VA-CASE LEAN CERTIFICATION PROGRAM

Transcription

1 VA-CASE VISN 11 VA Center for Applied Systems Engineering VA-CASE LEAN CERTIFICATION PROGRAM Recognizing healthcare Lean expertise to motivate continued learning and application Kimberly E. Johnson, PsyD, HSPP Carlos M. Garcia, MBA, CM, CLGB Professional Development Program VISN 11 VA Center for Applied Systems Engineering (VA-CASE)

2 1 Introduction The VA-CASE Professional Development Program works with Veterans Health Administration (VHA) facilities and offices nationwide to provide educational content, tools, and support needed to establish Lean healthcare solutions. In simplest terms, Lean is a process improvement methodology that shortens the time between start and finish of any given process by eliminating sources of waste. Waste in this context is defined as anything that does not add value to the final product or service from the veteran s perspective. The purpose of these educational services is to provide VHA staff with the knowledge, skills, and support needed to implement and sustain successful Lean and Lean Six Sigma healthcare or business practices within VHA facilities. The formal training sessions presented by VA-CASE faculty incorporate both didactic and hands-on learning experiences in Lean or Lean Six Sigma methods and techniques. In addition, participants are offered opportunities to utilize the knowledge acquired by participating in actual VA process improvement events to solidify learning and increase value in services offered to our Veterans. After successfully completing educational training, assessment, and process improvement application, participants have the option of obtaining VA-CASE Lean Certification at varying levels of expertise. Establishment of Lean certified VA staff nationally is a key component in the transformation of VHA Medical and Business Centers to a culture of targeted process improvement and overall cost reduction. Abstract The purpose of this paper is to highlight the focus, process, and progress achieved by the VA-CASE Lean Certification Program to support Lean and Lean Six Sigma process improvement within the VHA. Due to the anticipated increase in service needs by current and future generations of veterans, the VHA must embrace innovative strategies to reduce service cost, speed service delivery, and provide services viewed as valuable by our veterans. Lean and A3 Thinking have been selected as key elements for the change needed to champion the transition to a VHA culture of continuous process improvement.

3 2 VHA s Need for Trained and Skilled Process Improvement Staff As military troops return from the current wars and fewer troops are managed under the Department of Defense, there is an urgent need for a business, process and cultural transformation within the VHA system. The VHA has chosen Systems Redesign and its Lean components as one of the various improvement strategies to achieve this transformation. The ultimate goal is to improve healthcare quality, reliability, and access to care for our 22 million veterans nationwide. The VHA s Systems Redesign leadership has chosen the process improvement methodologies called Lean and Lean Six Sigma as its vehicle of transformation. Lean and its effectiveness to reduce organizational cost, increase process efficiency, and improve customer value have been proven for decades in numerous industries. Within the past decade, Lean has become a key management strategy and driver of change within civilian hospitals. The VA Medical Centers have also embraced Lean as the fundamental quality and process improvement tool for clinical, business, and management teams to champion VHA process improvement in the 21st century. The Lean principles exist within the VHA framework for improvement: Vision-Analysis-Team- Aim-Map-Measure-Change-Sustain (VA-TAMMCS). However, despite attempts by VA Medical and Business Centers at the local, regional, and National level to incorporate Lean and Systems Redesign into their organizations, barriers exist. Success was initially hampered due to few staff members having training or experience applying Lean principles to healthcare. Furthermore, few possessed understanding and application of Lean Thinking. Fundamentally, the Lean principles and approaches originated by the Toyota Production System (TPS) in Japan were foreign to most VA healthcare professionals and administrators. Therefore, a comprehensive solution was needed to educate, assess, and certify VA staff as they acquired Lean Process Improvement knowledge and application experience. VA-CASE Lean Certification Program The purpose of the VA-CASE Lean Certification Program is to provide VA staff who have acquired Lean or Lean Six Sigma training and skill with the Lean Yellow Belt (Practitioner), Green Belt (Facilitator), or Black Belt (Strategic) National level certification. The requirements for certification at each level are outlined below. There is no charge associated with the VA-CASE Lean Certification.

