Transcript LEAN at Denver Health - National Network of Public Health Institutes

Lean at Denver Health:
Saving Lives, Saving Money, Saving Jobs
Phil Goodman
Director, Lean Systems Improvement
Denver Health
Denver, Colorado
Lean At Denver Health:
Saving Lives, Saving Money, Saving Jobs
• Denver Health
• Lean Principles and Tools
• Application of Lean Results
– Pre-Hospital
– Inpatient
– Outpatient
– Public Health
• Financial Impact
HIT
Employed Physicians
Rocky Mtn
Center for
Medical
Response to
Terrorism
911
Denver
Health
Medical
Center
Public Health
Regional
Poison
Center &
Nurseline
Schoolbased
Health
Centers
Rky Mtn
Regional
Trauma Ctr
Family
Health
Centers
Correctional
Care
Non
medical
Detox
Denver
Health
Medical Plan
3
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?
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Underutilized Human Talent
Waiting
Inventory
Transportation
Defects
Motion
Overproduction
Processing
Lean Tools
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
Continuous
Improvement
Respect for
People
Pillars of Lean Transformation
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
Pre-Hospital:
Denver Health Paramedic Value Stream
Paramedic Division Response Time Performance Pre and Post RIE
Response Time in Seconds, 911 Answer to Arrival at 90%
Compliance
880
860
840
820
800
780
760
740
720
700
EMS
EMS
EMS
<48
48
49
RIE Conducted
This Week
EMS
EMS
EMS
EMS
EMS
50
51
52
53
1
Weeks of 2008-2009
Pre-Hospital:
Denver Health
Paramedic Value Stream
Note Revenue >Operating Expense 2010-2012
Total Personnel, Operating Expenses and Revenue 2007-2012
Improving Inpatient Safety
and Quality of Care
Improving Inpatient Safety
and Quality of Care
Improving Inpatient Safety
and Quality of care
Improving Inpatient Safety
and Quality of Care
Hospital Flow and Readmissions
Improving Inpatient Safety
and Quality of Care
UHC Quality and Accountability
Aggregate Score - 2011
Improving Inpatient Safety
and Quality of Care
Improving Patient Access
Community Health Services
Total CHS Patients
140000
120000
100000
80000
60000
40000
20000
0
2005
2006
2007
2008
2009
2010
2011
Total Patients 102710 101162 103826 108042 113003 117058 123614
Improving Efficiency
Community Health Services
Improving Outpatient Safety and Quality of Care
Improving Outpatient Safety
and Quality of Care
Community Health Services
Improving Outpatient Safety
and Quality of Care
Community Health Services
What About Applying Lean in
Public Health?
How Can Lean Help?
• Identify and eliminate waste
• Develop and Implement Standard Work:
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The currently best known, least waste way of getting the work done
Developed by the people who actually do the work
Not optional
Standard Work Wedge
Performance
STANDARD WORK
© Simpler Consulting, L.P. 1996-2012 All Rights Reserved.
