involving the hospital leadership in lean quality improvement
TRANSCRIPT
INVOLVING THE HOSPITAL LEADERSHIP IN LEAN QUALITYLEADERSHIP IN LEAN QUALITY
IMPROVEMENT
Richard Mitchell M.D.Georgia Institute of TechnologyEnterprise Innovation Institute
LEAN Healthcare GroupLEAN Healthcare Group
Who are we…
We help Georgia businesses, industries, and
Who are we…
communities to be more competitive through science, technology and innovation.
Georgia Tech’s Motto: Progress & Service
ENROLLING THE EXECUTIVE STAFF
• Why they need to be enrolled
• How to go about it
• What if they stay behind and not in front
• What is your experience and tips
We learned the “hard way” thatWe learned the “hard way” that …
• Leadership cannot “support” this … they mustddrive it!!!
• Lean radically changes themanager rolemanager role.
John Toussaint, CEO of ThedaCare,
The Lean JourneyThe Lean Journey
Problem Statement:
E ti t i ft l t i th• Executive management is often lost in the whirlwind…They are intent on meeting this month and this years goals.y g
• Lean is a long term commitment• They do not see that they have time to leave the
ffi h boffice to go to the gemba• Lean often increases capacity, however there may not be demand for the servicenot be demand for the service
• HR issues of decreasing/redeploying workers• Light green vs. dark green dollarsLight green vs. dark green dollars
ENGAGAING THE EXECSSUPPORT THE ORGINAZATIONSSUPPORT THE ORGINAZATIONS
STRATEGIC GOALS
• TRAININGTRAINING
• PROJECT SELECTION
PERSONAL PARTICIPATION• PERSONAL PARTICIPATION
• RESULTS AND FOLLOW UP
• LEAN CHAMPION AT THE EXECUTIVE LEVEL
Mechanics of ImplementationMechanics of Implementation
Assessment
Executive Project S l ti
ReportR lt Team
Project
Selection
Follow‐up &
Results
Preparation
Rapid Process Improvement
(RPI)
Standardize
(RPI)
ENGAGAING THE EXECS
• PROJECT SELECTION … At least have the Execs choose the projects and Demo Area ( Lean Learning Lab)‐Steve Hoeft( g )
• ALIGN PROJECTS AND DEMO AREA WITH THE ORGS. STRATEGIC PLAN
PROJECT SELECTIONPROJECT SELECTION
• What are the critical areas of concern for thisWhat are the critical areas of concern for this org. Meet with Exec Staff, list:
• Patient safetyPatient safety• Patient satisfaction• Core measures• Core measures• ProductivityC t f t i l• Costs of material
• Labor cost
PROJECT SELECTIONPROJECT SELECTION• What are the critical areas of concern for this org. Meet with Exec Staff list set a weight forMeet with Exec Staff, list…set a weight for importance of each category 1‐5:
• Patient safety 5• Patient satisfaction 4• Quality‐Core measures 2• Employee retention 2p y• Costs of material 3• Productivity (revenue/#FTEs) 5
PROJECT SELECTIONPROJECT SELECTION
• Set values from 1‐5 for each category result.Set values from 1 5 for each category result. Working one on one with responsible Executive to determine scores. For instance: Material Costs…– 5‐Will reduce materials costs by $250,000 or more.– 4‐Will reduce materials costs by $100,000 or more.– 3‐Will reduce materials costs by $50,000 or more.– 2‐Will reduce materials costs by $10,000 or more.– 1‐Will reduce materials costs minimally or not at all
PROJECT SELECTION
ITEM CATEGORYCategory Weight Rating = 5 Rating = 4 Rating = 3 Rating = 2 Rating = 1
Could reduce orCould reduce or minimize an error which could result in death or serious physical or psychological injury to patient (loss of limb,
NEVER EVENT Could reduce, minimize or eliminate CMS "never event" not covered in sentinal
Could reduce, minimize or eliminate events which could cause minor injury to patient, including prolonging
Could reduce, minimize or eliminate events which do not directly affect patient safety but may cause concern or anxiety to patient or No improvement in
