Transcript Document
Continuous Performance Improvement
Continuous Performance Improvement Continuous Performance Improvement
Agenda
• CPI at Children’s • Waste & Value • Just in Time • Built in Quality • Results Continuous Performance Improvement
Our Vision
We will be the best children’s hospital.
Continuous Performance Improvement
Our Reality in the Late 1990s…
• Safety concerns – Serious safety events • Service deficiencies – Access – Communication • Healthcare finance reform • Declining staff engagement To achieve our vision we needed a new management philosophy Continuous Performance Improvement
A Benchmark: Toyota
• High quality and reliability • Safety record that exceeds others in the industry • Cost effective with a short response time to customers • High levels of employee engagement and morale • Organization-wide philosophy and management system Continuous Performance Improvement
Our CPI Philosophy: Benchmarking Lean
•
Focus on the patient and family:
involve them in our improvement work; listen!
•
Engage staff at all levels:
those that do the work, can improve the work; use the scientific method •
Leaders provide guidance and commitment:
this is our management system and we support staff in their improvement work •
Long term view:
this is a generational effort without an end point, that utilizes P-D-C-A Continuous Performance Improvement
Our CPI House
Continuous Performance Improvement
What Does That Mean? No Waiting Engage Everyone in a Patient-Focused Philosophy No Harm “Just In Time” “Built-In Quality” Right service in the right amount at the right time in the right place Balance the Work Standard Work Make problems visible Never let a defect pass along to the next step Eliminate batches Error Proof Rapid Changeover Continuous Flow: Pull vs. Push Stop when there is a quality problem 5S and Visual Control Value Stream Improvement Through Waste Reduction
Continuous Performance Improvement
Waste & Value
Value Stream Improvement Through Waste Reduction
How do we do this?
1) Understand value for the customer: • Identify who is your customer • Identify what product or service the customer wants 2) Focus on Flow • Identify the process of how the value is created (The Value Stream) • Eliminate steps that do not create value (The Waste) Continuous Performance Improvement
Value Stream Improvement Through Waste Reduction Point Improvement Approach Admission Evaluation Ancillary Service Discharge Billing Value Stream Approach Admission Evaluation Ancillary Service Discharge Billing
Continuous Performance Improvement
The Basic Strategy
• Most processes are
95 – 99%
non-value-added. • Everything we do in a work process either adds
value
or is
waste
• We want to design systems that provide value with as little waste as possible Eliminate
Waste
Reduce Continuous Performance Improvement
Non-Value Added Activity (8 Wastes)
“Activity that consumes resources but
adds no value
to the product/service”
T
ransportation
I
nventory
M
otion
W
aiting
O
verproduction Google Image Photos; some rights reserved
O
ver-processing
D
efects
U
nused Creativity Continuous Performance Improvement
5S What are the 5S’s?
1. Sort
– separate unneeded from needed
2. Straighten
– a place for everything and everything in its place
3. Scrub
– visual and physical inspection
4. Standardize
– everyone doing the same thing
5. Sustain
– hold the gains through audits and accountability
Was 5S used in our airplane factory?
Continuous Performance Improvement
Workplace Organization Helps Eliminate Waste
How does the setup of the fire truck and code cart impact the ability to do the jobs they were designed for?
Continuous Performance Improvement
Visual Workplace
(cont’d.)
What needs to be re-stocked?
Re-stocking Rule
Do not re-stock until level falls below
red
line.
Re-stock only up to
green
line.
TOWELS GOWNS WASHCLOTHS
© 2005v.2 Joan Wellman and Associates, Inc.
BLANKETS
Continuous Performance Improvement
Visual Workplace
Visual workplaces use visual devices to: • Tell us at a glance how we are doing • Allow us to see abnormal conditions as they occur • Understand the status of an area in 5 minutes or less by simple observation, without use of computers or speaking to anyone © 2005v.2 Joan Wellman and Associates, Inc.
Google Image Photo; some rights reserved Continuous Performance Improvement
5S is More Than Tidying Up
5S is a visually oriented system for organizing the workplace to… • Wasted time • Training time • Errors • Maintenance • Inventory • Hazards • Barriers to success • Teamwork • Quality • Safety • Cleanliness • Discipline • Consistency • Culture © 2005v.2 Joan Wellman and Associates, Inc.
