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HEALTHCARE IMPROVEMENT
INITIATIVE

Glossary

3 Elements of Lean
1. Pace production to TAKT Time. 2. Create uninterrupted FLOW of products and services. 3. Wherever you cannot create FLOW today, implement some form of a PULL system.

See: JIT, Takt Time

3 GEN Principle
Is a guide for how to "behave" (especially if you are a Manager) in a Lean System. The 3 "GEN’s" are derived from three Japanese phrases that capture the three recommended behaviors: 1. Gemba or "go to Gemba" meaning go always to where the work is being performed (do not sit behind your desk and read reports or charts since they represent "filtered" and distorted information). 2. GEMBUTSU Observe the actual product (production process) and 3. GENJITSU Get the real situation or "facts" yourself.

ref: Gemba

3D’s
Work conditions that are "Dirty, Dangerous and Difficult".
3P
"Production Preparation Process" A Lean System Tool that is intended as the basis of creating a new process that is waste free. It uses a "Seven Alternatives Matrix" and paper models of the layout of the new process.
5S
5S is a methodology for simplifying, organizing, cleaning, developing, and sustaining a productive work environment. The methodology originated at Ford Motor Company and was elaborated by Toyota and is based on the simple idea that the foundation of a good production system is a clean and safe work environment. Translated from Japanese words that begin with an "s," the closest English equivalents are: Sort, Set in order, Shine Standardize, Sustain.

full: Five S

ref: Set in Order

ref: Shine

ref: Sort

ref: Standardize

ref: Sustain

5-S
A systematic process of workplace organization.
6M’s of a Process
Main, Method, Machine, Materials, Measuring System and "Mother Nature" (also referred to as "Environment").
8 Wastes
The eight forms of waste that exist in any process as originally defined by Taiichi Ohno at Toyota. Ohno’s version described "7 Wastes". The eighth was added in America: the waste of "human potential" to solve problems and find better work methods. The eight wastes are best captured by the acronym "DOWNTIME" where D = Defects, O = Overproduction, W = Waiting, N = Non-utilized Talent, T = Transportation, I = Inventory, M = Motion and E = Extra (or Excess) Processing. All healthcare processes need to be examined for any of these eight forms of waste.
A3 Report
Is a format for a Problem Solving or Corrective Action Report as used by Toyota. A3 is derived from the European Paper size "A3" that is approximately equivalent to 11 x 17". All the information for effectively communicating the solution to a problem should fit on this one page. If more space is required, that would indicate the likelihood that much unnecessary or superfluous information has been included. In the A3 Report format, there is great emphasis on accurate identification of the ROOT CAUSE of the problem.
ABC Classification
A method for prioritizing items based on the product of the annual demand and the unit cost. The high "annual dollar volume" items are classified as "A" items. The low annual dollar volume items are classified as "C" items. Based on Pareto’s law, the ABC classification system drives us to manage "A" items more carefully. This means that these item should be ordered more often, counted more often, located closer to the door, and be forecasted more carefully. Conversely, "C" items are not very important from an investment point of view, and therefore should be ordered rarely and not counted often. Some firms use other methods for defining the ABC classification -- such as the stockout cost or the medical criticality of the item. This has nothing to do with activity based costing. See Pareto’s law.
Abnormality
Any process or equipment condition that does not conform to the standard conditions required for the scheduled production and delivery of quality products and services.
Andon
A Japanese term that refers to the warning lights on an assembly line that light up when a defect occurs. When the lights go on, the assembly line is usually stopped until the problem is diagnosed and corrected. Can also be applied to defects or emergencies in healthcare processes.
Autonomous maintenance
A TPM principle of having each worker responsible for both maintaining and operating a machine. Maintenance activities include cleaning, lubricating, adjusting, inspecting, and repair.
Balanced Facility
A facility where capacity of all resources is balanced exactly with market demand.
Batch-and-queue
Refers to the usual movement of part lots in mass-production practices or customers through a service process. Typically, large lots of a part are made and sent as a batch to wait in queue for the next operation in the production process. Contrast with one-piece-flow or one step flow in a service process.
Benchmarking
Comparing products and/or processes to a standard in order to evaluate and improve performance. Benchmarking can be done for either product or process performance. Internal process benchmarking sets the standard by comparing processes in the same firm (e.g., another department, region, machine, worker, etc.). External process benchmarking sets the standard based on a process from another firm. Competitive benchmarking sets the standard based on a competitor’s product or process.
Best Practices
This term is typically used in the context of a multi-divisional or multi-location firm that has similar processes in many locations. For example, Wells-Fargo buys banks, which all have similar teller policies. Clearly, it is in the best interest of the firm to find out which of the many banking subsidiaries has the "best practice" for this process, document the process with process maps and other documentation, and then implement that process throughout the system. This is really just an application and extension of internal benchmarking.
Bottleneck
Any resource whose capacity is equal to, or less than the demand placed on it.
Capacity Constraint Resources
Where a series of non-bottlenecks, based on the sequence in which they perform their jobs, can act as a constraint.

Abb: CCR

Ref: Constraint

CCR
Where a series of non-bottlenecks, based on the sequence in which they perform their jobs, can act as a constraint.

Full: Capacity Constraint Resources

Ref: Constraint

Chaku-Chaku
A method of conducting single-piece flow, where the operator proceeds from machine to machine, taking the part from one machine and loading it into the next.

