CAPA is Lean p198-199

Toyota mantra:
People + Brilliant processes = Amazing results

Always:
Add value
Smooth flow
Pull not push

Make decisions slowly, implement quickly

Relentless reflection
Go see for yourself
Add value
Only 5% of NHS activity adds value!!
What % in NZ?

Cut waste (TIM WOOD)

1. Transportation-e.g have notes ready
2. Inventory- only have what is needed
3. Motion- reduce travel
4. Waiting-reduce and make active
5. Overproduction-not too many appts
6. Over-processing-not too many things
7. Defects correction- do it right first time
Smooth flow p 174-177

Analyse bottlenecks
Full booking
Daily referral screening
Reduce number of queues with Core work
Segment similar needs together
Plan time for admin
Give families things to do until next step

HELPFUL Habit
Pull dont push
Increase pull- draw resources to the user
Flex capacity
Use full booking systems in Choice and Partnership
Specific work added, not another waiting list

Reduce push systems:

fixed appointments- urgent slots
Avoid waiting lists
Toyota Production System

Goal: highest value to customer, as fast as possible

Respect for Product Continuous

People Development: Improvement

14 Principles

Foundation: Management applies and teaches lean thinking

Pillar 1: Respect for people
Don't trouble your customer
Includes the person after you in the
production chain
Develop people then build products
Managers Walk the talk
They are lean themselves; eliminate waste etc
Develop teams
Team work not group work
Teams and individuals evolve their own
practices and improvements
Pillar 2: Continuous improvement
o Go see (gengi genbutsu)
o Solve at the source not behind desks
o Kaizen
o My work is to do my work and to
improve my work
o Local experimentation
o Continuous improvement
o Value and waste
o Perfection Challenge
o Work towards flow
14 principles
Some highlights..
Use pull systems
Stop and fix problems (this means attend to issues now to save
time later

Visual tools (e.g. not just printed schedule information but how to bring the
processes and info to life in a visual way)

Decide slowly by consensus, implement

quickly
Time boxing
Setting small and near time limits to avoid outcome
delay
Lean Thinking
Is a set of tools and ideas that simplify
the Toyota Production system
Largely miss out the first pillar of
Respect for People
Effective none the less
Lean Principles
Specify Value: every step must add value
Would the customer pay for it?
(don't forget the customer is also your
colleague after you!)
Identify the Value stream
I.e. what acts add value?
Make the Process flow
Create Pull systems
Pursue Perfection
Waste
1. Transportation
2. Inventory (large stock)
3. Motion (having to move to complete
tasks)
4. Waiting
5. Over-processing
6. Overproduction
7. Defect Correction
Waste exercise (20 mins)
Separate in small groups of 4-5.
For each type think about your service
See if you can find waste of this type
Meet and discuss the identified wastes

Longer exercise...
As a group pick some of the wastes
Go back into the small groups to think of
possible solutions
Meet up again to plan!!
Push vs pull systems
Push
Timing of items flowing through system is based on high level
commands or schedules
Up-stream or Top down commands
Or number of things provided is based upon planning
CAMHS examples? ... Fixed number new patient appointments
Pull
Capacity provided or movement of items in a system based on
down-stream requests
Services or products are pulled to the customer by their demand
CAMHS examples?
Stock / inventory control examples
Kanban cards in TPS
Visual cards that signal a need for restocking (a pull
request)
Exercise: is CAPA a Lean system?
Think about the CAPA system and
consider which bits are pull and which
are push
Think about which steps add value and
eliminate waste cf traditional CAMHS