A Case Study and Exercise on How To Use Lean Principles to Overcome A Broken Paradigm

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1 A Case Study and Exercise on How To Use Lean Principles to Overcome A Broken Paradigm Cynthia Seaver, Director of Process Excellence Mercy Health Muskegon Certified Six Sigma Black Belt & Lean Expert

2 Case Study & Exercise Overview of Mercy Health s Design of Consolidation New Medical Tower Exercise When you see this yellow guy, it is a discussion point!

3 Healthcare Today U.S. is most costly per person as compared to all other countries Lower quality of health care outcomes U.S. hospital costs were $387.3 billion in 2011 a 63% increase since 1997 (inflation adjusted). Costs per stay increased 47% since 1997, averaging $10,000 in According to the World Health Organization (WHO), total health care spending in the U.S. was 17.9% of its GDP in 2011, the highest in the world. 19.5% of GDP by /30/2014 3

4 Einstein put it this way: The significant problems we face cannot be solved at the same level of thinking we were at when we created them.

5 Learner Objectives Define a paradigm Recognize there are paradigms in healthcare today that are not working When/how to apply basic lean principles and tools to see the paradigms in healthcare today Learn how to use lean strategy to lead a group to create a future state that will break the paradigm of healthcare

6 Paradigm is a distinct concept or thought pattern. What are some paradigms in healthcare?

7 Paradigms Mercy Health Identified 1. Physician/provider focus 2. Design of facilities support department silos 3. Patient hand-offs 4. Lack of collaborative participation 5. Workflow encumbered by the facility layout 6. Department silos - selfcontained 7

8 Result of Current Paradigms Our current health care model is broken. Current state based upon push thinking Patients are pushed through departments with separate goals, budgets, and management. Push creates Waste: Unnecessary movement of patients, staff, materials and equipment Multiple, long queues Defects throughout Complexity of processes Imbalance of workloads Poor utilization of staff

9 Provided Current State CURRENT Hospitals in community 3 locations + 1 Rural Acute Hospital Inpatient Room Sizes Undersized Room Types Semi-Private Total Bed Capacity 408 Patient Satisfaction Facilities <90% Physician Satisfaction Facilities <90% Quality Improvements Gradual-non scientific Cost Efficiency Improvements Limited Adaptability to Changing Environment Minimal 9/30/2014 9

10 What would you do if you were presented this business case?

11 Magnitude of Change Mercy Health We Must Chart a New Course & Strengthen our Foundation A Different Level & Pace of Change is Required Transformational Dramatic redefinition of value delivery, business models and business structures Time Evolutionary incremental changes to increase value (Traditional Lean PI)

12 Transformational Change Begins with a recognition that incremental improvement is not enough Need to recognize that we need to change We need to stop doing the same things over and over again expecting different (better) results What Lean Strategies have we heard about in healthcare that have been successful?

13 Learn from Toyota 6 Ideas to Transformation 1. Create collaboration in the processes 2. Increase the relatedness of everyone in the process 3. Create commitment from all involved 4. Optimize the whole system, not the pieces 5. Couple action with learning 6. Reduce complexity of processes and underuse of staff Lean, in healthcare, can best be understood as value as defined by our patients, pulled to our patients in search of perfection No one tool from lean strategies will produce transformational results as well as these six BIG ideas

14 Plan for Success Create a balance of services Focus on creating patient flow Greatest error is not inviting key stakeholders Who needs to be invited to the transformational workshops?

15 Create Guidance for the Teams Mercy Health Leadership created guiding principles for transformational work What Guiding Principles would you develop for the teams? 3P Participant Rights / Responsibilities What Participant Rights would you recommend?

16 Mercy Health s Guiding Principles Does it put the patients first? Does it add value to the patient experience? Does it empower patients to care for themselves? Is it safe? Is it convenient? Is it conducive to improve teamwork & patient flow? Is it adaptable and flexible? Can we afford it?

