Adapting the Shingo Principles to public health lean practice

The 13 CDPH Lean Principles

In a previous blog posting (Why I embrace lean -- and you should too) I introduced lean practice and the Shingo Model. To recall,

Lean thinking and practice is “systematically developing people to solve problems and consuming the fewest possible resources while continuously improving processes to provide value to community members and prosperity to society.”¹

Unfortunately, lean practice is misunderstood and undervalued, sometimes by prominent health leaders. Do not make this mistake. The Shingo Model ensures that you leverage a framework and theory of change to become a learning, healing, and impactful organization.

The Shingo Model is a evidence-based framework for building a culture of operational and organizational excellence. The Shingo Model has five components. First, the 10 Guiding Principles are the basis for building a lasting culture and achieving organizational excellence. Second, a system is a collection of tools working together to accomplish an intended outcome. Third, tools are solutions or methods that accomplish specific tasks. Lean is well known for its tools to eliminate waste in processes. Fourth, a result is a measurable outcome, either successful or unsuccessful, that results from the implementation of tools and systems. And fifth, culture is all the behaviors within an organization.

The Shingo Guiding Principles are ten principles that are the basis for building a sustainable culture of enterprise excellence. In the Guiding Principles diamond, the principles are divided into the three dimensions or its theory of change (aka, program theory)

• People — Cultural Enablers (“enable”),

• Process — Continuous Improvement (“improve”), and

• Purpose — Enterprise Alignment (“align”).

For the CDPH Lean Principles I added to the Shingo Principles three additional principles that are critical based on public health practice and expertise.

1. Measure What Matters (ie, Objective and Key Results)

2. Eliminate Waste and Undesired Variability

3. Respond and Adapt with Speed and Agility

I introduced Objective and Key Results (OKRs) in another blog posting (Why leaders embrace OKRs -- and you should too). Eliminating waste and undesired variability is one of lean’s superpowers, and that’s why I elevated it to a principle. And, of course, responding and adapting with speed and agility is critical for emergency preparedness and response, but also to be responsive to the diverse communities and constituencies of California.

Table 1 displays the 13 CDPH Lean Principles.

Table 1: CDPH Lean Principles consists of the Shingo Principles (https://shingo.org/shingo-model/) combined with Measure What Matters (https://www.whatmatters.com/okrs-explained), Eliminate Waste and Undesired Variability, and Respond and Adapt with Speed and Agility.

Here they are as a list for copying.

1. Respect every Individual

2. Lead with Humility

3. Embrace Scientific Thinking

4. Seek Perfection (improve safety, quality, customer value)

5. Measure What Matters (Objectives and Key Results)

6. Respond and Adapt with Speed and Agility

7. Focus on Process

8. Assure Quality at the Source

9. Eliminate Waste and Undesired Variability

10. Improve Flow and Pull

11. Think Systemically

12. Create Constancy of Purpose

13. Create Value for the Customer

I intentionally did not remove² any principle because I want to keep the Shingo Principles intact. The Shingo Model will give your lean practice a solid foundation and theory of change.

Don’t be discouraged. If you know of a better approach that is tested and validated, please share with me. I have not discovered a better model.

Enjoy,

Tomás

1. Lex Schroeder. Public Service: Lean’s Next Frontier? Lean Enterprise Institute, 2014.

2. If I were forced to remove a principle, I would only remove “Improve Flow and Pull.“