4 3 Lean Yellow Belt Certification The requirements for the Lean Yellow Belt certification through either VA-CASE or Purdue are: Attend the VA-CASE Yellow Belt Certification Workshop or obtaining equivalent Lean education from a difference source. Complete the online multiple-choice competency exam with a score of 70% or higher. Participate in a Lean or Systems Redesign improvement project within the VA. Submit for approval an A3 report on the 9-box A3 format for an improvement project that you participated in. These requirements can be completed in any sequence. For example, the participant may take the exam before or after participating in a project, or submit the A3 for a project they participated in prior to attending Lean Yellow Belt training. The purpose of the certification exam is to assess the level of understanding of Lean principles that VA uses in conjunction with its process improvement framework, Vision-Analysis-Team- Aim-Map-Measure-Change-Sustain (VA-TAMMCS). It is also designed to provide a learning experience. Education Complete LEAN Yellow Belt Course Knowledge Assessment Participation Pass Yellow Belt Examination Participate in LEAN project or event Submit project A3 showing your role VA-CASE Lean Yellow Belt Certification Process

5 4 The Lean Yellow Belt certification candidate is assumed to have received knowledge and gained skill, normally through participation as a member of a process improvement project, of the following Lean topics: Lean in healthcare, Lean principles and concepts; definition of Value, Value Stream Mapping, A3 Problem Solving, Voice of the Customer, SIPOC, GAP Analysis, Root Cause Analysis, PDSA/RCC, 5S and Workplace Organization; Measurement Systems, Standard Work, Just-In-Time and Single Piece Flow, Pull Systems, and Error Proofing (Poke-Yoke). Targeted participants include VHA supervisors and mid-level managers at medical centers, VISNs, and other VHA facilities; VHA Systems Redesign Coordinators (SRC); VHA Systems Redesign facilitators; and Health System Specialists. Lean Green Belt Certification The requirements for the Lean Green Belt certification through either VA-CASE or Purdue are: Attend the VA-CASE Green Belt Certification Workshop or obtain equivalent Lean education from a difference source. Complete the online multiple-choice competency exam with a score of 70% or higher. Participate in a Lean or Systems Redesign improvement project within the VA as a leader or facilitator of a project team. Submit for approval an A3 report on the 9-box A3 format of the improvement project that you led. As with Lean Yellow Belt certification, these requirements can be completed in any sequence. For example, the participant may take the exam before or after leading or facilitating a process improvement project, or submit the A3 for such project prior to attending Lean Green Belt training.

6 5 Education Complete LEAN Green Belt Course Knowledge Assessment Participation Pass Green Belt Examination Facilitate a LEAN project or event Submit project A3 showing your role VA-CASE Lean Green Belt Certification Process The Lean Green Belt certification is advanced in that the focus is facilitation of a Lean Improvement project. It presumes basic familiarity with Lean Healthcare and builds on that knowledge. Lean Yellow Belt certification is generally considered a prerequisite for the Green Belt certificate. Targeted participants include VA Systems Redesign Coordinators (SRC) and process improvement team leaders or facilitators. Candidates should have knowledge of and experience leading or facilitating a process improvement team using Lean principles, Lean tools, and the VA-TAMMCS framework for improvement. Familiarity with the following is necessary for certification and successful completion of the exam: Planning and executing Rapid Process Improvement Workshop (RPIW) events; project charter development, including project selection and scope; team dynamics; Voice of the Customer tools and analysis; workflow analysis, including Current and Future State Process Flow diagrams; Process Observation tools and methods; data collection tools; identifying operational barriers; Plan-Do-Study-Act (PDSA) cycles; how to develop plans to sustain and spread improvements; and how to develop implementation and control plans. Lean Black Belt Certification The primary objective of the Lean Black Belt certification program is to recognize VHA staff that possess Lean knowledge and proven skills and are able to support and independently facilitate or lead others who lead Lean projects in VHA healthcare facilities, and who actively participate in strategic oversight, planning and management of healthcare Lean programs. The program presumes that candidates are fluent in Lean

