Healthcare Assessment Forms Lean

HVN/Shingo Quick Assessment
for Operational Excellence

ORGANIZATIONAL TRANSFORMATION WITH PRINCIPLES, SYSTEMS, & TOOLS
The Shingo Prize for Operational Excellence

Jon M. Huntsman School of Business
Utah State University
Logan, Utah USA
www.shingoprize.org
Version 1.4/2011
June 2011
Copyright 2011 The Shingo Prize for Operational Excellence. All rights reserved.
The content of this publication may not be reproduced, copied, edited or distributed without the express written permission of
The Shingo Prize for Operational Excellence, administered by the Jon M. Huntsman School of Business at Utah State University.
Page | 2
Cultural Enabler Focus
Systems | Questions
OBJECTIVE
Who do you go to when you have a problem?

How do your supervisors/managers help you solve problems?
How accessible are your leaders to work on problems?
Tell me about how you have solved a problem with your supervisor/manager?
Do you see the same problems continue to reoccur in your area?
Enabling guided decisionmaking at the lowest

level.
Managers and supervisors are seen as

mentors & coaches
Leadership Training
Leadership Std. Work
Coaching
Employees are empowered and

recognized for signaling problems or
defects that occur in their area.
Visual Management
Suggestions/Idea
Award/Recognition
What do you do when you see a problem in your area?

What support do you receive when you are fixing a problem?
When do you work on fixing the problems?
Have you ever been awarded for detecting key problems in your area?
Problems are owned and

embraced by the
workforce. Problems are
seen as opportunities.
On-the-job coaching in lean practices is a

daily part of the culture
OJT
New Hire Orientation
What kind of ongoing training do you receive for your position regarding continuous
improvement and problem solving?
Tell me about the philosophy of continuous improvement when you were hired on,
now after working here for some time how does that correlate with reality?
Coaching creates front

line leadership and a
culture of empowerment
Recognition system focuses on

performance that encourages ideal
behavior.
Award/Recognition
Strategy Deployment
When was the last time you were recognized or awarded something?
Who awarded that to you? What was it for? Can you show me your award?
What would be a great award that would motivate you?
Recognition is frequent,
timely and specific;
awarded for achieving
great performance with
ideal behavior
Sense of trust among leaders, managers,

and associates.
Leadership Training
Communication/Sharing
Coaching
What are some of the barriers that you have seen with communicating to leadership?
Tell me about leaderships involvement in teams in your area.
How easy is it to communicate with your supervisor, manager, leaders?
Describe the support you receive from you leaders? How open, transparent is the
communication?
Eliminate a "we-they"
culture
Managers and supervisors are seen on a

regular basis in the work area engaging
with the workforce to better understand
their reality.
Go & See/ Gemba

Coaching
Improvement ideas are processed quickly

(within 2 weeks) with feedback to the
originator regardless if the idea was
implemented
Suggestion/Idea
Communication
Coaching
How often do you see managers and leaders in your area? Is it on a routine basis or
more sporadic? What do they focus on?
Do you feel they understand your day-to-day issues, concerns?
If you could change and improve ONE thing in your area that would make life easier,
what would you change? Tell me about how you would make that change, what is
the process?
Have you ever suggested an improvement in your area? When was it, and tell me
about what happened?
Page | 3
Promotes go and see

mentality and engaged,
coaching leadership team
Ideas are valued at all
levels with open &
transparent
communication to
encourage and coach
great improvement

mentors & coaches



behavior.

and associates.

their reality.

implemented
Observations(Behavior)
Page | 4

and associates.

their reality.

