introduction to next level partners lean healthcare · 2014-03-17 · typical 5 day rapid-cycle...
TRANSCRIPT
Introduction to NEXT LEVEL Partners
Lean Healthcare
Copyright © 2014, NEXT LEVEL Partners®, LLC, All rights reserved.
MISSION
To enable Healthcare Client Partners to continuously outperform through
deployment of NEXT LEVEL business, talent, and operational processes.
Client Partners
Competition
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Ensure the PEOPLE are properly developed at all levels so the appropriate knowledge & skills are resident
Cooperatively develop an improvement & implementation PLAN
Ensure the key PROCESSES for any continuous improvement culture are woven into the fabric of the organization
OUR BALANCED APPROACH
Changing Actions → Changes Behaviors → Changes Attitudes → Changes Culture Page 3
Assess the Current State
Document Desired Future State
Improvement opportunities are
identified
High
Easy
Improvement opportunities are
prioritized Establish Focused Improvement Plan
Not to exceed, Top 4-6 events and 4-6 “Go Dos”
Identifying Improvement Priorities (First, Seeing the Waste Using a Value Stream Mapping Approach)
A B
C
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INITIATING & EXECUTING THE IMPROVEMENT PLAN
Month 1 Month 2 Month 3 Month 4 Month 5 Month 6
6 – 8 Weeks PRIOR………………………. 4 Weeks PRIOR………….…..
< 2 Weeks PRIOR……..
“Value Stream” Assessment & Improvement Planning Workshop - To develop an effective plan for the improvement activity, we will initially facilitate a collaborative, TPS-based assessment called Value Stream Mapping (VSM). The resulting improvement roadmap from the VSM event will then be carried out via a series of rapid-cycle improvement (or kaizen) events involving staff that work in the subject area.
Clinton County: Reducing Re-Admissions St Clair: Elimination of ADE/ADR Jeanie Stuart-: Eliminate the causes of CAUTI JB Haggin: ADE/ADR Caverna: Med Administration
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Murray Calloway: CHF Fleming County: Re-Admissions/VTE Twin Lakes RMC: Re-Admissions/Edu Highlands RMC: Re-Admissions/VTE
• Clearly scoped, intensive, process improvement.
• The typical Rapid-Cycle Improvement (Kaizen) event runs Monday through Friday including a concise report-out to leadership at the conclusion.
• During this time, the targeted process is:
a) completely assessed for waste b) improved using lean principles c) repeat-ably practiced the new way by relevant associates
Rapid-Cycle Improvement (Kaizen) Event
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Typical 5 Month Project Committee plans to meet once/week for 2 hours because this is a high priority
Committee starts of the first week as planned, and then… - “Joe couldn’t attend because he was on vacation so we’ll hold off meeting until next week…”
- “Sue did not have time to review the data with her staff because…”
- “Budgets are due in a few days so we can’t make it this week…”
- “Maria is so busy…it’s difficult to get her to attend a meeting…”
- Etc, etc, etc….until finally…
- “Barb asked me to hold off on this project because something more urgent has come up that we need to deal with…”
Typical 5 Day Rapid-Cycle Improvement (Kaizen) Event
Day 1:
Management kick-off (present event charter)
Lean tool training
Document current state map
Team Leader update
Day 2:
Identification of Waste
Future state brainstorming of changes to eliminate waste
Try-storming new ideas
Document future state map
Team Leader update
Day 3:
Implementation of process changes
Document new work visuals, standards
Team Leader update
Day 4:
Train associates on process changes
Trial new process
Troubleshoot issues
Establish visual process dashboard
Team Leader update
Day 5:
“Go-live” with new process
Observe and support associates in work area
Present summary to leadership
Rapid-Cycle Improvement (Kaizen)
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DENY
RESIST
ACCEPT
EXPLORE
Attitude Shift
Typical Change Reaction Model During Rapid-Cycle Improvement (Kaizen)
Perfo
rman
ce L
evel
Time
Shock
Anticipation
Betrayal
Depression
Acceptance
Search for Solutions
Develop Plans
Execute Plans
Emerge Stronger
Guilt
Anger
Fear
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INITIATING & EXECUTING THE IMPROVEMENT PLAN
Month 1 Month 2 Month 3 Month 4 Month 5 Month 6
6 – 8 Weeks PRIOR………………………. 4 Weeks PRIOR………….…..
< 2 Weeks PRIOR……..
Rapid-Cycle Improvement (a.k.a. Kaizen) Workshops - These improvement events typically span 5 consecutive days and will include one or more “lean” improvement tools such as Visual Workplace, 5S, Standard Work, Material Pull (kanban) and/or Quick-Changeover among others.
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Value Stream Maps identified over $1.5 million in improvements related to Quality processes identified as key focus areas in the K-HEN
Standard Work 5s/Visual Management
Transactional Process Improvement Material Pull
Variation Reduction Quick Change Over
3P-Process Product People, Lean Design
Example K-HEN Rapid Cycle Improvement Event
What we did Revision of procedures • Catheterization and Intake / Output. • Procedures submitted for review / approval. • Changes include:
• Cleansing process at catheter insertion • Castile towelette / soap-water • Betadine swabs.
