creating a lean culture - cme manitobamb.cme-mec.ca/download.php?file=59y1l84jh.pdf · creating a...
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Creating a Lean Culture Transformational Leadership for Lean Health Care
Bruce Roe, MD
President and CEO
Executive Champion, Transformation February 15, 2017
180 Departments
7 Separate buildings on 20 acres of land
Number of employees 3,854
Number of beds 538
Patient days 169,265
Number of admissions 26,769
Outpatient activity 233,189
Doctors with admitting privileges 597
Annual budget $302,680.00
St.Boniface Hospital
• Tertiary care hospital, affiliated with the University of Manitoba
• Our major clinical programs include Cardiac Sciences (provincial referral
centre), Woman and Child, Internal Medicine, and Surgery
• 3,800 employees
• Total admissions in 2015: 20,147
• Total outpatient visits in 2015: 228,705
About St. Boniface Hospital
Our vision
To deliver the safest and highest quality of care to every
patient, every encounter, every day, with the best
outcomes….
At a price we can afford!
2007
• Patchy improvements in
quality
Could ”lean” help?
• In healthcare?
• Few pioneers
• Local business - mentors
Lean … in Health Care?
Let’s Talk About Lean
What are your assumptions about lean?
What role do leaders play in lean transformation?
What does an effective lean leader look like?
Measure Initial
State
Confirmed
State
Patient handoffs 7 4
Patient Distance Traveled 306 ft 306
EKG Tech Distance Traveled 1390 ft 10 ft
Emergency Cardiac Patients Presentation to EKG Interpreted RIE (example)
Rapid Improvement Event #1 ACS Triage to EKG Interpreted
Trials
Team work
New EKG room
Mission Control and Visual Management
“People are everything!”
Improvement ideas come from those who do the
work, or experience the care
“You’ve put the fun back into Health
Care”
“This gives us hope!”
A Few Of Our Proudest Moments...
• ER Results
• Direct Admit ACSS
• Surgical Safety Checklist
• Clinical Documentation
• Nurse-to-Nurse reports
• Surgery On The Move
• Inventory Right-Sizing
• Prevention of Falls
• Staff Scheduling
• Cardiac Transitions
• Accounts Payable Process
• Staffing Absences & WCB
Reflection Point
• Lots of activity
• Pockets of improvement
• Fragmented deployment – not connected
• Engagement at front line and connection to goals and vision
missing
“Lean tools are great!”
5S
One-piece flow
• A3
• Value streams & mapping
• Kaizen
• Rapid Improvement Events
• 6S
• 3P
• Kanban
• Audits /Kamishibai
But are they delivering the results you are looking for?
5S
One-piece flow
Tools, if not anchored in systems
or principles,
will not drive culture
Engaging SBH in Reflection
The “Whirl-Wind”
Cause & Effect Relationship
of Tools & Results
Cause & Effect Relationship
of Principles & Results
REFLECTION
POINT
Tool-based
Architecture
Long-term Sustainment
Source: Institute for Enterprise Excellence www.shingoprize.org
Result-oriented
Fragmented Thinking
Command & Control
Defensive
Knower’s
Thinking that Drives Complexity Thinking that Drives Continuous
Improvement
Result-oriented
Fragmented Thinking
Command & Control
Defensive
Knower’s
Process-oriented
Systems thinking
Leader as a teacher
Engaging
Learners
Source: LEI
Shingo Model of Operational Excellence
1. There is a relationship
between principles, systems
and tools.
2. We focus on both key results
and the best behavior to
achieve those results.
3. We actively leverage our
systems to drive the best
behavior.
Key Systems:
• Strategy Deployment
• Daily Management System
• Visual Management System
• Coaching System
• Leadership Development System
Key Behaviors
Building Systems to drive Right Behaviors
Systems Roadmap 2017 - 2018
Key Behaviours
Leadership Managers Staff
• Set high but achievable targets
• Align strategies to TN and Regional Priorities
• Organize and allocate resources
• Connect, translate, filter at next level
• Connect, translate, filter TN direction
• Align problem solving efforts to TN and strategic direction
• Allocate resources
• Connect work to purpose
• Monitor performance to TN visually
Purpose: Connect work to purpose at all levels. Create alignment, clarity, and focus problem solving efforts to get the best results
Strategy Deployment – Thumbnail Sketch
Results: • TN Metric Improvements • Strategic Objective A3s (Plans and Results) • Clear line of sight to results at all levels
Triggers • Strategic Planning • Annual Planning • Enterprise Performance
Meeting
Tools • True North Metrics • Watch Indicators • A3 • Countermeasure Summary
Process 1. Set Enterprise TN targets through Annual Planning 2. Catchball (Connect, Translate, Filter) at all levels 3. Define Strategic Objectives and resources 4. Deploy targets and objectives 5. Monitor, Maintain, Improve 6. Reflect
Related Systems Strategy Development Daily Management Problem Solving Visual Management
ALIGN: Connect To Our Purpose
Renewal Annual
Purpose: Recognize abnormal conditions (winning/losing) at a glance & trigger a consistent response at the right-level in real-time.
