What we do

LEAN Integrated is a consulting team focused on Continuous Improvement for Patient Centered Healthcare,,Advanced Education, First Nations, Government, and other People-Centred Processes. We carry our expertise beyond the Processes to Design, Construct and Deliver the Spaces needed in an Integrated Solution We facilitate advanced Lean Process Implementation to improve flow and eliminate waste. Our Lean Healthcare – Lean Architectural approach has proven to integrate the best care with the best environment. Lean for Education, First Nations and Government does the same. Lean for Construction integrates the delivery of the buildings on budget and ahead of schedule We support, train and guide patients, students, community members, providers, educators, support staff and management on their Lean journey. Our Lean certification process provides our clients the experience and expertise necessary to become fully autonomous on their Lean journey.

LEAN HEALTHCARE

WE INTEGRATE LEAN PROCESS IMPROVEMENT WITH BUILDING DESIGN TO TRANSFORM PATIENT CENTERED CARE.

While a building can support better processes that address these issues, these are operational process issues at their core. The heart of the process we engage is a LEAN Transformation that works with Patients, Support Staff, Managers and Executives to help them change the way they operate to address the waste in their facilities, and use the building design as the tool that fits the new processes. This is the origin of Lean in Healthcare, it is the process taught by John Black and Associates (JBA) at Virginia Mason that has proven the success of Lean in Healthcare. It is the process that has set Saskatchewan on the path as the largest Healthcare transformation in the world. Lean is the westernized term used to describe the Toyota Management System. Lean Healthcare is the application of this system to healthcare. In 1995, working with John Black and Joanne Poggetti, PeaceHealth pioneered the application of lean in Healthcare. Then in 2001, building on the pioneering work at PeaceHealth. In 2001, Virginia Mason Hospital in Seattle Washington became the first hospital in the United States to apply Lean principles to Healthcare. Through Lean implementation, they turned an ailing healthcare system into one of the top hospitals in the world. In 2007 and 2008, during the great recession, many hospitals were shutting down services and cutting back on staff. Virginia Mason prospered during this time, with staff receiving bonuses rather than cut backs. In 2010, nine years after their adoption of Lean, Virginia Mason was awarded Hospital of the Decade by the Leap Frog Group. Quality, Costs, Delivery, Safety and Morale all improved. The world began to take notice. Healthcare leaders worldwide began to adopt the Lean system. In 2011 Saskatchewan began their Lean journey province-wide. After four years and hundreds of Lean events, the Ministry has announced that surgery wait times are down significantly, errors are reduced, wait times have decreased and cost savings are dramatic. Tens of millions of dollars have been saved in construction costs alone.

BACK TO HEALTHCARE

Although Lean is an in depth system that requires many years of study and application, the 3P (Production Preparation Process) can be a good starting point. The basic concept of 3P is a complete reversal of the standard design process. The standard design process sends the program parameters to the architectural teams who apply current known best practice to design the facility. The 3P process is a collaborative effort between the hospital staff, the architects, the contractors and most importantly, the patients. The outcome is a hospital designed to optimize the “flow of care” for the patients and staff. In virtually every case, as mentioned above, the program budget is significantly reduced. At the end of the 3P event week, the architects carefully photograph and document the final design proposal. It is the job of the architectural firm to design the interior of the building according to this design. Following the event week is the 30 day review. At the 30 day review the design will be presented “As Designed” in the event week. At this time, the architects will present any issues the team must address in regards to adjustment required by code. The team will also review the flows of the patients, staff, materials, etc. to make any fine adjustments to the design. This leads into follow-up work 30/60/90 day work led by the architecture team to edit the design, keeping to the principles of the 3P design, and working to improve flow and eliminate waste.