7 6 and Systems Redesign concepts and principles; basic and advanced graphing; basic and advanced statistics; Project Management, and Program/Project Evaluation, including Return-on-Investment Analysis (ROI). Targeted participants include VA Systems Redesign Coordinators (SRC) and facilitators who have obtained Lean Green Belt certification. Requirements for certification include: Independent facilitation of at least two Systems Redesign or Lean process improvement teams and documentation of the projects using the A3 format. Active contribution to the VHA Lean Healthcare Community of Practice, and Successful completion of a competency-based assessment. Certification Knowledge and Competency Requirements Knowledge and competency requirements for the three levels of Lean certification are listed in Appendices I and II, respectively. All three levels require detailed knowledge of the VA-TAMMCS framework for improvement and of specific elements within each one of the framework s stages. Programmatic and strategic Lean principles, project management and return on investment (ROI) knowledge requirements are common to the Facilitator level (Green Belt) and the Program/Strategic level (Black Belt). Competencies required by the Green and Black Belt certification levels are similar, but the latter emphasizes teaching and a high degree of understanding of management and mathematics principles, and of healthcare regulations and legal requirements. Listed in Appendix III are the key personal attributes that are desirable in all candidates for Lean certification. These artifacts were translated utilizing a modified Delphi method by VA-CASE Health Services Research Partners.

8 7 Lean Certification Program Results: June 2013 May 2014 Number Candidates Certified Yellow and Green Belt Certification June 2013 to May YB Certified 143 GB Certified Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Figure 1: Lean Yellow and Green Belt certification results for one year. Between June 2013 and May 2014, monthly completion of the certification process for Yellow and Green Belt remained relatively stable. Completed certifications at the Yellow Belt level averaged 13 per month and 6 per month at the Green Belt level. It is reasonable to conclude that the monthly Green Belt certification average of 6 recognizes a more limited need in our client organizations for skilled facilitators vs. Lean improvement project participants. It is likely that as organizations mature in relation to a Lean culture, there will be greater demand for Green and Black Belt certification as organizations learn and experience the value of Lean Improvement events. VA-CASE expects this increased demand for Lean Certification and is actively planning for the demand through the development of program infrastructure, improved administration of the certification web site, expansion of exam questions, and a feedback loop to students identifying recommended areas of review.

9 8 VA-CASE Lean Certification Completions Lean Certification Level Certified from June 2013 to May 2014* Total certifications since inception (June 2012)* Yellow Belt Green Belt Black Belt 0 12 Total *Number of certifications derived from a hand count due to the inability of the software to quantify numbers. Future Direction and Focus Participation in the VA-CASE Lean Certification Program has grown since Interest in the application of Lean principles and approaches to improve the timeliness, quality and cost of VA healthcare services is anticipated to continue to grow, as more staff develops the necessary skill sets and experience to achieve recognition and Lean certification. Our Primary goal of developing Lean Improvement capacity in our client organizations will remain. We work to enable VA healthcare facilities to execute process improvement initiatives at all levels of their organizations with minimal external support and guidance, and to promote and support the new culture of process improvement. We know that I cultural transformation is a journey. The VHA has embarked upon this journey. The influx of new and existing veterans to VA healthcare over the next decade will serve to hasten the need for more Lean trained, experienced and certified workers. The continuation of the development and spread of the VA-CASE Lean Certification Program within VA healthcare will ensure that management and staff will acquire professional Lean knowledge and appropriate skill levels, while advancing continuous process improvement efforts at every organizational layer. The expansion of Lean process improvement thinking and utilization within VA will be a result of the VA-CASE Professional Development Program s continued offering of:

10 9 Nationwide competency, facilitation, and management training on Lean process improvement methodology and tools, enabling the spread of process improvement initiatives. Facilitation, coaching, and technical support of VHA process improvement initiatives at the local, VISN, and national levels. Communication forums to promote and expand process improvement discussions and sharing of knowledge and best practices. Lean Certification options to recognize Lean expertise and provide motivational incentives for continued learning. Recommendation The need for veteran-centered, cost efficient services has become a central objective for the VA. Embracing innovative and effective initiatives is crucial to achieving this goal. Proven process improvement methods and philosophies, such as Lean and A3 Thinking, have been chosen as the vehicles of change for VA facilities. Therefore, the Professional Development Program within VA-CASE will continue to expand its educational, training and certification options for all VA employees. Due to the volume of potential participants, continued flexibility in Lean training methods should be explored, such as continued onsite training, webinars, video, and online educational forums. However, regardless of the instructional method, timely and practical application of acquired process improvement skills and recognition through Lean certification should be emphasized. This will serve to enable and solidify delivery of valuable and efficient services to our current and future generations of veterans. Finally, VA healthcare organizations must continue to create improvement team facilitation opportunities for Lean certified Yellow Belts and strongly encourage and reward Lean Green Belt training and certification.

