Applying Lean Six Sigma to your Compliance Program

Transcription

1 Applying Lean Six Sigma to your Compliance Program April 2, 2014 John Kalb, JD, CHC, CCEP Operational Excellence Executive/ Compliance Officer Kootenai Health 1 Content Lean Six Sigma s goals of reducing waste and variation can help improve organizational compliance An overview of the application of the methodology to understand how it supports a culture of compliance Learn specific tools that can be applied throughout your organization to increase standardization and compliance 2 Lean Six Sigma Leadership Culture Honor and Respect People your people have good ideas recognize and reward them for that allow them to contribute through collaboration and empowerment Honor The Customer they are the reason we exist figure out what they want and make improvements and create standards around what they want Honor Standards it is the sustain plan to keep things in compliance document what you do, do what you document and prove it in practice Error proof practices to ensure minimal regulatory intervention 3 1

2 The Lean Six Sigma Difference Change in Culture LSS System Focus People are not perfect and will make mistakes System factors cause many negative events/ issues Reliable outcomes are obtainable with the right mix of people and processes Traditional Individual Focus People who make mistakes are poor performers Systems performance will improve by removing poor performers 4 The Lean Six Sigma Difference Change in Culture So, What Are Some Of The Barriers To Compliance? Poor Communication Flawed Teamwork No collaboration Rushed Procedures Time Pressure Policies that are hard to follow Inadequate Interfaces Lack of error prevention expectations or accountability 5 Overview of Lean Six Sigma Methodology Lean Eliminate Waste/ Improve Flow Reduce cycle time Lower complexity Analysis of physical layout Known Solutions 3 5 day deployment/ implementation Six Sigma Reduce defects & variability High complexity Unknown root causes/ solutions Data driven control Strategy 4 8 month projects 6 2

3 Benefits of Lean Six Sigma Process Improvement Before After Same value, Less time and Resource! Work Time (value add) Wait and Other Time (no value) Business Improvement = Eliminate waste in and around Processes + Eliminate defects in Processes Lean Six Sigma 7 Lean Processes that Operate at Six Sigma Lean reduce steps & waste Flow # of process steps % 99.38% 99.98% % % 95.73% 99.97% % % 93.96% 99.96% % % 77.82% 99.00% % % 52.23% 97.70% % % 15.43% 93.26% % % 0.20% 84.97% % % 0.00% 79.24% % % 0.00% 50.15% % Repeatability Six Sigma reduce defects & variability 8 How reducing steps reduces defects Rolled Throughput Yield Patient A is treated in 3 Steps Triage Diagnostic Testing Diagnosis Y FP = 80% Y FP = 70% Y FP = 90% Patient A Treatment Rolled Throughput Yield = Product of the First Pass Yields Y RT = (0.80) (0.70) (0.90) =.504 = 50.4% Rolled Throughput Yield is the Probability That the Process to treat the Patient Will Produce Zero Defects 9 3

4 A Brief History of the Toyota Production System Lean It started in Japan at the Toyota Motor Company 1902: Sakichi Toyoda of the Toyota group, invented an automated loom that stopped anytime a thread broke. 1908: Henry Ford invents the moving assembly line and raises the daily wage to $5.00 ; continuous flow as a production method is created. The thing is to keep everything in motion and take the work to the man and not the man to the work. This is the real principle of our production and conveyors are only one of many means to an end. Henry Ford : Today and Tomorrow Several decades later Taiichi Ohno, a production engineer at the Toyota Motor Company applied the same concept as he sought to eliminate waste, or non value added activities, within the Toyota organization. In addition to stopping production at every defect (Jidoka), he employed another key concept, JIT (just in time). Together, Jidoka and JIT are the pillars of the Toyota Production System, supported by a foundation of Heijunka (level loading) the basis of Lean. 10 Where Does Lean Come From? The basic philosophy of Lean is to provide the customer with What they want When they want it Using the absolute minimum resources Key Terms Value an activity that administers care or provides a service or information to meet customer/ patient needs and requirements (usually something that the customer/ patient is willing to pay for) Value Stream Map A graphic map of steps that occur from a request for a product or service to delivery of the product or service. Similar to a process map but with greater amount of detail such as time taken, resources consumed, inventory etc. Value added a step, activity or a process that is perceived to add value to the customer/ patient; it transforms the product or service Non value added a step, activity or process that takes time, resources and/or space but does not contribute to adding value or satisfying customer/patient needs Value Enabling or Non Value Added Essential a step, activity or process that does not add value but must be done, usually required either because of regulations or as a pre requisite to completing a value added step Muda = Waste anything that takes resources but creates no value for the customer, usually an excessive or unwanted step, resource, or activity TAKT Time the rate at which a customer/ patient demands a product or service TAKT Time is NOT Cycle time Pull used to describe the customer/ patient generating the demand for service / product as opposed to the producer pushing to the customer/ patient Kaizen / Kaizen event a Rapid Cycle Improvement 3 5 days where actual changes are made (Action) i.e. processes are changed, equipment is moved etc. 12 4

