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Virtual vs Physical Vizboards

It seems only natural that Stanford employees, nestled in the heart of Silicon Valley, in a time colloquially referred to as the digital or information age, would have an immediate affinity towards a cloud-based solution to vizboards.  Solutions such as Miro and Trello come with an astonishing set of  More features and increasingly compelling visual aesthetics.  However, those who have used these products extensively, know from hard-fought experience that they are not the panacea they are often made out to be.  At the School of Medicine no discussion around vizboards is more frequently pursued than the one that pits physical boards versus virtual boards.

It is our contention—particularly for teams new to Lean—that physical boards are hands-down a more pragmatic initial approach.  To summarize, physical boards are simpler to use, easier to customize, visible to the team and to the organization, and are highly conducive to building strong working relationships through in-person communication. 

Building Strong Team Dynamics

Vizboards are meant to help teams explore, organize, and prioritize work—that is, they’re designed to create an environment for structured discussion.  Since human communication is generally laden with non-verbal cues, discussions will always be more information-rich and, therefore, more meaningful and more relevant, if they are done face to face.  Physical boards require teams to physically interact while virtual boards facilitate virtual interaction.  The academic literature on organizational behavior has shown repeatedly that teams that regularly engage in structured physical interactions—e.g., huddles at their physical board—are more likely to build strong collaborative interpersonal dynamics than their virtual counterparts.

Customizability and Ease-of-Use

When it comes to customizability, virtual boards have come a long way in the last few years, but they still cannot beat the ease-of-use and the almost limitless potential of dry-erase markers and chalk.  In addition to the endless ways you can configure physical boards, many teams see significant engagement benefits by having fun with their boards and centering on a given theme (e.g. Star wars, Seinfeld, The Wizard of Oz, etc.)  This type of creativity is impossible with most, if not all, of the cloud-based tools.

Work that is Visible

Physical boards have the great advantage of always being “on”, where virtual boards are seen only when a user logs in—out of sight, out of mind, as the old dictum states.  Part of our journey in creating a culture of improvement is sharing our work, our process, our problems, and our successes with the broader community.  That’s easy to do with physical boards—hard to do with virtual boards.      

Where virtual boards have a clear advantage is when it comes to features.  There are things you can do in the digital domain that are impossible in the physical.  Though even this advantage is not clear-cut.  Consider the endless size of one’s virtual canvas.  It’s relatively easy to build a board that sprawls uncontrollably and becomes unmanageable.  In fact, this is the most frequent pitfall teams fall into when using virtual boards.  If the point of the vizboard is to facilitate structured discussions, the friction that arises when teams can’t find a note or idea, or if they simply get lost in the maze of stickies that have built up over time, is deadly to conversations that are meant to be short and to the point.  The tangible limitations of a physical board turn out to be a blessing in disguise as they force teams to learn to prioritize.        

While we understand their appeal, virtual boards only make sense for teams with considerable lean experience.  Even teams with highly distributed workforces or employees with remote workdays would derive benefit from starting with a physical board, learning what works for them and what doesn’t, and only then transitioning to a virtual board.  For these teams, there are plenty of options you can use to involve all your team members in a huddle around a physical board.  If you are part of a team and would like help setting up your physical board or, even, help in understanding the different virtual board platforms that are out there, please reach out to the Process Excellence team to help provide you with a framework on how to get started.

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What Does Sam Want Now
(world peace… and process improvements) by Sam Zelch

I am the school’s CFO. I can be frustrating, despite striving to be a good collaborator. I also like to think that I can be both forward-looking and borderline inspirational at times (my delusion, but I like it). When I leave Stanford - someday – I would hope you might raise a glass and say, “He might have been too determined  More and a bit impatient, but Sam’s opened our thinking and tangibly encouraged us to work better together.”


Leading up to the July 29th DFA/unit leader goals retreat, I watched how my DFA and director colleagues developed and defined the core services that have significant cross-unit processes – those processes that when not optimal hinder value to our stakeholders and burn up our precious staff time. The work I witnessed in preparation for the retreat went a step beyond the concept of inter-departmental sharing of useful practices and instead got to the very heart of the core services we could and need to improve to provide value to our customers through optimally effective solutions/support.

At the retreat, I was further inspired as the participants formed and focused their discussion on strengthening and accelerating improvement efforts throughout the school, some that we have undertaken with less than hoped for impact in the past few years. This includes core services such as faculty affairs, workforce planning, sponsored research administration pre and post-award, training grants, clinical trials management, and financial management. Plus our IRT group continues its work with University IT to improve key systems, and Marcia is working with top central University administrators (APEx) to consider University-wide improvements.

The outcome from that retreat shaped the newly developed FY20 SoM Operations Goals that will be rolled out in the coming weeks, and now that the teams have formed, how do they get started and flourish? One more quote: "Real dialogue is where two or more people become willing to suspend their certainty in each other’s presence.” Thank you, David Bohm. The Process Excellence Team, under the leadership of James Ramos, will be there to assist teams with suspending their individual certainty by developing problem (opportunity) statements, lead process improvement launches, facilitate mapping processes, help teams to identify customer and process pain points, waste and rework, provide improvement methodology skills development, consult on visual boards and huddle best practices, and provide coaching. For me, I plan to practice the concept of suspending certainty more often, as well as celebrate successes, provide resources where possible, and listen to any director any time who wishes to share ideas, seek guidance, or just have a friendly ear moving forward. I know the plight of a DFA – new requirements every day, coming faster and faster, and the old tools not working so well. I know what it’s like to manage a department, and want to take that empathy and help directors turn their challenges into action, capitalizing on the trust and relationships we have and continue to build over time.

