Lake Health’s Lean Journey

Innovative Improvement for Independence

Cleveland Ohio

• Team Members = 3,000 • Inpatient Beds = 270 • Adult Admits = 17,000 • Births = 1,900 • Surgical Cases = 14,000 • ER Visits = 76,000

A little bit about us

Presentation Roadmap

1. Reason for Action

: Why did we decide to embark on this journey?

2. Initial State

: Where were we when we started?

3. Target State

: Where do we want to be in 3…5…10 years down the road?

4. Identifying Gaps

: What are the major barriers that must be overcome?

5. Solutions

: What needed to be done to overcome those barriers?

6. Rapid Experiments

: Early successes/failures along the way?

7. Completion Plan

: Getting started on our journey!

8. Confirmed State

: Have we moved the dial?

9. Insights

: Lessons learned

1. Reason for Action

What is LEAN?

 Toyota Business System  The practice and process of identifying and removing waste    Waiting Unnecessary Motion Defects  The concept and practice of continuous improvement  The power of respect for people (Front line decisions)

1. Reason for Action

Organizations Practicing LEAN?

          3M Boeing Avery Dennison Dow Chemical General Electric Ford Motor Company Sears GlaxoSmithKline GEICO US Army, Navy, Air Force and Marines       Virginia Mason Mayo Clinic ThedaCare Denver Health Stanford Hospital & Clinics Lake Health!!

1. Reason for Action

Why did we decide to embark upon this journey?

 Desire to remain an independent,

community-based

health system  Recognition that the

status quo

or

incremental changes

in quality, cost and patient experience would not be sufficient to achieve goals  Require a

shared disciplined

approach to

innovative improvement

, that will transform the way we do business  Success of the transformation will ultimately depend on the

participation of all

team members, volunteers and physicians

1. Reason for Action

May 14-16, 2012 Leadership Retreat

7

2. Initial State

Where were we when we started?

 Operating in a dynamic/competitive market  Desiring to improve clinical quality and patient experience.

 Needing to extend focus beyond acute episodic care to continuum of care  Reimbursement not keeping pace with increasing expenses  Mediocre team member engagement  Average community perceptions

3. Target State

Where do we want to be in 3…5…10 years down the road?

 Improved patient and family value through:    higher quality lower cost improved safety  Waste eliminated from processes  Instill a culture of continuous improvement

4. Identifying Gaps

What are the major barriers that must be overcome?

Availability of space Staff Support Budget “Program of the Month” Structure Conflicting Priorities

5. Solutions

Deciding where to begin…

 Identify potential areas to begin  Identify the criteria for areas selected  Number of patients touched  Opportunities for improvement  Highest impact on the organization  Select ones that complement each other

5. Solutions

What needed to be done to overcome those barriers?

If We:

Identify and harvest value streams Utilize A3 thinking Develop a lean office Track results to True North metrics Create steering teams for guidance (enterprise, value streams) Provide coaching to leadership team Have leaders participate on RIE’s, every year Communication Plan Physician engagement Develop common terms/language

Then We:

#7, #8, Metrics will improve #1, #2, We will hardwire PI #1, #3, #6, #7 #1, #8, What gets measured gets results #2, #4, #6, #7, #8 #1, #2, #6, #7 #1, #5 #1, #2, #5, #7, #8 #1, #2, #5, #7, #8 #1, #2, #3, #4, #5, #6, #7, #8

5. Solutions

Addressing Space/Staffing

5. Solutions

Addressing Structure

Define Measure    

Pre-work Lean overview Observations Stakeholder analysis RIE planning

Analyze Improve Sustain

RIE



Review Pre-work



Validate observations



Brainstorm solutions



Try-storm solutions



Validate improvements Follow-up

 

Educate Tweak final changes



Sustain new process



Continuously improve through MDI

5. Solutions

Addressing Structure

RIE – Change Based on Knowledge of the World’s Greatest Experts Those doing the work

Monday

Current Condition Gemba Waste Observation

Tuesday

Waste Analysis Map Future State Generate Solutions

Wednesday

Run Rapid Experiments Problem Solving

Thursday

Run New Process Document Standard Work

Friday

Report Out

6. Rapid Experiments

Early successes/failures along the way?

