If linked to past projects, note event #s & names here:
on is documented here in a high-level format. Note
Sponsor: Current Situation:
the other 6 flows are inherently involved but the Team Leader:
Sub Team Leader:
3P Target Sheet
3P Target Progress Report and Results Sheet
3P # and Name: Report Out Date:
Departments: Sponsor:
Product/Process: Team Leader:
TAKT Time: Audit Lead / KPO Support :
(assigned by Sponsor)
Inventory
Quality (# Defects)
Capacity
Remarks: