Lean - Henry Ford Health System

Introduction to the 

Henry Ford Production System 

Creating a Deming-LEAN Culture 

LEAN Training 2010 

Ford Motor Company's River Rouge Plant, 1931 

in Healthcare 

QuickTime and a 

decompressor 

are needed to see this picture. 

“Quality is doing it right when no one is looking." 

-Henry Ford 

Richard J. Zarbo, MD, DMD 

Pathology and Laboratory Medicine 

Henry Ford Health System, Detroit 

Henry Ford Production System

LEAN 


What is it? 


We 


Lean? 

did 

Lean! 


Lean = 


Deming 

(perfected by) 


LEAN 

Toyota’s Unique 

Mass Production Processes 

Decoding the DNA 

of the 

Toyota Production 

System 


1978 

1991 

Steven J. Spear & H. 

Kent Bowen 

2003 

2003 

2004 

1925 1982 

Henry Henry Ford Ford Production System

Basics of LEAN 

Basics of LEAN 

Specify Value Desired by Customer 

• Identify value stream & challenge all wasted steps 

• Manage towards perfection (zero defects) 


Reduce & Eliminate Waste, Continually 

• Overproduction 

• Time waiting 

• Transportation 

• Processing 

• Stock on hand 

• Movement 

• Defective products 

Process Focused 

Incremental Improvements 

Specific Ideals, Rules, 

Operational Principles 


Toyota 

PROCESS FOCUSED 

Methods for 

Eliminating Waste 


• Just-in-time production 

Leveled production, allocate work evenly 

throughout day 

Pull system, link each process to preceding & 

following 

Continuous flow processing, reduce batch sizes 

Eliminating inventories 

Multi-skilled operators 

Employees in charge of own jobs 

Employees design standardized work 

Continuous improvements (kaizen) 


Why LEAN management? 


• Identify & addresses system problems 

• Identify & resolve bottlenecks to throughput 

• Create a learning organization and culture 

• Develop people 

• Active participation of all staff 

• Create ownership for problem resolution 

• Continually improve quality, meet customer needs 

• Move incrementally to the ideal, continuously 

Zero Defect Tolerance 


Zarbo RJ, D’Angelo R. Transforming to a quality culture: the 

Henry Ford Production System. Am J Clin Pathol. 

2006;126(suppl):S21-S29. 



“It’s the work, 

Not the man that manages.” 



4 Rules of Work Design 

4 Rules of Work Design 

Decoding the DNA of the Toyota Production 

System. Spear & Bowen 

Harvard Bus Rev Sept-Oct 1999 


• Rule 1- STANDARD ACTIVITIES 

• Specifications document all work processes to include 

content, sequence, timing, location & expected 

outcome (how do you do your work) 

• Rule 2- STANDARD CONNECTIONS 

• Connections with clear YES/NO signals directly link 

every customer & supplier (requests & responses) 

• Rule 3- STANDARD PATHWAYS 

• Every product & service travels a predefined, single, 

simple & direct flow path (no looping or forking) 

• Rule 4- IMPROVEMENT & WORKER EMPOWERMENT 

• Workers at level where work is done, guided by a 

teacher, improve their own work, using data 

STANDARDIZATION 

REDUCE VARIATION 


LEAN Tools to Improve Workflow 

LEAN Tools to Improve Workflow 


• Standard work 

• Mistake proofing 

• Batch size reduction 

• Level load 

• Work simplification 

• Visual displays, controls & and color coding 

• Andon white boards 

• Kanban 

• Stop the line 

Liker: The Toyota Way, 2006 


Medical “Business” Processes 

Medical “Business” Processes 


Raw material 

Processing 

Technology 

Product 

Medicine/Surgery, Outpatient clinic, Lab, Radiology, Kitchen, etc 

Humans 

Generic Manufacturing Industry 

PROCESSES 

Processes 

•Evaluation 

•Admission 

•Assessment 

•Testing 

•Treatment 

•Discharge 

Health Outcomes 

•Productivity 

•Defects, Cost 

•Process stability 

•Employee satisfaction 

•Patient satisfaction 




Current Work Condition 

Current Work Condition 


Top down management- threatening 

No workflow leveling- uncoordinated batches 

Hiding defects- fear & blame 

Lack of of communication 

No worker empowerment to to fix 

Worker creativity in in bad system 

Defects … Defects… 


Original Ford 


Production 



standardization 

coordination 

waste 

cleanliness 

just-in-time inventory 

Pull production 

one at a time production 

empowered workforce 

timing 

1925 


cycle time 

moving assembly line 

Foundations of LEAN 1986 

Quality focus 

Quality control 

measurement 

value of worker 

Continuous improvement 

Long term plan 

1986 

Kanban system 

continuous flow 

rapid changeover 

error proof machines 

1978 

1988 


Creating a Mass Production Culture 


“It’s the work, not the man, that manages “ 


Mass Production - Continuous Operation 

Sat. 

