maximizing roi during a lean transformation
TRANSCRIPT
Maximizing ROI During A Lean Transformation
Typical ROI Parameters
CostStartupRecurringConsultantsPersonnel
Expected Returns/BenefitsGenerally $$$Could be outcomesCustomer/Employee Satisfaction
TimeWhen will we achieve benefits to cover costs
To Accelerate ROI
↓ Expense or Cost↓ Time Modify Goals – Focus on areas with greatest opportunity
Lean Transformation
Built in ROI“Only improvement methodology which doesn’t rely on a catastrophic event as a catalyst for change”“Ongoing continuous improvement through the relentless elimination of waste”
True Lean ROI
Dependent on:Staff EngagementCultural ChangeSuccess of Kaizen EventsSustainment of Improvement
Cultural Transformation
Cultivating an entire staff of “Wasteologists”The value of an engaged and aware workforce working in the least-waste way is immeasurable and invaluable
$$$$$$
Staff SatisfactionStaff Satisfaction Patient SatisfactionPatient Satisfaction
Patient SafetyPatient Safety$$$$$$
Staff SatisfactionStaff Satisfaction Patient SatisfactionPatient Satisfaction
Patient SafetyPatient Safety
QUALITYQUALITYImproved processImproved process
Improved flowImproved flowImproved informationImproved information
Transformation Theory
Transformation Theory vs. Healthcare Challenges of TodayIncreased pressure to maximize returns due to reductions in reimbursements and ever changing healthcare standardsDemand ROI that are measureable, sound, profitable, and immediate
Jacobi Medical Center Campus
FY10 Jacobi NCB
# of Beds 479 243
Discharges 22,100 9200
Outpatient Practices
Visits
386,000 200,000
Emergency Department
Visits
113,400 61,000
Ambulatory Surgery Cases
9,500 2,700
Statistical Profile
Jacobi Specialty Programs
• Emergency Medicine
• Regional Snakebite Center
• Level 1 Trauma Center
• FAA-Approved Helipad
• Pediatric Trauma Center
• PICU
•Hyperbaric Chamber
•NYS-Designated Regional
• Perinatal Center
• Level III NICU
• Burn Service
• NYS-Designated Stroke Center
• Medical Oncology Program
• Breast Service
• Rehabilitation Medicine
• Pediatric Surgery
• Craniomaxillofacial Surgical
Institute
• Cardiac Cath Lab
• Bariatric Surgery Program
Lean Kaizen Events
0100200300400500600700800
2008 2009 2010
StaffParticipation
# of Kaizen Events # of Staff Participation
149 1478
Examples of Jacobi Improvements
Reduced Dwell Time in ED 3 hoursIncreased volume of surgeriesIncreased billing due to a better registration processIncreased Medicaid applicationsReduced patient travel, improving patient safety
OPD Revenue Cycle: Reason For Action
OPD Revenue Cycle:Initial State
Year 1 - 11 RIEs
OPD Revenue Cycle Value Stream:Confirmed State
OPD Revenue Cycle Metrics
JacobiMonthly Breakdown OPD
1000
3000
5000
7000
9000
11000
Month
Cas
h R
ecei
pt
FY08FY09FY10FY11Linear (FY08)Linear (FY10)Linear (FY09)FY08 5392 5128 4603 1339 3509 4021 4384 4197 10087 5599 5487 5764
FY09 4881 5082 4948 4293 4357 5329 4766 5440 6300 10227 5529 6210
FY10 4680 7137 6944 4948 5353 6245 5638 5084 6727 6594 11739 5876
FY11 5796 5436 5416 5768 9010 8428 5951 5830
July August September October November December January February March April May June
OPD Revenue Cycle Metrics
400004500050000550006000065000700007500080000
FY08 FY09 FY10 FY11
JMC
200002200024000260002800030000320003400036000
FY08 FY09 FY10 FY11
NCB
** FY11 ↑ 8% Vs FY10 YTD
** FY11 ↑ 5% Vs FY10 YTD
AED Hospital Wide Flow: Reason For Action
AED Hospital Wide Flow: Initial State
AED Hospital Wide Flow: Target State
Year 1: 11 RIE’s
AED-Hospital Wide Flow:Confirmed State
CY11 5.5 LOS
Current Value Streams at Jacobi Medical Center/NBHN
Nursing - 8 RIEsRadiology – 6 RIEsPeri-Operative Services – 11 RIEsAdmitted Patient-Medicine – New Value StreamAdmission/Readmission – 4 RIEsAdult ED Flow – 16 RIEsBehavioral Health Services/Rehabilitation – 1 RIE
Current Value Streams at NCB Medical Center/NBHN
Nursing - 4 RIEsRevenue in Process – 5 RIEsWomen’s Health Services – 10 RIEsPeri-Operative Services – 7 RIEsMedicine – 4 RIEsBehavioral Health Services – 6 RIEs
Maximizing your ROI
Directly related to the success of Kaizen Events
Stacking the Deck for Success
Enterprise Goals
Goals and Targets should be well defined, inter-related, and support each otheri.e. if financial performance ↑ but patient safety ↓, is this ok?