Nurse to Nurse Handoff

Initial

: • Average time from ED to inpatient bed 79 minutes and up to 250 • ED staff took patient to inpatient unit then had to find the nurse

Solution

: • Inpatient nurses pull the patients from the ED within 15 minutes • Developed new clinical summary screen to facilitate face to face handoff

Benefit

: • Reduced time to inpatient bed from 79 minutes to 40 • Improved perception of care from patients • Improved quality and safety of hand off.

Second Pass improvements Solution

: • Time reduced an additional 20 minutes!

6. Rapid Experiments

Early successes/failures along the way?

Periops

Initial:

• Increasing Cost/UOS • Different patient types cared for by same staff • Causing uneven patient flow through SDS • Need to expand SDS area to support patient volume $3M project

Solution:

• Developed flow/standard work based on procedure • Identified specific locations in SDS for each patient type

Benefit:

• Improved flow avoided need for additional SDS beds.

• Saved $2.5M in capital.

6. Rapid Experiments

Early successes/failures along the way?

Physician First

Initial:

• Median time Door to Doc was 40 minutes • Protocol Care creating excessive ordering • Patient satisfaction for arrival less than desired

Solution:

• Implement Physician first concept at peak volume times • Triage by physician • Earlier implementation of care

Benefits:

• Patient satisfaction with arrival improved by 57% • Door to Doctor time decreased by 48%

7. Completion Plan

Never complete…

 Review the System-wide Transformational Plan of Care  Integrate into System-wide plan.

 Looking to expand to new areas within the system  Expanding the number of facilitators  Implemented Management for Daily Improvement Boards  Managing for Daily Improvement (MDI) is focused on implementing a management system that creates, accommodates, and sustains a culture of continuous improvement  The MDI System facilitates an ongoing transformation to a data driven, action oriented, engaged & empowered lean organization

7. Completion Plan

Daily Activities

 Manage “Flow” of process outputs (Visually)  Identify and prioritize anomalies of performance and make improvements  Encourage associates to identify and eliminate waste  Create an environment where associates are responsible for identification (and assisting in the elimination) of waste

7. Completion Plan

MDI Goals

 Convert from being a reactive firefighter, whose attention and priority is focused on the self- perpetuating, never-ending fires whenever they occur (always on the edge of out of control) TO…  A proactive Lean thinker who is managing and controlling his priorities and ultimately his destiny 21

7. Completion Plan

Incremental daily improvement supplemented with Rapid Improvement Events

Improvement Level RIE Events Event based improvement RIE Events Daily MDI Activity Incremental Daily Improvement (coupled with events)

8. Confirmed State



Have we moved the dial?

20 months into our journey…   $5.9M in Hard Dollar Savings Patient satisfaction with the arrival process improved by 57%  Avoided $2.5M in capital expense by improving patient flow  Falls reduced by 55%

9. Insights

Lessons Learned?

1. Reason for Action:

Leadership focus on the “what” not the “how”

2. Initial State:

Must have 100% commitment from all (especially physicians).

3. Target State:

Double the good…or…half the bad

4. Identifying Gaps:

Focus on the process…not the people

5. Solutions:

- Creativity over capital

6. Rapid Experiments:

The best laid plans…

7. Completion Plan:

A disciplined approach

8. Confirmed State

: Hope is not a strategy…countermeasures

9. Insights:

Some people will want to get off the bus…let them.

9. Insights

“Committed and trained senior leadership, without question, is the key component in successfully transforming an organisation through lean initiatives” “Having a great partner, like Simpler, is essential to guiding an organization through such a transformative process.”