Did you know the school hires about 80 new staff each month? 880 thus far this year. 920 last year. I am hoping our improvement efforts will draw new process improvement ideas not only from the current front-line staff doing the work today, but will also draw energy and ideas from the newcomers to explore issues, define and select improvements ideas, and install workable and sustainable solutions with a new perspective. Why use new tools and new people? “No problem can be solved from the same consciousness that created it.” Thank you, Albert Einstein.

What’s on the table – everything. What’s off the table – fear. We need not look for perfection. Making major advancements every day in value to our customers is perfection. If we don’t improve, the school will continue. But what’s a better story? What do you want your legacy to be?

For a little light-hearted entertainment about what happened at the DFA Retreat, please click on this link, with compliments to Frank Topper for his creativity.

Tell your DFA if you want to be part of the process excellence continuous improvement cultural transformation.
Our mission is to empower innovation in every person, every day.

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cFTE Calculation Standardization

In early June, four division managers from the Department of Medicine and three members of the finance team from the Department of Psychiatry came together to solve a cumbersome process of tracking clinical full-time equivalents (cFTE) across the School of Medicine.  Dalia Vanderzee, project manager for the Department of Medicine and team lead explains, documenting accurate clinical efforts More  in labor schedule and in the cFTE Adjustment Application tool is critical in receiving faculty overhead and benefits from Stanford Hospital.  In order to facilitate the Funds Flow process, the School created a tool to track cFTE for all faculty.  This tool requires up to date information of how much given time faculty is providing direct patient care versus other clinical activities.  Updating this data can take a minimum of four hours due to multiple salary sources.  By means of this, revenue for clinical overhead and benefits are not recovered due to different workflows at the Division level.

              At the current state, the team identified five high level process steps, which added to the twenty-four additional steps in variation between the four divisions and department.  Forty-two pain points in the current state process signified four major themes: lack of understanding of the tracking process, the inability to reconcile, loss of overhead revenue due to no upward adjustment nor retro adjustments, and the manual data entry taking too much time.  From mapping out this process, the cFTE team generated fifty-four ideas for improvement.  Some of which included: better communication of the process between key partners such as IRT, the concept of automation which requires coordination with labor scheduling, the idea of reconciliation, data to be validated on a more frequent basis, and finally the idea of evolving the cFTE application.

              Situated at the end of their two-and-a-half-day launch, the cFTE team reported-out to ten DFAs, division managers and other SoM stakeholders including: Cathy Garzio, Deepa Basava, Dori Boyles, Indy Singh, Mike Propst, Rachel Cowan, Shahla Haider, Jason Irwin, Yun-Ting Yeh, Stephanie Edelman, Jon Davies, and Archna Mehta.  The report-out was filled with exciting and animated discussion between the DFAs and the launching team reviewing the way the tool worked and ways to consider other improvements.   

              Approaching their 30-day report-out, the team has committed to create best practices and deadlines to align with the labor schedule, data proof, and create a cFTE informational sheet.  During the key partners meeting, Jon Davies, Director of Business Analytics, joined to give his verbal commitment to support this team and make some immediate changes to better the Adjustment Application tool.  Stay tuned for the cFTEs report-out along with the continuous discussions among other DFAs to hear the progression of this meaningful initiative.  Fantastic job, cFTE launched team!  Looking forward to see the impact you make among the School. 

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SRWC Teams Huddle

It was the third day, the third floor of Discovery Hall moved into their new Redwood City space, and the IRT Webservices team was up and running with their thirty-minute huddle around their visual board.  The Process Excellence team was so impressed with how quickly the team put together their functioning board to help visualize tasks necessary to complete their daily priorities and ongoing  More projects, focusing on areas of improvement through their metrics.  With space on their board for backlog, ongoing projects, and deadlines; the team was able to use their huddle to check on priorities for the week and the remaining months until fiscal year end.  It was crucial to meet, Peter Chen, Webservices Manager explained, as many were off to vacation.  It was evident that staying on track and being able to reprioritize was critical to work cohesively and remove obstacles that can get in the way of providing value to their customers. 

Director, Mark Trenchard, joined the huddle and was able to provide real time support and organizational updates.  Inviting management to huddles helps remove barriers, and to show progress on larger issues.  From there, the team was able to status the execution of their priorities for the week, creating intent and purpose.  Getting back to huddling quickly after the big move to Redwood City, also provided opportunity for team members to ask and offer help to keep projects on track to meet deadline.    

What we saw was palpable- a team lead ensuring everyone was in alignment and that expectations and tasks are set out in clear terms to continue and increase the productivity of the team.   It was easy to visually see the status of tasks based on green and red symbols that denote whether the team was on track or not.  Additionally, the flow of the huddle was exceptionally natural and smooth.  Every team member spoke to their objectives, creating clear and succinct movement. 

Along with the Webservices team, we want to give a huge shout-out to the OAA FAA document and training group, Budget and Financial Planning group, and the Controllers group for getting their viz boards up and huddling within the first two weeks of their move.  If you need help or have any questions about how to resume huddling, please reach out to the Process Excellence group.  Way to go teams!

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Grants Application Proposal Process

In September 2018, a team of DFAs and Central Unit sponsors assembled together to launch the very first multi-departmental initiative that bridged several academic departments with a central office to improve the grant proposal process.  This extraordinary group encompasses the Research Management Group (RMG), Health Research Policy (HRP), Neurobiology, Neurology, Neurosurgery, and Radiology.  Their goal is to reduce  More the administrative burden with the proposal process by providing a resource library that provides support for both the Faculty and the Research Administrators.

                Access to clear guidance on the development of a wide variety of required proposal components for a broad range of sponsors can be difficult to find.  This can add additional stress to an already high-pressure process due to the sponsor imposed strict deadlines.  In addition, the roles and responsibilities of the Principal Investigator, Research Administrator and the Research Process Manager (RPM) can be unclear.  Lack of clarity impacts the timeliness of the process which can result in last minute confusion on the completion of proposal components.

