Lean’s origins started in manufacturing and the automotive industry, but Lean has also found success in other lines of business. With a focus on value from the customer’s perspective, operational waste is reduced and processes are streamlined. Employees are empowered to provide improvement solutions and metrics show the fruit of the organizational labor. Take a look at how UCSF Medical Center is using Lean to improve IT services. Key takeaways: -You will understand the high level concepts of Lean. -You will see how customer focus actually reduces cost. -You will be able to define and identify operational waste. -And… you will know that you want to learn more! About the presenter: Pierre Brickey has over twenty years of experience in the technology industry spanning the defense, telecom, and healthcare sectors. As Director of IT Quality at UCSF Medical Center, he is focused on enterprise IT value, process improvement, and service quality. In his spare time, he is the IT Program Director for the Mission Bay Hospitals construction effort, due to open in February 2015.

1. Lean Overview and
Case Study
UCSF Medical Center –
Information Technology
Pierre Brickey
October 2013

2. 2
Agenda
• What is Lean?
• Origins
• Aligning Vision and Purpose with Lean
• What is Customer Based Value?
• Value Stream Analysis
• Identifying Operational Waste
• Case Study: UCSF Information Technology
– Reason for Action
– Gap Analysis and Rapid Experiments
– Summary of Improvements
– Baseline, Achievements and Targets
– Sustained Results
– Final Staff Insights and Quotes

3. 3
What Is Lean?
 Organizational alignment in vision and purpose – How many
number one priorities can you have?
 Customer based value – Which steps in your business process
are of value to the customer?
 Identify and eliminate waste – The right process will produce the
right results
 Develop and empower your people – The people doing the work
know more than you think.
 Continuous Improvement – Question paradigms, chase root
causes, and don’t rest on past improvements
Philosophy, process, methods, tools and eventually culture

4. 4
Origins
 Manufacturing-
 1902: Sakichi Toyoda, the father of the Japanese
industrial revolution, invented an automatic power
loom that stopped itself when a problem occurred.
 Automobile Industry –
 1908: Henry Ford invented the moving assembly
line and raised the daily wage to $5.00.
 1940’s: Taiichi Ohno, a production engineer at the
Toyota Motor Company, applied the same concepts
to eliminate waste –non-value added activities –
within the Toyota organization, and the concept of
Just in Time (JIT).
 These two pillars would be supported by a
foundation of Standard Work, and would become
the Toyota Production System.
JustIn
Time
Stopthe
Line
TPS
Standard Work

5. 5
Aligning Vision and Purpose with Lean
• To Be the Best Provider of Health Care
– Standard Work that enables staff to provide safe, outcomes-
oriented care each and every time
– A relentless focus on value from the patient’s or internal
customer’s perspective
• To Be the Best Place to Work
– Improvement initiated and driven by staff
– Engaged leaders encourage and supported efforts
• To Be the Best Environment for Teaching and Research
– All are encouraged to participate and contribute

6. What is Customer Based Value?
6
Value Added Activity
Non-Value Added
Activity
Non-Value Added but
Essential Activity
A step or a process that
is perceived to add
value, from the
customer’s perspective
A step that is considered
waste but is required
either because of
regulations or as a pre-
requisite to completing a
value-added step
A step that does not
directly contribute to or
add value to the product
or service.

7. 7
Value Stream Analysis
IdealState
Current
State
Process
Lean Tools & Kaizen Events
Elimination
of Waste
Future
State
Process
• Sort -Straighten –Scrub-
Standardize -Sustain -Safety
• Standard Work
• Pull Systems and One Piece Flow

8. 8
Value Stream Analysis
Current State Future State

9. 9
Identifying Operational Waste
Sources of Non-Value Added Activity
1. Defects Production or goods or services that require rework,
or correction.
2. Waiting Patients waiting for tests & procedures, care delays
stemming from staff not being available, staff waiting
for equipment, approvals etc.
3. Motion/Movement Excessive motion by staff
4. Transportation Transporting resources, supplies or equipment
5. Inventories Accumulation of items awaiting processing (email,
orders, work queues)
6. Over-Processing Repeat placement of requests due to process
errors, vetting a decision that was already made
7. Over-Production Producing products or services “just in case,”
duplicative paper work, reports and documentation,
8. Under-Utilization Equipment, staff, physical space that is not fully
utilized or working at potential

10. 10
Case Study – UCSF Information Technology
• Turnaround time for new iPhone and PC
request fulfillment did not meet customer
expectations
• Field Services team routinely faced variable
workflows and demand, preventing timely
delivery of new hardware
• Lack of standard work drove unnecessary
complexity for customers and IT staff
Reason for Action

