Lean is entering healthcare and medical diagnostics - excellent fit between Lean practises and Biological system operation.

1. Tom.Pettersson60@gmail.com
Lean is the Biology
of Business
System Design for Quality
in a Complex
Organization
Learning, Adaptive and
Innovative Culture to
Manage Crisis in Healthcare

2. If We All Knew What We All Know?
Mobilize all Individual and Team
Intelligence and Brain Power (IQ +
EQ) in the Organization

3. Left-brainers Right-brainers
Specialized in seeing
Good at recognizes
many things at once
serial events
Synthesizes
Analyzes details
the ”Big Picture”
Emotional, Emphatic,
Logic, Abstract
Visual
A Whole new Mind: Why Right-brainers will rule the Future

4. What do you see ?
Human Microbiome 2012 Five Horses

5. Do we see the same ?
Communicate through Dialogue and Active Listening

6. Learn to see and act ?
Empower, Motivate
See Waste,
Uncover Problems
Eliminate Waste,
Correct Root Causes

7. Manage Quality
Quality is in the process

8. A
H B
Linear Flow Complex
A B C D G Adaptive C
Newtonian Linear Process View
System
Reductionist – Left brain approach F D
E
Quantum Complex Process View
Holistic – Right brain approach

9. Evolution
1.Self-creation Is
2.Self-reflexivity continuous
3.Self-regulation adaptation
4.Communications among all parts of a
5.Conservation of what works well complex
Biological
6.Creative change of what does not
System
work well.

10. Culture of a Complex Adaptive Organization
1. Pursue agility and resilience
Evolution
Is
2. Consciously learn from daily experience continuous
3. Allow solutions to emerge adaptation
4. Pull, don’t push of a
5. Seek healthy mixtures complex
6. Rely on vision and boundaries Biological
System
7. Appreciate the messy phases
8. Expect non-linear progress
9. Cooperate to create abundance
10. Promote grassroots initiatives
11. Work in a place designed for humans

11. ”No Waste”
Process design
Scientific method
Sokrates Franklin Ford Taylor Juran Project
TQM
Deming 14 points
Deming ”Purpose/People/Process”s The Evolution of Quality
Management in Industry
Toyoda Present
The Toyota Way The Industrial Management
TPS, TPM, 14 points
and Quality Maturity Model
Shingo Ohno
LEAN (1990)
Kaizen Production
Imai
A better Life
Womack Seddon Jones
Service
Healthcare (IHI)
”Lean, Six Sigma, ISO
Synchronization”
ISO Six Sigma QMS
CEN QA/QC
ISO 9001/2008
ISO 17025/ISO 15189
QMS
Smith Westgaard

12. Continuously Improve / eliminate Waste”/ Innovate
Lean Synchronize Flow/ Focus Speed and Customer
”Learn to see” Process Quality/ ”Quality by Design” / All Participate
Reduce Variation and Errors
Six Sigma ”World Class” Product Quality
Data Design for Six Sigma / Expert Driven
Documentation /Traceability/ Accreditation/ Certifying
ISO Quality Through Control / Regular Audits (internal/external)
Apply to Standards / Weak Focus on Process (traditional)
Document Tendency to Hamper Improvement Culture
Six Sigma Lean is
is Left Brain Right Brain
Thinking Thinking

13. Quality is Data driven Improvement

14. Lean Heritage from TPS
Toyota system is;
“profit-making industrial engineering”
Reduce the time from committing
money to the raw materials to when
collect money from customers
“Cash Flow”
”Design for best quality to
lowest price”
”Mobilize all intelligence in the
organization to meet our purpose”
Taiichi Ohno
Father of the Toyota Production System (TPS)

15. “Yet the most powerful aspect
of LEAN
is not what participants do to
add to improve a process but what
they remove from the process
to improve it”

17. Lean Pillars for Lean Culture:
1) Continuous Improvement
2) Respect People
Appreciate peoples brains
Job satisfaction motivates, self
respect reduces
negative Stress
“Lean IS Healthcare”
No Zero Sum but Win-Win !

