Leading in a Lean Management System: Implications for Boards and Senior Leaders Maura Davies, FCCHL, President & CEO, Saskatoon Health Region Jim

Transcription

1 Leading in a Lean Management System: Implications for Boards and Senior Leaders Maura Davies, FCCHL, President & CEO, Saskatoon Health Region Jim Rhode, Chair, Saskatoon Regional Health Authority National Health Leaders Conference Banff, June 2014 Affinity Health System January 29, 2014

2 What we hope to leave you with: A better understanding of what is different for boards of directors and senior leaders in a lean management system based on the experience of Saskatchewan

3 Saskatchewan s Health Care System 12 Regional Health Authorities 1 Provincially and Federally funded Health Authority Provincial Cancer Agency ehealth organization Shared Services Organization Health Quality Council 65 hospitals ~150 nursing homes Home care, public health Primary care employees, 2000 physicians First Nations & Inuit health services

4 a compelling vision Patient First must be embedded as a core value in health care. Health care in Saskatchewan needs to function as a cohesive system. Frontline providers must be empowered to deliver patient- and familycentred care.

5 Lean in Saskatchewan Far more than doing lean projects Lean is our provincial strategy and system for management and improvement Health care the lead but other government services (e.g. education) also adopting Definitely not business as usual Ongoing teaching, coaching and support by JBA Consulting, world leaders in application of Global Production System

6 Making Care Safer and Better Set provincial health strategy collectively (Hoshin Kanri or Strategy Deployment) Develop infrastructure to Support and Coordinate Continuous Improvement Efforts Build improvement science capability among our leaders and our entire provincial health care workforce Connect learning and doing with achieving health system priorities via improvement events and daily improvement

7 SK Health System Strategic Intent

8

9 What is Hoshin Kanri? An approach to planning that involves: Identifying a common vision Setting short- and long-term goals Executing plans to achieve those goals Tracking progress toward them Changing course as required

10 Hoshin Kanri: Key Characteristics Focus on a few key breakthrough improvements (or hoshins) Alignment of the entire organization (and health care system) around these breakthroughs Shared input and responsibility for plan and goals High participation throughout the organization Equal attention to end results and the methods for achieving them

11 Provincial Leadership Team CEOs and Board Chairs from: 13 Health Authority CEOs and Board Chairs Provincial Cancer Agency Provincial Information Technology Organization Provincial Shared Services Organization Provincial Health Quality Council 6 physician representatives Deputy Minister of Health & 4 ADMs

12 Alignment Strategic Visibility (Hoshins) 3-5 Year Outcome Targets BETTER CARE CULTURE of SAFETY Target Progress Why why #Action to be taken to return to CEO Vice President Wall Walk - QCDSM Zero Workplace Injuries #Action to be taken to return to why why Directors Daily Visual Management Work Area A Work Area B why why Work Area C Work Area D 6/13/2014 Point of Care and Service Mgrs

13 Provincial Wallwalk Regional Wallwalk Accountability: Weekely Regional Wallwalks and Quarterly Provincial Wallwalks

14 Strategy Visibility Wall

15 Safety Alert System Project Milestones

16 Surgical Wait Time

17 Budget Variance

18 Implications for Board Less autonomy in strategic planning More system alignment Board chair part of PLT setting provincial priorities and monitoring provincial performance Regional board - confirms additional regional priorities - confirms regional targets - monitors regional performance More rigorous target setting and performance monitoring Increased accountability Approve region-specific CEO Pay for Performance targets

19 Implications for Senior Leaders CEO part of PLT setting provincial priorities and monitoring provincial performance CEO and VPs lead regional hoshin kanri process: diagnosis and review, catchball, strategy deployment Focus on line of sight for provincial, regional and service level priorities Standard work for weekly regional and VP level wallwalks More rigorous target setting and performance monitoring Increased accountability Pay for performance (+/-10%) linked to provincial and regional targets

20 Building Improvement Capability Kaizen Promotion Offices and Kaizen Operations Teams Over 600 leaders currently in Lean Leader Certification (classroom and hands on learning) 83 certified 3 Kaizen fellows Over 40 physicians in training Over 16,000 staff have completed Kaizen Basics

21 SHR Organizational Structure Service lines, not traditional departments Adult Medicine and Complex Care Surgery Seniors Health Child Health Maternal Health Primary Care and Chronic disease Management Mental Health and Addictions Kaizen Promotion Office and Kaizen Operations Teams Annual Lean Depth Study reviews management structure and leadership maturity

22 Kaizen Fellows Identified through Lean Depth Study 2 year, full-time program Intense learning and doing applied to strategic projects Site visits to 6 lean organizations Coaching by JBA, VP and CEO

23 Implications for Boards Provincial standard for board member training on lean 3 books Kaizen Basics (1 day) Participation in one kaizen event (must be RPIW for SHR board members) SHR board chair only board member certified as lean leader (80 days) Ongoing learning Support for senior leaders training (and absences because of training and other lean-related work) Funding to support infrastructure and training

24 Implications for Senior Leaders Lean leader certification mandatory (87 days over months) Active participation on improvement teams as leader or participant Team members need to support and cover for each other Ongoing responsibility as a certified lean leader including maintenance of competence Lean Depth Study: succession plans, people development Board support critical

25 Learning and Applying Lean Tools and Methods From January 2012 to March 2014: 300+ improvement events engaging thousands of staff Lean facility design in major capital projects (e.g. Children s Hospital Lean design applied to Primary Health Care sites, staff scheduling and provincial laundry Patients and families participating in improvement events

26 Implications for Board May participate in lean events Attendance at Report Outs Application of lean thinking and tools to board processes e.g. value stream map

27 Implications for Senior Leaders Participate in lean events Sponsor all RPIWs Attend Report Outs Present on the gemba Support for daily visual management (team huddles, cascading operations calls) Apply lean thinking and tools e.g. A3s, corrective action plans, value stream maps Standard work and takt time Leader daily work Personal kanbans

28 Quality and Safety Commitment to continuous improvement Rigorous measurement Targets Performance monitoring (quality, delivery, safety, cost, engagement) Commitment to zero harm Corrective action plans Patients and families as improvement partners

29 Implications for Board Performance monitoring (virtual wallwalks) at Quality and Safety Committee and Board meetings Participation in quarterly reviews Gemba walks, including Board Quality and Safety Committee Patient or staff story starts each board meeting Tone at the Top- what interests my boss fascinates me

30 Implications for Senior Leaders Performance monitoring at regional and VP visibility walls Deficiencies more visible Supporting problem solving on the gemba Leaders as coaches Active participation in quality improvement Patients as partners- nothing for me without me Tone at the Top Accountability

31 VP Visibility Wall

32 Hand Hygiene Compliance

33 Measles Immunization Rate

34 Safety Alert/Stop the Line System Zero harm to patients or staff SHR (St. Paul s Hosp.) is Model Line 24 hour call centre 4 levels of severity with related response times

35 Implications for Board Board Chair notified immediately of Level 4 incidents Board Quality and Safety Committee reviews progress and recommends sign off to Board Chair. Only Board Chair can sign off Level 4 mitigation plan and closure of file

36 Implications for Senior Leaders VPs notified immediately of level 3 and 4 Coaching and support for immediate mitigation, root cause analysis, mistake proofing CEO notified immediately of Level 4 VPs sign off Level 3 incidents CEO, board chair review Level 4 mitigation plan

37 Lessons Learned Our world has changed Our work is changing We are changing No going back Very hard work- not for faint of heart We need teachers/senseis This takes time, a long time The cause is noble

38 Questions? Discussion?