As previously mentioned, this process will need to be repeated, one 3P for each large department or integrated patient care path. Although this process requires a significant upfront investment in time, the savings in overall project costs speak for themselves. Not to mention the benefit to the staff and the community at large. Essential to the success of 3P design is hands on transformation of the process. To achieve transformation of the care process the Lean consulting team will undertake Rapid Process improvement Workshops (RPIW’s) to work on process innovations that were identified in the 3P but were unable to be fully resolved within the week. There is typically a need for 3 to 4 RPIWs per 3P.  3P without process transformation will lead to confusion, frustration, and anger as the building cannot dictate how people work, the building has to support how people work. RPIW’s are a central tool to implement the process innovations that are key to the success of the 3P. Although Lean implementation requires 3-5 years for any organization to become autonomous, the goal of our Lean process is to ensure learning at every level. The old adage, “give a man a fish you feed him for a day, teach a man to fish you feed him for a lifetime”, fits well within the parameters of an advanced Lean implementation. Our goal is to guide teams through their own learning experience.

So what are the steps of the 3P process? At a very high level the 3P process includes assembling a team of providers to represent the entire staff of the hospital. This team includes recent or current patients and their family members. A large facility may require many 3P events to design the entire building. The 3P starts with focused data collection. The team, using lean tools, follows the flow of the patients and staff in real time. They document this information in a very disciplined process. Each 3P event requires two full weeks of data collection, followed by the event week, then a 30/60/90 day review. Rapid Process Improvement Workshops (RPIW) are then employed to address process improvement events established during the 3P event. A 3P team will consist of approximately 60 members including doctors, administrators, executives, nurses, technicians and patients. The first week of data collection consists of training the team to follow and time the patients and staff through their path of care. The goal is to understand the flow of treatment and to design the facility to optimize this flow. Data is collected to reveal the current and future demand for the region. It also reveals the individual services in highest demand. The second week of data collection focuses on assembling this data for application to design. All data is formatted to optimize the event week. While the 3P team is formed and Data collection is underway, the architecture team prepares 7 block schematic designs for a sun-process of the 3P called the 7Ways. Each design is carefully evaluated to ensure it meets all of the project parameters, including a careful adherence to the project program. Designs are tested against the 7Flows of medicine, and wastes are eliminated. The designs are also sent to the cost consultant at this time to ensure that they are on budget, and that modifications can be made if they are not. Structural and Mechanical requirements are included to ensure these do not derail the process. This ensures that each of the 7Ways is a fully considered design solution that will meet the project requirements. Each of the 7Ways is then documented and presented without prejudice to the 3P Team at a one day event. The 3P Team selects the design that best fits their identified criteria, and the selected design, forms the Framework for the 3P events. The 3P event week is a hands on process which starts with establishing the key goals of the design. The team creates hundreds of design concepts which are presented, voted on and optimized with all the best concepts integrated. The final two designs are divided amongst sub-teams of this group. These two teams, using 2D layouts, further improve their design. These two dimensional designs drive the 3D table top models. The first table top models are created, two per team, in quarter inch scale, then presented and voted on. These models are built with basic supplies which include sheet plastic for the walls, clay figures for staff, along with hobby type supplies which allow the team to create computers, beds, carts, etc.

The teams then vote on the best design and create a one inch scale 3D table top model. While half the team is creating this model, the other half is building full scale sections of the model to test the design theory. Exam or treatment rooms along with high traffic common areas, are commonly part of the full scale model. These models are built of cardboard, lumber and other basic supplies, inside a warehouse, to be tested by the staff and patients. These full scale models allow the teams to walk through their design to discover flaws well in advance of architectural design. At the end of the event week, the architects carefully photograph and document the final design proposal. It is the job of the architectural firm to design the interior of the building according to this design. Following the event week is the 30 day review. At the 30 day review the design will be presented “As Designed” in the event week. At this time, the architects will present any issues the team must address in regards to adjustment required by code. The team will also review the flows of the patients, staff, materials, etc. to make any fine adjustments to the design. This leads into follow-up work 30/60/90 day work led by the architecture team to edit the design, keeping to the principles of the 3P design, and working to improve flow and eliminate waste. As previously mentioned, this process will need to be repeated, one 3P per floor of the hospital. Although this process requires a significant upfront investment in time, the savings in overall project costs speak for themselves. Not to mention the benefit to the staff and the community at large. Following the 3P Week, the Lean consulting team will undertake Rapid Process improvement Workshops (RPIW’s) to work on process innovations that were identified in the 3P but were unable to be fully resolved within the week. There is typically a need for 3 to 4 RPIWs per 3P. Although Lean implementation requires 3-5 years for any organization to become autonomous, the goal of our Lean process is to ensure learning at every level. The old adage, “give a man a fish you feed him for a day, teach a man to fish you feed him for a lifetime”, fits well within the parameters of an advanced Lean implementation. Our goal is to guide teams through their own learning experience.