5 Lean Thinking Process The 5 steps to Lean Thinking Define value in from the customers perspective and express value in terms of a specific product 1 Specify Value 2 Map the Value Stream Map all of the steps value added & non value added that bring a product of service to the customer 5 Work to Perfection The complete elimination of waste so all activities create value for the customer 4 Implement Pull 3 Establish Flow The continuous movement of products, services and information from end to end through the process Nothing is done by the upstream process until the downstream customer signals the need Four Rules of Lean 1. Work activities are specified to: Content what is being done Sequence in what order Timing how long should it take Outcome what are the expected measurable results 2. All connections must be simple and direct 3. Pathways are simple and involve as few steps and people as necessary 4. Continuous Improvement by those doing the work and as close to the problem as possible Assign corrective action and improvement Follow up on the previous day s action items 14 Toyota Production System TOYOTA Toyota Production System Single Piece Flow Pull Production TAKT Time Production Just-in-Time Jidoka Autonomation Stopping at Abnormalities Heijunka Level Loading Sequencing 5

6 Toyota Production System: Jidoka Reasons to Stop a Process: Defective Material (Rapid Response Team) Material Shortage (Flash Sterilization) Equipment Breakdown Andon Boards (Call Lights) Sounds (Machine warnings) Make everything visible to everyone: Expose waste Make standards clear Improve efficiency The Lean Toolkit Basic Lean Tools Identifying and Eliminating Waste Value Stream Mapping (VSM) Root Cause Analysis Using 5 Whys 5S Spaghetti Mapping Takt Time Standard Work Level Loading & Sequencing Single Piece Flow Daily Action Review 17 The 8 Types of Muda (DOWNTIME) Defects Work that contains errors, rework, mistakes or lacks something necessary Medication error Wrong patient Wrong procedure Scrap Rework Correction Overproduction Producing more than the customer/ patient needs right now Medications given early or testing ahead of time to suit schedule Treatments done to balance hospital staff or equipment workload Writing or entering the same information many times Making copies of chart notes that are not used Producing more to avoid set-ups Batch process resulting in extra output Copies of reports that are sent automatically Waiting Non-Utilized Resources Transportation/ Motion Idle time created when material, information, people, or equipment is not ready Resources that either not be used at all or not being utilized to their full potential Movement of people that does not add value Waiting for Bed assignments Testing & Treatment, Discharge Patient lab test results Staff not be utilized at their skill level Empty Beds due to no staff Searching for patients Searching for meds and/or charts Gathering tools / supplies Handling paperwork Waiting for parts Waiting for inspection Waiting for information Waiting for others at meetings Excess Inventory on shelves Searching for equipment Sorting through materials Reaching for tools Waling to fax or copier machine many times a day Inventory Missing Information / Confusion More materials, parts, or products on hand than the customer/ patient needs right now People are not sure about the best way to perform work tasks Bed assignments Pharmacy overstock / Lab oversupplies Specimens waiting analysis Patients in beds past discharge time Variation in practice patterns Unclear orders Unclear systems for reporting/ communicating Patients scheduled with incorrect information Raw materials Work in process Finished goods Paperwork in process Variation in way same activities are performed No knowing what the next steps are Unclear systems for reporting/ communicating Extra Processing/ Rework Activities/ effort that adds no value from the patient s/ customer s viewpoint Multiple bed moves Redundant information gathering Excessive paperwork Unnecessary procedures Multiple testing / Retesting Multiple cleaning of parts Paperwork Awkward tool or part design Regulatory paperwork Tasks that are no longer needed 18 6