11 10 Appendix I Knowledge Requirements for Certification Levels I. Enablers for Lean Knowledge Requirements Practiti oner Level (Yellow Belt) (Basic) Facilitator Level (Green Belt) (Intermediate) Program/Strategic Level (Black Belt) (Advanced) VA-TAMMCS Framework Principles of Lean Leadership (Advanced) o Lean Corporate Culture, Lean Roles (Basic) (Intermediate) O SR Methods (RPIWs, Kaizen, 100D Projects, etc.) (Basic) (Advanced) o Teamwork and Team Dynamics (Basic) (Advanced) o Levels of Employee Training and Development (Basic) (Advanced) (Advanced) (Basic) (Intermediate) o Principles of Empowerment o Linkage to Business Vision, Mission, Values, Strategies and Goals o Data extraction, analysis and feedback o Motivation Theory, Teaching Adult Learners II. Core Operations and Processes Vision/Analyze o Opportunity Identification o Project Selection (Basic) (Advanced) o Value Stream Analysis (Basic) (Advanced) Team/AIM o Project Charter (Basic) (Intermediate) (Advanced) o Appropriate Project Scope (Basic) (Intermediate) (Advanced) o AIM Statement (Basic) (Intermediate) (Advanced) o Team Selection (Basic) (Intermediate) (Advanced) o Voice of the Customer MAP/Measure Workflow Analysis o Process Mapping (Basic) (Advanced) o Process Observation (Basic) (Advanced) o Process Observation Worksheet (Basic) (Advanced) o Spaghetti Diagramming (Basic) (Advanced) o Prospective Data Collection and Analysis (Basic) (Intermediate) (Advanced) o Retrospective Data Collection and Analysis (Basic) (Intermediate) (Advanced) o Value Stream Mapping (Advanced)

12 11 (Basic) (Intermediate) Change Systematic identification and elimination of waste (A-3) o Operational Barrier (Waste) identification and elimination o Value Stream Mapping o 5S standards o Visual workplace o Mistake proofing (Poka-Yoke) o Continuous improvement methods (PDSA, IHI Model for Improvement) Just-in-Time Operations o Capacity (Demand/Supply) Analysis o Process Triggers (Andon, Kanban) o Pull systems o Continuous flow o Just-in-time (JIT) o Quick changeover/set-up reduction (SMED) o Total productive/preventive/predictive maintenance (TPM) Workstation Design o Work cell design/setup o Single piece flow (reduction/elimination of batching) o Standardized work o Informatics/Automation Sustain o Key Characteristics for sustainability (Basic) (Advanced) o Implementation Plan o Control Plan III. Business Operations Vision and Strategy Operational processes vision, mission, strategies, objectives and targets (goals) Lean principles (programmatic, strategic) Employee empowerment (programmatic, strategic) Operational alignment with organizational vision and strategy IV. Project Design and Communications o Project Management Product Design and development of products and services o Quality function deployment o Variety reduction o Design for Veteran Centered Care (VCC) o Design for environment o Failure mode and effects analysis (Basic) (Intermediate) (Advanced) o Knowledge transfer methods and practices Product market service o Voice of the Customer o Customer specifications and requirements (Basic) (Advanced) o New market development and current market exploitation

13 12 o Benchmarking (Basic) (Advanced) Other stakeholders o Stakeholder engagement methods o Stakeholder satisfaction measurement o Corrective action system o Human Factors Engineering V. Return on Investment Return on Investment Analysis o Cost of Poor Quality (Basic) (Advanced) o Soft vs Hard Cost savings o Fixed and variable costs o Value stream profitability

14 13 Appendix II Performance Criteria and Competencies Performance Criteria Competencies Practitioner Level (Yellow Belt) Facilitator Level (Green Belt) Program/Strategic Level (Black Belt) 1. Understand and have access to the Lean body of knowledge". 1.1 A body of knowledge can be accessed and understood. Access to and understanding of various Lean and Lean methodologies;. Maintain a personal library, a company library, a computer database or other collection of information. Contribution to VHA or other Lean Healthcare Knowledge Database 1.2 Taken courses with a focus on Lean that address the items in the knowledge table Successful completion of courses on Lean or Lean and related topics documentation required Certified in Lean or Lean Successful completion of courses on Lean or Lean and related topics documentation required Certified in Lean or Lean Successful completion of courses on Lean or Lean and related topics documentation required Certified in Lean or Lean 2. Demonstrate the skills to use Lean knowledge during project assignments 1.3 Taught courses or short courses on Lean (see the knowledge table) 1.4 Have an education that supports the knowledge that is required for Lean Projects 2.1 Demonstrated ability in each area of Lean or Lean listed in skill table. 2.2 Demonstration of the effectiveness of Lean or Lean activities listed in the skills table. Demonstrated practitioner level skills in competencybased training Demonstrated effectiveness at a practitioner level for Lean or Lean activities in competency-based training Demonstrated facilitator level skills in competency-based training Demonstrated effectiveness at a facilitator level for Lean or Lean activities in competency-based training Taught courses with student evaluation of knowledge of instructor evaluations required Has taken courses in business, management, mathematics and other disciplines needed to support the work Demonstrated expert level skills in competency-based training Demonstrated effectiveness at an expert level for Lean or Lean activities in competency-based training

15 Work experience can be demonstrated for each area of Lean or Lean listed in the skill table. References from clients attesting to practitioner level skill in using the methods listed above References from clients attesting to facilitator level skills in using the methods listed above References from clients attesting to expert level skill in using the methods listed above 3. Demonstrate the attributes for Lean practitioners 3.1 Practice personal attributes necessary for the effective and efficient conduct of Lean or Lean services Demonstrated practitioner level attributes in competency-based training Demonstrated facilitator level attributes in competency-based training Demonstrated expert level attributes in competency-based training 3.2 Attest to attributes listed in the table from former clients References from clients attesting to practitioner level skill in using the methods listed above References from clients attesting to facilitator level skills in using the methods listed above References from clients attesting to expert level skill in using the methods listed above 4. Demonstrate important communication skills for Lean practitioners 4.1 Effective communication is practiced 4.2. Interview skills are used to effectively acquire information required for the Lean or Lean activity Knowledge of effective communication (verbal, written and listening) is demonstrated Knowledge of effective interview techniques to acquire valid evidence is demonstrated Effective communication (verbal, written and listening) is demonstrated within the context of facilitating Lean Teams Effective interview techniques are used to acquire valid evidence during projects Effective communication (verbal, written and listening) is demonstrated within the context of advancing the strategic direction of the Lean Program Effective interview techniques are used to inform Lean Program strategic direction 4.3 Written comments in Lean or Lean documentation accurately reflect findings, observations and interventions Effective contribution to reports/presentations is demonstrated Lean Project findings and results are recorded accurately, analyzed, prioritized and summarized Lean Program findings and results are recorded accurately, analyzed, prioritized and summarized

16 The requirements for information security are understood and applied Information Security requirements are understood Reports and all notes are securely maintained Outcomes are not discussed with or distributed to unauthorized personnel Reports and all notes are securely maintained Outcomes are not discussed with or distributed to unauthorized personnel 4.5 Understand the application of the regulations, industry codes of practice and other considerations that are relevant to the Lean or Lean effort (e.g., environmental, health and safety regulations) An understanding of how relevant regulations, legal requirements and codes of practice are applied within the organization where the Lean service is being provided 4.6 Understand the impact of the Lean processes on bargaining unit employees Any potential issues or conflicts with bargaining unit employees are proactively addressed with union representation 5. Demonstrate the ability to effectively contribute to a Lean Project 5.1 Respond to a request for a Lean or Lean assignment 5.2 Create project charter for the Lean or Lean assignment Knowledge of components of the Project Charter is demonstrated Meaningful contribution to the creation of the Project Charter is demonstrated The Project Charter is created and effectively utilized as part of the project preparation and project execution The services requested are identified and assessed as being within the goals/deliverables of the Lean Program Appropriate Facilitator, Management Guidance Team and Process Action Team resources are allocated to support the project Project Charters are aligned to meet specific strategic or tactical program goals or deliverables

17 Management Guidance Team (MGT) meetings Knowledge of role of the Management Guidance Team in project development and management is demonstrated Meaningful contribution to the MGT is demonstrated (if applicable, includes regular attendance at MGT meetings and timely completion of any assigned action items) Facilitator schedules and conducts 2 MGT Meetings, completes project charter and insures that project action team (PAT) team is appropriate resources and chartered Management Guidance Teams and other organizational committees are aligned to meet specific strategic or tactical program goals or deliverables 5.5 Conduct PAT Meetings/RPIWs Knowledge of role of the Process Action Team (PAT) and PAT team members in project execution and implementation is demonstrated Meaningful contribution to the PAT team is demonstrated (if applicable, includes regular attendance at PAT meetings and timely completion of any assigned action items)) Conduct RPIW and/or PAT meetings in an effective manner, insure that deliverables are met and implementation/action plans are executed against in a timely manner - The facilitator must have knowledge of a range of Lean/Lean tools and methods, employee engagement methods and demonstrate the ability to determine which would work best under different situations Resources are appropriately allocated Barriers to implementation are removed/address in a timely manner

18 Address the issue of the resistance to change, sustainability and spread adoption Knowledge of the key factors impacting resistance to change, sustainability and spread adoption is demonstrated Meaningful contribution to the implementation as well as the sustainability and spread adoption of the project is demonstrated (if applicable, includes regular attendance at PAT meetings and timely completion of any assigned action items)) Prepare action/implementation plans that will address the need for change and the actions required to manage/resolve resistance from the internal stakeholders Effective/Timely escalation of delays in implementation against the action plans Regular reporting of progress against goal Knowledge of the key factors impacting resistance to change, sustainability and spread adoption is demonstrated An overview of the business plan and key outcomes, specifically the outcomes required of the current intervention is developed Resources are appropriately allocated Barriers to implementation are removed/address in a timely manner 6. Demonstrate the ability to effectively contribute to a facility or VISN based Lean Program 6.1 Develop Effective Program Infrastructure 6.2 Develop Effective Project Selection/Prioritization Processes Lean Board, Management Guidance Teams and other organizational committees are aligned to meet specific strategic or tactical program goals or deliverables *Lean Project Selection is tied to facility/visn strategic and tactical planning

19 18 Appendix III Key Personal Attributes Ethical fair, truthful, sincere, honest and discreet Open-minded willing to consider alternative ideas or points of view; be inquisitive and ask a lot of questions; listens well Proactive and organized takes the initiative with issues and is personally organized Systematic shows a balanced affiliation for both tasks and people Logical makes decisions based on facts and reasoned logic Decisive reaches timely conclusions based on logical reasoning and analysis; expedites decisions methodically Diplomatic relates to others and shows tact in appropriate situations Observant shows the ability to identify both patterns and exceptions in complex situations; actively aware of physical surroundings and activities Perceptive instinctively aware of and able to understand situations Flexible shows a balanced global and detail focus Process focused- demonstrates the ability to follow a pre-determined method; sees the interconnections between core product and service processes and the host of supporting processes People sensitive is sensitive to and can identify a person s emotional state Versatile adjusts readily to different situations Tenacious persistent, focused on achieving results Self-reliant acts and functions independently while interacting effectively with different types of people in a range of situations and copes with change Confident demonstrates certainty and competency and reacts well to a variety of challenges demonstrating calm and poise in such challenging situations.

20 19 Bibliography [1] PR Web Online Visibility from Focus: Veterans Health Administration Steadily Increasing Use of Lean Six Sigma Process Improvement to Support Its Systems Redesign Initiative. Retrieved from [2] Sober II, D. & Smalley, A. (2008). Understanding A3 Thinking: A Critical Component of Toyota's PDCA Management System, New York: CRC Press.