continuous performance improvement at seattle children’s hospital lessons in leadership: getting...

Continuous Performance Improvementat Seattle Children’s Hospital

Lessons in Leadership: Getting Leaner – Getting Results

March 24, 2011

Our CPI Philosophy

• Focus on the Patient and Family• Involve patients and families in our improvement work• Don’t imagine we know what they want, listen • The uniqueness of our patients should be our only variation

• Support Faculty and Staff in their Work• Give people the opportunity to participate • We are partners to be engaged, not customers to be served• Make it easy to do the right thing• No Layoffs

• Take a Long Term View• Relentless, iterative improvement (PDCA)• Patience, this is generational work• Focus, avoid the squirrel syndrome

Our Approach

● Leader Guidance and Direction: this is our management system, our method of improvement

● Staff (and Family) Participation: this is how we will improve

● Understand the Sequence of Work: map the process

● Identify Waste: reduce or eliminate it

A Few Words About Waste…

Waste comes cleverly

disguised as real work

Waste Comes in Many Forms

Processing Search TimeCorrection Transportation Underutilized People

InventoryWait Time Space Complexity

A Few Words about Leadership

● Presence

● Knowledge

● Participation

● Tenacity

● Patience

Continuous Performance Improvement: Our Results

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

FQ103

FQ203

FQ303

FQ403

FQ104

FQ204

FQ304

FQ404

FQ105

FQ205

FQ305

FQ405

FQ106

FQ206

FQ306

FQ406

FQ107

FQ207

FQ307

FQ407

FQ108

FQ208

FQ308

FQ408

FQ109

FQ209

FQ309

FQ409

FQ110

FQ210

FQ310

Quality – Overall Rating of Care

Lower is better!

• New Ambulatory Clinic and Surgery Center

• Using CPI principles, reduced building size from the architect’s original program by approximately 30,000 sq ft

• $20 million capital cost avoidance, plus• $10 million construction cost savings

Cost

Delivery - Central Line Access

% of Patients with Leukemia Receiving PICC Lines

and Access for General Surgery to Place Elective Central Line(Lower is better)

10

5

2

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

2005 2006 2007

0

2

4

6

8

10

12

% Receiving PICC

Median Days Lead Time for ElectiveLine

Arlene Libby

Updated 12/14/07

Year 1 Year 2 Year 3

Safety - Blood Stream Infections

0

1

2

3

4

5

6

Ra

te p

er

10

00

CL

da

ys

Hospital-Acquired Catheter-Associated Bloodstream Infection RatesHousewide- By Quarters (Fiscal Year)

Series1 Linear (Series1)

Gallup Q12® Engagement Index at Children’s Over Time

19%12% 12% 10% 12% 9% 9% 8% 9% 8%

42% 40% 40%

25%35%

41% 42% 45%50% 50% 50% 51% 52%

56%

53%47% 48% 43%

41% 41%

0%

20%

40%

60%

80%

100%

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

% E

ng

ag

ed

Engaged

Not Engaged

Actively Disengaged

Ratio of Engaged to Actively Disengaged: 1.32:1 2.92:1 3.42:1 4.20:1 3.75:1 5.56:1 5.56:1 6.25:1 5.67:1 6.50:1

Copyright © 2005 The Gallup Organization, Princeton, NJ. All rights reserved.

CPI Can Be Applied Anywhere

March 11, 2011 CPI Report-Outs:

• Dietitian Documentation

• Feeding Tube Management

• Primary Care Clinic Flow

• Cardiac Surgery Scheduling

• Research Grant Invoicing

Lessons Learned

● This is hard work

● Takes time and effort to see results

● Very engaging for staff, faculty and families

● Requires substantial leadership and financial investment

● Learn to fish

CPI at Seattle Children’s Hospital

Thank you