OAHHS LEAN WEBINAR DECEMBER 9, Purdue Research Foundation

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1 OAHHS LEAN WEBINAR DECEMBER 9,

2 Overview A3 Improve Key Components Control tools Deeper dive into a tool Questions? 2

3 DMAIC 3

4 4

5 Project Title and Area: Date: Organization: Authors: Pre- Define Measure Select Project 5 Hoshin Kanri VOCS VSM Define the problem Project Y Project charter SIPOCS VOCS (SWOT; Affinity; CTS; Kano) Communication Plan Quantifying the waste & variation Visual display of current process Data collection plan Gemba MSA Process flow charts Spaghetti diagrams Scatter plots Set Goal SMART Team Selection Exec sponsor Process owner Gantt Chart Pie charts; Bar graphs Control Charts Pareto Process capability (DPMO; Sigma score) Takt time; cycle time Understanding the waste & variation Y = f(x) Future State Map Hypothesis Testing Correlation Regression Gap analysis (current/future) Root cause why gaps exist Removing the waste & variation Target state Prioritize solutions Impact/Effort Affinity Multi-voting List Reduction Fishbone; 5 Why Opportunity prioritization Risk/Frequency Affinity diagram Multi-voting/List Reduction families of variation Gantt chart Kaizen newspaper Small tests of change PDCA Quick change-over Cellular layout 5-S Preventing recurrence of the waste and variation Control Plan Standard Work Visual controls Kan ban 2 bin systems Poke yoke Analyze Improve Control

6 Project Title and Area: Select Project Date: Organization: Authors: Understanding the waste & variation Pre- Define the problem 1. Primary obstacles and barriers are specified 2. Root causes are specified 3. Method of identifying root causes is shown 4. Goals regarding root causes are shown Analyze Define 1. Business case has been explained 2. Problem statement in measureable terms 3. Data provided to describe the problem 4. Performance gap is described 5. Metrics are specified Removing the waste & variation 1. Proposed changes are specified Measure Quantifying the waste & variation 1. Current state performance is described 2. Visual representation of process is shown 3. Data describing problem/process is provided 4. Project objectives/goals are specified Set Goal SMART 2. Visual representation of Target State is shown 3. Implementation plan is detailed 4. Results of Implementation are specified 5. Spread is in Implementation Plan if applicable Preventing recurrence of the waste and variation 1. Process owner is specified 2. Plans for follow up monitoring is detailed Improve Control 6

7 The Control phase Show that you ve built a new process that is performing at the desired level The new process is hardwired Showing that measurements and monitoring are in place Roll out to other areas as applicable 7

8 Measuring the result What are the metrics you are tracking? How will you know if you have made an impact? How can you make those metrics visible to everyone? 8

9 Control Phase Confirm the change really improved the process 9

10 HIERARCHY OF CONTROLS Building Information into the Workplace Warnings that Problems Exist Eliminating the Causes of Problems Physically Changing the Workplace Training and Standards 10

11 CONTROL PLANS Project: Bed Management Goal: Time from ED request for inpatient bed to patient placed in bed < 30 minutes Date: Pre-project average time = 166 minutes (2.7 hours) # Metric w/target Goal Collected By Sample Size/Frequency Collection Method Frequency of Review 1 Decrease average time from ED request for inpatient bed to patient placed in bed from 166 minutes to < 30 minutes Jane Doe 100%/Daily Manual (already being collected daily) Daily at morning bed meeting 2 Decrease average time from ED request for inpatient bed to bed assignment from 90 minutes to < 5 minutes Jane Doe 100%/Daily Manual (already being collected daily) Daily at morning bed meeting 3 Decrease average time from inpatient bed assignment for ED patient to nursing report from 48 minutes to < 10 minutes Jane Doe 100%/Daily Manual (already being collected daily) Daily at morning bed meeting 4 Decrease average time from nursing report provided to ED patient placed in bed from 32 minutes to < 15 minutes Jane Doe 100%/Daily Manual (already being collected daily) Daily at morning bed meeting 5 Eliminate ED bed diversions (averaging hours/month) Jane Doe 100%/Daily Manual (already being collected daily) Daily at morning bed meeting 11

12 PURPOSE OF STANDARDIZATION Reduces variation More reliable process and results Spreads and sustains improvement Improves quality Standardized Tasks are the Foundation of Continuous Improvement and Employee Empowerment 12

13 PROJECT REPORT PRESENTATION Team Members should present to the Executive team Project Aim Purpose and goal of project Problem Statement Why was it identified to be a project? What was the impact and extent of that impact What are the metrics? What was the state of the process pre-project? What is the future state? 13