night 


3 ½ 

days 

Wed. 

noon 

From: The Ford Industries. Ford Motor Co., 1925 


Mass Production 

Mass Production 

•Continuous 

Production 

•Conveyor belt 

assembly line 


•Division of 

labor 

•Simple 

repetitive tasks 

•Integrated 

supply chain 

•Standardized 

parts 

•Reducing 

waste 


Our Roots: Henry Ford Hospital 

• Founded October 1, 1915 

By Henry Ford as sole owner & president 

Wife, Clara’s honey-do list 

Employed staff model after dinner with Mayo brothers 


Standardization 

“It seems reasonable that a permanent staff 

be responsible for the work that goes on in the 

hospital. After all, I don’t ask every person who 

wants to build a car to come into my factory to build it. 

The Ford Motor Company is responsible for the car it makes. 

Why should not the hospital be responsible for the 

medical work that is done there?” 

– Henry Ford 


Production System Characteristics 

Triumph of the Lean Production System, Sloan Management Review 1988 

Trait Craftsmen Pure Fordism Recent Fordism TPS 

Work 

Standardization Low High, by managers High, by managers High, by teams 


Span of Control Wide Narrow Narrow Moderate 

Inventories Large Moderate Large Small 

Buffers Large Small Large Small 

Repair Areas Integral Small Large Very Small 

Teamwork Moderate Low Low High 

“Rather than continuing to refer to the different paradigms as recent Fordism 

And TPS, I would like to introduce two new terms herebuffered 

and lean production systems.” 

- John Krafcik (1988) 


LEAN 

QUALITY 


It’s the Culture, 

Stupid! 


Total Quality Management 

Total Quality Management 


• We’ve been here before- circa 1989 

• “A culture, attitude & organization that 

strives to provide customers with products 

and services that satisfy needs” 

• Quality Improvement using PDCA 

Scientific basis: Plan, Do, Check, Act 

• Deming principles 

• Failed because we didn’t change our 

culture 


Leaders Transform Culture 

Leaders Transform Culture 

“Culture eats strategy for breakfast & process for lunch” 


Culture = How people have been conditioned to behave 

“The only things that evolve by themselves in an 

organization are disorder, friction, and malperformance.” 

-Peter Drucker 


Changing Culture 

It Starts & Ends with YOU 


“Western management must take on leadership for change.” 

“Adopt the new culture” 

-W. Edwards Deming 


Deming Culture 

Deming’s Redefinition of Management 


“In companies that have embraced Deming’s vision, 

management’s job is to ‘work on the system’ 

to achieve continual product and process improvement. 

The Deming-style manager must- 

‣ensure a system’s consistency and reliability, by bringing 

‣level of variation in its operations within predictable limits, then by 

‣enlisting the participation of every employee, and by 

‣giving subordinates the practical benefit of his experience 

and the help they need to chart improvement strategies.” 

(A. Gabor) 


Henry Ford 


Production 



Hub & Spoke Design - Pathology & Laboratory Medicine 

HF-MAC 


HF-WBH 

24/7 

24/7 

HF-KG 

HF-WH 

24/7 

HFH 

HF-MWAR 

HF-COT 

Hospital 

24 Hr. Med Center 

Medical Clinic 

24/7 


Creating Culture 


Transforming to a Quality 

Culture 

The Henry Ford Production System 

Richard J Zarbo, MD, DMD, and Rita D’Angelo, MS, ASQ, CQE, 

SSBB 

American Journal of Clinical Pathology 

2006;126:Suppl S21-S29. 

BCBSM Foundation 2008 McDevitt Excellence in Research Award 

for Policy Research- the ‘Henry Ford Production System’ 


Constancy of Purpose 


“Obstacles are those frightful things you see 

when you take your eyes off your goal.” 



The Business Case for Quality 

Customer Satisfaction 

Market Share 


Quality 

External 

Internal 

Productivity 

Prices 

Costs 

Profits 

Deming’s Quality Chain Reaction 


Henry Ford LEAN Lab Progression 

FAIL 

LEAN Specialist, Coordinators 

Surgical Pathology 

2-day LEAN 

Training 

-Biobehavioral 

-HFH Surgery 

-HF Transplant 


2004 2005 

2006 2007 2008 

Onsite Mandatory 

8 hr. Training 

Programs 

Cytology 

2009 

Clinical Pathology Core Labs 

Chemistry-Hematology-Coag-Urinalysis 

Microbiology 

Medical Centers 

5 Community 

Hospitals 

Outreach 


Problem Solving Culture 


It takes systems to integrate Systems 


The Power of Integrated Teams 

Aligned Path of Work Flow 


“Systems do not produce quality, 

people do.” 