18. Business Customer
Value Value
“(Cost)”
“(Delivery) “
Quality in
Staff Value Process
“(Motivation)” “(Quality)”
Input - Process - Output
• Quality in raw material/sample
• Quality in process
• Product Quality

19. Do not sell
out Quality
Allways improved Quality/Value to
Lower Price

20. First Kaizen Culture then Tools
Process VSM 5S 5W PDCA/A3
Kaizen Dayly Spagetti
Board Steering JIT Takt time map
Flow Mäta Transformation Team Pull
Onepiece
Flow Muda Mura Muri Root Cause
Initiate first
<
Kaizen
feeling among
staff
”Lean Toolbox” ”Lean Thinking”

21. First Kaizen Culture then Tools
Initiate first
Kaizen
feeling among
staff
<
”Lean Toolbox” ”Lean Thinking”

22. First Kaizen Culture then Tools
5S/5W Initiate first
VSM
Spagetti map Selected Kaizen
Flow Tools feeling among
Measure staff
PDCA/A3
<
”Lean Toolbox” ”Lean Thinking”

23. First Kaizen Culture then Tools
Abandon Command and Control Culture (No Blame)
Cease dependence on inspections for quality
Empower people to continuously improve quality
Establish Lean Coach, Facilitator, Change Agent
Pull according to Need - do not Push !

24. Lean Design Healthcare
Enterprise
Integrated Delivery System

25. Design System for Value and Flow
1. Understand ”Big Picture”
2. Utilize Industrial Maturity Model for Management Quality,
Competence and Skills
3. Design Education and R&D for right Knowledge, Science
and improvement Culture
4. Lean Value Stream Design all interconnected Processes
involving all Stakeholders (Extended Value Stream)
5. Deliver right Care and Health/Wellness Support

26. Manage all Parts that Interact
Act
The Lean House Add Resources
Base Decisions on Data
of Identify relevant Problems to Solve
Understanding the Big Picture and Needs
Individual/Global Industrial Global/Individual Global/Individual
Patient need of
Quality and Patient need of Academia
Healthcare Management Medical Cure Health - Wellness
Education for
Maturity Adequate
Design for Flow 1 Sokratic direction Clinical Specialities Practice
”Dialogue”
2 B Franklin ”No waste” People
3 F Taylor ”Scientific Focus on Relevant
Management”
Processes Knowledge, Dismiss
Irrelevant Knowledge
4 H Ford ”Assembly line –
Process for
Purpose
Waste
Waste
Out
Massproduction”
Out
5 E Deming – Total Quality
Management”
6 J Juran ”The Quality
Triangle”
Academia
R & D for
7 Toyoda – ”TPS . Toyota
Production System” Medical New Biology
8 Womack/Jones/ Seddon –
”Lean Production /
Services”
Diagnostics Knowledge
9 B Smith, “Six Sigma” Medical
10 JH Holland ”CAS Biology
Systems Thinking” Applications
11 “CEN- ISO regulation”
In Vitro Health
Pharma Medical Devise IT/ICT/IST
Diagnostic Wellness
Industry Industry Indsutry
Industry Industry
Waste
Out

27. Look for waste !
Category Sources Excess Costs
Unnecessary Services 210 billion US
Inefficiently delivered Services 130 billion US
Excess Administrative Costs 190 billion US
Prices That are Too High 105 billion US
Missed Prevention Opportunities 55 billion US ”Best Care at Lower
Fraud 75 billion US Cost”
Total 765 billion US
Report IOM USA
2012
5 202 000 000 000 Skr

28. Science and Technology
Revolution
New Possibilities – New
Demands
Intuitive Healthcare
Empirical Healthcare
Precision Healthcare
Patient Participation

29. The Ecological Approach
”The New Biology”
Health, Food, Energy, Environment
Medical Diagnostics support Integrative and
Functional Medicine
Personalized Medicine, Pharmaco- and Nutrigenomics

30. New Business Paradigm
Power through Collaboration
In Complex Organizations Capability
and Capacity depends on
Relationship Management and
Collaboration in Multifunctional
Teams

31. Extended Value Stream

32. New Roles
Changing Roles in Healthcare –
Customer Always in Focus
The intelligent Patient
The well informed Patient
Patient Health Awareness
Patient as Health Consumer
Patient as a Healthcare Professional
Doctor as Consultant
Healthcare professional Team effort

33. Access Healthcare Information

34. Patient Mobilisation
patientslikeme
”Because of PatientsLikeMe, we are better able to recognize
warning signs... [and] keep things in perspective. In short,
PatientsLikeMe empowers us.”
”PatientsLikeMe has provided me with new friends- people who
are experiencing the same problems as I am.”
”I joined because I didn't want to feel alone anymore. Simply put.
And I knew that I could be helpful [by sharing] my experience.”
http://www.patientslikeme.com/