14 PROJECT REPORT PRESENTATION What were the identified root causes? Identified constraints (sacred cows) What were the identified solutions? Target area for each solution Literature supporting the identified solutions What is the status of each solution? Implementation Plan/Kaizen Newspaper Gantt Chart What is the target state? 14

15 PROJECT REPORT PRESENTATION What is the return on investment? Improvement realized as a result of the project Expected improvements to be realized in future Specify which Strategic Plan Breakthrough Goals the project directly and indirectly assisted the organization to achieve or closer to achieving Obstacles, barriers, ongoing constraints requiring executive / leadership assistance 15

16 16

17 Lessons Learned Revisit your plan if you re not achieving the stated goal Set plans to revisit the measurements in the future (6 months-1 year) Hand off the project to the process owner Spread your learning and improvement to others that may benefit 17

18 Brian Hudson, MS, LSSBB Senior Advisor Lean Six Sigma (office) (mobile) Purdue Healthcare Advisors Purdue University 18

19 Lean Story Preventing Inpatient Falls & Decreasing Inpatient Fall Rate Adventist Health Tillamook Regional Medical Center Julia Fontanilla, Quality/CIS Director 19

20 About Us Tillamook Regional Medical Center 25-bed critical access hospital in Tillamook, a rural coastal community in Northern Oregon Operated by Adventist Health since 1973; lease renewed through 2045 Services Hospital Acute Care Services 5 Rural Health Clinics Hospice/Home Care Clinical Outpatient Therapy Services Ambulance Services 20

21 Our Lean Project PREVENTING INPATIENT FALLS & DECREASING INPATIENT FALL RATE PROBLEM Our average fall rate in 2013 was 4.78 inpatient falls per 1000 days; Corporate s 2013 rate was 2.5 inpatients fall per 1000 days or less. WHY? Right thing to do for our patients and our hospital AIM STATEMENT - To reduce patient fall rates by standardizing our patient fall assessment process and implementation of fall reduction strategies Original Outcome Measure patient falls per 1000 pt. days Original Process Measure - Number of completed fall risk assessments completed within 1 hour of inpatient admission 21

22 Project Team TEAM MEMBER ROLE Chief Nursing Officer Senior Sponsor Administrative Director Project Owner Quality & CIS Director Facilitator (Green Belt) 3 Med-Surg RNs Planning/Implementation Physical Therapist Planning/Implementation Unit Secretary Planning/Implementation Nursing Supervisor Planning/Implementation Quality Manager Control Metrics Clinic Director Project assistant (Yellow Belt) Pharmacist Subject Matter Expert 22

23 Define TRMC is not consistently meeting patient fall targets for over 2 years Due to low patient volumes/patient days, one patient fall dramatically affects the pt. fall rate 23

24 Measure CURRENT STATE OBSERVATIONS & FEEDBACK Variation noted in the following areas: Time patient admitted to inpatient unit to time initial fall risk assessment completed Implementation of specific fall risk precautions Interpretation of patient mobility assessment 24

25 ROOT CAUSE ANALYSIS Analyze 25

26 Improve ROOT CAUSE SOLUTIONS Changes: 1)Standardize risk assessment procedure and EMR documentation 2)Standard implementation of fall prevention strategies 3)Patient/family education and involvement 4)No Pass Zone teamwork in preventing patient falls 5)Visual Cues risk score, fall posters, 6)Hourly rounding includes fall prevention 7)Bedside shift nurse to nurse report includes patient fall precautions 26

27 Control (Sustainability/Spread) Identified Process Owner Administrative Director Sharing Control Metrics with all stakeholders Involving Front Line Staff in all phases - (auditing and reporting to Quality Council) Utilizing other departments (No Pass Zone, patient teaching) Phase II Design Rewards & Demand Accountability redesign job description; performance appraisals; coaching systems 27

28 Influencer The Power to Change Anything by Kerry Patterson & others 28

29 Successes and Key Takeaways PATIENT/FAMILY INVOLVEMENT? Feedback on teaching tools Helpful, not helpful ADVICE? - Value the patient/family feedback involve them in understanding fall scores and precautions - Visual cues are beneficial - Involve front-line staff OUR JOURNEY HAS JUST BEGUN WE ARE EAGER TO SEE POSITIVE RESULTS FROM OUR TEAMWORK! 29

30 Julia Fontanilla Contact Information (work) 30

31 QUESTIONS? 31

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