Continuous Performance Improvement
“Just in Time” -No Waiting
“
Just in Time
”
– No Waiting
Right service, right amount, right place, right time Batch Processing Continuous Flow Processing
Continuous Flow = Steady Velocity
Continuous Performance Improvement
Batch Processing vs Continuous Flow Processing
Batch Processing
Large batches
Continuous Flow Processing
Batch of 1 (one-piece flow) Process silos (operate independently) Layout of space designed to optimize silo (promotes batching) Connected processes (dependent on each other) Layout of facility/space based on sequence of work Schedule each process and push to the next Equipment & supplies are stored in “warehouses” Problems remain hidden in buffers of inventory Entire process linked with no inventory or waiting between steps Equipment & supplies (including meds) are stored at the point of use Problems become visible (stop the line) Continuous Performance Improvement
Continuous Flow Enables “Just in Time” Services
If… The customer and value is identified Service is produced one-at-a time to meet demand Physical layout eliminates transportation and movement Product or service is provided on customer request Then it’s Just the…
Right Service Right Amount Right Place Right Time
= No Waiting
Continuous Performance Improvement
Creating Flow with Signals: Kanban
• • •
Definition:
A signal for communication that allows the customer to say, “
I am ready for more
” or “
I need more
” Signal can be a card, empty space, cart, etc.
Used to create flow between disconnected processes often due to physical layout • • •
Purpose:
Paces the work to prevent batching Authorizes work to begin Authorizes supplies or equipment to be moved
Was kanban used in our airplane factory?
Continuous Performance Improvement
“Built in Quality” - No Harm
The Importance of Built in Quality
Errors become “defects” when work moves beyond where the error occurred.
E
Error Occurs
D C B A
Customer
What are the effects of later detection?
Start Continuous Performance Improvement
1. DETECT the Abnormality
Knowledge in the Head Knowledge in the World
Need to rely on memory or look up acceptable level Quick glance enabled by simple visual indicators Continuous Performance Improvement
1. DETECT the Abnormality
Continuous Performance Improvement
2. STOP
Give Stop-the-line authority to everyone and prevent defects from being passed on
= STOP
STAR:
S top; T hink; A ct; R eview
Stop and Resolve
when uncertain = Need Help = Normal Andon Continuous Performance Improvement
3. FIX or Correct the Immediate Condition
Respond immediately to the abnormality
ARCC:
A sk a question; R equest a change; voice a C oncern; and C hain of Command
Stop and Resolve
when uncertain Continuous Performance Improvement
4. INVESTIGATE root cause…
Solve the problem to prevent recurrence
SBAR:
S ituation, B ackground, A ssessment, R ecommendation Continuous Performance Improvement
4. …and INSTALL Countermeasure
Build quality into the process with…
5S & Visual Standards Standardized Processes Visual Alerts Audible Alerts Error Proofing Continuous Performance Improvement
Management System
Daily Management
7 am – Supply Chain Night/Day Shift Team Huddles 7:30 am - OR Huddles 7:45 am – Nursing Flow Huddle 8am – Supply Chain Team Huddles 8:15am – Supply Chain Division Leadership Huddle 8:50 am – Daily Safety Briefing 9:30am – VP/Supply Chain Issues Communication 10:00am – Executive Leadership Team Huddle 1pm - OR Huddles 3pm- Nursing Huddles 3 pm - Day/Evening Shift Team Huddles 11 pm – Supply Chain Evening/Night Shift Team Huddles Continuous Performance Improvement
Daily Huddles Agenda Director
•Shares Organizational Message to Team •Discusses Outstanding Issues/Projects •Discusses Patient Safety Issues Manager •Updates Performance Metrics •Shares Barriers and Potential Counter Measures •Shares Barriers From Team Huddles •Shares Barriers from Nursing Huddles Continuous Performance Improvement
Supply Chain Daily Management
Continuous Performance Improvement
Our CPI Management System
Continuous Performance Improvement
Present: Strategy Deployment
Continuous Performance Improvement
Results Our Results Our Results
Continuous Performance Improvement Continuous Performance Improvement
Engagement: Gallup Q 12® Results Over Time Ratio of Engaged to Actively Disengaged: 1.32:1 2.92:1 3.42:1 4.20:1 3.75:1 5.56:1 5.56:1 6.25:1 5.67:1 6.50:1 6.00:1 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
Continuous Performance Improvement Copyright © 2011 Gallup Inc.,. All rights reserved.