• Incorporated betadine swab sticks • Clarified labeling expectations • Added sections for emptying catheter and
transporting patients with catheters.
Penny
What we did Revision of procedures
• Visual aids added to procedures
Penny
What we did • Daily evaluation of need
• Ensure that Foley Catheters are only inserted when warranted. (CDC guidelines)
• Request to add to Clinical Care Station. • Request to add to CPOE. • Added to SBAR for every floor (number of days and indication) • Updated all SBARs – now electronic copies for every floor!!! • Request to add to rounding and huddle.
Toniann
Process Changes • Urinal and specipan
• Only one type of waste per container • Label and date container • New container every 72 hours. • Reason: avoid contamination
• Wiping Outlet Hose after Emptying. • Clean outlet hose with alcohol swab after emptying catheter. • Reason: avoid contamination
• Reinforce the use of the stickers and the statlocks
Toniann
Transport Changes • Identified that wheelchairs did not
have a place to hang the Foley bag below patient bladder during transport.
• Added cable and changed process. • Slide bag through the back and the
seat of the chair, hang on the cable.
• Trial run 12/12 – SUCCESS!!
Added plastic cable to wheelchair
Toniann
Empty patient bag
before transport
Metrics • Created a split chart for each floor
showing house wide performance and floor performance for CAUTI rate.
• Placed charts in staff restrooms on every floor.
• Charts to be updated monthly.
Polly
Training • Identified training
necessary by function • Working with Staff
Educator and Bard Representative to develop simulation training program for mid-January
• Opportunity for policy review as well as hands-on training.
• GOAL – Consistent best practice housewide
Polly
“Being Present” in the Workplace or “Gemba” • “Gemba” means “the real place where the truth can be found” or where the actual work takes place
• very important to have a clear and obvious focus and purpose when you are rounding through the workplace
start simple with a focus on facility 5S & Rapid-Cycle Improvement (Kaizen) follow-up progress into a focus on red indicators on your department performance boards without focus, you’ll accomplish nothing and confuse everyone on priorities
• perform DAILY couple minutes of observation of the new process for compliance brief review of the posted process measure(s) to understand performance inquiry to at least one associate on how it’s made their job easier should take no longer than 5 – 8 minutes, unless there are significant issues anything exceeding this time increment is a sign of poor technique
• use as a mechanism to deploy a Rapid-Cycle Improvement (Kaizen) team to address significant process issues
Workplace Presence or Gemba Walks are THE most effective practice to promote continual improvement behaviors!
“Think and speak based on verified and proven data. Go and confirm the facts yourself” (Jeff Liker, The Toyota Way).
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INITIATING & EXECUTING THE IMPROVEMENT PLAN
Month 1 Month 2 Month 3 Month 4 Month 5 Month 6
6 – 8 Weeks PRIOR………………………. 4 Weeks PRIOR………….…..
< 2 Weeks PRIOR……..
Lean Daily Management Workshops – This partnering work provides a lean-based managerial structure generally intended to be standard work for your “front-line” leaders (supervisors and managers). This structure becomes the key foundation to ensure improvement activity becomes “the way we operate” going forward.
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Several hospitals in the KHA have implemented this critical problem solving tool and are using it successfully to improve patient safety and care
Key Performance Metrics by Department
Area Safety Safety Quality Delivery Cost Cost Productivity
CCU
NA
Zero pts with missed beds ide
reports
Target = 0
No missed orders
Target = 0
No more than 5 late med passes
per day
Target = 0
NA
El iminate early clock ins and
late clock outs
Target = 0
NA
Med Surg
El iminate fa l l s
Target = 0
No more than 10 pts with missed hourly rounding
per dayTarget = 10
Zero incomplete white board
Target = 100%
No more than 5 late med passes
per day
Target = 5
NA NA NA
Pharmacy
El iminate mis label ing IV
premixes/insul ins
Target = 0
NA NA
Reduce occurances of
lost meds
Target <5
El iminate waste due to out of
date meds
Target = 0
NA
Reduce number of Omni cel l s tock outs
Target = 0
ReHab
100% compl iance to pt PT/OT/Speech
needs on the "white board"Target = 100%
NA
100% compl iance to pt
eva luation checkl i s t
Target = 100%
100% POS documentation
Target = 100%
NA NAPt care time at
80%
Target = 100%
Case Mgmt
100% compl iance to pts sent home
with safe discharge plans
Target = 100%
NA
Increase occurances of
LACE tool completed da i ly
Target = 100%
100% compl iance to discharge plan review before
day of dischargeTarget = 100%
El iminate unplanned pt
readmitted
Target = 0
NA NA
Fleming LDM Metrics
20 Julie
LDM Gemba Board- Med Surg
21 Gabe
Month 1 Month 2 Month 3 Month 4 Month 5 Month 6Assessment Event
Improvement EventDaily Managment Event
“Set” of Value Stream
Improvements
PRACTICAL APPLICATION EXAMPLE
Executive Workshop
Staff Awareness Training Results Realization
Improve OR Utilization from 42% to 70% by DEC 2012
Surgical Services Value Stream Mapping Event (3 Day Event)
EXAMPLE APPLICATION:
Pre-Operative Standard Work Event (5 Day Event to cycle
time from arrival to OR)
OR Quick Changeover Event (5 Day Event to time from wheels out to next in OR)
Lean Daily Management Event (5 Day Event, establish daily workplace routine in Pre-Op, OR, PACU &
Sterile Processing)
Case Scheduling Standard Work Event (5 Day Event to average # daily cases between 7a – 4p)
Case Cart Variation Reduction Event (5 Day Event to case cart complete &
accurate by 7a day of case)
1
2
3
4
5
Month
Month
Month
Month
6 Month
Month
Executing Process Improvements to Drive a Desired Outcome!