-anonymous 


Lab Lean Journey 2004-2010 


• Cultural change to an empowered workforce 

• Quality-focused Mission, Vision, Values, Org. Structure 

• Deming management & Toyota (LEAN) work rules 

• Visible, blameless identification of defects by workers 

• PDCA (A3) based solutions at the level of the worker 

• Fix defects in ‘real time’ 

• Over 700 trained employees- all System lab sites 

• Quality coordinators, Defined Work Teams, Customer- 

Supplier meetings, Monthly ‘Share the Gain’ presentations 

• Expectation 1 improvement/ team / month 

• 100s of improvements made each year by autonomous 

work cells (536 done in 2009 at HFH alone) 


Standardization 

-Work Rules- 


“Today’s standardization, instead of 

being a barricade against improvement, 

is the necessary foundation on which 

tomorrow’s improvement will be based.” 


1. Activities 

2. Connections 

3. Pathways 

4. Method of Improvement 


LEAN Culture of Continual Improvement 

PROCESS FOCUSED 

Methods for Eliminating Waste, Continually 


• Process Defects & Waste- the Twin Problems 

• Continuous, Smooth Flow, Just-in-Time- the Work Redesign 

• Standard Work & the Customer-Supplier Loop- the Solution 

• Empowered Personnel, Correcting One’s Own Errors, 

Creating Standard Work- the Problem Solvers 

• Presentations- the Motivators 

• Meetings- the Leadership Reinforcer 

• Visual Cues, Easy to See Quality- the Helpers 

• Technology reinforcing work rules & standards- the Enablers 

• Teamwork-hundreds of process improvements- the Results 



Effective Reduction of Process Defects and 

Waste in Surgical Pathology 

Richard J Zarbo and Rita D’Angelo AJCP 2007;128:1015-1022. 


Measures of Process Defects and Waste 

in Surgical Pathology as a Basis for Quality 

Improvement Initiatives 

Rita D’Angelo and Richard J Zarbo AJCP 2007;128:423-429. 


“We do nothing at all in what is sometimes 

ambitiously called research, excepting as it 

relates to our single objective.” 


Reduction of Surgical Pathology In-Process 

Misidentification Defects by Bar Code Specified 

Work Process Standardization 

Richard J. Zarbo, J. Mark Tuthill, Rita D’Angelo, Ruan Varney, 

Beverly Mahar,Cheryl Neuman, and Adrian Ormsby 

AJCP 2009;131:468-477 



LEAN Process Redesign Improves Service in 

the Molecular Diagnostic Laboratory 

Cankovic M, Varney R, Whitely L, Brown R, D'Angelo R, 

Chitale D, Zarbo RJ: 

J Mol Diagn 11:390–399, 2009. 


As leader, 

I don’t have all the answers 


“Doing your best is not good enough. 

You have to know what to do. 

Then do your best.” 

-W. E. Deming 



Rx 

FULL 

DEMING 

PRESCRIPTION 

or 

Half-dose ? 


Why empower the worker? 


Executive Leader 

Supervisor/Manager 

Ultimate Solutions 

Depend on 

View 

of the 

Problems 

“There are no big problems, there are just a lot of little problems.” -Henry Ford 

Line Worker 


Empowerment 


“Most doctors prescribe pills, 

I prescribe empowerment” 

–Jay Parkinson, MD 


Lean 


Right 

Light 

Empowered Workers 

Transformed Culture 

Continuous bottom up 

Management Style 

Sporadic Kaizen Events 

Management Style 

Direct Top-down Projects 

Concepts & Tools 

Partial Adoption 

Passing Fad 

“Let’s Outlast This Thing” 

SUCCESS 

Degree of 

effort 


Redefine the Expectation of ‘Work” 


“It’s the work, 

Not the man that manages.” 



The Engaged Worker 

The Engaged Worker 

Transform approach to work 

Not just showing up for work, but arriving to do the 

work better 


Culture 

Empowered workers who see their daily 

work in the context of- 

-Continually learning 

-Constantly communicating 

-Making effective process improvements 

-Designed and tested by scientific method 


Never Pass a Defect 

The ‘Mantra’ 


“Quality is doing it right when no one is looking." 



Worker Empowerment 

Worker Empowerment 


“The suggestions are supposed 

to go in the box.” 

“Has knowledge, 

skills, authority & 

desire to decide and 

act within 

prescribed limits. 