               From the launch process to huddling on a weekly basis, this team of sixteen individuals were able to design the Resource Library of 92 standardized documents that provide templates, examples, and guidance on an expansive list of proposal components. The team is now focused on the development of a variety of proposal checklists for the various sponsors and proposal types.  The idea is for the RPM to provide the appropriate checklist to the Principal Investigator and Research Administrator upon completion of the Proposal Intake Form.  The checklist will include links to the applicable documents in the Resource Library.  It will also identify who is responsible for each of the components listed on the checklist.  

The cohort also created a research administrator community of Research Administrative Professionals at Stanford (RAPS).  The first meeting included 36 membersfrom the participating departments.  They plan to come together for monthly meetings to solve problems and share ideas.  This platform also allows participants to get to know their colleagues from other departments. 

               Throughout the team’s 30-60 and 90 day step-backs, team members discovered that the relationship between RMG and the departments grew in a positive manner.  In the past, the two entities were siloed, unable to collaborate- especially during high-pressured times.  With such a big team, the launched exposed a significant need to divide workload.  A generally quiet team, now feels empowered by their focus to eliminate the major pain points elicited by faculty and research administrators, creating positive change. 

               What’s unique about this initiative versus a traditional departmental launch, is that this particular improvement enables a School of Medicine-wide change.  “The Central and Department joint effort was really special generating impactful outcomes and change in culture”, shares a team member.  Leadership feels even more equipped to tackle more initiatives.  The hope to strengthen the partnership between Central Units and Departments established trust amongst one another.  This allowed the groups to expand their network, even outside of this initiative.  Even after 90-days, the team is passionate about continuing to huddle weekly, as their work is “just beginning”.  In the near future, they hope to see self-sufficient administrators and PIs with a major reduction of stress and more simplicity.  What a great improvement, the Grants Application team!  Looking forward to hearing about your achievements in more timely and polished proposals. 

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Pathology: Blocks and Slides

The Pathology team has been actively huddling since their November 2018 launch to improve the process for blocks and slides. Blocks are removed tissue used for patient care, research and teaching in which pathologists slice tissue into thin layers onto glass slides.  The team launched to amend their process of inconsistent tracking leading to, (1) delays to patient care when team members need to search for slides and (2) lost slides.  Blocks and slides  More are required for patient care and there can be requests for new slides from older blocks for on-going patient care.  If these items cannot be located, this creates distress, delays in care, and the possibility of legal issues for SHC.

Reflection by Rachel Cowan, Director of Finance and Administration, Pathology

After the launch, I was very concerned the goals and timeline the team developed were unrealistic.  I felt that the team perceived, “if we only hired more people” the problem would go away.  None of that was in the budget and I felt bad having to convey that message. This problem was much bigger than a quick fix; it was systemic.  This was the first time I launched a project where I was part of the on-going team and I found that very tricky.  When I walked to the huddle, I was the DFA and at the board, I was a team member.  Instead of directing the team, I needed to inspire and persuade from within it.  That was harder than I thought.

Today, I couldn’t be happier with how things are progressing.  The team is very open with sharing concerns about potential barriers to our success in real time.  I try hard to give those concerns my immediate attention to keep the project moving forward.  At this week’s launch, we all watched as boxes of our work were moved out while we stood there.  It was great to see the physical evidence of our work first-hand.  I have no doubt the group will meet our goals and be much happier in their work as a result.  I feel very fortunate to be working with such a fun and committed group of professionals.

Team member, Krista Tanquary, shares, “The huddle has helped [the team] stay on task and gives a good space to address questions, concerns and possible process change.  It has also been valuable in that we are all doing individual work but also working as a team to make valuable changes within our organization.”

It is clear that the Pathology team is making great strides and huge impact in achieving their ultimate goal- to reduce instances of missing slides to zero within their 90-day mark.  With 50% of their goal realized, there is no doubt the team will meet their objective.  Phenomenal job, blocks and slide team!  

Be sure to check our website for updates on the team’s 90-day report out.  We’d love for you attend!  

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OAA and FAA: Process Documentation and Training

The Office of Academic Affairs (OAA) came together in early February to solve the limited amount of content available to Faculty Affairs Administrators (FAAs).  The search, appointment, reappointment, and promotion processes are carried out between the departments (FAAs) and OAA.  There are specific policy requirements that must be met, and the process has strict confidentiality requirements.  The lack of training for FAAs impacts  More the efficiency and timeliness of the process.  OAA cannot maintain the faculty that are essential to the teaching, research and patient care in the School of Medicine.  The current state of the process works, but not optimally for the departments, for OAA, or for the faculty.  Errors in the process can delay actions, can cause legal difficulties, and cause rework for both OAA and departments.

On the first day, the current state map was completed with eight steps, but several email loops cause the process time to vary from 15 weeks to 2 years!  The current percentage of the time that any step in the process could be done completely, accurately and correctly the first time is approximately 20%, showing a serious need in reducing the back and forth communications between FAAs.

This process contained several challenges including 16 pain points that the team was able to define together.  They generated 64 ideas which allowed the team to revisit their goals and metrics.  Their first goal is to have 100% of FAAs onboarded within two weeks of hire.  For metrics, they chose to measure the percentage of FAAs onboarded within two weeks, attendance to all onboarding activities (welcome session, orientation, intro to the website, etc.) including the number of days from OAA notification to complete onboarding.  The second goal is for OAA to provide resources and information to FAAs that guides them on how to perform faculty affairs processes effectively and accurately.  The team intends to measure this by tracking milestones for the percentage of information developed and accessible to FAAs.  Most importantly, their overall goal is to reduce the process time by 20% by attaining their first two goals.

The team was excited to look towards the future and generated ideas to attain a potential future state map.  They commented that the future state gave more detail and helped them lay down the track to see the details that are truly actionable.