Visual Management System – Thumbnail Sketch
Results: • Near misses, good
catches, defects resolved
• Containment Plans • PDSA
Key Behaviours
Leadership & Managers Staff
• Set targets and make visual • Respond in real-time to abnormal
conditions • Promote problem-solving &
containment of defects at the source
• Engage staff or leadership in problem solving
• Huddle often • Measure, monitor visually and
report on performance daily • Identify and embrace defects as
opportunity to improve
Triggers • Huddles • Gemba • Follow-Up • Shift Change • Abnormal Condition
Tools • Visual Standards • Andon • Visual Management
Centres • Metrics / KPIs • Escalation Standards
Process 1. Define targets / normal vs abnormal 2. Make visual 3. Monitor Daily or Real-Time 4. Respond to Abnormal Conditions (Contain, Solve,
Escalate) 5. Follow-Up
Related Systems Strategy Deployment Daily Management Problem Solving Coaching
IMPROVE: Assure Quality At The Source
Renewal Annual
SBH Management System (v1)
Dai
ly Im
pro
vem
ent
Daily Status Exchange
Monitoring, Maintaining, & Sustaining
Un
it P
erfo
rman
ce M
anag
emen
t
P
DS
A
GTS2
GAC
Daily Stat Sheet
Weekly Stat Sheet
Daily Improvement Huddle
Visual Management
Unit Performance Steering Team
A3 Problem Solving
Monthly Scorecard
Unit Performance Meeting
Countermeasure Summary
Standard Work
Leader Standard Work
Process Observation
Model Cell Approach to Learning Wave 1 - Sep 2015 – Apr 2016
(32 weeks)
• Pharmacy
• Cardiac Surgery Inpatient Unit
Wave 2 : Sep 2016 – Dec 2016
(16 weeks)
• Intensive Care Cardiac Surgery
• Internal Medicine Inpatient Unit (E5)
• CT Scan
• Ultrasound
Management System - Assessment Management System - Assessment Scores
Dimension Target June August September October November December January February March April
Daily Status 4 4 4 4 4 4 4
Daily Improvement 1 2 2 2 3 3 3
Unit Performance & Management 1 3 3 4 4 4 4
Monitoring, Maintaining & Sustaining 1 1 2 3 3 3 3
Overall 1 1 2 2 3 3 3
Daily Status 2 4 2
Daily Improvement 2 3 2
Unit Performance & Management 1 2 1
Monitoring, Maintaining & Sustaining 1 1 1
Overall 1 1 1
Daily Status 2
Daily Improvement 1
Unit Performance & Management 1
Monitoring, Maintaining & Sustaining 1
Overall 1
Daily Status 3 3 3
Daily Improvement 3 3 3
Unit Performance & Management 1 1 1
Monitoring, Maintaining & Sustaining 1 1 3
Overall 1 1 1
Daily Status 2 2
Daily Improvement 1 1
Unit Performance & Management 1 1
Monitoring, Maintaining & Sustaining 1 1
Overall 1 1
Daily Status 2 3
Daily Improvement 1 3
Unit Performance & Management 1 1
Monitoring, Maintaining & Sustaining 1 1
Overall 1 1
ICCS
3
E5
DI - CT/Xray
DI - US
Wav
e 2
3
3
3
2016 2017
Pharmacy
3
3
CSIU
Area
Wav
e 1
Management System – Spread
Wave 3
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Wave 4 Wave 5
Wave 6
2017 2018
6 units
8 units
8 units
10 units
Transformation Journey
“Hubris is a dangerous enemy”
~Pascal Dennis
Relentless pursuit of perfection means
just that; self-critique and facing one’s
problems”
~Steven Spear
Questions?