Leadership
Senior Leadership should be “All In”Setting goals and participating activelyEncourage and support true transparencyIntegrate Lean into all hospital-wide strategic planning
“You don’t know what you don’t know”
Choosing Lean Leader (Transformation Officer)
Respected in the organizationWell-KnownHave established credentials
“If you want something done, give it to a busy person to do”
Integration of Lean Message
Consolidate meetings utilizing Lean Metrics and hospital wide dataAgenda at all:
Hospital Wide MeetingsService Line MeetingsExecutive MeetingsAffiliateCAB MeetingBoard Meetings
Integration of Lean Message
Not the “Flavor Of the Month”“Lean is the way we work, not in addition to how we work”
AdvertiseCommunicate
Educate
Integration of Lean Message
Ongoing Lean CurriculumPart of New Employee OrientationStaff Engagement is critical and is the key component to maximizing ROIAs time ↑ and more staff are actively practicing Lean, improvement will become the way you work and good won’t be a barrier to great
Aim for Early Success
“Low Hanging Fruit”, “Fruit on the Floor”Sustainment will fertilize the treeEarly successes will support spread and enhance the Lean transformation
Metrics for Success
Metrics should be easily defined and measurable using existing data“Figures don’t lie, liars figure”
Understand the genesis of the data and how it originates
Driver Metrics
Use driver metrics:# of steps saved# of completed
registrations# follow-up phone calls
To ultimately reach targets:Length Of Stay
ReductionRevenue
Length Of Stay
# of Steps # of handoffs
The best Kaizen Events are….
Events that are well choreographedTransformation should not be a random sequence of events with the results dictated by chancePlan, Plan, Plan
Select proper staff, times, and dataPre-meetings, targets, metrics
“The more I practice the luckier I get”- Gary Player
Scoping Events
Scope the Kaizen Events as tightly as possible“A mile deep and an inch wide”“Do not boil the ocean”It is the collective changes and dovetailing of events that will bring the greatest returnsSelect subject matter experts at all levels
Lean Words to Live By
Listen! Listen! Listen!Walk Around!Observe!
You don’t know what you don’t know, but your staff does
Sustainment
Sustainment is the key to a successful transformation and greatly accelerates ROIStandard work is the critical linchpin for sustainmentDemand It!
Ensuring Lean Success
Assign strong, responsible parties to monitor past event progress/completion plans and follow upsHave regular scheduled program reviews
Target adjustmentsIdentify new areas of focusPriority shiftsFuture schedules
Lean Lessons to Share
Creativity Before CapitalFlexibility over rigidityThere are no “Bad” EventsAvoid the “doing more with less” trap
Creates resentment, excuses, makes bad processes more inefficient, and promotes mediocrity
Don’t Be Shy!!!
Celebrate your successDon’t be afraid to highlight true progress
Questions? Comments?