The process excellence team was thrilled to be involved in OAAs launch, and encourages you to keep an eye out for this team’s 30, 60 and 90 day report out in the coming months!  Please continue to visit our website for dates to come.

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Processing Reimbursements Efficiently

“How can we make our reimbursement process more efficient”, asks Olgalydia Winegar, DFA of Bioengineering.  As we returned from winter break, a group of 8 people from Bioengineering walked into the Lean room at 3172 Porter and two and a half days later, an accomplished team walked out.  The problem the team hopes to tackle, is how to process 240 transactions (PCard, TCard and expense requests) per month, effectively, and clear the unresolved backlog  More of 407 out of 1032 open reimbursements that are between 60 and 610 days old.  The team began this process with some trepidation and apprehension, but by the end of each day everyone had the opportunity to share pain points, ideas and different pieces of the process.

During the first phase of mapping the current state, the entire team was out of their seats, working the process map to understand their problem.  The team identified 36 pain points that include but are not limited to: timely supply of required documentation, quality and consistency of information provided, and training standardization and enforcement- to name a few.  The team recognized their current process causes stress, excessive effort (maybe even duplicative work), which affects the working relationship across teams.  From this, the BioE team decided on their goals and objectives for this initiative which includes: creating a streamlined and consistent process that will help future training, no longer carrying PCard transactions over 60 days, and to partner with Travel and Reimbursement to share best tips for processing and to create better partnership.  By accomplishing this, BioE is committing their efforts to ensure their faculty focuses on the research, while allowing the administrative focus to be on other academic and research needs.

This team had incredible support by their sponsor Olgalydia.  She has committed herself to supporting this group and initiative by removing roadblocks that potentially face the team.  Throughout the launch Olgalydia was able to step in and out of the launch to offer input when needed, while allowing team lead, Tiffany Ngo, Research Financial Analyst, to take charge and drive the team.  When asked what this particular team learned from the experience, a common response was finding comfort in having similar pain points and frustrations with their process.  Others commented, though the problem they were solving was complex, the launch process made them feel like solving this problem was manageable.  One person expressed how much they enjoyed being part of a team that enables them to make change.

Not one single person was left out of this process- everyone’s handwriting was on the process map.  And by the end of the launch, the BioE team was jumping at the opportunity to own actions by creating improvements to their broken process.  Keep up the great work, BioE!  Looking forward to see what you’ve accomplished at your 30-day report out!  (Date TBD- please check website for updates)

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What to Expect When You're Expecting..To Launch

Process Excellence is a cultural shift.  It is a way for people at all levels of the organization to initiate change.  The idea is to empower people closest to the work to continuously improve their daily work with a focus on the customer.

Cultural change can start anywhere, but the more traditional start is through a Launch.  The Launch is a two  More and a half day process where a core team gets together and deep-dive problem solve. 

·         On the first day, the team maps out the major steps of the current state process/ problem which begins with a baseline to create a starting point for the improvement connecting to the Organizational Goals.  While process mapping, the team identifies different wastes: defects, wait time, non-utilized talent, and extra-processing to name a few.  From there, the team categorizes the non-value added activities that make up the existing process.  Using real data and a gut check, the team also denotes timing with each process step and generates pain points. Shortly after, the team begins to generate ideas that will create an ideal state addressing the low-hanging fruit and understanding the potential state.

·         On the second day, team members return feeling invigorated and energized with new ideas to define their focused objectives.  The team invites key partners/ customers (faculty, PIs, other departments, etc.) to gain a different perspective of the current state.  From there, the team creates a roadmap of 30, 60, and 90 day goals with metrics to track their progress. 

·         On the third day, the team revisits the ideas and prep for the report-out.  The report-out is the final step of the launch, which thoroughly documents the current and future state process.  The team communicates the newly designed process to the rest of the organization, customers, and other inquisitive colleagues across the School.  During the report-out, the team has covered a significant level of improvement potential that exists, with a likely chance of employees who are not part of the core team to see further possible improvements.

The value here, is sessions like this also provides senior management with a forum to communicate that we are here to work smarter- not harder, with continuous improvements.  Leaders can help with roadblocks and give guidance, but it is really the people who are closest to the day-to-day that can think up ideas to make the changes. 

Don’t be blind to the gaps and broken process.  Take a step and create your first improvement initiative.  Not sure how to take your first steps?  Contact us!  

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Intro to Huddle

Many teams struggle with keeping problem solving momentum after they have completed a launch. In order to continually march forward, the process excellence team has found that huddling regularly is the solution to this challenge.  By huddling weekly, we create a cadence of employing process excellence methodologies to enhance higher focused objectives and reduce obstacles that get in the way of providing value to our customers.  More Weekly huddles should consist of meeting for at most 30 minutes with core team members responsible for executing priorities of the week (some teams even chose to huddle daily for less than 15 minutes as it better suits their works style). Teams should have these stand-up meetings around their visual “viz” board.  This is a strong indicator that the meeting will be short- creating purpose and intent.  Typically, these huddles are to achieve understanding and alignment for the week’s “must do” and respective roles in executing the task.  During these huddles, teams are able to identify other opportunities for improvements by using gaps in metrics that help generate new ideas.  These non-set agendas allow for everyone to speak up, creating team bonding- encouraging team members to speak up on processes that are working or issues/ concerns related to the respective priorities.

Here are a few questions/ statements we encourage you to bring up during your huddles:

·         Let’s set our priorities for the week.

·         Are there any concerns that require attention or escalations?

·         Were there any significant issues that still require our attention from last week?

·         What were some small to big wins to share?

·         Any new improvement ideas?

While there are many ways to implement huddles, we strive to set weekly priorities, acknowledgments to team members and co-workers, as well as celebrating small and big wins while creating a culture of continuous improvements!

