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Lean At Denver Health: Saving Lives, Saving Money, Saving Jobs
Phil Goodman
Director
Lean Systems Improvement
What is LEAN?
• LEAN can be defined as a systematic approach of
continuous improvement, based on the Toyota
Production System (TPS) of LEAN principles and
LEAN tools, used for the identification and
elimination of waste.
Lean Pillars of Transformation
Transformation R
esp
ect
for
Peo
ple
Con
tin
uou
s
Imp
rovem
ent
Lean Deployment at Denver Health
• Process Transformational Plan of Care Value Streams Rapid Improvement Events • Black Belts • Application in healthcare settings • Results
Selecting Value Streams: The Matrix
One Year
Enterprise Goals
Weight RankRxWRankRxWRankRxWRankRxWRankRxWRankRxWRankRxWRankRxWRankRxWRankRxWRankRxWRankRxWRankRxWRankRxWRankRxW
Financial: Improve Net
Revenue 10%5 5 25 5 25 5 25 5 25 2 10 4 20 5 25 3 15 5 25 4 20 5 25 5 25 5 25 5 25 5 25
Delivery (Timeliness)
Reduce Lead Time 50%4 4 16 4 16 4 16 4 16 3 12 2 8 3 12 5 20 5 20 4 16 4 16 4 16 2 8 4 16 4 16
VOC: 90th Percentile Pt
Satisfaction3 5 15 4 12 5 15 3 3 3 9 1 3 5 15 2 6 5 15 4 12 5 15 3 9 2 6 4 12 3 9
Growth/Access :
Increase Unduplicated 2 2 4 2 4 4 8 1 2 1 2 1 2 3 6 2 4 5 10 4 8 2 4 2 4 4 8 2 4 2 4
Quality: Reduce
Nosomial Infections1 1 1 3 3 5 5 5 5 1 1 1 1 1 1 1 1 3 3 3 3 5 5 2 2 2 2 3 3 1 1
Total
OB
60
Ca
se
Mg
mt
49
ED
Pt F
low
Ima
gin
g
Ph
arm
acy
Ca
th L
ab
OR
Wo
un
d C
are
Pt. T
ran
sp
ort
Me
d R
eco
rds
Pt R
eg
./S
ch
ed
.
Eq
uip
Mg
mt
61 60 69
Me
d/S
urg
51 34 34 73 59 65
La
bo
rato
ry
4659 56
Re
ve
nu
e C
ycle
55
CORE Processes
Selecting Value Streams
Value
Stream
Analysis
(VSA)
Value
Stream
Analysis
(VSA)
Value
Stream
Analysis
(VSA)
Value
Stream
Analysis
(VSA)
Rapid
Improvement
Event (RIE)
Rapid
Improvement
Event (RIE)
Rapid
Improvement
Event (RIE)
Rapid
Improvement
Event (RIE)
Rapid
Improvement
Event (RIE)
Rapid
Improvement
Event (RIE)
Rapid
Improvement
Event (RIE)
Rapid
Improvement
Event (RIE)
Rapid
Improvement
Event (RIE)
Rapid
Improvement
Event (RIE)
Rapid
Improvement
Event (RIE)
Rapid
Improvement
Event (RIE)
Rapid
Improvement
Event (RIE)
Rapid
Improvement
Event (RIE)
Rapid
Improvement
Event (RIE)
Value
Stream
Analysis
(VSA)
Transformation Plan of Care
(TPOC)
Enterprise Transformation Alignment
System Metrics
Value Stream Metrics
RIE Metrics
Quality Delivery
(Access)
Productivity Financial Human
Development
Nosocomial
Infections
ED Divert Visits per
Session
Expense per
D/C or
Encounter
Employee
Engagement
OB ED/
AUC
Spec
Clinic
Rev
Cycle HR MC Rx BHS RMP
DC RN OR CP Med
D/C
CHS
RIE
RIE
RIE
RIE
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Enterprise LEAN Alignment “Constancy of Purpose”
2012 Value Streams Value Stream Executive Sponsor Value Stream Executive Sponsor
Emergency Department Phil Mehler MD, CMO Pharmacy Rick Dart, MD Director, RMPDC
Human Resources (HR)
Gregg Rossman, Chief HR Behavioral Health Stephanie Thomas Chief Operating Officer
Managed Care MC
LeAnn Donovan, Director, MC
OB/Gyn Chris Carey, MD Chief OB/Gyn
Nursing Kathy Boyle, CNO Ambulatory Care Paul Melinkovich, MD Chief Ambulatory Care
Perioperative Svcs Kathy Boyle, CNO Revenue Cycle Peg Burnette, Chief Financial Officer
Clinical Processes Tom MacKenzie,MD Director Pt Safety and Quality
Medical Discharge Rick Albert Chief of Medicine
Rapid Improvement Event (RIE) Simpler
–Using LEAN Tools in Focused Manner
Day 1
Mon
• Examine a process/function or area
• Identify areas of waste, non-value added steps
• Identify metrics
Day 2
Tues
• Develop new process, standard work and communication to eliminate
identified waste and increase value