Takes responsibility 

for the consequences 

of their actions & 

for contribution to 

the success of the 

enterprise.” 

-JM Juran 



Teamwork 

“There are no big problems, 

there are just a lot of little problems.” 



LEAN Team 

LEAN Team 

“Creativity prospers best under particular conditions, 

especially where there is a flow of ideas between 

people who have different sorts of expertise.” 

-Ken Robinson 

LEAN = Team success 


Depend on the TEAM 

Admit you don’t have all the answers 

Mine the creativity of the group 

Dysfunctional Team? 

= LEAN failure 


Teamwork 

You may lead it…… 

But it’s ALL about them 

“The day you become a leader, 

It becomes about them.” 

-Jack Welch 

Now empower them! 


“Present” to “Future” Culture 

“Renters” 

“Owners” 


-Develop a culture that leads, manages and drives 

patient safety & quality everyday 

-Engage entire workforce 

-Accountability for seeking ‘perfect’ work 


Expose Defects 


“Even a mistake may turn out to be the one 

thing necessary to a worthwhile 

achievement.” 



Blameless 

“Don’t find fault, find a remedy; 

anybody can complain.” 



“On the internet, nobody knows you’re a dog.” 


What is a defect? 

What is a defect? 


Poor quality of service or product that makes you: 

• Stop your work 

• Reject it 

• Return it to sender 

• Delay your work to fix it yourself 

• Not pleased, could be better 

Measures of Variation 

Error = hurts someone 

= WASTE 

= REWORK 


Customer Feedback Informing Improvements 

Feedback to Suppliers 

Customer Feedback 


Suppliers 

LEAN culture 

Your Processes 

In-process 

feedback 

LEAN culture 

Customers 

-Radicalogic, incidents 

-Customer satisfaction surveys 

-Customer complaints 

-Press-Ganey surveys 

-Focus groups 


Understanding 


& 

Minimizing 

VARIATION 



Data Collection 

Data Collection 

Dry-Erase 

Posters 

“Data is of course important in manufacturing, 

but I place the greatest emphasis on facts.” 

-Taiichi Ohno 

If you cant measure it… 

Surgical 

Number/ Part 

A, B, C, D 

Entered Part Type Correct Part Type Source of Incorrect Part 

Information 

White Boards 


Defect Board- Make Defects & Resolution Visible 


• Histology Core lab 

• Lab meets weekly to 

review past week’s 

defects 

• Defects are posted on 

white board with 

resolution for all to see 

and learn from 


Minimizing Variation 

Henry Ford Production System Methodology 


1. Know performance expectations from your system of work 

2. Expect regularly collected measures of key work 

performance in each work cell, leader and worker driven 

3. Make performance deviations visible, blameless, daily 

4. Understand magnitude and causes of that variation 

5. Survey internal and external customers-suppliers for 

sources defects (dissatisfaction, patient safety concerns) 

6. Use whiteboards in workplace to identify daily defects 

1. Lack of, or deviation from standard work 

2. Lack of, or deviation from standard connection 

3. Lack of, or deviation from standard pathway 

4. 7 types of waste that can be redesigned OUT 


As Leader, 


this is your 

JOB #1 


Coming Full Circle 

1926 to Present 


"Our system of management is not a system at all; 

it consists of planning the methods of doing the work 

as well as the work." 



Roles of the 


‣GROUP LEADER 

‣TEAM LEADER 

‣TEAM MEMBER 

‣FACILITATOR 


Leading 


CHANGE 


Implementing Successful Change 


“The effort is usually a time consuming and highly complex 8-step process, 

never a 1-2-3, hit-and-run affair” 

1. Create a sense of urgency 

2. Put together a strong enough team to direct the process 

3. Create an appropriate vision 

4. Communicate that new vision broadly 

5. Empower employees to act on the vision 

6. Produce sufficient short-term results to give efforts 

credibility and dis-empower the cynics 

7. Build momentum and use that to tackle the tougher 

change problems 

8. Anchor the behavior in organizational culture 

“Managers who opportunistically skip steps 

or proceed in the wrong order rarely achieve their aspirations” 

On What Leaders Really Do -John Kotter 


Change 


Tried it before, didn’t work 

Your gonna do what? 

It’s about time 

Resistance 

Maybe this will work 

This isn’t so bad 

We should have done this 

a long time ago 



“Getting things done 

is not the same 

as making things happen.” 

-Gina Trapani 


Role of Management 


• Set LEAN management expectation for all leaders 

• Set high performance expectation & continual change 

• Integrate people, process, tools, technology 

• Engage & empower your people to solve problems 

• Form core teams with strong leader and team members 

• Drive reduction in variability by standardizing the work 

• Visual management, posted daily metrics 

• Stabilize processes through waste reduction 

• Move to continuous flow, innovate ‘pull’, front loading 

• Continual push to reduce time waste 

• PDCA as operational engine of continual improvement 

• Sustain the cultural change of work 


“Toyota’s success is the result of 

leadership and employee involvement. 