Do you have an improvement idea that you or your team want to implement starting with a weekly huddle?  Email us! 

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Budget and Financial Planning: Making the Budget Season Easier!

Last year, the Budget and Financial Planning (BFP) team embarked on a launch to improve the long-range financial forecast process.  The long-range forecast is a complex financial model that provides critical information to our School leadership.  Before the launch, running an instance of the forecast (“a roll-up”) involved linking 20 independent financial models as well as following dozens of auditing steps to ensure all of the calculations accurately flowed More  through.  The process was time-consuming and error-prone: a single “roll-up” could take three hours to run and up to three days to complete if an error was detected and needed to be resolved.

“The challenge was [there were] too many models to maintain,” explains Florence Leung, Associate Director of Budget and Financial Planning.  After the launch, the BFP team reduced the number of models by 25% (15 vs. 20 models) and developed a set schedule for roll-ups to occur on a weekly basis.  The key benefits of these improvements were twofold:  first, they allowed the team to spend more time uncovering key insights instead of troubleshooting errors.  Second, they dramatically shortened the turnaround time for creating the forecast, which allowed the team to provide more timely information to the senior leadership.

Since their launch, “Our mindset has shifted to think of ways to continuously improve.  Most of our ideas are generated from our viz board… as we think about [what matters for our] customer,” shares Florence.

The team has focused their sights on other improvement projects.  A recent addition was transitioning the primary budget support system from a call-in “hotline”, staffed on a rotating basis by all team members, to a partner based system where each department has a dedicated member of the Budget and Financial Planning team to answer questions and provide support.  The idea was a hit with DFAs and departmental finance staff: survey results showed 99% of their respondents appreciated the partnership and found it easier to communicate with their dedicated budget partner through multiple channels such as Slack, email, phone, or Zoom.  Way to go BFP!  Excited to see more of your great ideas come to fruition!     

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Intro to Process Excellence

All this talk about Lean, and what is it you might ask?  Mass production was developed by Henry Ford in 1913.  He was the first person to truly integrate an entire large scale production process in manufacturing.  Less than twenty-years later, Kiichiro Toyoda applied a series of simple innovations to provide both continuity and process flow inventing the Toyota Production System.  This system shifted the focus of manufacturing engineering from individual machines and their utilization, to the flow of product through the total process forming the five lean principles: More 

·         The value desired by the customer

·         Organize work to deliver value

·         Focus on flow of the work

·         Produce at the rate of customer demand

·         Continuously improve

Lean today continues to spread to every country in the world where leaders are also adapting the tools and principles beyond manufacturing such as healthcare.

How is Lean applied here at Stanford, you ask?  Process Excellence is about a holistic cultural evolution. The Process Excellence group provides the principles of customer focus, alignment, and continuous improvement together to bear results.  The changes come from all levels and are systemic.  The culture is based on respect for people which creates a higher standard, a greater acceptance of experimentation, idea generation, and follow through on those ideas.  When people share ideas and those ideas are followed up with, they then create a virtuous cycle that creates a culture where the workforce is more engaged.  An engaged work environment that generates ideas to continuously improve products or processes for their customers is what Lean is all about.

If you have an improvement idea and not sure where to start- contact us!  The Process Excellence team will help you create value for your customers, be the best at getting better, and foster an environment for improvement while respecting our most value resource- you!

If you’re still unsure about Lean and want to know more, sign up for our Intro to Process Excellence course in December.  Sign up quickly as space is limited. 

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HRG Talent Acquisition Implements New Standard in Recruitment Process

    The Human Resources Group (HRG) Talent Acquisition team supports 30 departments and 7 institutes within the School of Medicine. After taking part in a three-day launch, the Talent team recognized an opportunity to more efficiently provide the best possible candidates to our customers (hiring managers, faculty/ or PIs), explains Patty Urban, Director of Talent Acquisition Strategy.

    Overall, the team has simplified their process by automating certain steps and gathering more specific information in the screening stage. Screening standards and communications  More between the Talent team and hiring managers across the School became more thorough through the implementation of a questionnaire used by the team to identify qualities a hiring manager is looking for in addition to a standard candidate package consisting of a resume, summary and video interview which is now provided to the hiring managers. The team is able to produce more candidates and promote worthy contenders by focusing first-round interviews on specific skills and technical competencies sought by the hiring manager.

    After 90 days of trialing their new process, Patty describes the great strides her team has made: starting with an average of 90 days to fill an open position, the Talent team was able to achieve an average of 10.8 days to find a good candidate and add them to the hiring manager’s pool. “We were hitting milestones to reduce the pain [of recruitment] at the right time,” shares Patty. 

    Another initiative the Talent team organized was a summer “matching event” on campus, which invited Stanford students to rounds of speed interviews involving hiring managers from SoM. Of the 500 students who attended, 25 were invited to in person interviews and 11 were hired within 60 days.

    Patty illustrates, “This is a service we provide: we’re working towards putting quality people in the right seats at the right time.”

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Emergency Medicine Streamlines the Reimbursement Process by 80%

  With standardized processes and guidelines, the Emergency Medicine (EMed) team has made the administrative work needed to manage reimbursements and Stanford Purchasing Card (PCard) transactions less burdensome while ensuring physicians and residents get paid sooner.                         

    The EMed team began the journey to enhance workflows in October 2017, after a dramatic rise in faculty left staff members handling reimbursements and PCard transactions for more than 105 attending physicians and 43 residents.   More 

    Faced with a backlog that potentially impacted compliance, the EMed team decided they needed to standardize their workflow, improve communication, and boost departmental morale. The team participated in a three-day launch hat enabled them to focus on identifying pain points and opportunities for improvements within the PCard and reimbursement processes.

