Leading a Lean Transformation in Healthcare

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Brianne Foster
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1 Leading a Lean Transformation in Healthcare John S. Toussaint M.D. CEO Thedacare Center for Healthcare Value IHC 08/30/12 Remarkable Results At St Jude Medical Center in Fullerton California a visual board exists outside of each ventilated patient s room. On this board are Red/Green magnets that are flipped every two hours as the preventable measures are executed. This allows for the team to quickly see and avoid missing any preventable measure anytime. As a result of this focused effort on the true north metric, Critical Care has had zero preventable VAPs in over three years. 1

outside of each ventilated patient s room.

2 Remarkable Results Inova in integrated delivery system in Virginia with 9 ERs and visits per year reduced time to doctor in all the ERs from 55 minutes to 22 minutes at the same time reducing ambulance on diversion hours from 1371 in 2008 to 17 in 2010, improving operating margin by 10 million dollars and improving customer satisfaction. The Christie Clinic decreased patient wait times 28% increased capacity by 10% and improved patient satisfaction to 4.5 out of 5 in the ENT outpatient clinic over nine months. Remarkable Results New York Health and Hospital Corporation across eight hospitals improved on time surgical starts by 40% and reduced the percentage of O.R. cases that had to be rescheduled due to late starts from an average of 21% to an average of 4.4% of total cases. At Seattle Children s Bellevue Center surgeries start on time 99% of the time. Patient/family satisfaction with the Surgery Center ranks second among the entire organization, with 92% of families giving the Bellevue Surgery Center a 9 or 10 rating for overall care. And these outcomes are within a facility that is only 79,000 square feet, built at $30 million less than initially estimated. 2

The Christie Clinic decreased patient wait times 28% increased capacity by 10% and improved patient satisfaction to 4.5 out of 5 in the ENT outpatient clinic over nine months.

3 Definition of Lean in healthcare An organization s cultural commitment to applying the scientific method to designing, performing, and continuously improving the work delivered by teams of people leading to measurably better value for patients and other stakeholders. Lean Healthcare is an operating system composed of six principles 1. Value creation for patients 2. Unity of purpose 3. Continuous improvement (pursuing perfection) 4. Visual management to see and understand patient flow 5. Standard work for administrative and clinical care processes 6. Respect for the people 3

Lean Healthcare is an operating system composed of six principles 1. Value creation for patients 2. Unity of purpose 3.

4 5 Principles of Lean Thinking VALUE - what customers are willing to pay for VALUE STREAM - the steps that deliver value FLOW - organizing the Value Stream to be continuous PULL triggering flow from customer needs PERFECTION - continuous improvement forever (culture) (from Lean Thinking, Womack and Jones, 1996) 7 Value Creation for the patient Value=Q/C Value Stream: The steps in a process that deliver value to the customer 4

PERFECTION - continuous improvement forever (culture) (from Lean Thinking, Womack and Jones, 1996) 7 Value

5 Vertical Orientation of Healthcare Horizontal Focus for Healthcare 5

7 First Pass Baseline Improvement by segment 13 Unity of purpose: True North Metrics Safety/Quality 50% Preventable Mortality Medication Errors People OSHA Recordable Injuries HAT Scores Employee Engagement Index Customer Satisfaction - Access - Turnaround Time - Quality of Time 12/15/09 Draft. 6 Financial Stewardship Operating Margin Productivity 7