To be functional leaders, senior staff at 

Toyota must believe, drive, understand, 

and live the same training philosophy and 

employee empowerment 

that in turn reinforces the culture 

established by the original company 

founders.” 

Zarbo RJ, D’Angelo R. Transforming to a quality culture: the 

Henry Ford Production System. Am J Clin Pathol. 

2006;126(suppl):S21-S29. 


Think This Through Before You Start 

Think This Through Before You Start 

“Western management must take on leadership for change.” 

“Adopt the new culture” 



These key aspects defined by the leaders 

are core to ‘Lean’ Success 

• Leadership driven 

• Create organizational & value structure 

• Define roles of middle management and worker 

• Worker- value, respect, empower & protect 

• Align incentives 

• Recognize & reward 

• Educate & develop workforce & next leaders 


Commitment 

“Mere lip service or lukewarm support 

from top management is the “kiss of death” 

for any such program.” 

-Armand Feigenbaum 


Unwavering 

Enthusiastic 

Supportive 

Empowering 

Delegating 

Developing 

No place for 

micromanagement 


Physician Involvement 

Physician Involvement 

“Most doctors prescribe pills, I 

prescribe empowerment” 

–Jay Parkinson, MD 


“But I hafta generate RVUs now, not another quality project!” 


Employees Mirror Leader Behavior 

Employees Mirror Leader Behavior 

WHAT DO YOU WANT YOUR TEAM TO LOOK LIKE? 


YOUR LEADERSHIP TRAITS 

=Team traits 

Enthusiastic 

Passionate 

Positive 

Authentic 

Integrity 

Respectful 

Thoughtful 

High energy 

Dependable 

Caring 


Road to DEMINGISM 

“When the best leader leads, 

the people say- 

‘We did it ourselves’.” 

–Lao Tzu 

Your talk as leader- 


• Key opportunities to improve & develop a 

culture of efficient, safer work 

The ‘system” determines performance 

Teamwork is the cure 

Require & know your metrics in workplace 

Redesign work to minimize variation 

Use work rules & improvement tools 



“One that would have the fruit 

must climb the tree.” 

-Thomas Fuller 


Leader’s Role 

Management’s job is to ‘work on the 

system’ to achieve continual product 

and process improvement. 

-W E Deming 

• Develop and communicate 

Vision, Goals, Priorities, Resources 

Strategies for leaders, team members, ownership 


• Facilitate 

Remover barriers and roadblocks 

Communications, connections outside department 

Accountability for progress 

Require follow up, monitoring, documentation of changes 

• Encourage 

Celebration and recognition of contributions 

• Spread enthusiasm 


Role of 


the 

Team Leader 


Champions Along Path of Workflow 

Champions Along Path of Workflow 

PROCESSES 

Pre-Analytic 

Analytic 

Post-Analytic 


Pre-Treatment 

Humans 

Treatment 

WORKCELLS 

Evaluation 

Admission 

Assessment 

Testing 

Treatment 

Discharge 

Post-Treatment 

Health Outcomes 

•Productivity 

•Defects, Cost 

•Process stability 

•Employee satisfaction 

•Patient satisfaction 



Path of Workflow 

Human Tissue 

Processing 

Technology 

Diagnostic Report 


Surgery 

Specimen 

delivery 

Paraffin 

embedding 

PATHOLOGY 

WORK CELLS 

Specimen 

accession 

Slide 

cutting 

Gross 

dissection 

Slide 

staining 

Tissue fixation 

& processing 

Slide 

label & 

delivery 

Report 

generation 

& delivery 

Pathologist 

interpretation 


Define Your Work Cells & Teams 


What is a work cell? 

Semi-autonomous & multi-skilled work teams 

contributing to a task, service or product that is 

used by or serves another group in the workplace 

Questions: 

Who does what for whom? (Customer-Supplier) 

‣Who passes you your work? (supplier) 

‣Who requests work from you? (customer) 

‣Are they inside or outside your dept.? 

(internal or external suppliers & customers) 

Train the team, 

not individuals, 

to work together 


Identify Team Leaders 


1. 

2. 

3. 

4. 

5. 