    The team set a goal to submit all PCard receipts within 10 days from the original transaction date and to reduce the number of transactions without receipts from 20 percent to zero. They also aimed to have all reimbursements submitted within 10 days of when the request was received. Less than 60 days post launch, there was measurable success: the median processing time for reimbursements in FY18 was less than one day and PCards were cleared within eight days. Equally important, physicians were typically paid just 15 days after submitting a reimbursement request.  

    The EMed team was inspired to come up with more innovative ideas to further enhance their processes. To help administrators to better track who initiated the reimbursement of a PCard transaction, the team created a faculty tracking sheet that lists reimbursement status and activated a “time out” function through Oracle. In addition, they developed a way to give faculty insight into the process, so submitters know the status of their request. Finally, to help everyone stay inspired, staff contributions are recognized through their “Hall of Fame” wall on their visual board. Next, to accommodate a growing residency program, EMed plans to standardize the process for resident reimbursements in FY19 using the same Lean principles and their new internal workflow.

If you are in need of invigorating daily improvements, please email us: processexcellence@stanford.edu for more information. 

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Metricizing with Process Excellence

Come Metricize with Francesca Heinzmann, Process Excellence Manager!  What is Metricize, you ask?  The workshop series formally called Race to Eight, Metricize is a metrics based workshop that help teams advance to meet all eight Lean foundational elements.  The eight foundational elements involve measurable goals under our Four Key Systems:  More Strategy Deployment, Visual Management, Daily Improvement, and Standard Follow-up.  Together, these systems and subsystems create a culture of daily team-based problem-solving, which is our ultimate goal.  Metricize creates an environment that taps into the passion, creativity, and commitment of our teams. 

           These workshops, which focus on goal setting, idea generation, and reflection are catered to teams who want more hands on experience in deploying the foundational elements.  For instance, daily kaizen is an approach to develop teams by practicing regular habits to create and implement improvements in our daily work.  “If teams are struggling to get over a hump, daily kaizen can be a solution,” Francesca explains.  Race to Eight is not siloed, departments have an opportunity to work and share with different teams, which creates a collaborative and rich experience.

           “Having gone through two of the three classes, my team and I were left feeling energized which also helped us focus on our own metrics.  These sessions challenged us in a way that made us think about our own improvements- to our visual board especially”, shared Archna Mehta, Controller.  “The focus skills training permitted dedicated time, which we would not have otherwise given thought to with our busy day-to-day,” expressed Margey Corbett, Manager, RMG.  Race to Eight is a challenging but helpful series, allowing teams to work through obstacles and facilitate discussions of impactful results and solutions.  If you are in need of invigorating daily improvements, please email us: processexcellence@stanford.edu for more information. 

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Child Health Research Institute's (CHRI) 90-day report-out

Stanford Medicine’s Child Health Research Institute (CHRI) has completed its 90-day report-out with groundbreaking results!  Mary Chen, Assistant Dean, Maternal Child Health Research, and Mike Propst, Associate Chair, Finance and Administration, who attended the report-out among other Peds staff learned about CHRI’s most impactful finding:  More the importance of implementing a better process for capturing time effort.

    May Zepeda, Clinical Research Manager and launch leader, outlined  challenges and solutions for recording time tracking efforts.  A challenge was the amount of data entry time clinical research coordinators (CRC) enabled on-time invoicing for PIs.

    CHRI simplified their logging procedures by more than 50% while creating consistencies in the way CRCs input their time; created an FAQ document to get end users involved; reached 100% increase in tracking submissions and eliminated the need for administrative reminders.  Overall, a 50% reduction in median time spent is a tremendous accomplishment!  Now CHRI has a roadmap to accurately estimate their CRCs time spent and allocate time and efforts appropriately.

    In reducing data entry time, the team increased accuracy and timeliness of entries, while also enabling on-time invoicing for PIs.  As part of the same action, the improved entry quality afforded better data to support improving the clinical trial budgeting tool in the future.

    With that, as the process was developing, the team was able to adjust goals as needed and build an even stronger bond. Way to go CHRI!  

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Department of Surgery: 60-Day Report Out 

Process Excellence had a busy month of Lean launches and report-outs. We were able to attend the Department of Surgery’s 60-day report-out where we saw their famous viz board that has received quite a lot of attention. They are on track to hitting their goals, and have come to the realization that working as a group has not only been effortless, but also rewarding, as everyone has benefited from these changes for on-boarding. We are excited to see their metrics next month.


Faculty Compensation's Lean Launch

Faculty Comp’s Lean Launch focused on reduction of delays and errors involved in processing changes for faculty who have a Palo Alto VA appointment. These changes include actions for hires, promotions, sabbaticals and other leave types; retirement and 8th’s changes. These actions are all complex due to the need to maintain the parity balance of Stanford salary with often-changing VAPAHCS salary. At the Lean Launch the team mapped out the current process steps for these faculty changes, and then invited colleagues from five departments and the University Benefits team to provide feedback.  As a result, several education projects to help department and divisions understand the process, as well as required information have been identified for the team’s 30, 60 and 90 day goals.


SoM Grants and Contracts Group

The SoM Grants and Contracts group were featured in Stanford Connected for applying the Lean Processes to reduce grant-award processing. Click here to read the full story.


Crafting the Goal

The teams in the School of Medicine Operations have been hard at work visualizing their goals. Senior leaders are engaged in a year-long training course, and teams have started putting some of their knowledge into action. 

Some of the keys to this are aligning the strategy of the team to the greater organization, managing the work visually, and developing ideas and a way to prioritize ideas. One of the ways that teams have made this more interesting is by not only visualizing their key elements, but by doing it in a creative way.

Marcia Cohen was able to see some of these boards in action when she came to visit the Porter site in early August.


Lean Leadership Training  

This year, leaders from throughout the School of Medicine Operations have been taking a year-long course to learn the Lean methodology. Taught by Mike Martyn of SISU Consulting, the course goes in depth on how to run an organization based on Lean principles.