7 Waste examples that lead to compliance concerns: Data collection process steps that do not add value for the patient. For example when in clinical trails there is the collection of extraneous data that will not be utilized in the study. This creates waste, risk and liability. Can the data collection be streamlined to remove the collection and retention of unused data? When communication of information and ideas is isolated or siloed within a company and/or departments. When the same information needs to be submitted separately to different regulatory agencies and if they have different data definitions. Underutilization of staff to identify and help prevent defects 19 Clues to Waste & Non Value Added Work Remeasure Reevaluate Remake Redo Recall Repeat Recheck Rework Reject Revise Reissue Return Redesign Retest Reship Retype 20 Waste Observation Tool Waste Observation Tool VALUE STREAM/PROCESS NAME: OBSERVER: DATE: LOCATION: NO. PROCESS NAME WASTE DESCRIPTION/OBSERVATION D O W N T I M E TIME (SEC) In the next 24 hours, I will remove the Waste No. and communicate to the affected people. 21 Signature: 7

8 Ohno Circle Tool Explain the 8 wastes Stand in the same spot every day in the center of the workplace (gemba) Find wastes every day Identify Root Causes Remove at least 1 waste everyday 22 Which of these add value for the customer Preregistration process call prior to procedure Arriving and waiting for the nurse to call for you Being walked to the exam room Taking vital signs Waiting for the doctor Getting directions to the hospital Finding your way to the lab to get blood drawn Filling out billing information Correcting the bill 23 Which of these are compliance concerns Preregistration process call prior to procedure Arriving and waiting for the nurse to call for you Being walked to the exam room Taking vital signs Waiting for the doctor Getting directions to the hospital Finding your way to the lab to get blood drawn Filling out billing information Correcting the bill 24 8

9 Value Steam Mapping Why Value Stream? INPUTS Your Hospital OUTPUTS TOTAL VALUE STREAM Understand current situation Big picture Ratio of Non Value to Value Added Time Exposes sources of waste not just waste Shows linkage between the 7 types of flow The 7 Flows 1. Patients 2. Communication 2. Supplies 4. Information (What and When) 5. People (Std. Work, Takt Time) 6. Equipment (Portable X Ray, EKG, etc) 7. Specimens Guidelines for Mapping Start at the customer and work backwards Walk the actual flows Don t map the organization but map the flow through it Identify value added and non value added steps (muda or waste) Identify where to focus analysis of activities Don t be too detailed this is an overview Use pencil not power point quick and crude 25 Value Steam Mapping Example: Cath Lab Value Stream Map Inpatient Reception Check in Registration 0 5 Pts. Admitted Pre Cath Recovery Cath Lab Discharged Eliminate waste in and around processes 26 Three Versions of Value Stream Map Processes What You Think it is What it Actually is: What You Would Like it to Be Current State VSM is created from the patient/customer s perspective (i.e. walk the process). The process to develop and map concepts for the Future State provides a gap analysis between where you are and where you need to go and helps to determine the improvement strategy. 27 9

10 Root Cause Analysis (RCA) 28 Root Cause Analysis (RCA) A process for identifying the basic or causal factors that underlie variation in performance, including the occurrence or possible occurrence of a defect Why Conduct an RCA: To identify the processes and systems related to the occurrence as well as the proximate cause of the event Leads to an improvement in processes or systems Decreases the likelihood of similar events in the future 29 Root Cause Analysis (RCA) 5 Whys Tool A simple and widely used tool Team asks/ considers why at least five times Agree on root cause Develop action plan for improvement 30 10

11 Root Cause Analysis (RCA) 5 Whys Tool Department/Area: Initiator: Date: Issue/General Information : Occurrences: Why #1: Why #2: Why #3: Why #4: Why #5: Final Countermeasure: Temporary Countermeasure: 1. Ask WHY a final time: Read backwards after completion. Does the analysis make sense? Circle One: Yes No 31 5S What is 5S? Sort Keys to Success Arrange & Prioritize Distinguish Get everyone involved. needed and unneeded items Integrate 5S Principles into daily work. Prevent Problems from occurring Communicate need for 5S, roles of all Simplify arrange and identify needed item for participants. ease of use Be consistent in following 5S in all areas Shine Inspect and Clean up area daily Leadership involvement at all levels Standardize Establish Orderliness/ Standards/ clearly define tasks Follow through 5S takes effort & persistence. Sustain Discipline to maintain established procedures audit area Link 5S activity with all other initiatives. 32 5S Create Standards Detect Abnormalities Look Here 5 cowboys to drive 1000 cattle Should take one look and understand the situation Clearly differentiate between what is Normal and Abnormal Detect what is Abnormal Not Here 33 11