implemented
No evidence
Very little evidence that problems

are made visible. Manager as
problem-solver.
Manager leading problem-solving,

engaging front-line staff
Significant problem-solving at
lowest level of organization.
Managers consistently acting as
coach, asking Socratic questions.
Enabling guided decisionmaking at the lowest

level.
No evidence

behavior.
OBJECTIVE
Few employees involved in

signaling defects and problems,
no recognition
Some employees are empowered

and some recognition, or only in
parts of the department
Significant # of problems and

defects are identified and solved
by employees, with visible and
meaningful recognition.
Problems are owned and

embraced by the
workforce. Problems are
seen as opportunities.
No evidence
No evidence of coaching.
Posters, etc. but manager
continuing to solve issues
Coaching evident but

inconsistent. Manager continues
to solve most problems without
employee input
Coaching is consistent and

evident throughout the
organization. Employees can site
examples/
benefits
consistently.
Coaching creates front

line leadership and a
culture of empowerment
No evidence

Ideal behavior, standard work, is

found in spots but no recognition
Ideal Behavior evident and

recognition is seen though
inconsistent in content and
application.
Recognition is consistent, evident

and visible to everyone.
Examples of ideal behavior
recognized, accompanies
celebrations.
Recognition is frequent,
timely and specific;
awarded for achieving
great performance with
ideal behavior
No evidence

Little evidence of issues being

reported. Employees hiding
issues.
Employees reporting system

issues but continue to hide
"mistakes"
Employees express ability to

report issues with confidence in a
positive response consistently.
Eliminate a "we-they"
culture
No evidence

mentors & coaches
Few occurrences of leadership at

place of value add (gemba)
Pockets of consistent leadership

engagement at gemba, but not
everywhere
Consistent and predictable

leadership engagement at
gemba
Promotes go and see

mentality and engaged,
coaching leadership team
Ideas are valued at all
levels with open &
transparent
communication to
encourage and coach
great improvement
No evidence
Page | 5

mentors & coaches



behavior.

and associates.

their reality.

implemented
Strengths | Opportunities
Page | 6
(to move to the next level)
Continuous Process Improvement Focus
Immediate action is taken when the work

area is ahead or behind schedule
Systems | Questions
Problem Solving
Pull
Leveling/Scheduling
Visual Management
OBJECTIVE
Describe how you schedule your work for the day?

How do you know if you are on time, ahead or behind schedule?
What do you do when youre ahead or behind?
Can you show me what you do?
It is easy to see when an

area is ahead or behind
schedule
How does product/material come in and out of your area and how do you know what
to work on first?
Can you show me what you do to know if your area is meeting the customer
demand?
Waste is eliminated that

causes bottlenecks,
waiting, excessive
transportation and
movement of patient
The flow of service or product is simple

and direct, creating continuous flow
Cellular Design
Visual Management
Value Stream
The Current State and Future State are

an ongoing continuous cycle Actively
pursued with a visual and detailed action
plan and timeline
Value Stream
Strategy Deployment
Visual Management
Coaching
Can you describe or show me what you area looked like a year ago? What has
changed and what role did you play in those changes?
How do you know what areas to focus on in your area to improve?
How do other people know what you are working on?
Are there timelines associated with this work?
Have you ever revisited an improvement implementation to make it even better?
Standards (SWI), work-areas are highly

visual, simple and USED (routinely being
updated as improvements are made)
Standard Work
Visual Management
Coaching
Suggestion/Idea
How do you know you are doing your work correctly?

How do you know when there is a problem or defect?
When you make changes how are these documented?
Can you show me your process for updating your work instructions?
There is a sense that continuous

improvement is just part of the job
Coaching
Communication
Problem Solving
How does your team communicate and share improvement ideas during the
workday?
How do your leaders support you in problem solving?
Does continuous improvement or problem solving ever get in the way of your job?
Strategy Deployment
Value Stream
How do you or your area select which problems to work on?

How are these goals then communicated to you?
How does your work impact these goals?
Do you know the current status for of these goals? (Show me)
Idea Sharing (Yoketen)