Topics covered so far include the background and history of Lean, organizational maturity, engaging teams, and determining gaps. As we move forward, the team will continue to focus on putting these ideas into practice in their daily work.


Basic Science Financial Reporting Launch

Basic Science DFAs and Analysts and Dean's Office representatives have come together to streamline their financial reporting. They're working to reduce the amount of manual data manipulation so they can spend more time forecasting and analyzing.

They learned about what reports other departments used, and what data was available in various systems, but one of the key takeaways was that a lot of issues are actually very similar across departments. Rather than working in nine different silos, they can leverage the knowledge that people have to create a larger community.

After three days, the team has become just that, a team, and a group that will continue to work together to bring forth ideas and work through issues together.


IRT Provisioning's first 90 days

IRT Provisioning has completed their 90 day journey and had their report out. During that time they accomplished some key goals and have continued to think up new ideas that will take them beyond their first 90 days.

The team has done work to make the ordering process smoother for customers with a new website and a Google form used for ordering. They've tried to make things smoother for their coworkers with a "go-bag" for the most common adaptors and cords that may need to be used when new computers are being deployed by their desktop support colleagues. They've also automated some of the back-end processing by the Finance team. And last, but not least, they've streamlined their own work and improved their accuracy.  


BLIMP (Brilliant Lean Inventory Management Process) Rises High

The BLIMP team took flight in early June to help you get your repairs done faster. The team took on the Inventory Management Process, in order to make sure the supplies people need for their repairs are on hand when they need them. 

The Launch took place over three days and included customers, people in the field, people who order supplies, and the people who work in the stock room. It was eye opening to see the current process works from start to finish. The team has planned out their next 90 days, and included in that is everything from automating some notifications, to completing a physical audit, to shadowing partners to learn from their process.

They've got a lot going on, but they'll be sure to rise up and deliver on a brilliant new inventory management process.


IRT Data Center Takes Center Stage

The IRT DCS (Data Center) team took three days from their busy schedules to try to tackle the problem of... their busy schedules. As the School of Medicine grows, their need for data also grows. And this team is the backbone of that data. It's a very dynamic environment for this dynamic team.

During their Launch DCS reviewed how they take new projects in, prioritize those projects and get clarity on what they need to be working on.

What they found was there were ten different ways that people contacted them to make requests, everything from a shoulder tap to an email to an Service Now ticket. Everyone also had different ways of keeping track of information, which made it difficult to see what everyone was working on.

They have come together to decide on a few key ways of keeping track of their workload that will give greater visibility into what they do and allow leaders to prioritize.


Provisioning's first 30 days

The Provisioning team has been hard at work for the 30 days since their launch. They've already put into place some quick wins that are making them optimistic that they will hit their goals in time for their 90 day report out.


FAA from the Department of Medicine report out

The FAA team has been hard at work after their launch and were excited to present to a very interested group. The team presented in front of a diverse group of people including people from the Office of Academic Affairs, Faculty Compensation and an extended group from the Department of Medicine. They shared some new standard work that the team developed as a part of their Launch including an adminstrator packet to share with the administrators, a pre-kick-off meeting packet, a calendar among other tools.


IRT Provisioning launches forth

Have you ever wondered what happens when you request a computer? From the initial request to having the computer delivered and ready to install, it’s a complex process that touches multiple teams in IRT (Information Resources and Technology), as well as colleagues in the departments and finance. In late March, a group from across the School of Medicine operations teams came together with some key Stars (key departmental purchasing partners) to try to resolve an issue that had been surfacing from multiple sources: it was taking too long for people to get new computers.

Response times had increased from what had been same day responsiveness to a two to four day wait, not including the time it took to get the computer shipped from the manufacturer. The Provisioning team is new, their scope had grown fast. What last year was 10 -20 requests a week was now clocking in around 70 – 80 requests a week.

Stars from across departments, IRT, Finance and Procurement came together as a team to tackle the questions around how to make their process faster, with more consistency and better visibility for Stars and IRT throughout the provisioning process.

The launch itself lasted two and a half days. During that time they got a brief overview of Lean, mapped their current process, envisioned the future state, identified pain points, brainstormed ideas for improvement, went back over their goals and metrics to reach those goals, identified some key objectives and discussed what was next. They also had a lot of fun while coming together as a group to tackle a complex problem.

Some of their key learnings were that this was a much more complicated process than people realized, with many people involved at various points. It takes around 30 steps, with an additional 16 administrative steps to get a computer out to you. It was also surprising to people that there were multiple rework steps in the process that surfaced from the mapping. People also felt that it was good to get perspectives from around Stanford. Coming out of the launch, the team feels like they are aligned on their goals and how to achieve them. There are some concrete next steps and the team is already hard at work. We are excited to see what they achieve and let us know during their 30, 60 and 90-day report outs. 


OFPM reports on their Lean initiatives

At the OFPM (Facilities Planning and Management) all-hands the leaders shared their Lean journeys, including some successful Lean launches, standard work, and how people huddle. Some final thoughts include the fact that, “Lean is cool” and while adopting the Lean approach is not easy, and you need to hang in there and wait for the payoffs, when the team starts to experience the benefits, it’s a really cool thing to watch and be a part of.


Marcia walks the halls

Marcia came to see the continued maturation of the Lean program as she visited the halls of Porter, Page Mill, MSOB (Medical School Office Building) and Li Ka Shing. Her teams were excited to see her and show her their great progress.


HRG is on the right "Track": Human Resources streamlines it's hiring process

Hiring a new employee can be a daunting task for any manager. It takes the time and resources of teams across the organization to find the right candidate to fill a position. In October 2015, a cross-functional team gathered together to launch a Lean initiative to make the hiring process faster  More and less repetitive for the hiring manager and other School of Medicine staff  involved along the way. The “Lean” approach, made famous by Toyota and others, aims to improve processes like these by engaging team members who actually do the work as well as customers who benefit from it to recognize and solve problems. The team began by focusing on the process then used to fill regular staff positions.

