Hurley SmithTrinity HCAD Class of 2012

Thursday, November 5th 2015

Lean at Tenet

True North“Where do I fit in?”

True North

Why do we exist, really?........

For Our Customers

Who Have These Needs

We Provide

~Generic Mission~

Unlike Our Competito

rs

We Are Better in

These Ways

~Generic Vision~

“Loyola Jettisoned whatever traditional religious practices stood in the way…

…like praying...

…more accurately, praying according to the monastic tradition”

True North: Mission & Vision

St. Ingatius Loyola, SJ

Mission: Develop souls and propagate the faith.

Vision: To do so by focusing on education, speed, and adaptability.

True North

Why do hospitals exist, really?........

For Our Customers

Who Have These Needs

PatientsEmergent

Medical

Surgical

Women's

Diagnosti

cs

We Provide

Healthca

re

~ Generic Hospital Mission Statement ~

So… Are we any good?

So… Are we any good?

7

High Level

Business

Indicators

Service-Line Level

Business

Indicators

Process-Level

Business Indicators CAUTICLABSI SepsisReadmit

s

Service

VTE-1 STK-4 Falls with

Injury

CLABSI Infecti

on Rate

Readmissions Rate

Sepsis Excess Days Rate

Exparel Usage

Blood Utilizat

ion

PSMS Actual Score

TARGET 96% 92% 0.023 0.500 14.0% 29% 1.6 40% 72TENET 95% 85% 0.041 0.900 13.4% 29% 3.4 44% 72.0California 93% 59% 0.043 1.097 14.7% 26% 3.7 32% 71.9Central 99% 100% 0.000 0.395 12.7% 36% 5.2 59% 69.9Detroit 99% 100% 0.000 2.675 19.9% 35% 0.0 63% 72.3Florida 95% 97% 0.000 0.855 14.5% 37% 4.2 39% 70.4Northeast 98% 71% 0.186 0.513 13.1% 32% 0.0 45% 71.1PHOENIX MARKET 98% 100% 0.000 0.422 7.5% 29% 1.9 29% 67.2Southern 97% 100% 0.741 1.422 12.2% 25% 2.0 34% 72.0Texas 93% 86% 0.056 0.299 12.4% 24% 6.5 46% 75.0

Hospital Name

Process ValueBSC Metrics

Safety Outcome

LD

M

Managem

en

t Syst

em

3 West

ICU ER 2 North

Complicated vs. Complex

Requires lots of schooling.

Requires leadership.

Complex Systems: Why Hospitals Are Hard

1840 – Textile Mills

“Of more serious consequence to the workers... Company production innovations”

Source: There is Power in a Union, Philip Dray

The “Speed Up”

Running the machines at a faster pace

The “Premium System”

Reward the most productive workers with cash

The “Stretch Out”

Increase in the number of machines for which a worker is responsible

Quality Service Cost People Growth

“Volume cures all ills”

“Work faster”

“More market share”

“Cut costs!”

“Physicians are our number 1 customer!”

“EBITDA!!!!!”

Why did early managers do that?

W. Edwards Deming on Leadership

1. Lack of constancy of purpose to plan product and service that will have a

market and keep the company in business, and provide jobs.

No True North. No Economic sense of purpose.

2. Emphasis on short-term profits: short-term thinking (just the opposite

from constancy of purpose to stay in business), fed by fear of unfriendly

takeover, and by push from bankers and owners for dividends.

Emphasis on Cost and Growth (discounting the other 3

pillars)

3. Evaluation of performance, merit rating, or annual review.

Sub optimization (constraint theory)

Visual Management

Consensus

Is

Golden

“Quiet at Night”

Lean Daily Management

January, 2013 - “lais·sez-faire” Gemba

April, 2013 - Leader x-ray vision

November, 2013 - Look to the Glass Wall!

2014 – Propagate the faith

Spring, 2015 – Trail of tiers

Fall, 2015 – High Reliability

The evolution of a management system…

Vanguard

Tenet

High Reliability

People Developme

nt

Management System

Performance

Improvement

Strategy Deployment