12 5S Classifying Supply Locations By Frequency of Use Tag based on Frequency Priority Frequency of use How to Store Low Less than once a week Throw away!! Store in distant place Medium Once a week Store together or somewhere in department High Once a day Carry or keep at once per takt time individual work place 34 5S Tool Item # and Description Five S Evaluation Form Item Score ( 0 5 ) What is the team doing to improve to the next level? 1 Removing unnecessary items All paperwork, supplies, tools, equipment, cabinets, stands etc not required for performing operations are removed from the area. Only tools and product are at work stations. 2Storage of Cleaning Equipment All cleaning equipment is stored in a neat, orderly manner, handy and readily available when needed. 3 Floor Cleaning All floors are clean and free of debris, oil and dirt. Cleaning of floors is done routinely daily at a minimum a posted schedule or checklist is present. 4 Bulletin Boards All bulletin boards are arranged in a neat and orderly manner. No outdated, torn or soiled announcements are displayed. 5 Emergency Access Fire hoses and emergency equipment are unobstructed and stored in a prominent easy to locate area. Switches and breakers are marked or color coded for visibility. 6 Items on Floor Supplies and any other materials are not left to sit directly on the floor. Large items such as boxes are placed on the floor in clearly identified and marked areas. 7 Aisle ways Marking Aisles and walkways are clearly marked and can be identified at a glance, lines are straight and at right angles with no chipped or worn paint. 8 Aisle ways Maintenance Aisles are always free of materials and obstructions, nothing is placed on the lines, and objects are always places at right angles to the aisles. 9 Storage and Arrangement Storage of boxes, containers and material is always neat and at right angles. When items are stacked, they are never crooked or in danger of toppling over. 10 Equipment Painting All machines and equipment are neatly painted, there are no places in the area less than six feet high that are unpainted. Score 0 to 5 with 5 being the highest. Subtotal For Page S Tool Item # and Description Five S Evaluation Form Item Score ( 0 5 ) What is the team doing to improve to the next level? 11 Equipment Cleanliness All machines and equipment are kept clean by routine daily care. 12 Equipment Maintenance Controls of machines are properly labeled and critical points for daily maintenance checks are clearly marked. Equipment check sheets are neatly displayed and clean. 13 Equipment Storage Nothing is placed on top of machines, cabinets or equipment. Nothing leans against walls or columns. 14 Documents Storage Only documents necessary to the operation are stored at the work stations and are neat and orderly. 15 Documents Control All documents are labeled clearly as to content and responsibility for control and revision. Obsolete or unused documents are routinely removed. 16 Tools and Gages Arrangement Tools, gages and fixtures are arranged neatly and stored, kept clean and free of any risk of damage. 17 Tools and Gages Convenience Tools, gages and fixtures are arranged so they can be easily accessed when changeovers or setups are made. 18 Shelves are arranged, divided and clearly Shelves labeled. It is obvious where things are stored, status Arrangement and condition is recorded. 19 Work areas and desks are kept free of objects including Work area and records and documents. Equipment is clean and Desk Control placed in their proper location. 20 There is a disciplined system of control and maintained 5S Control and at the highest possible level. It is the responsibility of Maintenance everyone to maintain this system and environment. Subtotal + Subtotal Score 0 to 5 with 5 being the highest. For Page 2 Page

13 Spaghetti Mapping A diagram that shows the motion of the patient / family / care giver throughout the care experience Not to exact scale Guidelines for Mapping Obtain / draw a layout of the care area Observe first the patient as he/she goes from one station to another and draw on the layout Do not lift your pencil from the paper continuous flow Repeat for care giver & family Measure the total distance traveled and note 37 Spaghetti Mapping Shopper Non shopper Non shopper Shopper 38 Takt Time Takt = Rate at which the Patient/Customer PULLS from you (the heartbeat of the org). Takt = Total Available Time (in seconds) Total Patients seen in that time frame (Demand) Ex. If there are 60 patients that come into an ED during a given shift, Takt time can be calculated as: 60 sec. x 60 mins. x 8 hrs. 60 patients = 480 Secs. In order to keep up at the rate at which a patient walks into the ED, you would need to complete a patient treatment every 480 seconds OR Every 480 seconds there is a patient walking into the ED, so every 480 seconds, there should be one being discharged or else there will be a wait NOTE: This does not mean it only takes 480 seconds to treat a patient! It means that the slowest step in the process should not exceed 480 seconds, and if it does, there will be waits and bottlenecks