Communication
Before your area improves or problem solves, is there a way to see if others in your
organization have had the same issues? (Show me)
How do you communicate information to your colleagues about improvement projects
that have been implemented in your area?
Has your team ever had the opportunity to take an improvement idea that started in
another dept/service, and applied it to your own workgroup?
Improvement activities are directly linked

back to the organizations strategic focus
and primary objectives
Improvement ideas are routinely shared

openly throughout the organization,
across multiple value streams &
departments
Page | 7
Improvement is truly
continuous, not event
driven. Areas are
constantly moving
toward an Ideal Future
State
All work is highly
specified at to content,
sequencing, timing, and
outcome in order to
signal abnormal
conditions immediately
Continuous improvement
is owned by the entire
organization.
Improvement is not a
shot-gun approach,
rather specifically
targeted in the strategic
direction of the
organization
Avoid reinventing best

practices



plan and timeline




departments
Page | 8
Services or patients are batched

and process is complex and
difficult to see. No visibility or
communication between
upstream and downstream
processes.
The process flow is easy to see

and but theres only
communication between
connected processes. Waste and
bottlenecks are looked at during
events only
All processes are connected

visually and easy to see and
understand. Waste is immediate
identified and addressed to adjust
for continuous flow of service to
the patient and families.
Staff reference displays of

improvement goals that related to
future state. Staff recognizes the
connection between current
improvements and achieving
future state. Mapping is seen as
an event with limited follow-up.
Work and improvements are

reviewed on a scheduled basis so
immediate adjustments can be
made when deviating from the
future state. The future state is
met within 6-12 months where a
new future state is created.
The associates standard work

program is displayed so that it is
easy to audit for compliance
Associates improve SWI plan,

documenting the improvement
and sharing with managers
Staff is unclear in describing the

future state and how to get there.

Standard work is evident in the

associates work process, but not
always followed. Updating it is
more of a hassle.
Continuous improvement is a
burden and usually in the way of
doing REAL work. Associates
and managers are not able to
describe improvement work/
projects in relation to their role.


departments
No evidence

No evidence

plan and timeline
No evidence
Associates can detect if they are

ahead/behind but no actions are
taken to respond.
Associates can rarely detect

when their area is ahead or
behind schedule.
No evidence

Associates can predict throughout

the day and immediate action is
taken by the appropriate people
to adjust, fix and improve the
process.
No evidence

No evidence
No evidence
Associates can show you where

to find organizational goals, but
can't describe how their work has
impacted the goals.
People are unsure how to share

improvement ideas and are too
busy to see them as priorities.
There is limited communication
and sharing between
departments of improvements
that are going on
Staff can describe some

improvement projects they've
participated in.
Staff can articulate organizational

goals and objectives and identify
some examples of improvement
projects in their area.
Staff can tell you when and where

regular forums occur to report out
on improvement efforts.
Leaders and managers share
ideas and work to implement
these within their area. Not
happening consistently across the
organization.
People are expected to provide
improvement ideas but are
unclear about the process
Page | 9
All Associates signal problems

immediately and can speak to the
response system. Staff integrates
problem solving into daily
activities and can speak to how
they contribute to larger goals.
Staff integrates improvement into
daily work and all can
demonstrate how improvement
work is linked back to strategic
focus and primary objectives.
Before any improvement is made

the team systematically checks to
see who if any has encountered
the same problem, and use their
countermeasure as a starting
point to improve.
OBJECTIVE
It is easy to see when an
area is ahead or behind
schedule
Waste is eliminated that
causes bottlenecks,
waiting, excessive
transportation and
movement of patient
Improvement is truly
continuous, not event
driven. Areas are
constantly moving
toward an Ideal Future
State
All work is highly
specified at to content,
sequencing, timing, and
outcome in order to
signal abnormal
conditions immediately
Continuous improvement
is owned by the entire
organization.
Improvement is not a
shot-gun approach,
rather specifically
targeted in the strategic
direction of the
organization
Avoid reinventing best

practices



plan and timeline




departments
Page | 10
Enterprise Alignment Focus
Systems | Questions
OBJECTIVE
Employees can describe what the mission

and vision of the organization is and how
they personally impact it
Communication
Coaching
Strategy Deployment
What do the mission and values of the organization mean to you?

