Most staff including managers and clinical staff have little understanding of waste and its causes. If staff are seen to be busy but not really thinking about how productive they are. Such situations should not be tolerated. If an action is not adding to the care of the patient then it should be eliminated. If a whole practice engages then small improvements found in reducing waste culminate into larger overall effect.

This key introduces the Treasure Mountain Map. It is a device that helps staff identify waste and its causes. At its best it identifies , at a glance where waste is occurring. it also charts the practices progree in eliminating it. By labeling problems with “gold”, “silver” or copper in their order of seriousness puts problems in a more positive light. The larger the problem the more oppurtuntity there is to mine something valuable from reviewing it. The system highlights the amount of value adding work done and makes it possible to compare and encourage the various groups involved.

The map fosters good natured competition between groups creating a fun and efficient workplace while eliminating waste efforts.

Level 1

At Level one there is little interest and understanding of waste. Some staff may complain why something is done or is done a certain way but it goes no further than that. Managers are happy to see their staff working as hard as they possibly can. Such managers feel that the situation is best left alone. It is believed that change may damage their motivation. It is believed that efficiency is labor intensive.

• Ensure that all staff understand that any efforts that do not add value are waste.
• Common forms of waste are:
  • moving inventory round when it is not needed.
  • Looking for forms, tools, consumables such as pens, print cartridges, paper.
  • Moving positions round the office. i.e logging on to another computer takes time.
  • Waiting
  • Unnecessary meetings
  • Supervising
  • Seeking advice
  • Repeated patient visits.

Only complete actions that will lead to the care outcomes of patients. Anything else is waste.

Level 2

At level 2 all staff understand waste and engaging in finding it in all aspects of their work. Staff will start to realise that a mistake is a gold nugget where the practice can improve. This is because it provides so much improvement when it is by digging it out.

A Treasure Map Mountain (TMM) is a tool where staff can, at a glance, identify where and to what extent waste exists. It is these two pieces of information that allows it to be effectively ‘mined’. The TMM method is a map and a sampling chart.

The map makes a game of identifying waste using an outline of a familiar area with various rugged parts labelled as gold, silver, copper or flat lands. These allow staff to label areas in order/ degrees of waste and the potential for elimination. Even area designated as flat lands can yield value. You have to dig down, think of it as striking oil.

The sampling chart brings these areas to life. Staff, in groups make sample observations of their area of work. They assign numeric scores on a designated scale about what they have observed. The chart uses the same form of labels as on the map to express scores on the various areas. The map and chart are posted in central area that everyone can access/ use. Friendly competition is encouraged. However it must be noted that the culture of a practice must be healthy. Otherwise practices where the culture is poor and other keys have not been implemented, bickering will ensue. In practices where there is a strong/ good culture a feeling of unity is achieved when obstacles are overcome together.

This game must be played by the entire practice.

Level 3

The TMM is in a conspicuous location and all teams are using the posted ratings for some health competition.

• Teams start to draw up and submit plans to reduce the amount of waste. These plans also include how they intend to increase the work ratio in their area. The work ratio is the time spent in value added activities divided by the total time spent on their job (minus breaks, improvement meetings and so on).
• The areas needing improvement are clearly identified. A level 2 practice will not know how to make a significant difference.
• Brainstorm/ study meetings share the scores on the “Treasure Audits” along:
  • With the relative position if the teams.
  • Areas with high actual work ratios and areas needing improving because of low actual work ratios (Essential).
  • Review the evaluation system so that everyone understands the best way to improve scores.
  • A representative from each group describes the strategies and plans for future improvements.
  • Ensure the meetings are enjoyable. Thus if any group performed poorly last time still looks forward to it the next time.
  • Before the meeting have the managers review the review the gold, silver and copper areas and look for specific problems and think about solutions.

Enthusiasm only goes so far. It is of the upmost importance that definite plans are put in place and are complete to ensure success (digging out the waste).

Level 4

Level 4 can only be achieved when the work ratio passes 85% Working patterns: where, what and when are clearly defined (See Quick Changeover Systems).

Level 4 must be achieved in all other keys.

Group Communication Method

GC or group communication method is a tool where employees write obstacles on cards that are placed on board which has zones and in the middle a fortress with the title: Real Work. Employees plan to defeat the obstacles. In may be helpful to provide manuals or training in an effort to remove difficult to mine waste.

Level 5

Actual work ratio at level 5 is 95% with all other keys at level four or higher. The keys are highly interconnected and work together seamlessly. At level 5 there is an outstanding level of productivity.