14 Standard Work Standardizes the way everyone does specific tasks Best process for quality, safety, compliance and efficiency Helps maintain control Makes it easier to expose and solve problems Everything should be made as simple as possible, but not one bit simpler Albert Einstein 40 Standard Work Sequence Standard Work Sheet Standard Work / Combination Sheet Standardized Work Job Instructions (SWJI) easy to follow displays, placed where the work gets done, to ensure consistency 42 14

15 Level Loading & Sequencing Process Step Ensures that all steps in a Value Stream operate at or below Takt 43 Level Loading & Sequencing By redistributing some of the tasks in Step D to A, B, and C..we can easily identify our target for improvement. If we reduce the cumulative Cycle Times for all the steps by 12 seconds, we can potentially reduce from four steps to three. Time 60 A B C D (50 ) (44 ) (56 ) (42 ) Time 60 A B C D (60 ) (60 ) (60 ) (12 ) Takt Time Step Takt Time Step 44 Single Piece Flow Batch Production Single Piece Flow From: The Toyota Production System Catches Defects too Late How many more do you have? Where are they in the process? What is the root cause? Catches Defects Immediately You only have one You know where it occurred Resolve the root cause immediately 45 15

16 Daily Action Review Series of interconnected, brief and structured daily meetings that: Compare actual to expected performance Assign corrective action and improvement Follow up on the previous day s action items 46 What is Six Sigma Measure of Quality Process For Continuous Improvement

17 Understanding of Six Sigma Statistically Six Sigma refers to a process that produces only 3.4 defects per million opportunities Sigma DPMO 2 308, , , Most U.S. Businesses Goal Business Strategy An overall strategy that encompasses an organization s quality philosophy. It sets the vision for achieving Six Sigma levels of quality in key processes and services. Tools and Tactics A set of statistical tools and a disciplined methodology used by specially trained individuals to improve processes by reducing variation and defects. 49 Measure of Quality Every Human Activity Has Variability... Lower Customer Specification Mean Upper Customer Specification 1 p(defect) Target Reducing variability is the essence of six sigma 50 Measure of Quality What is Sigma? Mean 3 Customer Specification 6.6% Defects BEFORE 3 w i d e v a r i a n c e Mean slim variance 6 Customer Specification No Defects Patients don t feel the averages, they feel the variation AFTER

18 Six Sigma Quality 68% of data falls within 1 standard deviation of the mean 95% of data falls within 2 standard deviations of the mean 99.7% of data falls within 3 standard deviations of the mean 52 Six Sigma Quality Lets look at our average LOS for a procedure. Looking at the last 30 patients we had an average LOS of 5 days. What is the problem? 5 days Is this what our patients are feeling? Is everyone getting out in 5 days? 53 Six Sigma Quality No! Lets look at a distribution of the actual data. Frequency 2 days 5 days 8 days It probably looks more like this with the average being 5 days

19 Six Sigma Quality We can see that there are a significant number of patients getting out later and earlier. Either way this can be a source of customer dissatisfaction & regulatory inquiry LSL is 4days USL is 6days Frequency 2 days 5days 8days Lets say that our patients & regulators are OK if they are out between 1 day early and 1 day late. These are our spec limits. 55 Six Sigma Quality Where are our defects, or, where are our dissatisfied patients? LSL is 4 days USL is 6 days Frequency 2 days 5 days 8 days If our standard deviation was 1day, then we would have 68% of our patients getting out between 4 and 6 days AND 32% not. 56 Six Sigma Quality If we can reduce variation, we can reduce dissatisfied patients & regulators LSL is 4 days USL is 6 days Frequency 2 days 5 days 8 days If our standard deviation was reduced to.5 day, then we would have 95% of our patients getting out between 4 and 6 days 57 19

20 Six Sigma Quality Patient Wait Times (mins) Starting Point After Project Average Mean Big Change 25% improvement What Patients Feel What We See Variability No Significant Change! 58 Process for Continuous Improvement Six Sigma provides a process based approach to continuous improvement. It can be used to improve any process business, transactional or healthcare. 59 Process for Continuous Improvement Six Sigma Methodologies DMAIC: To improve any existing product or process Define Measure Analyze Improve Control Who are the customers and what are their priorities? What are the most important causes of the defects? How can we maintain the improvements? How is the process performing and how is it measured? How do we remove the causes of the defects? 60 20