35. Lean Design and
Innovation
Medical Diagnostics

36. Integrate Diagnostic Services
1 Customer/ Lean Healthcare Key Qualities
Patient level Patient Experience/Flow/Security/Medical and Operational Excellence
2 • Integrate
Service level Medical Diagnostics Services Integrated
3 Integrated Radiology
Physiol. Laboratory Medicine • Consolidate
information ”Imaging”
4 Biological
Integrated Tissues Micro- Fluids Nucleic • Automate
Production Cells Organisms Molecules acids
Level Core, Rapid Response, POC Functions
Diagnostic, Scientific, Operational, Managerial
• Share
5 Integrated Knowledge
Imaging Biochemistry Transfusion Med
Scientific Physiology
Histopathology Hematology Immunology
Medical
Cytology
Coagulation Toxicology
• Mobilize all
Knowledge
Base
Bacteriology
Virology Serology Pharmacology intelligence in
6 organization
Skills Lead, Improve, Innovate, Transform, Drive Change
7 Common Develope the Medical Diagnostics Knowledge Worker through • Continuously
Purpose Collaboration and Shared Purpose learn

37. Design End to End Processes (Lean Six Sigma)
Key Deliveries 1) Order, 2) Sample material, 3) Report
Correct from me in every step
KPIs for Flow, Timing, Continuous improvenet, Team efforts

38. Lean Histopathology - Model
Improve and
Innovate;
• Methods
• Process design
• Flow, Value
• Team
• Autonomate
(Instrumentation/IT)
Potential TAT within 24
hours (TAT = Turn Around Time)
Sample No
Quality WorkCell Delay Repeat FLOW - Autonomate

39. Lean Bacteriology - Model
Improve and
Innovate;
• Methods
• Process design
• Flow, Value
• Team
• Autonomate
(Instrumentation/IT)
Potential TAT within 24
hours (TAT = Turn Around Time)

40. Lean Healthcare.org
Organize for Single Unit Patient Flow !

41. Patient in real Focus ?
Central vs Decentralized
LEAN for the patient
would change
Health Care forever.
Klaus Schipper Med Dr, Viborg, Danmark, 2010

42. Educate for Team Effort
The Diagnostic
Team
Operational
Excellence
Diagnostic Scientific
Excellence Depth
Management
Leadership

43. Basic Common Design
Lean Organization
and
Biological System

44. Hierarchy of a Biological System
Sensing Environment
Top
Brain,
Hypothalamus, Releasing
Pituitary, Hormones
Pineal
Stimulating Neural
Middle Signaling
Endocrine Hormones
Organs
Autonomous
Activities Hormones Interstitial
fluid
Front Line O2/CO2
Re/Ox, pH
Blood
Organs Electrolytes Complex Complex
Cells ProteinsXYZ
Tissues Plasma
Hormones Signaling Crosstalk
Vitamins
Cells) Metal Ions
Carbohydrates
Nutrients Amino Acids
Lipids
Gastrointestinal Tract
Microbiome, Skin, Environment

45. Biological System vs Lean System
Biology
System
Hierarchy
Lean Leadership Top Down
Lean System
Hierarchy
Bottom up

46. Transforming Leadership
Traditional
Manager
Future
Leader

47. The Lean Organisation - Model
Cultivation
Blood
Donation
Trans. Med
Cell
Tissue
Testing
Testing
Biological
Fluids

48. The Meeting Point

49. Direction through Why ?
Why ? Identifies Purpose - Sets Direction

50. Direction through Why ?
Fractal Thinking
5 Why
In Depth Analysis
Why ? Finds the Root Cause
Focuses the Countermeasure

51. World Class Lean Organization
IT/ HR/Procurement/Accounting

52. Lean Dilemma
Lean and Nature Manage
• Need
• Risk
• Damage
• Repair
Traditional Industry Manage
• Financial Bottom Line

53. Design Lean Healthcare
System
New Roleof Leadership – Quantum Lead
Fronline Autonomy - Sustained Teams
Improve and Innovate Complex Value Streams

54. System - Synchronization
Core – Discipline Integrated Central Function
RRL – Rapid Response Function
POCT – Function at Point of Decision

55. System - Flow
System Lean Healthcare
Components of Flow / Lab Deliveries / Lab
Patients Medical Excellence
Patient security
Clinical Information
Data
Sample material Information
• Biological fluids Knowledge
• Cultivation Fast - Timely
• Tissues Coordinated
Correct – no Error
• Nucleic Acids
Reproducible
Operational Excellence