LEAN HEALTHCARE: THE STEPS

BACK TO HEALTHCARE

BACK TO HEALTHCARE

LEAN CONSTRUCTION

WE EMBED A CONTINUOUS IMPROVEMENT CULTURE ON THE JOBSITE, STARTING WITH LAST PLANNER SCHEDULING AND WORKING DOWN IN DETAIL UNTIL EVERY TRADE IS IMPROVING EVERY TASK EVERY DAY.

LEAN for construction starts with working as an integrated team. We work to integrate the team of Architects, Engineers, Construction Managers and Trades. they work together to produce a detailed project delivery schedule using the LEAN pull planning tool called ‘Last Planner Scheduling’. This planning work confirms the viability of meeting the required schedule, with a detailed plan of everything that will need to happen week-by-week to deliver the project. With the functional plan is completed with the client, the Integrated Team works together with client project representatives to complete the detailed technical Design and Construction Planning together using TARGET Value Design Methodology. This incorporates all required building, structural, HVAC, plumbing, sprinklers, electrical, data, and security systems required to serve the design. We facilitate the Integrated Team working together in a ‘Big Room’ to produce the detailed design and scheduling in a fully integrated design and construction delivery to deliver the best value to the client and the customers they serve ON TIME and ON BUDGET. Once Construction is underway, the LEAN work undertaken during the Planning and Target Value Design will be carried into a LEAN for Construction Delivery. The Last Planner Schedule becomes an onsite ‘living’ document: managing the weekly progress, tracking the Percent Plan Complete (PPC), and forming the core of the Visual Management for the Construction Site that the team can use to keep the project moving on track, identify any complications that arise, and respond with an integrated plan to get things back on track. The Onsite Team conducts regular huddles with Architects, Engineers, Sub-trades and client project representatives to track progress, manage safety, and use the Last Planner Schedule to ensure all documentation, materials, supplies, personnel and equipment are planned and ready when they are needed ‘just in time’. In addition, the onsite Construction Manager and Trade Team conduct daily short huddles to focus on the details of work for the upcoming day, week and 6-week look-ahead. 6-Week Look Ahead plans coordinate what every trade is working on every day, and are updated daily to understand the detailed implications of any changes to the schedule as they occur, and to develop plans for the crews to adapt. This is of particular importance with multiple trades onsite to ensure each trade and worker has the work area and material laydown needed to maximize productivity without interfering with the rest of the team. Trades prepare Fishbone Diagrams to plan the steps of their work to identify the manpower, material, machines and methods needed for each task. This facilitates the use of standard LEAN improvement methods such as 5S, Kanban, Load Levelling, External Set-Up, and Stop The Line. This combined process represents the best practices of LEAN for construction being utilized by teams we have coached on construction sites across Canada.