17 Mercy Health s 3P Participant Rights / Responsibilities Champion Guiding Principles Challenge all assumptions about how work gets done To be heard / To voice your thoughts To disruptively innovate / To optimize the whole (not the parts) To expect design requests to guide the plan / To seek clear explanations when they don t To represent others doing similar work / To collaborate with others to optimize the whole

18 Participants? Ideas to Improve Patient Flow? BLOW-UP & REDEFINE THE PROCESS

19 Current State Procedural Patient Flow

20 Teach Strategies for Removing waste Together we can begin to change everything! 1. Review the guiding principles 2. Discuss Team care principles 3. Simplify/standardize work and environments 4. Teach the 8 wastes of Lean DOWNTIME 5. Combine knowledge from the Gemba & Value Stream in search of perfection

21 Shared Healthcare Strategies to Prepare for the Future 1. Operate more efficiently pull rather than push 2. Focus on Outcomes 3. Embrace new technologies 4. Build right sized, adaptable sustainable facilities 5. Learn from manufacturing processes it can now evolve in accordance with and even surpass current lean thinking)

22 Discussion: Team Care Vs Departments Teams work together to produce value outcomes in the care pathway Results in decreased cycle times for processes Results are based on optimization of the whole Multidisciplinary teams New team care model Reduces the size of the facility

23 Ideas you would have for future state?

24 Mercy Health s Proposed Future State Procedural Patient Flow

25 Prepare for Facility Design CASE STUDY 3P WORKSHOPS

26 3P Preparation: Shell Selection 7 Ways Shell Selection = 6 Various layouts +1 totally new hospital

27 Picture of Selected Shell Main Floor Tower

28 The Flow of a 3P: Preparation Multi-functional Teams: including those that designed the future state process Stakeholders in the new process Including physicians & representatives of ALL front line staff Participants are assembled in outcomes based teams Participants will identify a specific value stream & develop architecture Value Stream Maps with data Value vs Non-value Current state as well as an envisioned future state.

29 The Flow of a 3P: Five Day Workshop Day 1 Leadership kicks off workshop & empowers team Lean Learning Review of Current State & envisioned future state Teams begin to resolve the program 7 Ways using puzzle pieces Day 2 Complete 7 Ways of program & assess against patient values The teams then pull down all their to no more than 3 Teams model up to three layouts by building ¼ =1 three dimensional models. Teams then model their final version in a three dimensional model scaled at ½ =1 Day 3-4 Full scale mock-ups of key rooms in the program, test and refine Identify rapid process improvement opportunities, Day 5 PDSA Report to Senior Leaders & Physician Leaders

30 Value Stream Maps Current State Future State

31 7 Ways - Puzzle Design

32 ¼ Metric Model

33 Full Size Models

34 3P Report Outs Leadership Departments Physicians Board Members Stakeholders

35 3P Follow Up Design of architecture based on new process Prioritize the rapid process improvement lists Participants bring their peers to review their work, facilitate continued dialogue regarding the change that is coming Create a common understanding for the opportunity that change promises Semi-permanent full scale mockups of unit sections are built to provide simulation opportunities for teams to begin to envision how they will accomplish better outcomes in less time with fewer resources. 30/60/90 day reviews for design compliance with 3P Workshop report outs

36 Magnitude of Change Transformational Process Transformational Improvement Tools Transformational Future State Production Preparation Process (3P) Platform Design Teams Time Transformational Change Optimizes FTE Efficiencies Spatial Reductions / Capital Costs Quality of Care Patient Satisfaction Physician Satisfaction

37 Tips For Implementing for Transformation Engage stakeholders as multidisciplinary teams to participate in kaikaku or 3P workshops Workshops can begin to identify/form new cultures in the workplace Envision the changes to the environment for optimizing the flows Greatest error in the implementation process is to error by deference consultants can never be as vested in the organization s success as the organization itself. The expertise must come from within, not some expert from outside. The quality of our answers is never greater than the quality of our questions Consultants can therefore coach successful implementations but should not be considered the de facto leader of change The architect for a given project should never be the facilitator of a 3P workshop for that project they will already be too vested in one outcome.

38 Vision of Future Consolidated Mercy Health

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