Transcript Retreat Lean Presentation

PERFORMANCE
IMPROVEMENT
Jennifer Hooks
Manager Performance Improvement
MBA, Six Sigma Master Black Belt, Lean Sensei
I.M.P.R.O.V.E.
Center for Clinical Effectiveness and Patient Safety
What the organization wants
• Smooth operations
• Ensure patient safety
• Provide quality care
• Effective patient treatment
• Utilized staff and resources
What that leads to:
• Available and prompt care
• Better patient outcomes
• Increased patient satisfaction
• Improved financial viability
• Improved patient throughput
• Improved publicly reported
information
• Higher employee involvement
and satisfaction
• Reduced LOS
Center for Clinical Effectiveness and Patient Safety
What do our Patients need?
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Favorable patient outcomes
Patient safety
Implement new procedures and capabilities
Slow rising healthcare costs
Center for Clinical Effectiveness and Patient Safety
The Pressure on Healthcare
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Improving patient care
Controlling costs
Government regulations
Increasing competition
Implement new procedures and capabilities
Treatment reimbursement rates are capped based on diagnosis
Number of uninsured
Growth in the number of people age 65 and older
Healthcare costs continue to rise.
New technologies are “Expensive” and adoption in question.
Staff shortages in some areas continue to drive up costs.
“Report Cards” on providers – quality, cost, number of procedures
Center for Clinical Effectiveness and Patient Safety
MUSC Applying
Lean Six Sigma
to Healthcare
Center for Clinical Effectiveness and Patient Safety
Lean Six Sigma Basics
The Hospital as a System
information
Suppliers
information
Hospital
Processes
information
information
All work is a process . . .
this is true of a hospital too!
Center for Clinical Effectiveness and Patient Safety
Patients
IMPROVE
• What is IMPROVE?
IMPROVE is MUSC’s management philosophy using a
structured process for staff members to change the way they
work.
• Why is IMPROVE important?
It's important to use this process so that everyone can base
decision-making and problem-solving on data, rather than
opinions. MUSC’s leadership has made the commitment to a
culture where all leaders and the entire organization will
make the transition to the IMPROVE philosophy and
process, today and in the future
Center for Clinical Effectiveness and Patient Safety
I.M.P.R.O.V.E
The acronym used by MUSC which stands for the seven phases used in the streamlining process
Identify the problem
Measure the impact
Problem analysis
Remedy the critical issues
Operationalize the solutions
Validate the improvement
Evaluate over time
I.M.P.R.O.V.E.
Center for Clinical Effectiveness and Patient Safety
Six Sigma and IMPROVE
Data Clarity
The Measure phase
ensures a clear set of
measurements are in
place before problem
analysis starts
Graphical
Techniques
Reinforces the
importance of
basic graphing
tools
(histograms, run
charts etc)
Data Driven at every
Phase
Provides a data driven
approach to every phase
of problem solving
Data Driven
Data Quality
Focuses on quality of data collection
ensuring process measures are
meaningful and accurate
Problem Focused
Provides a
structured
approach to solve
problems. MUSC 7
phase approach
IMPROVE
Problem Solving
A Rigorous Approach
The IMPROVE approach
focuses on problems, not
solutions (therefore
projects that have predecided solutions are not
suitable)
A Simple Approach
The power of the
IMPROVE problem solving
Statistical Techniques
flow lies in simplicity and
Applies the power of
clarity. Each phase has
statistics in a practical
clear objectives, actions
format, helps assess risk
and outputs
in decision making
A Generic Approach
The IMPROVE approach
is generic and applicable
to all departments
Center for Clinical Effectiveness and Patient Safety
Lean and IMPROVE
A process that is Lean is one that delivers products that the customer wants, at a price that
reflects only the value that the customer is willing to pay for
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What does the patient want?
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– They usually want it
immediately!
– So a Lean process must be fast.
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They usually want it how they
want it!
– Patients are not willing to pay for
the costs of:
– Taking too many tests before
they are needed
– Delays or unclear
communication in the process
– Wasted time transporting them
to one area to another
– So a Lean process must be
flexible.
Value
Value
Stream
Eliminate
Waste
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And what are they willing to pay
for (or not)?
These costs are examples of
“waste” in a process which is a
key focus of Lean
Flow
Perfection
Center for Clinical Effectiveness and Patient Safety
Identifying Waste in Healthcare
Waiting
Waiting on people, information,
equipment, service
Transportation
Any excess movement of what
flows in the process
Documents, patients, specimens,
excessive email attachments, multiple
hand-offs, multiple
approvals
Intellect
Any failure to fully utilize
the time and talents of the
healthcare staff
RNs scheduling return
appointments, staff assignments
not evenly balanced, lack of cross
training
Delays in test results, bed assignments,
receiving patient information
Patients waiting to see physician. System
downtime, system response time, waiting for
approvals, information from customers
Printing paperwork before it is really needed,
purchasing items
before they are required, unnecessary
patient treatments or tests
Rework
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All the processing required to correct
a defect or mistake
Wrong patient info, missing information,
redraw, reexamine, order entry errors,
design errors, invoice errors, employee
turnover
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Motion
Inventory
Any excess movement of people,
equipment or information that does not
add value
Too much or too little stock, supplies,
work piles
Overstocking supplies, expiring drugs on shelf,
patients in waiting room. Filled in-boxes
(electronic or paper). Office supplies, sales
literature, batch processing transactions and
reports
Overproduction
Producing too much or too soon
Processing
Over-processing, Process Variability
Entering repetitive information on any type of
document or form, unnecessary forms. Extra
copies, unnecessary or excessive reports,
transactions
Searching for patients, physicians, orders,
charts, supplies, excessive walking, inconsistent
information systems. Walking to and from
copier, central filing, fax machines, other
offices
Champion
Senior Level Manager who has the authority to
commit the necessary resources to an IMPROVE
project in a significant area of MUSC.
– Translates MUSC’s vision, mission, goals and metrics to
create a deployment plan and identify individual projects.
– Identifies resources and removes roadblocks.
– Owns the success for the project.
Center for Clinical Effectiveness and Patient Safety
Process Owner
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Knows what is critical about the process
Manages the entire process improvement cycle
Helps to assemble the team
Owns the solution delivered by the team
Makes sure the process is documented and that
documentation is used and updated regularly
– Works with the Champion to ensure that gains
from the project are sustained
Center for Clinical Effectiveness and Patient Safety
Facilitator
– Helps to guide the team in accordance
with the Agenda & IMPROVE model
– Trains and coaches project teams
– Ensures that meetings stays on task
– Promotes interaction & participation by
all team members
– Facilitators are not members of the
IMPROVE project team
Center for Clinical Effectiveness and Patient Safety
Team Members
Individuals from various functional areas
who support specific projects.
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Subject matter experts
Contribute ideas in respectful manner
Are receptive and ready to make changes
Selected by Champion or Process Owner
5 to 7 members too many team members may
hinder team performance
Center for Clinical Effectiveness and Patient Safety
The Road Map to
I.M.P.R.O.V.E.
I
M
P
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V
E
What is the
Problem?
Define the
measures of
success
What is
causing the
problem?
Review best
practice and
Brainstorm
How are you
going to
Make it
Work?
Quantify
Benefits
Track the
data over
time
What is the
scope?
System or
unit?
Create a
plan to
Measure
Use Data
not
Anecdote!
Design and
Execute a
Pilot
Assign a
Team
How are you
going to
Communicate
Changes?
Mistake
Proof, Do
not rely on
Education!
I.M.P.R.O.V.E.
Center for Clinical Effectiveness and Patient Safety
How are you
going to
Hardwire?
Documentation
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Good documentation is crucial
Provide information about data
Suitable for future use
Best Practices
Center for Clinical Effectiveness and Patient Safety
Department
Start Date
Problem Title
Anticipated Completion Date
Champion:
Process Owner:
Team Members:
Validate Effectiveness:
Completion Date
Facilitator:
Identify (Describe) the Problem:
Completion Date
Measure (Metrics and Goal):
Completion Date
Problem Analysis (Determine Root Causes):
Completion Date
Remedy (Brainstorm/Determine) Solutions:
Evaluate for Sustainability:
Completion Date
Operationalize (Implement) the Solutions (Who/What/How):
30 Day
90 Day
120 Day
Lessons Learned:
Completion Date
10-21-2010
Department
Problem Title
Lab
Red Cross Lab Payment
Start Date Oct 2010
Anticipated Completion Date Jun 2011
Champion: Stacia Lancaster
Process Owner: Iola Powell
Team Members: Steve Hargett, Ralph Greene
Facilitator: Karen Garner
Validate Effectiveness: Lab Services Business Office will monitor savings reflected on
invoice Projected annual savings for FY11 in blood cost: $148,500 Completion Date Feb 2011
1.5% Savings on Payment of Blood
Identify (Describe) the Problem: Not taking advantage of Net 15
day payment term offered by Red Cross for blood products and
services (1.5% discount).
Completion Date Oct 2010
$160,000
$148,500
$140,000
$120,000
Measure (Metrics and Goal):
$100,000
Net 15 payment terms reflected on blood invoices
Decrease in payment to Red Cross by taking advantage of Net 15
day Payment Term
Completion Date Nov 2010
Problem Analysis (Determine Root Causes):
Insufficient cash
on hand in prior budget years
Completion Date Dec 2010
$71,997
$80,000
$60,000
$40,000
$20,000
$0
1
FY11Savings Goal
FY11 YTD Savings
Remedy (Brainstorm/Determine) Solutions:
Lab works with Controller and accounts payable to change payment
terms to immediate
Completion Date Jan 2011
Operationalize (Implement) the Solutions (Who/What/How):
Lab Services fiscal staff ensures prompt entry of PO Blanket release for invoice
payment and hand deliver invoice to Accounts Payable.
Accounts Payable staff promptly enters invoice with “immediate” payment terms
to ensure vendor receives payment within 15 days of the date of the
invoice.