Whats the relationship between your work and the organizations mission and
values? Show me an example of that.
How do leaders communicate what is important to your organization?
A well communicated
vision that creates a
senses of urgency, unity,
and loyalty
There is a structured process for aligning

goals and strategic priorities that is simple
and visible at all levels of the organization
Strategy Deployment
Visual Management
Communication
What is one way your work contributes to the goals of the organization this year?
How are strategic priorities established in your area?
Who was involved in setting the goal? Did you have any input?
Are you meeting your goals, where would I see that, Show me.
Each person in the

organization understands
their role in supporting
and achieving the
strategic goals
The voice of the customer directs focus of

continuous improvement and future
development of the organization
VOC
Value Stream
Strategy Deployment
Who are your customers?

How do you know what your customers value?
How to you systematically listen to your customers needs?
What do you do with that information?
Understand what is
valued by the customer
and focus development
on creating value for the
customer
Open communication across value

streams, support and administrative
departments.
Communication
People Development
Idea Sharing (Yoketen)
How do the other departments impact your work?

How do you communicate and understand the impact other departments have?
How do you work together to solve problems? (Share or show an example)
The organization
functions as a team,
working together not
against each other to
create value for the
customernot waste
Leaders and managers follow standard

work and are routinely seen out of the
offices and in the work areas.
Go & See/ Gemba

Coaching
How often do you talk with your manager about key issues in your work area?
When leaders/managers visit your area what do they typically talk about?
Tell me about the involvement that leaders have in your area?
Tell me about the involvement that managers have in your area?
Leaders systematically
monitor and maintain
organizational alignment
Tracking boards are used daily for open

discussion and feedback so that
adjustments can be made quickly
Visual Management
Strategy Deployment
Problem Solving
How is the work and status of the work kept visible to the team?
How often do you meet in front of these boards? Where on the boards do you spend
80% of your energy?
How do the boards help you?
Can you affect or impact all the measures on your board?
How do these measures help you improve?
Quick adjustments can be

made on a daily basis to
re-align focus to strategic
direction of the
organization
Metrics and goals are simple and clearly

aligned, driving the right behavior to
achieve the organizations vision.
Strategy Deployment
Visual Management
Coaching
What are your work units goals?

How are they measured?
How are your goals tied to the organizations vision?
How can you tell if your work is contributing to the success of the organization?
Can you show me how you track this in your work unit?
Eliminate short-term
focus that gets
immediate results but
damages the Long-term
focus on the vision.
Page | 11




departments.



Page | 12
Associates can identify their goals

for their workgroup and can
articulate the strategic nature of
those goals.
The workforce can quickly identify

their goals and where they are in
achieving them (visually). The
goals are simple and directly
related to their work area, but also
tied directly to the strategic
objectives of the organization.
Each person in the

organization understands
their role in supporting
and achieving the
strategic goals
Surveys are conducted to get

feedback from the patient, but
based on a push system. Seldom
is feedback used to improve key
systems in the area. Key issues
repeatedly surface in the survey.
Patients, families, and the

community are actively and
systematically listened to and
involved in key improvement
areas.
Understand what is
valued by the customer
and focus development
on creating value for the
customer
We talk about the impact of

improvements in our work area,
but seldom about the impact we
have in other departments.
We ask and communicate about

the impact of our work with other
departments, but improvements
are still made with local efforts.
We coordinate our work across

departments daily and collaborate
to continuously create value for
the customer. Cross functional
teams are used routinely.
The organization
functions as a team,
working together not
against each other to
create value for the
customernot waste
Leader standard work is

documented. Leaders and
managers rarely are in the work
area.
Leader standard work is

documented and posted.
Managers are frequently in the
work areas. Managers ask
questions predominately about
day-to-day operations and offer
solutions. Dept objectives and
metrics are posted by not tied to
organizational goals.
Managers are in workplace daily.

While there, managers coach by
asking question and aid in
eliminating barriers to help areas
achieve strategic objectives.
Leaders systematically
monitor and maintain
organizational alignment
No evidence

No evidence
The workforce understands that

the patient is the customer, but
their processes dont demonstrate
this understanding

departments.
No evidence

Tracking boards are up.

Managers listen to reports by
team leads & workers daily.
Managers solve problems after
the huddle.
Tracking boards are up.