• Design rapid experiments
Day 3
Weds
• Implement the new processes, standard work
• Monitor production board and communicate standards
• Observe new process and any change in metrics
Day 4
Thurs
• Adjust and fine tune new standard work
• Put visual controls in place
Day 5
Friday
• Celebrate! Report out to executive staff
• 10 minute team reports
Lean Deployment at Denver Health
• Process Transformational Plan of Care Value Streams Rapid Improvement Events • Application in healthcare settings • Blackbelts • Results
Pediatric Access RIE Team
Let’s just say that there’s a certain level of bonding
that occurs in RIEs
Examples of RIEs Clinical Rapid Improvement Event Non-Clinical Rapid Improvement Event
Venous Thromboembolism
Prophylaxis
Standardized use of Low Molecular
Weight Heparin (LMWH),
Unfractionated Heparin (UFH), and
Sequential Compression Devices
(SCD)
Managing Facility Charge Denials
By putting rules in Med Assets,
putting standard work into place for
denials management and
communicating with registration, UM
and Contracts Management about
denials that can be prevented on the
front end, we believe we can reduce
outstanding denials by 15%, or
$225,000
Oct 2011 Baseline: 5.7% Target ( 15%): 4.9% June, 2012 Denials: 3.3%
Lean Deployment at Denver Health
• Process Transformational Plan of Care Value Streams Rapid Improvement Events • Black Belts • Application in healthcare settings • Results
Denver Health Lean Academy/
Black Belt Training Lean Tools to “Diagnose” Waste Lean Tools to “Treat Waste”
Process Mapping Standard Work
Time Observations Poke Yoke (Mistake Proofing)
Level Loading Diagram Kanban (Pull Systems)
Spaghetti Diagram 6S (Sort, Set, Shine, Standardize, Sustain, Safety)
Communication (Handoff) Circle Andon (Stop the Line)
Waste Walk Visual Management
A3 Problem Solving A3 Problem Solving
Black Belt Project Example:
Common Canister
Inhalers for Asthma and COPD: Combivent, Albeterol, Atrovent, and Flovent
Pharmacy/Respiratory Therapy “Common Canister” Black Belt Project: Pre Lean: 6,624 canisters/year
Post Lean: 2,381 Canisters/year
Savings in Acquisition Costs: $363,000!
(75% Reduction)
Lean Deployment at Denver Health
• Process Transformational Plan of Care Value Streams Rapid Improvement Events • Black Belts • Application in healthcare settings • Results
Pre-Hospital:
Denver Health Paramedic Value Stream Paramedic Division Response Time Performance Pre and Post RIE
700
720
740
760
780
800
820
840
860
880
EMS EMS EMS EMS EMS EMS EMS EMS
<48 48 49 50 51 52 53 1
Weeks of 2008-2009
Res
po
nse
Tim
e in
Sec
on
ds,
911
An
swer
to
Arr
ival
at
90%
Co
mp
lian
ce
RIE Conducted
This Week
Denver Health Paramedic Value Stream
Denver Health Paramedic Value Stream
Total Personnel, Operating Expenses and Revenue 2007-2012
Note Revenue >Operating Expense 2011-2012
Hospital Flow and Readmissions
Hospital Acquired Conditions
UHC Quality and Accountability Aggregate Score
Outpatient:
Community Health Services
2005 2006 2007 2008 2009 2010 2011
Total Patients 102710 101162 103826 108042 113003 117058 123614
0
20000
40000
60000
80000
100000
120000
140000
Total CHS Patients
Community Health Services
Improving Outpatient Quality
Improving Outpatient Quality
SUMMARY • Lean is a philosophy and tool set that fits for healthcare
• Eliminating waste improves quality of care
• Lean tools are intuitive
• Frontline staff must be respected because they understand where the waste exists and how best to eliminate it
• Lean has the power to change culture because it truly empowers employees to break down silos, rapidly implement change and own the process!