‣By work cell 

‣By leadership role 

‣May side step with co-leader 

‣By ability 

‣By passion 

‣By vote of the work cell members 



Team Leader Role 

CHAMPION 

• Project identification, selection, prioritization 

• Focus on problems, process, not personalities 

• Adhere to work rules & principles, use tools 

• Team member selection 

• Project definition, study, measures 

• Customer-supplier connections 

• Reality test proposed interventions 

• Project tracking 

• Push for continual problem ID & ideas for change 

• Communication & recognition 

• Coach, develop and encourage team members 

• Deal with failures 

• Celebrate the team’s success 

KEY 


Lean Facilitator Role 

• Educate in appropriate use of LEAN rules & tools 

• Assist in study design & statistical data analysis 

• Assist in scheduling meetings 


• Follow-up on team progress 

• Remove communication roadblocks 

• Facilitate cross-departmental meetings 

• Address resistance and blaming 

• Facilitate presentations & worker recognition 

• Facilitate group learning from failures 

• Spread knowledge of best practices as lessons learned 

• Maintain a positive attitude in confronting problems 


Team Members Role 

• Identify defects, daily, cluster around whiteboards 

• Form groups to share & brainstorm problems 

• Join teams to address interventions 


• Assist in design of measurement tools 

• Collect data 

• Assist in root cause analysis 

• Communicate to other teams, customer-suppliers 

• Communicate to managers/leaders 

• Keep track of process improvements 

• Continually seek better ways of performing the work 

• Present results of successes 

• Learn from the failures 


STRUCTURE 



Create a 

LEAN ORGANIZATIONAL CHART 

How is change authorized and made? 

• FIND YOUR ROLE 


LEADER 

LEADER 

Champion Champion Champion Champion 

member member member Shared member 

member member member 

Team Customer-Supplier Interaction Team 


LEAN 

Champions 

HFPS ORG CHART 

Henry Ford Hospital Campus 

LEAN Team Leaders & Champions 

Dr. Zarbo 

“Systems do not produce quality, 

people do.” 

-anonymous 


Autopsy 

Vernette 

Histology 

Beverly 


Sandy 

Accessio 

n 

Cheryl 

N. 

Rebecca 

Pathologists 

Dr. 

Ormsby 

Gross Rm. 

Immunohisto 

Bev 

erly 

Cat 

hy 

Nelson 

Dr. 

Linde 

n 

Mon 

ica 

Dr. Raju Dr. Alassi Dr. Torres 

Cheryl C. 

Dr. Jones 

Secretaries 

Laure 

Dr. 

Ormsby 

Dr. Cankovic 

Joann 

Molecular 

Lisa 

Chem 

Er 

na 

Microbiology 

Dr. Samuel 

Dr. Chitale 

Cytology 

Dr. Tibbetts Rhonda 

Mary 

Toni 

Dawn 

Jerry 

Clinical Laboratories 

Dr. 

Carey 

Coag 

HFPS Quality 

Support Staff 

Deb 

S 

Deb C. 

UA 

Steph 

anie 

Ruan 

Anjna 

Rita 

Dr. 

Feldkamp 

Blood Bank 

Linda 

Ed P. 

Steve. 

HLA 

Sharon 

Core 

John Z. 

Jennifer 

Kare 

n. 

Deb 

Don 

LSS 

Ralph 

Will 

Eula 

Pathology Informatics 

Dr. 

Tuthill 

Barb 

Hematology 

Kedar 

Admin. Team Lead Support 

John W. 

Miche 

le 

Joy Ron Lisa Dave 

Spec. Hema 

Rita 

Ken 

Denise 

S. 

Cathy R. 

Carolyn U. 

Regional Medical Centers 

Dr. Meier Dr. Jones 

Judy S. 

Dr. Carey 

WBM 

Sally L. Val C. 

Columbus 

Olivia Kathy S. 

Tarek 

Outreach 

Dr. Assarian 

Residents 

Je 

nni 

Joy P 

Ann Beth Melissa Karen 


HFPS Guiding Principles 

We will be “best in class”, striving for zero defects 

Continually perfect processes & patient safety 


Our people, partners & patients are most important- 

Treated w/ respect, understanding, & cooperation 

Adapt & innovate Lean principles to HFHS 

Empowered workers, continuously learning, 

making scientifically based improvements that 

standardize process & eliminate waste, 

moving daily & continuously toward the ‘ideal’ 



Credo card 

Steps of Quality 

Motto 

Employee Promise 

Credo 


Steps of Quality 

Doing 

the RIGHT thing, 

the 

RIGHT way, 

at the 

RIGHT time 

“Our invariable reply to 

‘It cant be done’, is 

‘Go Do It’. 


