Using Lean to Put Patients First

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Daniela Walsh
10 years ago
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1 Using Lean to Put Patients First Michele James, Rouge Valley Health System Scott Ovenden, Rouge Valley Health System

2 Overview of Today s Session 1. The Rouge Valley Health System Lean Journey 2. Linkage to the Action Plan to Health Care 3. Using Lean to Deliver Greater Value to Patients 4. Reflections and Next Steps 2

3 About Rouge Valley Health System Rouge Valley Centenary (RVC) 2867 Ellesmere Road, Toronto Rouge Valley Ajax and Pickering (RVAP) 580 Harwood Avenue, Ajax 2 hospital campuses serving the communities of west Durham and east Toronto RVHS formed in 1998 as part of a provincial amalgamation of hospitals $300 million annual budget: ~ 490 inpatient beds, ~130,000 E.D. Visits 2,774 staff, ~300 active physicians 3

4 Dollars ( Thousands) Our Burning Platform for Transformation 10, Year Surplus/Deficit Trend 5,000 - (5,000) (10,000) (15,000) (20,000) (25,000) (30,000) (35,000) 2004/ / / / / / / /12 B 2012/13 P 2013/14 P Surplus / (Deficit) (3,014) (5,748) (2,527) (6,470) 2,419 4,406 8,938 4,500 4,677 4,750 Nothing Done (6,748) (10,280) (14,457) (19,351) (23,875) (28,090) (32,531) Years 4

5 How are We Transforming? What s Different at RVHS? We adopted Lean Thinking as our hospital-wide management philosophy Lean training and management development gives all managers a consistent approach for how we expect the organization to be run All leaders are required to lead and manage using the Lean Management Philosophy Continuous improvement is part of everyone s job We have hospital-wide Dedicated Gemba Time every day from 9am to 11am (no meetings) We have a Transformation Management Office " In a lean environment, the expectation is that everyone has two responsibilities. The first is to run the business on a day-to-day basis. The second is to improve the business, or contribute to improving it continuously." (David Mann in Creating a Lean Culture: Tools to Sustain Lean Conversions ) 5

6 A Typical Lean Transformation RVHS Executive Team identified 2 key areas for corporate development: Continuous Improvement and Capability Building Graphic From: J. Liker, The Toyota Way to Continuous Improvement 6

7 The Rouge Valley STAR Framework Corporately Defined Expectations for Lean Deployment and Sustainment STANDARD All of the following are in place: Process Control Boards Performance Trending Boards 6S A3 Rounding Kaizen Participation Leader Training 2010/11 90% ADVANCED All of the following are in place: Sustainment of Standard level Kamishibai Safety Calendar (could be part of kamishibai system) Idea Board with problemsolving huddles Department leads and sustains its own kaizen events (at least 2 per yr) 10% ROLE MODEL All of the following are in place: Sustainment of Standard and Advanced levels Internal knowledge sharing (joint kaizen with another dept; facilitator for another dept s Lean event; lead an in-service; internal article or poster presentation) External knowledge sharing (e.g. joint kaizen event with external partners; conference presentation; published article) Use of one or more higherlevel Lean tools (e.g. Kanban, Andon, SMED/changeover, etc.) 0% 2011/12 100% 40% 10% 2012/13 100% 67% 33% 7

8 Developing a hospital-wide Lean Management System 8

9 MOHLTC: Action Plan for Health Care 9

10 The RVHS Quality Framework (The House of Rouge) 10

Episodic versus Continuous Improvement VSA Training Kaizen Business as Usual Business as Usual If we rely on periodic Lean training or improvement events and the rest of the time it is

11 Episodic versus Continuous Improvement VSA Training Kaizen Business as Usual Business as Usual If we rely on periodic Lean training or improvement events and the rest of the time it is business as usual, then we are communicating that it is business as usual. Improvements occur daily in a Continuous Improvement Culture Adapted From: Robert Kegan and Lisa Lahey, Immunity to Change 11

12 Inventory Management Improvement Opportunities Across the Organization Unit Supplies Linen Supplies Support Services 12

13 Pharmacy Departments Initial Goals Maximize time spent in direct patient contact time Improve staff morale Improve fiscal picture 13

14 Developing Pharmacy Staff Through the Idea Board The pharmacy team generated 199 ideas and implemented 146 ideas last year. This is the most ideas implemented for a single department at Rouge Valley! 14

15 Using the Performance Board to Develop the Team and Manage Pharmacy Initiatives 15

Implementing Kanban in the Pharmacy Key Gemba Observations: 1) Inventory management was not visible or standardized 2) Underlying philosophy was to order high quantities 3) Staff worked in silos and

16 Implementing Kanban in the Pharmacy Key Gemba Observations: 1) Inventory management was not visible or standardized 2) Underlying philosophy was to order high quantities 3) Staff worked in silos and didn t not work as a team to solve problems Key Changes: 1) Calculated inventory levels to carry 1 week of product 2) Created Kanban card to standardize ordering quantity and process using a visual system 3) Engaged vendors in returning expired products for refunds 16

17 Impact on Pharmacy Department 17

18 Results from the Pharmacy Kanban Implementation 34% reduction in drug inventory! 10% savings in our $7M drug budget! Patients receive their medications on time High performance despite dramatic out-of-stock situations within the pharmaceutical industry Minimal time spent on stock rotation and expiry monitoring 18

19 Impact on Patient Care and Patient Experience Increased MD and Nursing satisfaction with pharmacy services to 90% Increased Patient satisfaction with pharmacy services to 95% 19

Applying Lean Thinking in the RVHS Kitchen The Kitchen staff were able to move from traditional batch and queue processes toward single piece flow using Takt Time.

20 Applying Lean Thinking in the RVHS Kitchen The Kitchen staff were able to move from traditional batch and queue processes toward single piece flow using Takt Time. This allowed the team to reallocate 3.0 FTE to create real patient value through the implementation of a spoken menu which improves the patient experience through improved communication regarding food preferences 20

21 Reflections on Developing Kanban Systems Significant benefits from having a management system to create and spread change Increasing inventory does not eliminate stock outs Examine your replenishment schedule Does replenishment align with consumption? Have you minimized the maximum time between deliveries? Develop a set of process evaluation criteria that are founded on principles of operational excellence Is the ordering trigger highly visual? Is the process standardized or does it require expertise of front line staff? Are inventory levels managed? (both maximum and minimum quantities) Is product being rotated consistently? Look for opportunities further up the value stream Ensure the problem is visible and do not get ahead of your customer. 21

22 Next Steps on the Lean Journey at Rouge Valley 1. Integrate best practices in creating a culture of patient safety (Engage hearts AND minds) 2. Further development of unit based QI teams 3. Align Lean processes with the organization focus on Patient and Family Centred Care 4. Integrate patient experience design process improvement tools into the Rouge Valley toolkit 22

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Using the Lean Model for Performance Improvement

Using the Lean Model for Performance Improvement Presented by Content Expert: Cindy Mand Director, Lean Enterprise BloodCenter of Wisconsin, Milwaukee, WI Learning Objectives 1. History of Lean and it