2

Supply Chain Improvements: Moving from the model line to hospital wide

implementation

2014 Annual Healthcare Symposium: Lean Strategies in

Transforming Patient Care

Ryan Adams

Kristin Hurt; RN, MSN, CWOCN

Amy Sequeira

10-10-2014

Spectrum Health at a Glance

Spectrum Health:

Not-for-profit health system based in West Michigan

Spectrum Health Hospital Group, which is comprised of 11 hospitals

Helen DeVos Children’s Hospital

170 ambulatory and service sites

Medical Group, - 1,080 employed physicians and advance practice providers

Priority Health, a 575,000-member health plan

West Michigan’s largest employer with 21,300 employees.

The organization provided $250 million in community benefit during its 2013 fiscal

year.

History of Process Improvement at Spectrum Health

•

2004 2007 2009 2010 2011 2012 2013 2014

Operational

Improvement

Spectrum

Health Hospital

Group

HPI Training

Operational

Excellence

Spectrum Health

Medical Group

Herman

Miller

Partnership

Bronze

Certification

Vice

President

Process

Improvement

Denver

Health Visits

Director of

Process

Improvement

Visit to

ThedaCare

Center for

Healthcare

Value

Virginia

Mason

Visits

SHPIS

Operational

Improvement &

Operational

Excellence

Merge

MLC Gemba

Visit

CSII

Structure

Healthcare

Value

Network

Gemba Visit

MLC Annual

Healthcare

Symposium

High Level Improvement Continuum

Phase 1 -

Build the System

Phase 2 -

Create Models of Improvement

Phase 3 - Spread Improvement Throughout

SH

Phase 4 - Embed Improvement into our

Culture

Investm

ent

Retu

rn

5

Phase 1 -

Build the System

Phase 2 -

Create Models of Improvement

Phase 3 - Spread Improvement Throughout

SH

Phase 4 - Embed Improvement into our

Culture

Investm

ent

Retu

rn

6

Key Measures

7

Traditional

Lean Metrics

SHPIS Metrics Example

Quality, Safety, &

Cost

Drive Exceptional Value • Patient Outcomes

• Process Indicators (Hand washing)

• Patient Satisfaction Scores

• Expense Reduction

• Revenue Growth

Delivery, Patient

Experience

Transform the Care

Model

• Tele-health visits

• Throughput

• LOS Reduction

Growth Grow with Purpose • % Market share

• Panel size

• # Priority Health Members

People

Development

Lead New Health

Solutions

• Redeployment

• Golden Ticket Suggestion System

• Yokoten (Respect for People)

• Engagement (Event Participation)

8

A3 Problem Solving

Why is an Improvement Structure Needed?

Top Management

Middle Management

Line Management

Front line

Maintenance

Innovation

Traditional perception of job functions

Top Management

Middle Management

Line Management

Front line

Maintenance

World class perception of job functions “Kaizen,” Imai, 1986

Because most

organizations

are built for

firefighting

Innovation

Phase 1 -

Build the System

Phase 2 -

Create Models of Improvement

Phase 3 - Spread Improvement Throughout

SH

Phase 4 - Embed Improvement into our

Culture

Investm

ent

Retu

rn

10

VSA – Value Stream Analysis

Define the customer and what they

value

Develop understanding of the

Current State process

Develop the Future State for the

process

Develop metrics to measure

success

Develop detailed action plan

11

RIE – Rapid Improvement Events

Small teams of people focused on

improving a part of a value stream

Using a structured process

(PDCA and A3) with clear targets

Developed to train staff and deliver

results by the end of the activity

Rapid Improvement Events engage

teams in generating, testing and

implementing new ideas.

13

Models of Improvement

Primary Care

Surgery

Cath Lab

Children’s Ambulatory

Services

Priority Health

Supply Chain

Pharmacy

Neuroscience

Urgent Care

Information Systems

Research

Facilities

Emergency Department

Physician Revenue Cycle

Critical Care

Electronic Health Record

Rehab and Nursing

Breast Care Services

Phase 1 -

Build the System

Phase 2 -

Create Models of Improvement

Phase 3 - Spread Improvement Throughout

SH

Phase 4 - Embed Improvement into our

Culture

Investm

ent

Retu

rn

14

15

How do we share improvement?

16

Spread Improvement Throughout

Model Lines

• Transforming areas to

support strategy of

the organization

• Complete A3s

• VSA, RIE engine

Future Sites

• Require similar

transformation

• Pull knowledge when

needed

Completed

A3s

Virtual

“Binders”

New Learnings

Pull

Yokoten

17

Start with the Model Line

SCM Equipment Optimization

Putting needed equipment closest to

the point of use to avoid delays in

patient care

Current state:

No standard equipment process,

patient /staff waiting for needed

equipment

Emergency orders for equipment:

Cardiac Unit 111/month

Critical Care 159/month

Start with the Model Line

18

Start with the Model Line

19

Cardiac Unit Critical Care Unit

Current State 111 159

30 Days Post RIE 10 0

60 Days Post RIE 6 2

90 Days Post RIE 0 0

Spread Improvement Throughout

Current state of pilot hospital

Hospital emergency orders

174/month (9 nursing units)

20

21

Spread Improvement Throughout

Advantages of our spread process-

Leadership and managers

• Have “Bought In”

• Are problem solvers

• Are improving the process

• Act as advocates

22

Results

Emergency Orders

Prior State 174

30 Days Post “Go Live” 63

60 Days Post “Go Live” 45

Seeing Results and a Retrospective Review

23

24

Reflections from adopting units

Phase 1 -

Build the System

Phase 2 -

Create Models of Improvement

Phase 3 - Spread Improvement Throughout

SH

Phase 4 - Embed Improvement into our

Culture

Investm

ent

Retu

rn

25

26

Embed Improvement into Our Culture

Transformation Control Center

Bronze Certification

Managing For Daily Improvement

27

Daily Huddle

Golden Ticket Flow

New Golden Ticket

Reviewed in Huddle

Value / Effort Grid

Top 3

1

2

3

Completed

Standard Work Compliance

Audit cards with

status color

Audit cards

Standard

work

30

Leadership Standard Work

Operate to daily standard work

What huddle are you attending and when?

When and what Gembas will you visit today?

What did the information board tell you today?

How will you help a leader to help solve these issues?

High Level Improvement Continuum

Phase 1 -

Build the System

Phase 2 -

Create Models of Improvement

Phase 3 - Spread Improvement Throughout

SH

Phase 4 - Embed Improvement into our

Culture

Investm

ent

Retu

rn

31

Summary

Choose Measurements

Limit the scope

Create a plan of action

Take action Share the knowledge

Mentoring, Teaching, Coaching

Lessons Learned

Leadership Engagement (Must Have)

Model Value Stream Approach

“See what good looks like”

Pace of Change

Prioritization

Expect Results!