Injuries HAT Scores Employee Engagement Index Customer Satisfaction - Access -

8 A3: What Are You Talking About? 8

9 Measurably Better Value ThedaCare s Strategic Plan People A3 (level 1) Problem statement, background and targets deployed People People (level 2) level 2 A3 al Unity of purpose:deploying Level 1 Priorities to Level 2 ThedaCare s Breakthrough Objectives Shared Safety A3 Productivity A3 Growth A3 (level 1) (level 1) (level 1) Plan Plan Plan Plan Safety Shared Growth Productivity Safety Shared Growth Productivity (level Safety 2) Shared (level 2) Growth (level 2) (level Safety 2) Shared (level 2) Growth level 2 A3 (level Safety 2) Shared (level 2) Growth (level Safety 2) Shared (level 2) Growth (level Safety 2) (level 2) (level 2) level 2 A3 level 2 A3 al al al Continuous Improvement:Thedacare Improvement System 6s Visual Management PDSA A3 Value Stream mapping Kaizen Standard work 3P 2P Vertical Value Streams Hoshin Kanri Senior Management Visual Control Gemba Transparency Kanban 9

Growth Productivity (level Safety 2) Shared (level 2) Growth (level 2) (level Safety 2) Shared (level 2) Growth level 2 A3 (level Safety 2) Shared (level 2) Growth (level Safety 2) Shared (level 2)

10 Mission Improve The Health of Our Communities Strategy Deployment: Breakthrough objectives developed through the use of PDSAs and crossfunctional teams Vision Shared Values Strategy Measurably Better Value True North Metrics O:SLT/Pub Pres/HEVLN June 1, 2009 SD Work (20%) Safety People Shared Growth Productivity SD CDI Overlap Catchball VSM s, RIE s, PDSA Continuous Daily Improvement Work (80%) Running The Business Lean Management System Scientific Method: PDCA 10

O:SLT/Pub Pres/HEVLN June 1, 2009 SD Work (20%) Safety People Shared Growth Productivity SD CDI Overlap Catchball

11 Continuous Daily Improvement Front line workers and supervisors able to solve problems, and sustain improvements. PDSA Process Actionable Item log Number of Staff ideas implemented Understanding Flow using visual management What is the current state? 11

PDSA Process Actionable Item log Number of Staff ideas

12 Visual Management:Color Coding on Tracking Tools Same colors used light red/light green for tracking information. 12

13 Visual management: Flow of the lanes Tracking sheet Pareto sheet A3s/Actions related to lane. Standard Work A paradox of standard work is that the standards established release creativity. With standard clinical approaches, patients who deviate from the standard are more easily appreciated, freeing up the clinicians to expend their mental energy on issues and patients that demand it. An example at Seattle Children s is the asthma care unit, in which standardization of albuterol therapy has allowed doctors to better identify patients that are not following the typical course. The fact that the standard approach to treatment doesn t work calls into question the diagnosis of asthma and forces the doctors to search for other etiologies. Howard Jeffries M.D. Seattle Childrens 13

it. An example at Seattle Children s is the asthma care unit, in which standardization of albuterol therapy has allowed doctors to better identify patients that are not following the typical

14 Respect for People:White coat leadership vs. Improvement leadership All knowing In charge Autocratic Buck stops here Impatient Blaming Controlling Humility Curiosity Facilitator Teacher Student Communicator Perseverance 14

Buck stops here Impatient Blaming Controlling Humility

15 Can you say yes to these three questions every day? Are my staff and doctors treated with dignity and respect by everyone in our organization? Do my staff and doctors have the training and encouragement to do work that gives their life meaning? Have I recognized my staff and doctors for what they do? 15

16 Respect for people: Developing a Community of Problem Solvers Education/Skill Level Lean Grad School K. We are Here 100% of employees are problem solvers improving something every day!!! ?? Time (years) 16

17 Management by objectives: It nourishes short term performance, annihilates long term planning, builds fear, and demolishes teamwork It leaves people bitter, crushed, bruised, battered, desolate, and despondent 17

fear, and demolishes teamwork It leaves people

18 The lean management system or management by process A way to do it right the first time 18

Lean: The Method for Improving the Patient Experience

Lean: The Method for Improving the Patient Experience John S. Toussaint, M.D. CEO ThedaCare Center for Healthcare Value Patient Experience Summit: Empathy and Innovation May 20 th 2014 Founded in 2008