1 Patient Safety 5 other sentinal event) events care. family safety.
2 Patient Satisfaction 4
will significantly improve patient satisfaction..>20 points
will improve patient satisfaction by 10‐20 points
slight improvement in patient satisfacton
no improvement in patient satisfaction
may decrease patient satisfaction
can significantly i i
can improve one ifi littl ff t
may have adverse i t
3 Quality ‐ Core Measures 2improve core measure scores
can improve core measure scores
specific core measure score
little or no effect on core measure scores
impact on core measures
4 Employee Satisfaction (Retention) 2
will significantly improve employee satisfaction..>20 points
will improve employee satisfaction by 10‐20 points
slight improvement in employee satisfacton
no improvement in employee satisfaction
may decrease employee satisfactionWill only minimally
5 Material Costs 3
Will reduce materials costs by $250,000 or more.
Will reduce materials costs by $100,000 or more.
Will reduce materials costs by $50,000 or more.
Will reduce materials costs by $10,000 or more.
reduce materials costs; nuissance problem only.
Productivity will increase immediately
i l ti
Productivity will increase within 3 months of i l ti thi
Productivity will increase within one
f i l ti
Productivity will increase within 3 years f i l ti thi
Productivity will remain the same after i l ti thi
6 Productivity (Net Revenue/# FTEs) 5upon implementing this project.
implementing this project.
year of implementing this project.
of implementing this project.
implementing this project.
Project 1 Project 3Project 2Project Title
Description
jClinical Lab VSM
Flow of specimins from order received in the lab to
results on the chart
jMed/Surg 5S
Rework storage areas on one Med/Surg floor and establish the setup to be followed throughout the Hospital
Patient flow through department from check in to discharge. Evaluate reasons
for prolonged LOS
ED flow project
j
OwnerExecutive Sponsor
CATEGORYWEIGHT FOR CATEGORY
RATING ASSIGNED
CATEGORY SCORE
RATING ASSIGNED
CATEGORY SCORE
RATING ASSIGNED
CATEGORY SCORE
1 P ti t S f t 5 2 10 4 20 2 10
3 North Charge Nurse
results on the chart
Director of Lab
COO CEO
throughout the Hospital
CNO
ED Clinical Manager
for prolonged LOS
1 Patient Safety 5 2 10 4 20 2 10
2 Patient Satisfaction (Service 4 4 16 5 20 2 8
3 Quality ‐ Core Measures 2 3 6 3 6 2 4
4 Employee Satis. 2 5 10 2 4 5 10
5 Material Costs 3 2 6 3 9 4 12
6 Productivity 5 4 20 4 20 4 20
PROJECT SCORE 68 79 64
SCORE FOR PROJECT 1 IS 10+16+6+10+6+20=6810+16+6+10+6+20=68
C tITEM CATEGORY
Category Weight Rating = 5 Rating = 4 Rating = 3 Rating = 2 Rating = 1
Could reduce or minimize an error which could result in death or serious physical or
NEVER EVENT Could reduce, minimize or eliminate CMS
Could reduce, minimize or eliminate events which could cause
Could reduce, minimize or eliminate events which do not directly affect patient safety
1 Patient Safety 5
physical or psychological injury to patient (loss of limb, other sentinal event)
or eliminate CMS "never event" not covered in sentinal events
which could cause minor injury to patient, including prolonging care.
affect patient safety but may cause concern or anxiety to patient or family
No improvement in safety.
will significantly improve patient
will improve patient satisfaction by 10‐20 slight improvement in no improvement in may decrease patient
2 Patient Satisfaction 4 satisfaction..>20 points points patient satisfacton patient satisfaction satisfaction
3 Quality ‐ Core Measures 2
can significantly improve core measure scores
can improve core measure scores
can improve one specific core measure score
little or no effect on core measure scores
may have adverse impact on core measures
will significantly i l
will improve employee ti f ti b 10 20 li ht i t i i t i d
4 Employee Satisfaction (Retention) 2improve employee satisfaction..>20 points
satisfaction by 10‐20 points
slight improvement in employee satisfacton
no improvement in employee satisfaction
may decrease employee satisfaction
5 Material Costs 3
Will reduce materials costs by $250,000 or more.