11. 11
Gap Analysis and Rapid Experiments
Problem Potential Root Causes Rapid Experiments
Information Gathering
• Type
• Timing
• Accuracy
• Use of free text in Service Now tickets
• High potential for error within intake process
• Lack of standard workflow and Service Now use
• Source data not trusted and multiple manual
checks required
• Remove / redirect non standard
procurement portals
• Test Customer Intake form with several
customers
No Standard Work within
Field Services Team
• Priority over task
• No ticket “Pull System”
• Non-Specific categorization of work
• Internal “Trust” issue with accuracy of data and
completion of other’s work
• Development categorization and priority
workflow
• Define Pull and Fulfillment standard
work
• Test dedicated resource model
Inventory Management • Zero demand analysis
• No integrated inventory management system
• Very manual process
• No global transparency (across the entire Field
Services team)
• No process for removal of obsolete equipment
(stock-piles of equipment that will never be
deployed); clutter distorts visibility
• Validate inventory
• Define Par Levels
• Remove obsolete inventory
• Explore Pull inventory systems
• Explore Service Now and PMM
inventory management options
No established iPhone
deployment process
• Porting Blackberry process to new product
• Forms obsolete
• Lack of oversight
• Define HW Standard review cycle
• Explored self deploy strategy
Field Services managing
scope beyond IT
• Network
• Facilities
• Lack of single Service Management platform
• Field Services first and last touch point
• Poorly defined roles and responsibilities
• Explore wireless standard
deployment
• Meet with Facilities to understand
process, scope, tools

12. 12
Summary of Improvements:
Request Intake and Deployment
Manual and variable
information gathering
process
Service Now standard
request form/script
Multiple procurement
channels
Service Now as only
procurement source
Competing Field Service
demands
Better categorization of
work and dedicated
deployment resource model
Extended wait times for new
requests
Self-deployment option
Network cable install
significantly increase
turnaround time
Standard wireless
deployment
Problem Solution

13. 13
Summary of Improvements:
Inventory Management
Manual Inventory
Management
Automated Inventory
Management with
Reporting Capability
Limited Inventory
Transparency Across
Techs & Locations
Increase transparency
through PMM and
ServiceNow
Large Quantities of
Surplus Inventory
Right Sized Inventory
With Monthly Par Levels
Identified
H-Level “Off the Grid”
No Cleaning in H-Level
Space for Several Years
Now Added to the
Hospitality Services
Cleaning Priorities
Fragmented Storage in 3
locations
Consolidated Inventory
with Real Time Reporting
& JIT Replenishment
Problem Solution

14. 14
Baseline, Achievements and Targets
Kaizen Metrics Baseline Achieved
during
Kaizen
30 days 60 days 90 days
iPhone
Fulfillment
16-24 days 5 days 2-5 days 2-5 days 2-5 days
PC Fulfillment 8-19 days 5 days 3-5 days 1-5 days 1-5 days
0
5
10
15
20
25
30
iPhone Fulfillment
Initial State Current State
PC Fulfillment
Initial State Current State
0
5
10
15
20
25
30
79% Reduction!
74% Reduction!

15. Sustained Results
15
July August Sept Oct Nov Dec Jan Feb March April May June
Days 11.3 9.2 19.6 17.6 7.9 10.2 7.8 4.2 4.3 6 5.88 5.29
0
5
10
15
20
25
IPhone Provisioning

16. Sustained Results
16
July Aug Sept Oct Nov Dec Jan Feb Mar April May June
Days 11.8 13.8 9.2 13.3 15.2 12.6 13.8 11.5 6.3 4 3.2 3.25
0
2
4
6
8
10
12
14
16
Desktop/Laptop Provisioning

17. 17
Final Staff Insights and Quotes
“Two dedicated weeks of focused
work, netted the equivalent of nine
months of regular work.” – Vishnu S
“A multi-disciplinary approach enables
full utilization of existing tools”
– Rob H
“Everybody has a great idea.”
– Dave G
Insights
• Customer feedback is key
• Customer satisfaction makes work
satisfying
• Standard Work is only possible if
documented and consumed
• Mapping the workflow and process
reveals waste
• To make true progress, we had to
demolish existing paradigms
• Having the doers be part of the
process creates a foundation for
continuous improvement
• The camaraderie that we’ve
developed in this room will carry
forward to our other work together
“For the first time, I feel like we’re really
thinking outside the box”
– John C
“The collaboration in this room is
awesome!”
– Mark U