Managers facilitate discussion of
daily work at huddle at the board.
Managers questions commonly
result in problem solving by the
team.
No evidence

No evidence
OBJECTIVE
A well communicated
vision that creates a
senses of urgency, unity,
and loyalty
Associates can communicate

where to locate written definition
of vision and mission
Associates can communicate

where to locate organizational
goals and goals for their work
group.

Associates identify specific

examples of how they impact the
mission and vision. Management
is coaching problem solving that
is centered on achieving the
vision.

Associates are able to define

several elements of the mission
and vision, and provide examples
of projects in their workgroup to
support the mission and vision
No evidence

0
No evidence
Multiple metrics are tracked by

managers and rarely shared with
work unit.
Metrics and goals are posted in

work areas. Managers frequently
refer to them while in the work
unit.
Page | 13
Managers consistently ask

questions in order to identify
problems and barriers. The team
is highly engaged in the huddles
and discuss ideas for solving
problems on a daily basis.
Actions are specifically assigned
and followed up daily to meet
strategic objectives.
Specific key metrics are visually
tracked in the work unit.
Associates consistently discuss
how the metrics show the work
unit progress toward
organizational goals.
Quick adjustments can be

made on a daily basis to
re-align focus to strategic
direction of the
organization
Eliminate short-term
focus that gets
immediate results but
damages the Long-term
focus on the vision.




departments.



Page | 14
Administrative &
Clinical Support
Med./Surgical &
Pharmacy Supply
Care Paths
Quality Care Development
Patient Experience
Community Relations
Senior Leadership
Assessment Areas
BUSINESS PROCESSES
Cultural
Enablers
Continuous
Improvement
Enterprise
Alignment
People Development:
Education Training & Coaching,
Empowerment & Involvement
Continuous Improvement
Weight
6%
13%
6%
43%
13%
19%
Weight
60%
8%
8%
8%
8%
8%
Enterprise Alignment
Quality
Measures (50 pts.)
Results
Cost/Productivity
Measures (50 pts.)
Delivery
Measures (50 pts.)
Customer Satisfaction
Measures (50 pts.)
Morale
Measures (50 pts.)

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HVN/Shingo Quick Assessment

for Operational Excellence

The Shingo Prize for Operational Excellence

Cultural Enabler Focus

Who do you go to when you have a problem?

Enabling guided decisionmaking at the lowest

Managers and supervisors are seen as

Employees are empowered and

What do you do when you see a problem in your area?

Problems are owned and

On-the-job coaching in lean practices is a

Coaching creates front

Recognition system focuses on

Sense of trust among leaders, managers,

Managers and supervisors are seen on a

Go & See/ Gemba

Improvement ideas are processed quickly

Promotes go and see

Cultural Enabler Focus

Managers and supervisors are seen as

Employees are empowered and

On-the-job coaching in lean practices is a

Recognition system focuses on

Sense of trust among leaders, managers,

Managers and supervisors are seen on a

Improvement ideas are processed quickly

Sense of trust among leaders, managers,

Managers and supervisors are seen on a

Improvement ideas are processed quickly

Very little evidence that problems

Manager leading problem-solving,

Enabling guided decisionmaking at the lowest

Recognition system focuses on

Few employees involved in

Some employees are empowered

Significant # of problems and

Problems are owned and

Coaching evident but

Coaching is consistent and

Coaching creates front

On-the-job coaching in lean practices is a

Ideal behavior, standard work, is

Ideal Behavior evident and

Recognition is consistent, evident

Employees are empowered and

Little evidence of issues being

Employees reporting system

Employees express ability to

Managers and supervisors are seen as

Few occurrences of leadership at

Pockets of consistent leadership

Consistent and predictable

Promotes go and see

Cultural Enabler Focus

Cultural Enabler Focus

Managers and supervisors are seen as

Employees are empowered and

On-the-job coaching in lean practices is a

Recognition system focuses on

Sense of trust among leaders, managers,

Managers and supervisors are seen on a

Improvement ideas are processed quickly

(to move to the next level)

Continuous Process Improvement Focus