Continually 

striving for 

ZERO DEFECTS 

to be the 

“BEST in 

CLASS” 

LABORATORY 

in the world 

Together we will 

strive for 

PERFECTION 

by applying 

principles of 

mutual respect, 

integrity, 

understanding, 

cooperation and 

effective 

communication 

I am 

EMPOWERED 

to work with my 

colleagues to make 

changes, based on 

HFPS principles, to 

make things right 

for ourselves, our 

clinician customers 

and our patients 


Organizational Structure 

Organizational Structure 

Senior Leadership 

Medical & Administrative 



Quality Improvement 

& 

Patient Safety 

Your Existing Leader 

Quality Facilitators 

Group Leaders 

Work Team Leaders 

Ad hoc Leaders 

Team Members 

Information Technology Support 


Inverted Pyramid 

Inverted Pyramid 

“Your success will be affected 

by the quality and quantity of 

new ideas you suggest.” 

-Brian Tracy 


Work Cell Team Members 

Work Cell Team Leaders 

Group Leaders 

Support Staff 

Informatics 

PROCESS IMPROVEMENTS 

Cust- 

Suppl 

Meetings 

Quality 

Initiatives 

Quality 

Specialists 


Sustaining Cultural Transformation 


Create a structure in top management that will 

push every day on Deming’s 13 points. The 

transformation is everybody’s job! 

#14 

• People Focus 

Choose champions & teams well 

Passionate, committed 

Educate continually from defects, solutions 

Hear the voice of the worker 

• Meetings, driver of continual improvement 

Leaders must meet weekly with champions 

Champions must meet weekly with team members 

All teams must meet monthly to ‘Share the Gain” 

• Performance Evaluation 

• Recognition, not $ 


Your Best Asset 

“Any company has to recognize that 

not only is the human capital of their 

employees a major asset, it is also a 

depreciating asset that needs 

continual investment. -Gary Becker 

Developing People 


“The Henry Ford Production provides the fertile ground for 

self growth and breeds our next generation of leaders.” 


Empowered Teams - Recognition & Reward 

Spotlight Team of Month 

Spotlight Team of the Month 

• Monthly HFPS Group Meetings 

• Share successes/failures 

• Spark enthusiasm 

• Set continuous expectation 

• Develop staff 


Cheryl Neuman, Maria Gainer, Barbara Dionsi, Connie Shepard 

and Cassandra Parham 

Successful Process Improvements March–May 

2006 

• 5 s in the Gross Room 

• Accession Leveling 

• Standardization of Outside 

• Printer at scanner 

• Cross Training to cover frozen room 

• Protocol Standardization 

• Standardization of specimen holding buckets 

• Standardization of flags in CoPath 

• Standardization Flag Reporting 

• Specimen flag training 

• Standardize placenta template 

• Standardization and redesign of rehab missing information labeling 

• Participation of MIS ID project 

• New container labeler in Gross Room 

• Standardization and revision of lab tags 

• Standardized work procedures 

• Standardization of scanning tags 

• Standardization of requisition form process 

“Share the Gain Meeting” 

Henry Henry Ford Ford Production System



Recognition

Meetings 

“The bitterness of poor quality 

lingers long after the sweetness of 

meeting schedules is forgotten” 

-Kathleen Byle 


“No, Thursday’s out. 

How about never—is never good for you?” 

Weekly 

-Division Leaders 

-Division Teams 

Ad hoc 

-Customer-Supplier 

Monthly 

-Process 

Improvements 


Align Incentives 

Align Incentives 

“Opportunity is missed by most 

people because it comes dressed 

in overalls and looks like work.” 

-Thomas Edison 


“You’ve got mail.” 

-Accountability 

-Performance 

evaluations 

-$$ incentives 


Measures of Success 

Measures of Success 


• Productivity 

• Defects 

• Cost of production 

• Process stability 

• Employee morale & satisfaction 

• Customer satisfaction 

• Competency pass rate 

• Resistance level 

 

 


WASTE 

Quality Comparison 


"It is not possible to repeat too 

often that waste is not something 

which comes after the fact” 



2006 2007 2008 

Total SP Cases 1690 1791 1000 

Cases with 

Defects 

472 223 24 

Total Defects 494 288 24 

Defective Case 

Frequency 

Defect reduction 

1 of 3 1 of 8 1 of 40 

27.9% 12.5% 2.5% 

50/day 30/day 5/day 

55% 91% 

Fix 

Realtime 


Reality Testing 

Reality Testing 

“Failure is simply the opportunity to begin 

again, this time more intelligently.” 



• Juran Institute estimates that 

30% of direct healthcare outlays 

are due to poor process quality 

Midwest Business Group on Health, Juran Institute, & Severyn Group, Inc (2003) 



DEFECTS 

Stations in the process 

POST- 

ANALYTIC 

PRE-ANALYTIC ANALYTIC 

Amended 

Reports 

Immuno Sp. 