Engagement: Morehead Associates Overall Workforce Commitment 2013 Seattle Children's 4.38
4.37
Performance Difference: National Children's Healthcare Average National Healthcare Average +.09
+.22
+.06
+.21
Workforce Commitment Percentile Ranking 95 th 94 th
FY13 Goals: Baseline = 4.37; Target = 4.39; Stretch = 4.41
Note – GREEN / RED
notes a statistically significant difference.
• National Children's Healthcare Average +/- .04
• National Healthcare Average +/- .04
Continuous Performance Improvement
Quality: Family Experience Survey 70 60 50 40 30 20 10 0 58.3
54.6
49.9 47.3 47.4
43.7
40.2
34.6
ART (FES Year) 2004 2005 2006 2007 2008 2009 2010 A: Accountability – Nurses answered questions understandably. R: Respect – Involvement in decision making. T: Teamwork – Staff worked as team to care for child.
2011
Continuous Performance Improvement
Quality: Family Experience Survey
80,0% 78,0% 76,0% 77,0% 76,6% 77,6% 78,4% 79,4% 80,4% 74,0% 72,0% 70,0% FY 2012 FY 2013 FY2014 YTD Goal Cumulative Hospital Score
Using any number from 0 to 10, where 0 is the worst possible and 10 is the best possible, what number would you use to rate Seattle Children’s Hospital?
Continuous Performance Improvement
Delivery: New Patient Wait Times
35 30 25 20
Wait Times for New Patient Appointments Trend by Year and Visit Volume
Days FY13 Target 120 000
96 248
100 000
90 245 80 581
80 000
72 377 67 635
60 000 15 10
38 033 43 989
5
21 20
0 FY07
** FY13 Median Wait Times
FY08
19
FY09
20
FY10
20
FY11
15
FY12
15
FY13 40 000 20 000 Continuous Performance Improvement
Safety: FY FY 2008 FY 2009 FY 2010 FY 2011 FY 2012 FY 2013 HAI Rate 14.2
11.9
10.1
8.6
8.1
8.35
Discharges 13514 14144 14321 14107 14594 14374 # of Infections 192 168 145 121 116 120
Continuous Performance Improvement
Cost: Supply Chain
• Two-bin kanban system: “Demand Flow” • $2 million reduction in excess supplies • $539,000 (50%) reduction of Central Service Main Supply Area • $410,000/year reduction of returned supplies cost • 48,000 hours/year returned to staff (projected) • Reduced off-contract supply orders (~$2 million per year) • Eliminated ~20,000 stat/rush calls per year Continuous Performance Improvement
Cost: Supply Chain
90
Quality Staff: *Increased Leadership
80
*Strategic Sourcing Managers
70 8 60 8 50 40 30
$6 296 231
60,2 20 10 0 2008
$6 908 111
62,2
FTE per Managed Supply
12
$8 132 662
58,95 2009 Supply Chain Staff 2010 16
$10 618 306
60,25 19
$12 701 182
60,75 2011 2012 Supply Chain Quality Staff 63,55
$18 359 540
$20 000 000,00 $18 000 000,00 21 $16 000 000,00 63,55 $14 000 000,00 $12 000 000,00 $10 000 000,00 $8 000 000,00 $6 000 000,00 $4 000 000,00 $2 000 000,00 $0,00 2013 2014 Supply Chain Managed Spend Continuous Performance Improvement
Our Approach: Wins and Challenges
• Wins: • • Early successes allowed us to prove the methods worked Early leadership buy-in and enthusiasm provided a basis for engagement throughout the organization • Executive leadership and Board support afforded a strong foundation • Challenges: • • Value stream approach earlier on would have allowed us to see the system-wide impacts Early focus on the tools and event-based – RPIWs, 5S, etc.; management systems approach did not start soon enough to support sustainment of work (audits, leader standard work, etc.) Continuous Performance Improvement
Lessons Learned
• Requires a long term view • Requires substantial leadership and financial investment • This is
hard work!
• Learn to fish – external consultants can get you started, but you have to develop leaders within your organization Continuous Performance Improvement