Same: Load-Load

Constraint
Anything that limits a system from achieving higher performance, or throughput. Alternate: That bottleneck which most severely limits the organization's ability to achieve higher performance relative its purpose/goal.

Ref: Bottleneck, Throughput

Covariance
The impact of one variable upon others in the same group.
Dependent Events
Events that occur only after a previous event.
Five S
5S is a methodology for simplifying, organizing, cleaning, developing, and sustaining a productive work environment. The methodology originated at Ford Motor Company and was elaborated by Toyota and is based on the simple idea that the foundation of a good production system is a clean and safe work environment. Translated from Japanese words that begin with an "s," the closest English equivalents are: Sort, Set in order, Shine Standardize, Sustain.

abb: 5S

ref: Set in Order

ref: Shine

ref: Sort

ref: Standardize

ref: Sustain

Flow Kaizen
Radical Improvement, usually applied only once within a value stream.

Ref: Value Stream

Same: Kaikaku

Gemba
Japanese word of which the literal translation is "the real place." In healthcare, Gemba means the hospital, where the actual service is delivered, as contrasted to the office, where support services are provided.
Hoshin Kanri
The selection of goals, projects to achieve the goals, designation of people and resources for project completion, and establishment of project metrics.

Same: Policy Deployment

Information Management Task
The task of taking a specific service from order-taking through detailed scheduling to delivery.

See: Value Stream

Inventory
The money the system has invested in purchasing things it intends to sell.
JIT
A philosophy developed by Toyota in Japan that emphasizes delivery when needed of small lot sizes. The philosophy includes an emphasis on setup cost reduction, small lot sizes, pull systems, level production, and elimination of waste (Muda).

full: Just-In-Time Manufacturing

ref: Muda

Judgment Inspection
A form of inspection used to determine non-conforming product.

See: Informative Inspection, Inspection

Just-In-Time Manufacturing
A philosophy developed by Toyota in Japan that emphasizes delivery when needed of small lot sizes. The philosophy includes an emphasis on setup cost reduction, small lot sizes, pull systems, level production, and elimination of waste (Muda).

Abb: JIT

ref: Muda

Kaizen
Continuous improvement through incremental improvements.

Same: Process Kaizen

Lean
Producing the maximum sellable products or services at the lowest operational cost, while optimizing inventory levels.
Muda
Japanese word for "waste". Any activity that does not add value (that which the customer is not prepared to pay for). Originally part of a trilogy of Mura (imbalance), Muri (overload), and Muda (waste or non-value-added). In more popular terminology, Muda is used for any type of waste. In common usage in Japanese, Muda means useless, futile or waste.
Non-Value Added
Activities or actions taken that add no real value to the product or service, making such activities or action a form of waste.

Ref: Real Value, Waste

See: Value Added

Operating Expenses
The money required for the system to convert inventory into output.

Ref: Inventory, Throughput

Policy Deployment
The selection of goals, projects to achieve the goals, designation of people and resources for project completion, and establishment of project metrics.

Same: Hoshin Kanri

Problem Solving Task
The task of taking a specific product or service from concept through design to launch.

See: Value Stream

Process
A material flow or service flow in time and space. The accumulation of sub-processes, or operations that transform material from raw material to finished products or complete a service.

Ref: Operations, Sub-Processes

Process Kaizen
Continuous improvement through incremental improvements.

Same: Kaizen

Quality
Meeting expectation and requirements, stated and un-stated, of the customer.
Real Value
Attributes and features of a product or service that, in the eyes of customers, are worth paying for.

See: Non-Value Added, Value Added

Resource Activation
Using a resource regardless of whether throughput is increased.

Ref: Throughput

See: Resource Utilization

Resource Utilization
Using a resource in a way that increases throughput.

Ref: Throughput

See: Resource Activation

Sensei
An outside master or teacher that assists in implementing lean practices.
Shine
clean the work area.
Sort
get rid of clutter.
Standard Work
Specifying tasks to the best way to get the job done in the amount of time available while ensuring the job is done right the first time, every time.
Standardize
Use standard methods to keep, sort, set in order, and shine at a high level.
Statistical Fluctuations
Kinds of information that cannot be precisely predicted.
Sub-Optimization
A condition where gains made in one activity are offset by losses in another activity or activities, created by the same actions creating gains in the first activity.
Sub-Processes
A series of operations combined. Part of a process.

Ref: Operations, Process

Sustain
Maintain through empowerment, commitment, and discipline.
Takt Time
Daily throughput number required to meet current demand divided into the number of working hours in the day.
Theory of Constraints (TOC)
A lean management philosophy that stresses removal of constraints to increase throughput while decreasing inventory and operating expenses.

Ref: Constraint, Inventory, Operating Expenses, Throughput

Value Added
Activities or actions taken that add real value to the product or service.

Ref: Real Value

See: Non-Value Added

Value Analysis
Analyzing the value stream to identify value added and non-value added activities.

Ref: Non-Value Added, Value Added, Value Stream

Value Stream
The set of specific actions required from initiation of a service to completion.

See: Information Management Task, Physical Transformation Task, Problem Solving Task

Visual Controls
Displaying the status of an activity so every employee can see it and take appropriate action.
Waste
Anything that uses resources, but does not add real value to the product or service.