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EXAMPLE RETURN ON INVESTMENT TABLE
Improve OR Utilization from 42% to 70% by DEC 2012
ROI EXAMPLE CALCULATION:
We should expect a financially
quantified annual return of 3-5 times the investment in
EVERY SET of value stream
improvements!
1 Surgical Services Value Stream Mapping Event 3 Days $9,000 $1,200 0% A
2 Pre-Op: reduce avg cycle time from patient arrival to OR from 86 min to 57 min (34 %) 5 Days $14,000 $1,500 $25,000 $50,000 363% B
3 OR: reduce time from wheels out to next patient in OR from 58 min to 32 min (44%) 5 Days $14,000 $1,500 $25,000 $80,000 508% C
4 Lean Daily Management: daily routine implemented Pre-Op, OR, PACU & SP 5 Days $14,000 $1,500 $45,000 218% D
5 Scheduling: increase average # daily cases between 7a – 4p from 18 to 20 (11%) 5 Days $14,000 $1,500 $25,000 $87,000 $625,000 3566% E
6 Sterile Proc (SP): improve case cart complete & accurate by 7a day of case from 32% to 64% 5 Days $14,000 $1,500 $15,000 $75,000 435% F
Note A: improvement plan only - no change made $79,000 $8,700 $135,000 $87,000 $830,000Note B: pre-op productivity, case cancell ing reductionNote C: OR staff OT reduction, increased case add-onsNote D: PACU & CSP productivity, case cart accuracyNote E: further productivity gain, contribution margin from 11% more cases, cost of capital avoidance (OR suite build not req'd)Note F: instrument inventory reduction
*multiplied by 0.75 to account for organizational resources dedicated to improvement activity, DOES NOT INCLUDE IMPACT AFTER INITIAL YEAR
NoteEvent ROI*
900%
total returntotal investment
ExpensePractitioner
FeeDurationEvent: Performance ImprovementMonth
$1,052,000$87,700
Endorsed Financial ImpactCost
SavingsCost of Capital
Revenue Capture
Month 1 Month 2 Month 3 Month 4 Month 5 Month 6Assessment Event
Improvement EventDaily Managment Event
“Set” of Value Stream
Improvements
Executive Workshop
Staff Awareness Training Results Realization
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• 10% of what you read • 20% of what you hear • 30% of what you see • 50% of what you see and hear • 70% of what you say • 90% of what you say as you do (e.g., orally work out a problem)
- Robert W. Pike (1989)
Retention of Adult Learning
We Must Actively Involve Adults in the Learning Process through Experienced Application to
Maximize Retention & Master Skill!
DEVELOPING FACILITATOR COMPETENCY THROUGH CYCLES OF LEARNING
For EACH “core lean tool” (at a minimum): 30/60 Day Sustainment Checks
1 2
3 4
Questions & Answers
Steve Moore, VP/Program Director Healthcare Mike Holland, VP Lean Healthcare
2 years with NLP as a Vice President responsible for developing Health Care and associated markets
8 years with NLP as an Executive Level Practitioner with hands on experience in managing change, improving processes, driving to the root cause of problems, working with C Suite leaders managing in a team environment to transform companies and cultures.
20 years with Coca-Cola in Sales, Marketing, Operations, and Finance. 2 years with GE Capital in Six Sigma Management & Marketing in the Finance Industry. 3 years with Danaher in a Lean environment managing Operations, Customer Interface
Groups, and New Product Implementation. Six Sigma BlackBelt (DMAIC) Expert in 5s, Standard Work, Transactional Process Improvement, Variation Reduction,
Value Stream Mapping, Sales & Operations Planning, Visual Management, and Lean Daily Management.
Engagement Results Streamlined process in the Health Care market to include Hospital Systems, Critical Access
Hospitals, Ambulatory Surgery Centers, Labs, Provider and Physician offices, Clinical Administration, and Specialty Centers.
Successfully implemented Lean in Business Development in the Health Care markets supporting hospital systems.
Successfully implemented Lean transformation programs in adjacent markets to include technology, lab support, medical manufacturing, and administrative.
BSBA from the University of North Carolina, MBA from High Point University. Experienced in implementation internationally in Europe, Asia, South America, Canada, and Mexico. Working on fluency in Spanish.
Steve Moore Vice President/Program Director