Stain 

Histo Slides 

Grossing 

Accessioning 

Spec.Receiving 

Power of People 

Recuts 

Rehab 

2 

2 

1 

8 

Defect Comparison 2006 to 2007 

9 

13 

17 

24 

50 

96% 

61 

72 

85 

99 

123 

151 

0 20 40 60 80 100 120 140 160 

Totals 

31% 

“My theory of waste goes 

back of the thing itself into 

the labour of producing it” 


42% Top 4 defects 

Lab made 

66 97% 

62% 

62% 

2007 

2006 

89% 


Waste, Rework, & Inefficiency 


"It is not possible to repeat too often 

that waste is not something which 

comes after the fact” 


“My theory of waste goes back of the 

thing itself into the labour of 

producing it” 



Accountability & Satisfaction 


“When the best leader leads, the people say- 

‘We did it ourselves’.” 

–Lao Tzu 


Employee Satisfaction 

Technical Staff 



>15% = significant 

• Henry Ford Health System Employee Surveys 

• Percent FAVORABLE by Surgical Pathology workers 

2003 2006 

• 64% 94% There is a strong emphasis on customer service 

• 71% 94% Customer problems get corrected quickly 

• 56% 91% Where I work, we are continually improving the 

quality of our products & services 

• 79% 91% My job makes good use of my skills and abilities 

• 65% 91% The people I work with cooperate to get the job done 

• -- 87% Management shows by their actions that patient 

safety is a top priority 

• 47% 84% Where I work, day to day decisions demonstrate that 

quality & improvement are top priorities 

• 27% 75% How do you rate your overall physical environment 

IMPROVED 


Mindset of 

Continual Improvement 


“We know from the changes that have already been brought 

about that far greater changes are to come, 

and that therefore 

we are not performing a single operation 

as well as it ought to be performed ” 

- Henry Ford 




IMPROVED 


• Anatomic Pathology Clinician Customer Satisfaction Surveys 

2005 2007 

2009 

Percent Favorable Score 

86% 88% 90% Overall Satisfaction 

92% 94% 91% Tumor Board presentations 

91% 88% 97% Teaching conferences and courses 

90% 92% 92% Quality of professional interaction 

89% 89% 92% Diagnostic accuracy 

89% 90% 90% Pathologists responsiveness to problems 

89% 92% 89% Pathologists accessibility for frozen sections 

87% 89% 90% Courtesy of secretarial/technical staff 

84% 88% 89% Communication of relevant information 

81% 88% 91% Notification of significant abnormal results 

81% 86% 87% Clarity & format of paper & electronic reports 

78% 85% 84% Timeliness of reporting 

5 Excellent 

4 Good 

3 Average 

2 Below average 

1 Poor 


LEAN Culture & Management 

GOALS 


• Adopt Deming’s philosophy of work and leadership 

• Constancy of purpose- manage through focus on quality 

• Create a learning organization & culture 

• Develop people, active participation of all staff 

• Create ownership for problems and resolution 

• Operate according to defined structure, work rules, using 

manufacturing based tools, in empowered teams 

• Continually improve quality, meet, exceed customer needs 

• Move incrementally to the ideal, continuously 


NEVER PASS A DEFECT 


Sustainers of LEAN Cultural Change 


• Departmental Key Strategy- LEAN Management implementation 

• Clear messages quality ‘constancy of purpose’ 

• 8 hour mandatory LEAN training- all service-line workers 

• 2 day Intensive LEAN training- all leaders 

• On-line (Healthstream) LEAN training refresher core courses 

• Intranet (Henry) quality tools for our own ‘workforce’ 

• Intranet Lab Division-specific quality tools for our ‘customers’ 

• Electronic document control of standard work procedures 

• Intranet, paperless access to policy, procedure, standard work 

• Visual workplace, daily metrics 

• Weekly meetings- leaders, then teams 

• Monthly presentations, enforcing, recognition, learnings 

• Embedded quality professionals supporting the ‘new work’ 

• Supplier standardization-Electronic Lab User’s Guide for all 

‘customers’- intranet and internet access 


Reasons to LEAN your Work 

Reasons to LEAN your Work 


• Eliminate wasted time, effort & materials 

• To provide customers what the customer 

wants, when they wants it 

• Reduce defects to theoretical minimum 

• Reduce cost while improving quality 

• Quality enhances patient safety 

• Job security 


Future 

"“Learning is not compulsory, neither is survival” 



The 

Henry Ford 

WAY 


Q & A 


“We know from the changes that have already been brought 

about that far greater changes are to come, and that 

therefore we are not performing a single operation as well 

as it ought to be performed.”

Lean - Henry Ford Health System

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