Completion Date Feb 2011
Evaluate for Sustainability:
30 Day Lab Business Office will follow up on timely processing of PO, invoice entry,
and check writing.
90 Day
120 Day
Lessons Learned:
10-21-2010
Department: Perinatal Services
Title: Electronic Competency Validation
Champion: Debbie Browning
Process Owner: Debbie Browning
Team Members: Michelle Sharp, Kathleen White, S. Mcconnell
Facilitator: Debbie Browning
Start Date: FY11
Anticipated Completion Date:
Validate Effectiveness:
Completion Date
Identify (Describe) the Problem:
Identified ability to shift some of the traditional 4 hour annual
competency assessment to online process; will result in less hours
needed for actual skill validation and increased RN satisfaction.
Completion Date
Measure (Metrics and Goal):
Total Projected Savings= $11,848
Annual competency assessment (hands on) check-off sessions have
been decreased to 2 hours per RN.
Cost savings of $11,648 for RN’s in Perinatal services annually and
$200 in supplies. Total Projected Savings= $11,848
Completion Date
Problem Analysis (Determine Root Causes):
Competency validation has traditionally been 4 hour teaching session
and skills check-off
Remedy (Brainstorm/Determine) Solutions:
Educators are currently planning competencies for Spring 2011;
working to separate what “must” be hands on skills validation
Completion Date
Evaluate for Sustainability:
Operationalize (Implement) the Solutions (Who/What/How):
90 Day
Will operationalize Spring 2011; and measure RN staff satisfaction
with process.
Completion Date:
120 Day
30 Day
Lessons Learned:
10-21-2010
Department
Problem Title
Performance Improvement
10 West Discharge Process
Champion: Nancy Tassin
Process Owner: Mike Sawin
Team Members: Florence Simmons, Kathy Sloan, Karen Boyd,
Jessica Stout, Gayle Wadford, Roxanne Cuzell, Christa Schaff,
Allison Swingle, Metze Sulyma
Start Date: 6/29/2010
Anticipated Completion Date: 12/31/2010
Validate Effectiveness:
weekly
Real-time data collection began 7/28/2010. Monitoring
Completion Date
Facilitators: Stephanie Sargent, Rob Finch
Lead Time: September, October
From the time that the physician writes
the discharge order until the patient leaves is too long (245 mins). Patient
satisfaction scores are below goal on the discharge process and capacity is
decreased by inefficient throughput (i.e. transfers from
ED/ICU/PACU).
Completion Date: 7/1/2010
Identify (Describe) the Problem:
700
600
500
1. Decrease the average length of time
between when the discharge order is written and patient leaves the unit
from 245 to 105 mins minutes by the end of December 2010. Decrease
standard deviation from 138 to 70 minutes.
2. Press Ganey goal 65th percentile. New patient satisfaction goal in
Avatar TBD.
Completion Date: 7/15/2010
Measure (Metrics and Goal):
Constructing a swim lane and
a fishbone analysis revealed the top three root causes of discharge delays:
1. Appointment making, 2. Transportation and 3. SW issues surrounding
RXs
Completion Date: 8/5/2010
Problem Analysis (Determine Root Causes):
Remedy (Brainstorm/Determine) Solutions: Appointments:
ASAP; MD appts progress notes; White board “D+1” visual cue; standing f/u appts:
ortho 1-14 days; ID 4 weeks; Uro 7-10 days Transportation: Nursing admission
assessment; standing item in daily care meetings with CM, SW, CUL, etc.; Night RN D+1
patients call family for a.m. DC; Day RN D patients call; “discharge” whiteboard
Medications/SW: Self pay SW Rxs smaller dispenses Just Do Its: VS/labs 0600 from
0800; Lovenox teaching prior to DC
Completion Date: 8/18/2010
Operationalize (Implement) the Solutions (Who/What/How): ASBs ASAP
8/23; Sawin/Leon/Hartsock 9/17 DC in progress notes; CUL owns D+1daily by
10:00 8/18; ASB owns standing f/u appts 8/18 ; Sawin RN admit assess 9/24;
CM/SW care rounds re transp. 8/18; Sawin/staff pt.s calling family 9/24;
Sawin/staff DC whiteboard 10/14; SW meds 9/1; Sawin Just Do It’s 8/5
Completion Date: 11/8/2010
Data
400
300
267.189
215.066
200
100
0
September
October
Evaluate for Sustainability:
30 Day: 1/31/2010
90 Day: 3/31/2010
120 Day: 4/30/2010
Total Savings $11,340
Lessons Learned: Do not assume that just because a message has been communicated,
that it was received. Ensure proper team membership. A communication plan is in place.
10-21-2010
Lean Six Sigma Books
Center for Clinical Effectiveness and Patient Safety
Your Performance Improvement
Team
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Jennifer Hooks: Master Black Belt
Scott Brady: Black Belt Improvement Facilitator
Stephanie Sargent: Green Belt Improvement Facilitator
Mike Roudabush: Senior Improvement Facilitator
Marilyn Winkel: Improvement Facilitator
792-4906
e-mail
[email protected]
Center for Clinical Effectiveness and Patient Safety