56. System - Connectedness
System Lean Healthcare
Start Goal
Lean Lean Lean Lean
Customer Service Human Resources Lean IT
Procurement Accounting
”Lean Management” (System value)
Medical Excellence
Patients Top Down Patient security
Clinical Information Data
Sample material Medical Diagnostics Information
Radiology, Physiology Knowledge
• Biological fluids Fast - Timely
Input Laboratory Medicine Output
• Cultivation Coordinated
• Tissues Bottom Up Correct – no Error
Reproducible
• Nucleic Acids Operational Excellence
”Lean Operations ” (Process value)

57. System – Diagnostic Work Station – Patient Focus
Single Patient Flow EHR, EMR, EPR
• Historic
• Intelligent
• Standardized
RIS/PACS/LIS/LIMS
Disciplin
Integrated

58. System – Access and Share
”Cloud Computing – abundant but waste free data flow”
”Lean for the Information Age”

59. Manage Change
Responsibility
Accountability
Committed
Respected

60. Manage Change
The test
Toyota Kata question is:
“Your vision becomes your beliefs
Your beliefs become your thoughts Am I working
Your thoughts become your words with or
Your words become your actions
Your actions become your habits against
Your habits become your values nature?
Your values become your destiny”
Mahatma Gandhi

61. Nature and Healthcare are Fractal
Autonomous Lean Cell in a Fractal Organization

62. Make it Simple but not Simpler
A Einstein
Lean is the Biology of Business
Balancing left with right
Autonomation = Automation
with a human touch for a better life
TPS Approach
Create the Medical Diagnostic
Konwledge Worker in Team Organization
Classic Drucker

63. Learn from Nature - Work with Nature - Altruism - No Ego

64. System design
The Question is How
do we Become more
Hummingbird versus Working Man / Team
like Birds ? Weight 2 - 20 g 50 - 110 kg
Heart size (% wight) 2,43 0,31
Heart beat / min 300 - 1000 70 - 120
Lifetime O2 cons. L / kg 500 000 180 000
Lifespan /years 10 80
Rel. Longevity / kg 200 1
Lean is the Biology of Business

65. Lean Ceases to be Lean when
used for Bad
Biology dies when abused
Business fails when driven by
Greed

66. Lean is the Biology of
Business
Design Pull Systems – Do Not Push !
Contact: Tom.Pettersson60@gmail.com

67. Appendix: Proposed Change Agenda
1. Improve Patient Involvement in Care and Health Process – Individualized / Personalized Medicine – Patient Role as a
Profession
2. Transfer Healthcare / Medical Diagnostics Focus towards Prevention and Culture of Wellness – Integrative and Functional
Medicine shifting Mindset from fragmented (reductionist) to a holistic (quantum) View
3. Foster Healthcare Organization in Continuous Learning, Respect for People and continuous Work Process Improvement for
a better Life – Healthcare Kaizen
4. Design Healthcare / Medical Diagnostic system for Patient Flow and Flow of Work – Lean /Complex Adaptive System (CAS)
oriented Healthcare
5. Design Laboratory Processes for Analytical Material Flow and timely Delivery of Reports through Integration, Consolidation,
Autonomation (= Automation with a human touch) and Multifunctional Operational Teams – Lean Laboratory Medicine
6. Utilize new Technology and Biological Knowledge in Genome, Proteome, Metabolome and Microbiome for new Diagnostic
Applications – The New Biology, Systems Thinking and Science Integration
7. Designing IT / ICT / IST for Process Management, Flow of Data, Access of Information and Knowledge Sharing – Lean
Process Design for Lean IT, Impact of Internet and Social Media
8. Transforming Leadership towards Teaching, Coaching, Motivation and Self-sustaining / Empowered Operational Teams –
Lean Management / Quantum Leadership
9. Shifting Quality Focus from End Product to Process Quality through Continuous Improvement Culture for Medical
Excellence, Operational Excellence and Patient Safety – Lean Six Sigma and ISO Synchronization
10.Shifting Healthcare / Medical Diagnostic Operations towards a Biological Adaptive Business Model generating Power
through Collaboration – Participation, Responsibility, Accountability, Flexibility and Growth
11.Developing Relationship IT / IVD Industry, Medical Diagnostics Laboratory and Healthcare for Innovation - Lean Extended
Value Stream and Innovation Sourcing, Ecological Approach
12.Educational Programs for improving Diagnostic and Scientific Knowledge Base , Operational Management Competence and
Skills for Team Operations, Productivity and Value for Money – Lean / Biological Systems Thinking / Lean Higher Education