Time
Value Stream Mapping in Public Health
ABC County Health Dept
General Clinic
Current State
December 6, 2012
Actual Value Stream Map
= Wait
Client Arrives
Client Exits
Documentation
= Kaizen Opportunity
Registration
CT=37min
Class
CT= 45 min
25 Mins
Wait
Sing in
Paperwork
Create Chart
Complete Self Hx
Access
Client
History I
CT= 8 min
Obtain chart
Complete lab
forms
Review
immunizations
Info
Client
Specimen
CT= 4min
Access Client
History II
CT= 21 min
20 Min
Wait
Lab Work
CT=6 min
22 Min
Produce lab
specimen
Physical Exam
CT= 19min
12 Mins
Can’t move
Forward
w/o
lab test
15 Mins
Post Council
CT= 14 min
Client
Checkout CT=
3 min
28 Mins
Payment
Survey
Blood Tests x3
UA x 2
Access need
Dispense meds
Clin F/U
Adapted from: Nat’l Network of Public Health Institute’s Public Health Performance Toolkit
http://nnphi.org/tools/public-health-performance-improvement-toolkit
Application of Lean in Public Health to
Improve Services to Clients
ETOH Screening Current State Process in STD Clinic and Community Health Services at DH
PREVENTING ALCOHOL-EXPOSED PREGNANCIES IN
UNDERSERVED WOMEN ATTENDING A SAFETY-NET INPATIENT/OUTPATIENT HEALTHCARE SYSTEM
P Gillen,1 K Peterson2
1University of Colorado-Denver, Anschutz Medical Campus, 2Denver Public Health, Denver, USA
• Reason for Action: Poor
coordination of FASD
prevention and treatment
services within Denver
Health
• Gap Analysis:
Silos across multiple departments
with poor coordination of
services/referrals
• Initial Condition:
Relevant work being done
in silos of departments
• Solution Approach:
• Target Condition:
Integration of services to
provide best care efficiently,
utilizing existing resources
well
• Rapid Experiments: DPH took leadership in creating a collaborative at DH, with
technical assistance provided by CityMatCH. Two half-day planning sessions utilizing
LEAN methods identified the current siloed state of prevention efforts and care at DH,
analyzed the gaps, and developed solutions. DPH clinic data were used to assess the
prevalence of high-risk alcohol use in reproductive age women, defined as 4 or more
drinks on one occasion or 8 or more in a week, and their rates of effective
contraception.
ObGyn
• Pre-natal Care
• High-risk Deliveries
• Contraceptive Care
Including methods gained from
Practice Collaborative training
and forum with other sites
• Completion Plans:
Arrange trainings with clinics to
coincide with the new EMR in Jan,
2013
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Confirmed State: 16% of
women attending the DPH clinic
were both drinking at high-risk
levels and not using effective
contraception (816/4976)
Outpatient Behavioral
Denver Public Health
Larger Community
Pediatrics
Health Services
Maternal
Child
Health
COFAS
Substance
Abuse
Pre-natal Care
• Kids’ Care
Program
FASD Education
Treatment
Low-risk Deliveries • Child Advocacy
STD-CHOICES
Legislative Policy
Services
• Contraceptive
Kids’ Care
Demonstration
Project
Other Health
Other
Mental
Care
Adult Care
Contraceptive
Care
Care Systems
Health Care
Contraceptive Care
Data Analysis Expertise
Et cetera
Family Practice
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CityMatCH Practice Collaborative to Reduce the Risk of Alcohol-Exposed Pregnancy
Applying Lean to Business Processes
at Denver Public Health
• Implemented standardized billing for Public Health Services which
traditionally has not been done. Examples include:
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Billing for certain lab tests ordered out of the TB clinic;
A collaboration between the TB clinic and DU to test their
foreign born students for TB which resulted in a small profit for
the clinic;
Created standard work for billing of insured walk-in patients in
our STD clinic;
Billing third party payor sources for immunizations given in our
Immunization Clinic and during immunization outreaches
including outreaches occurring in Denver Public Schools.
Applying Lean to Business Processes
at Denver Public Health
• Automated ways of pulling and sharing data:
Retrieving STD lab data from the main lab to be
automatically loaded into our STD Electronic
Medical Record.
Before this was created the results (18k per year!)
had to be manually entered by clerical staff.
Applying Lean at
Colorado Dept of Public Health
• Created standard work to eliminate
redundancies (re-work) in:
 Licensing of Health Facilities
 Background checks and CEUs required for
certification of EMS professionals
• Implemented “andon” (red flags) to prevent
actual issuance of inappropriate license
Source: Nancy McDonald, BS, RN: Director for Medical Facilities and Emergency
Medical Services Division at Colorado Department of Public Health and Environment
(and former Assistant Director of Lean Systems Improvement, Denver Health
Financial Impact: “Hard Green Dollars”
from Denver Health’s Lean Initiative
Summary
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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
855-888-LEAN
Acknowledgements and Thank Yous!
Judith Shlay MD, Denver Public Health
Karen L. Peterson MD, Denver Public Health
Dean McEwen, Data Applications Supervisor, Denver Public Health
Andrew Yale, Administrative Director, Denver Public Health
Nancy McDonald, Director for Medical Facilities and Emergency
Medical Services Division at Colorado Department of Public Health
and Environment