21 Process for Continuous Improvement Formulating the Practical Problem DMAIC Steps A,B,C : CTQ s, Charter, Process Map How do my customers look at me? DMAIC DMAIC DMAIC Step 1 : Select the CTQ characteristic Step 2 : Define Performance Standards Step 3 : Validate the Measurement System What do I want to Improve? What s the best way to measure? Can I trust the output data? Changing to a Statistical Problem DMAIC DMAIC DMAIC DMAIC Step 4 : Establish Process Capability Step 5 : Define Performance Objectives Step 6 : Identify Variation Sources Developing a Statistical Solution DMAIC DMAIC DMAIC Step 7 : Screen Potential Causes Step 8 : Discover Variable Relationships Step 9 : Establishing Operating Tolerances Implementing the Practical Solution DMAIC DMAIC Step 10 : Validate X Measurement Systems Step 11 : Determine Process Capability Step 12 : Implement Process Control How good am I today? How good do I need to be? What factors make a difference? What s at the Root of the Problem? How can I predict the Output? How tight does the control have to be? Can I trust the in-process data? Have I reached my goal? How can I sustain the improvement? 61 Case Study Surgical Services Equipment Availability Pictures of Before State: Blocked doorways/ clutter Equipment in non sterile hallway 62 Case Study Surgical Services Equipment Availability Pictures of Before State: Expensive equipment in vulnerable location Egress blocked by equipment 63 21

22 Case Study Surgical Services Equipment Availability Improvements: Equipment moved to storage room on first floor Relocated 2 pharmacy employee offices Removed expired equipment & supplies Moved vendor items to one location, initiating consignment process which vendors had been resistant to Added wall boards for more efficient storage Taped floor for access to door and where equipment goes Put pictures of items on wall to indicate where it goes in room; also put picture in old location with note indicating where it is now located Created equipment transport process Tagging process so equipment is no longer just left in elevator due to not knowing the clean or dirty status of equipment Now know what equipment is going up (clean) and going down (dirty) Included involvement of Patent & Equipment Transport Team and Central Sterile team, in addition to Surgical Services Staff 64 Case Study Surgical Services Equipment Availability Improvements: Renovated Darkroom located in Surgical Services Was rarely used, and had become unnecessary due to new technology Replaced water damaged wall and flooring that had created a great environment for growth Fixed water drained that leaked into Unit on floor below Reconfigured open space with wall mount system which allowed relocation of supplies Renovated and reconfigured an exiting work (storage) room: Large 248 sq foot space with a lot of extra room that was underutilized Dropped par levels on supplies by over $3,000 Removed cabinets and sinks, and expanded the doorway New open space allowed storing $3M of equipment that was formally stored old hallway expensive, easily damaged equipment now in a protected area Able to outline floor to ensure storage locations are maintained 65 Case Study Surgical Services Equipment Availability Pictures of After State: Cleared Egress Hallway cleared of clutter 66 22

23 Tenants of Successful Lean Six Sigma Management The basis of management decisions should be long term vision and strategy, even if that is at the expense of short term gains Create a process to continuously bring problems to the surface Level out the work (The tortoise and the hare) Build a culture of stopping to fix problems and getting things right the first time Standardize processes and tasks to get to and maintain continuous improvement and front line empowerment Implement visual controls so problems will not be concealed 67 Tenants of Successful Lean Six Sigma Management Use technology that serves your people and processes do not become subservient to technology Develop leaders who understand the work, live the vision, strategy and values and teach it to others Develop excellence in your people an dteams Respect your extended network of partners and help them improve Go to the work (gemba) and understand the problem Make decisions slowly, considering all your options, but implement decisions rapidly Become a learning organization 68 Ending Thoughts Tracking and trending data and issues will highlight issues that need to be brought better into compliance Standardized work and documentation will improve by involving the stakeholders Bringing a cross functional team together to resolve issues ensures a common approach and culture throughout the organization 69 23

24 Self Assessment What is your experience? Lessons Learned Successes Good judgment comes from experience, and a lot of that comes from bad judgment Will Rogers 70 Application of Learnings One Thing Learned...One Thing to Apply 71 Ending Thought It s easier to behave ourselves into a new way of thinking than to think ourselves into a new way of behaving. Managing on the Edge, R. Pascale 72 24

25 Questions 73 Contact Information: John Kalb, JD, CHC, CCEP Operational Excellence Executive/ Compliance Officer Kootenai Health Phone: