1. Introduction to Lean and PDSA
Thinking

2. What is Lean
 Its about principles, thinking and practices
 Toyota Toyota Production System Lean
management or Lean production
 Focused on improving the performance of the
business by
 Maximizing value as defined by the customer
 Reducing waste in work
 Collapsing time
 Decreasing spending
 Increasing market share
 Creating new products or service lines

3. Benefits of Lean Thinking
 Stability within our work
 Vitality of our organization
 Respecting people
 Creating meaningful work
 Creating ownership of
your work

4. How ThedaCare uses Lean
TIS 9 Methods to See and Remove
Waste in a Process within a Value Stream
Adjust
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Sequence and
Continuity
50,000 ft
GROUND LEVEL
INCREASING DETAIL
STANDARD WORK
Adjust
5S
SIPOC
TAKT TIME
FLOW DIAGRAM
COMMUNICATION CIRCLE
SPAGHETTI DIAGRAM
TIME OBSERVATION
BAR CHART
STANDARD WORK
COMBINATION
5SVisual Management
Adjust
Adjust
Continuous Daily
Improvement
Value Stream
Analysis

5. What is the scientific method
 Penicillin
 Vaccinations
 Gravity
 Electricity
 Genetics

6. What is PDSA
 Lean’s version of the scientific method
 A document or artifact that represents your
thinking, data collection and problem you are
solving
 Its your story
 Used to gain a shared understanding of an
issue to be able to problem solve and get
results

7. Header
• Title should be reflective of problem at hand
• Owner – Party x (person who is responsible for the
problem / process and accountable to solve the problem)
• Coach – is the supervisor of the owner (sets challenge,
insures problem is resolved, and responsible for owners
development)
• Start date – date of initial draft
• Revision date and number

8. Background
Definition:
• Helps us understand the extent and importance of the
problem, how did we get here today
• Why this, why now?
Questions:
• What is business context? (True north, challenge)
• How did you decide to work on this problem?
• What is the compelling story or reason for action?
Tips:
 We should not be answering why
 Brief, one or two bullets

9. Current Condition
Definition:
• What is happening today
• Diverge and Converge
• Find the patterns
Questions:
• What should be happening,
what is actually happening?
What is the gap?
• What do you actually know
and how do you know it?
• Have you engaged other
people?
• Can you quantify the

10. Current Condition
Questions, continued…
• 4 W’s and 2H’s – Divergent questions
 What? (is flowing, happening, is the problem…)
 Where? (in the flow, in the facility, in the region…)
 When? (is it occurring – all the time, end of shift, middle of
day, once a year, seasonal, peaks…)
 Who? (what role, area, process…)
 How? (Methods…)
 How many/often?
 Consequence? (impact)
 How will you break down the problem?
Tips:
 We should not be answering why
 Should be visual (Maps, paretos)
 Have you gone to see?

11. Problem Statement
Definition:
• Clearly and succinctly defines the actual issue that is
being felt
• Quantifiable gap
Questions:
• What is the quantifiable problem?
Tips:
 Just the facts
 Solve just one problem
 Watch for solution in problem statement (words like
due to, no, isn’t etc)

12. Example Problem Statements
 Daily in the TC ICU, at
least 2 RN’s/day out of 23
potential staff are
assigned as a resource
RN due to the lack of a
clinical lead structure
which creates a lack of
consistent process
owners, lack of formal
frontline leadership role
and variability in staffing
decisions and problem
solving, thus impacting
financial metrics, and
people engagement per
our true north metrics.
 Within the TC ICU, when
ICU patients meet
UWOPO clinical triggers
staff is calling statline
within one hour 62% of
the time from January-
Sept 2011, which has
resulted in actually
missing 1 donation
opportunity in 24 months,
potentially delaying
UWOPO analysis for
appropriate candidates,
affecting Theda Clark
medal of honor
recognition, and increased
family dissatisfaction with
donation process.

13. Goals and Targets
Definition:
• Know that the work has been successful
• Goal is a condition of where we want something to be,
targets tell us how we are progressing
Questions:
• Am I using words like reduce, increase, eliminate,
decrease, NOT using words like implement, create or
establish?
• Have you validated your targets with your sponsor?
Tips:
 Make the team uncomfortable with the goals and
targets (should be challenging)
 Should touch all elements of the triangle (do not

14. Analysis / Root Cause
Definition:
• Identify the most significant causes of the problem
stated.
• Identify the true underlying source(s) of the problem.
Questions:
• Is there a standard? Is it known and practiced?
• Is the process performing at the designed quality
level? Cost level? Delivery level?
• How do you know you are at a root cause?

15. Analysis / Root Cause
Tips:
 Use Fishbone and 5-why’s to root cause if:
 There is a standard that isn’t being practiced
 There is a standard and the quality is poor
 The problem you are solving is at the step level
 Use 9 Methods to see waste if:
 There is no standard
 The problem you are solving involves collapsing time
and space at a process level
 Use Value Stream Analysis if:
 The problem you are solving involves collapsing time
and space at a value stream level
 Verify the root cause/waste by going to see.

16. Countermeasures
Definition:
 Untested actions to remove waste or address root
causes (hypothesis)
Questions:
 Do your countermeasures address the root cause(s)?
 Is there more than one suggested countermeasure for
each root cause?
 Have you created a detailed plan for experimentation?
 Can you show how your proposed countermeasures will
address the waste / root cause?
 Has your sponsor approved the “Plan” portion of the
PDSA

17. Countermeasures
Tips:
 Countermeasures should be reductive (do not add
complexity)
 Creativity over capital
 Bias for action
 Countermeasures should be within your team’s
scope of control/influence
 Plan should include how to deal with change
management

18. Experiments
Definition:
 Verify the effectiveness of the planned
countermeasures (hypothesis) prior to
implementation.
 Applying the scientific method to allow the effect of
the implementation to be simulated.
Questions:
 What is the first thing you need to learn?
 What is the smallest thing you can do to test this
hypothesis?
 Has the experiment allowed you to reach your goal?
 How will you track the experimentation process?

19. Experiments
Tips:
 Always state what you believe will happen
 Have a plan
 Respect the needs of the people performing the
work
 Practice change management
 When experimentation delivers on the expected
results, implement the proven countermeasures.

20. Study
Definition:
 Measurement of the performance over time to verify that
the targets have been achieved.
 Reflect on the success / failure of the PDSA process and
implemented countermeasures.
Questions:
 Are we able to see if the performance changed upon
implementation?
 Are the countermeasures sustainable, repeatable and
measureable?
 How will you continue to support the people doing the
work?
 How long will I study the countermeasures?

21. Study
Tips:
 Make performance over time visual
 Use Pareto’s to track abnormalities in the new
process.
 Go and see
 Train to the new standard

22. Act / Adjust
Definition:
 Actions required to close the gaps identified in the
study phase.
 Celebration of the success of the improvement effort
Questions:
 Are there other areas that can benefit from this
work?
 What is your next challenge? Will you raise the bar
or focus on another problem of consequence?
 Is the PDSA ready for closure (have we achieved the
target performance)?
 Has the new practice been standardized?
Tips:
 Establish a target completion date
 Document your reflections

23. Do
Study
Adjust
Plan
The Real PDSA Wheel…
Do
Study
Adjust
Plan

24. Additional Resources
 Lean Production Simplified by Pascal Dennis
 Managing to Learn by John Shook
 Article: Origins of Lean Management in America
 Article Link
 TIS website
 Lean.org