Lean at Denver Health: Saving Lives, Saving Money, Saving Jobs Phil Goodman Director, Lean Systems Improvement Denver Health Denver, Colorado
Denver Health Patients Denver Health cares for approximately 176,000 individual patients almost one third of Denver County s population 37% of Denver s babies are born at Denver Health 40% of Denver children use Denver Health 70% of patients are ethnic minorities 75% of patients are below 185% FPL Gabow, 2012 2 2
The Holy Grail of Process Improvement in Health Care Improve Patient Safety and Quality of Care Improve Patient Access Reduce Cost Is it possible to drive all three goals simultaneously? Hint: Try eliminating waste, and see what happens!
What Waste? Underutilized Human Talent Waiting Inventory Transportation Defects Motion Overproduction Processing
Tools of Lean Lean Tools to Identify Waste: Process Mapping Time Observations Takt Time Spaghetti Diagram Communication Circle Waste Walk Voice of the Customer Root Cause Analysis Lean Tools to Eliminate Waste: 6S Standard Work Poke Yoke Heijunka A3 Thinking Visual Management Quick Change Kanban Framework for Using Lean Tools in a Focused Manner: Value Stream Analysis Rapid Improvement Event 2P/3P Vertical Value Stream Analysis
Respect for People Continuous Improvement Lean Pillars of Transformation Two Pillars of Lean
Principles of Lean The customer defines value Deliver value to the customer on demand and without waste Standardize to solve and improve Transformational learning requires a deep personal experience Mutual respect and shared responsibility enable higher performance
Day 1 Mon Day 2 Tues Day 3 Weds Day 4 Thurs Day 5 Fri Rapid Improvement Event (Based on Simpler Business Model) Examine a process/function or area Identify areas of waste, non-value added steps Identify metrics Develop new process, standard work and communication to eliminate identified waste and increase value Design rapid experiments Implement the new processes, standard work Monitor production board and communicate standards Observe new process and any change in metrics Adjust and fine tune new standard work Create visual controls Celebrate! Team reports findings and results to CEO, executive staff, and peers
RIE Employee Engagement YTD August 21, 2012 425 Rapid Improvement Events 2,050 Employees participated on RIEs, representing 220 Departments 247 Denver Health Black Belts 16 value streams
Application of Lean to Quality Surgical Site Infections Diabetes Chronic Care Management Reducing inpatient laboratory send-out tests Improved Cancer Screening Anticoagulation Clinical Quality Project VTE Prophylaxis Outpatient Anticoagulation Services Redesign
2012 Value Streams Revenue Cycle 1 st Floor Managed care Education RMPDC OB/Gyn Paramedics Primary Care e-health Services Human Resources Nursing Behavioral Health Medicine Discharge Specialty Clinics Pharmacy Perioperative Services
Non-Clinical Lean Events Financial Counseling Specialty Clinic Charge Capture Physician Credentialing Enrollment Appointments Grant Billing Commercial Insurance AR Days In Patient Enrollment Address Verification ED Charge Capture Ortho Clinic Charge Capture Specialty Clinic Registration Financial Counseling (2 nd Pass) Physician Billing Facility Bill Clean Claim Rate 2nd Pass-Improve turnaround time on accounts holding for coding edits Improve Internal Processing turnaround time for Medicaid Pending accounts Reduce # of accounts on front end work lists due to authorization or referral requirements Co-pays with No Charge OP Pharmacy Billing Insured Patient Access Specialty Clinics CHS Charge Capture Unsponsored/Out of County Patient Access MAK Cart Levels Med Assets
Clinical Lean Events VTE Prophylaxis D/C Pharmacy Cancer Screening Specialty Bed Surfaces OB Fast Track Discharge D/C Planning Surgical Site Infection PES ETOH Pts Geographic Rounding Provider Flow Cells Psyche Consults Venous Access
Clinical Lean Events VTE Prophylaxis D/C Pharmacy Cancer Screening Specialty Bed Surfaces OB Fast Track Discharge D/C Planning Surgical Site Infection PES ETOH Pts Geographic Rounding Provider Flow Cells Psyche Consults Venous Access
Venous Thromboembolic Prophylaxis Expense by Quarter
Hospital Acquired VTE's 14.0 12.0 10.0 8.0 6.0 4.0 2.0-4Q08 1Q09 2Q09 3Q09 Target 4Q09 Actuals 1Q10 2Q10 3Q10 4Q10
UHC Quality and Accountability Aggregate Score - 2011
Standard Work: Metric Monitoring RIE Team Lead/Process Owner Lean Facilitator Sr. Financial Analyst Associate CFO Review CFO Review CEO Review
Denver Health Lean Financial Standard Work Must be verifiable in general ledger Expenses Supplies, etc. Revenue Gross charges Miscellaneous revenue Only count net revenue as impact, not gross Soft savings not counted Personnel hours freed up example Cost avoidance Case by case discussion Quality metric Must have supporting literature and review of Chief Medical Officer
Denver Health Financial Standard Work (cont d) Primary Contact person needs to be listed on every report. Financial data must come from current financial reports (examples below) located on the T:\Finance drive MMIR Budget Comparison Report Any report requiring special report generation (data not found in reports mentioned in #2) needs to be reviewed and approved. Any data requests from other areas (e.g. DSS, Managed Care) must be made by the Primary Contact or designee. Hard dollar impact will be derived from analyzing data in the GL/Budget Comparison Report. Note: If volume increases so should charges, if supplies decrease we can see it in the GL. Support for financial impact identified on Black Belt report must be provided at time of Black Belt report submission. If unsure how to calculate financial impact, please contact Rachel Koch Finance Dept) prior to submitting the report.
Accomplished With NO Reduction In Patient Services..And NO Layoffs!
Summary Lean is a philosophy and tool set that fits for healthcare Eliminating waste improves quality of care Lean tools are intuitive Frontline staff must be respected because they understand where the waste exists and how best to eliminate it Lean has the power to change culture because it truly empowers employees to break down silos, rapidly implement change and own the process! March, 2011: DH first Healthcare Organization recipient of Shingo Prize for Operational Excellence