A year later the team, comprised of Susan Hoerger, sponsor Cori Bossenberry, and stakeholders within School of Medicine departments and the Dean’s office, took stock to evaluate progress.

An up-to-date re-mapping yielded impressive results, with a much more streamlined process for over half of the hiring requests moving through the system.

How did they do it? In the past, all regular staff requisitions passed through the same hiring funnel. This resulted in all requisitions taking about the same amount of time, regardless of whether the position was a standard entry-level role or a complex, hard-to-fill role.

Done the old way, it would take on average 75 to 150 days from the time a hiring manager first made contact to getting an offer out. The new process has resulted in most straight-forward, open positions having offer letters delivered in 45 to 105 days. Groups have seen a significant decrease in the time for the most straightforward hires. Even the position types that need to go through the most review levels are now being completed in 50 to 144 days.

So, what changed?

The new process breaks hiring requests down into four categories. While this may seem like it’s adding complexity, it helps assign the right level of service to each hiring category, enabling simple requests to move through the pipeline faster.

This was eye opening for many. There were fewer bottlenecks, and the rework that frustrated hiring managers, Directors of Finance and Administration (DFAs) and human resources staffers was identified and reduced.  It was great to see a cross-functional team working so well together to determine a way to address process flaws.

The team is now looking at further opportunities to streamline their processes by focusing on a new pain point – quality of applicant pool.

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FAA and CISL 60 Day report outs

FAA had their 60 day report out in late February. The team shared their learnings along with some of the work they've done on the Faculty Search Committee Packet.

CISL had a 60 day report out in late February, where they shared some of their successes and roadblocks. The team reported that they've now started thinking about Lean in how they do everything, and they've already started down the path of another avenue of improvement.


2017 Lean Leadership Cohort

We are very excited to announce that we have started our 2017 Lean Leadership Training Program. The first session was on Building Principles-Based Daily Management Systems, and is being led by consultant Mike Martyn.  A group of leaders throughout the organization were introduced to the history of lean and the nature of the Toyota Production Systems.  The course covered key principles of operational excellence, the relationship between principles, systems and tools, and the industry’s best practices from organizations who have successfully created a culture of continuous improvement build on a foundation of respect, humility, and daily kaizen. This new cohort joins the 13 people who have previously taken the training in Seattle.


Marcia “walks” the Alway halls

Marcia Cohen “walked” over to Alway to visit the OFPM teams for a quarterly Wall Walk. She got a glimpse into some of the key ways the teams have been improving their core services and how they keep track of their progress.


Tech support at medical school gets ‘lean'

Learn about how the IRT Help Desk has adopted and adapted to Lean Process Improvement Prinicples.  See how these principles come to life in a group who takes the plunge! 


OAA report out:

OAA had their 90 day report out in late January. During that time they discussed how not only were they able to streamline some of their processes, but how they were able to strengthen their customer relationships and build in cross-training within their own organization through the launch process.

 


CISL 30 Day Report-Out

During their 30 Day Report-Out, CISL revealed the good progress on form design and communications. They continued to review their goals and celebrated their wins! Awesome work CISL team on the collaborative efforts! 


January 24: Marcia Cohen returns for Wall Walk

Marcia Cohen returns to 3172 Porter Drive for the quarterly “Wall Walk” with HRG, IRT, Facilities, Fiscal Affairs, and RMG teams.  


December 15: Department of Medicine Faculty Affairs 30 Day Report Out

Kudos to the Department of Medicine Faculty Affairs team on their 30-Day Reportout! Since their October Lean Launch, the team has been “huddling” every week to explore and implement ideas like an online form for capturing faculty recruitment requests and new tools to assist faculty search committees. We will unveil the progress of their goal- reducing the time it takes to send a faculty recruitment offer letter at their 60-Day Reportout!  


November 28- Nov 30: CISL Launch 

The Goodman Immersive Learning Center (ICL) is an exciting hub where state of the simulation medical training takes place inside the Li Ka Shing building.  With growth in demand and complexity for ICL resources across Stanford Medicine, the Center for Immersive and Simulation based Learning (CISL) team came together during their November Lean Launch to improve their annual scheduling process for their customers. Check back to see how the team begins to test and implement their ideas at their 30-Day Reportout in January! 


October 25- October 27

Department of Medicine Faculty Affairs Launch: Improvement Focus Area- Department of Medicine professoriate recruitment process.  


October 24th: Marcia's Quarterly Wall Walk Visit 

Excited to have Marcia Cohen, Senior Associate Dean of Finance and Administration, journey through our visual boards. Sending a big thank you to all teams: Facilities, Fiscal Affairs, HRG, IRT, and RMG! We are excited to see all the great improvement work you are doing! 


SoM Controller's Group: FY17 Goals

Building the "Viz Board": Newest member of the Controller's Group, Jennifer Chan, Associate Controller, reflects on the useful tool to help familiarize with various projects- past and present.  


CT RMG: Lean Conference 

Congratulations to the CT RMG team for submitting their poster and representing SoM at the Lean Conference while learning how providers apply Lean in the health care setting. 


September 26-27 at Stanford

Stanford School of Medicine is proud to co-sponsor- Lean Healthcare Academic Conference at Stanford. 

Key speakers include John Shook, Chairman and CEO of the Lean Enterprise Institute, and Edgar Schein, author of Humble Inquiry. 

Learn more


September 22nd, University of Washington Lean Training and Visit

Visiting University of Washington and learning how leaders connect daily huddles with their team to their monthly leadership huddles that review progress towards their annual goals.