MIKE WEISHAAR EXECUTIVE LEAN CONSULTANT

Mike Weishaar began his Lean career as an executive at Genie Industries, a company well known for its advances in world class manufacturing. Reporting directly to a former executive from Honda, Mike learned and applied the processes and philosophies of the Lean management system. Over the following decade, sales increased from approximately $50m to nearly $1b in gross receipts. Mike had P&L responsibility for the self-propelled division which included all motorized manufacturing, assembly, industrial/manufacturing engineering, materials management, R&D and customer service. As the President of Rendezvous Ind., a luxury RV manufacturer, Mike led the Lean effort. Application of Lean principles reduced customer delivery lead times from several days to two hours. Material shortages and overstock were eliminated through the transformation from ERP to kanban. New product design lead-times were reduced from several years to 6 months. Mike was asked by the department of labor and industry, to serve as the industry representative on the Washington State legislature. At Boeing Mike worked with the senior management team implementing Lean for all major airplane programs. Focusing on total productive maintenance (TPM) and worldwide asset management, Mike created and deployed TPM training for all major programs and their tier-1 suppliers. Union leaders and operators supported the effort to reduce equipment downtime through project partnering with industrial engineering. Through these efforts, materials shortages due to unscheduled equipment shut-downs were virtually eliminated. As the VP of Operations at Glacier Bay, a yacht manufacturing company, the Lean effort focused on factory flow, full scale kanban implementation, engineering, customer service, extended supply chain management and sales. Mike led the design team for the 34' luxury yacht which integrated company engineers with engineers from suppliers and customers. The Lean 3P process increased production output by 400%. Materials management was converted from ERP to kanban eliminating supplier shortages for over 10,000 parts.

As CEO of United Marine, a yacht management company, Mike applied Lean principles to full scale disaster recovery projects. Significant reductions in operational lead time were achieved through multi-disciplinary project partnerships. All stakeholders including Insurance underwriters, legal representation, owners and contractors established project parameters prior to contract negotiation. Up front clarification of project outcomes set the baseline for collaboration between project managers, service managers and sub-contractors. Projects were completed on time, on budget, outside of litigation. As executive consultant for John Black and Associates, Mike has extended his Lean experience into the healthcare industry. The past four years have seen the largest Lean healthcare implementation ever undertaken as the entire province of Saskatchewan transforms their healthcare model. Traveling to Japan with JBA to lead executives, doctors, nurses and staff, Mike participated in the Shingijutsu Global Consulting training with the team to redesign new processes using 3P at Japanese manufacturing companies. Mike has provided Lean Leadership training and certification for hundreds of healthcare professionals and executives. Leading RPIWs in ED, PICU, OR, Materials, COPD, PACU, Well-care, Information Services, Surgery, Cancer and Mental Health to mention a few. Recent 3P’s include cancer center redesign, long term care facility and process redesign, mental health in collaboration with corrections, clinic redesigns, records and payment redesign, along with ICU and endoscopy. On special assignment By special request, Mike was assigned as lead consultant for the Saskatchewan Ministry of Health value stream mapping of the legislative process as it pertains to healthcare. Also by special request, Mike was asked by JBA and the Premier to lead a 3P process to support the hospital redesign in North Battleford Saskatchewan. Currently Mike serves as CEO of Lean Integrated International, a North American based Lean consulting company and CEO of MTW & Associates, a locally owned Lean consulting firm. Working in partnership with other global Lean consulting firms, Mike brings Lean to organizations throughout the world. 2016 marks Mikes 31st year of Lean implementation.

BACK TO OUR TEAM

STEVE MANTHEY EXECUTIVE LEAN CONSULTANT/SENSEI ARCHITECT

Steve is a licensed Architect and has devoted over Thirty-Nine years to finding responsive design solutions for his clients. 35 years ago, he began working in an office that specialized in Healthcare. From that point until now, he has focused on Healthcare Architecture. Steve’s passion has brought Lean to his Healthcare Clients which has been his focus for most of his last nine years. This began in 2004 when he worked with Virginia Mason Medical Center. During this 5 year period, he was the architect on a number of projects including the most memorable: The Ambulatory Surgery and The Kirkland Family Practice Clinic. For the past four years, Steve has had the opportunity to work with John Black Associates as the Sensei Architect. During this period he worked in Salem Oregon, Spokane Washington but had a primary focus on Saskatchewan Province in Canada.