Will reduce materials costs by $100,000 or more.
Will reduce materials costs by $50,000 or more.
Will reduce materials costs by $10,000 or more.
Will only minimally reduce materials costs; nuissance problem only.
Productivity will
6 Productivity (Net Revenue/# FTEs) 5
Productivity will increase immediately upon implementing this project.
increase within 3 months of implementing this project.
Productivity will increase within one year of implementing this project.
Productivity will increase within 3 years of implementing this project.
Productivity will remain the same after implementing this project.
Project 1 Project 3Project 2Project Title
Description
jClinical Lab VSM
Flow of specimins from order received in the lab to
results on the chart
jMed/Surg 5S
Rework storage areas on one Med/Surg floor and establish the setup to be followed throughout the Hospital
Patient flow through department from check in to discharge. Evaluate reasons
for prolonged LOS
ED flow project
j
OwnerExecutive Sponsor
CATEGORYWEIGHT FOR CATEGORY
RATING ASSIGNED
CATEGORY SCORE
RATING ASSIGNED
CATEGORY SCORE
RATING ASSIGNED
CATEGORY SCORE
1 P ti t S f t 5 2 10 4 20 2 10
3 North Charge Nurse
results on the chart
Director of Lab
COO CEO
throughout the Hospital
CNO
ED Clinical Manager
for prolonged LOS
1 Patient Safety 5 2 10 4 20 2 10
2 Patient Satisfaction (Service 4 4 16 5 20 2 8
3 Quality ‐ Core Measures 2 3 6 3 6 2 4
4 Employee Satis. 2 5 10 2 4 5 10
5 Material Costs 3 2 6 3 9 4 12
6 Productivity 5 4 20 4 20 4 20
PROJECT SCORE 68 79 64
ENGAGAING THE EXECSENGAGAING THE EXECS
• TRAININGE h i d h LEAN P i i l– Enough to introduce them to LEAN Principles (LEAN Cool Aid)
Thi k JIT f f th t i i l ith th i– Think JIT for further training…along with their individual projects
ENGAGAING THE EXECS:PARTICIPATION
• Participation in their RPI (VSM or Kiazan event)event)
• A personal LEAN project concerning their own work
• Go to the Gemba
• Meeting free zone…
Mechanics of ImplementationMechanics of Implementation
Assessment
Executive Project S l ti
ReportR lt Team
Project
Selection
Follow‐up &
Results
Preparation
Rapid Process Improvement
(RPI)
Standardize
(RPI)
ENGAGAING THE EXECS:FOLLOW UP• The Execs RPI is a one year processThe Execs RPI is a one year process
– Follow up with the Exec. Sponsor at 3,6,9 and 12 monthsThi t lt t th E ti T– This sponsor reports results to the Executive Team
• Show them the Results– Calculate savings Dollars for the CFO Use a LEANCalculate savings…Dollars for the CFO. Use a LEAN budget category
– Patient safety and satisfaction resultsE l f db k– Employee feedback
– 3 month team presentation to hospitals leadership group
If you can’t enroll the Execs
1. Find new Execs
2. Find a new Job
3. Continue with an effective lean demonstration project (project lean)
– Execs may become excited and enrollxecs may become excited and enroll
– Continued successes are possible
– Organizational transformation is unlikelyOrganizational transformation is unlikely
Georgia Tech’s ApproachGeorgia Tech s Approach
© 2011 Georgia Tech Research Corporation
The Lean JourneyThe Lean Journey