Steve’s total combined 3Ps (Production Preparation Process) to date include 30 projects. Of these, 11 have been in Saskatchewan as part of the JBA contract. These projects range from the Regina Clinic to very large projects such as the Children’s Hospital in Saskatoon and Saskatchewan Hospital North Battleford. Steve’s mission and directive is to be the Lean Sensei Architect. That is, to be a teacher as well as a part of the team to bring continuous improvement to their clients. Steve is a listener, creative problem solver and collaborative team leader. He has been a registered architect in Washington State since 1979, registered non-practicing architect in Saskatchewan since 2013 and a member of the National Council of Architectural Registration Board. His education includes a bachelor’s degree in Architecture (1974), a professional degree in Architecture (1975) and was sent by JBA to be trained in Japan in 3P by Shingijutsu Global Consultants under Sensei Takeshi Iwata.

BACK TO OUR TEAM

Mr. Blaser returned to his Saskatchewan home in 2005 after 13 years of Architectural education and experience in Canada and Europe. With a Professional Degree in Architecture, Paul’s education also includes a degree in Environmental Studies from University of Waterloo. Paul is the Founding Chair of the Saskatchewan Chapter of the Canada Green Building Council and is well versed in the practical practice of building construction, serving as both Design Architect and Contract Administrator for diverse projects across Canada. Since his return to RBMA, Paul has made the Integrated Design Process (IDP) central to the way the firm conducts its services. The evolution of IDP has been Paul’s investment in the Lean Process. Learning under Sensei Architect Steve Manthey of John Black and Associates (JBA), the firm has worked to put Users including patients, students, community members, families and front line staff at the centre of the design process. The results are designs that increase flow, eliminate waste, increase value-added time, and keep the most important thing the most important thing. And the most important thing in is the Customer.

EMPLOYMENT 2008 - present RBM Architecture Principal Architect, Saskatoon 2006 - 2007 RBM Architecture Partner, Saskatoon 2005 B. Rajani Architect Ltd. Project Architect, Saskatoon 2000 - 2005 John MacDonald Architect Inc. Project Lead, Kitchener, Ont.. 1999 B. Rajani Architect Ltd. Designer, Project Lead 1999 Arkkitehtitoimisto Suominen Ky Designer, Helsinki, Finland 1999 Akin Bergerman Architects Designer, Saskatoon 1998 Frits De Vries Architect Designer, Vancouver, B.C. PROFESSIONAL AFFILIATIONS Registered Architect, Saskatchewan Association of Architects (SAA), Current President Registered Architect, Manitoba Association of Architects (MAA) Registered Architect, Alberta Assciation of Architects (AAA) Registered Architect, Architectural Institute of British Columbia (AIBC) Registered Architect, Northwest Territories Association of Architects (NWTAA) Member, Royal Architectural Institute of Canada (RAIC) LEED Accredited Professional LEAN EXPERIENCE Principal Architect, BUH ICU and Endoscopy Renovation – JBA 3P Process Principal Architect, Kelvington Integrated Health Facility – JBA 7Ways/3P Process Lean Architect, Prince Albert Victoria Hospital, - JBA 7Ways/3P Process Lean Architect, Saskatoon Cancer Centre - JBA 7Ways/3P Process Lean Architect, JBA Sensei Architect – Saskatchewan Hospital, - JBA 7Ways/3P Process Lean Architect, JBA Sensei Architect – Swift Current LTC, JBA 7Ways/3P Process Principal Architect, PNRHA Strategic Capital Infrastructure Plan for Primary Care Principal Architect, BUH Outpatient Recovery

BACK TO OUR TEAM

PAUL BLASER SAA, MAA, AAA, AIBC, NWTAA, MRAIC, LEED AP PHONE 306•229•6442 EMAIL paul@leanintegrated.ca

ENTER NAME

ENTER EMAIL

Submitting Form...

The server encountered an error.

Form received.

ENTER YOUR MESSAGE

TITLE

DATE

PARAGRAPH

ODD STYLE

EVEN STYLE

NOTE: DO NOT DELETE THIS STYLE BLOCK

This block will not display when Previewed or Published.