Lake Health’s Lean Journey
Innovative Improvement for Independence
A little bit about us
Cleveland
Ohio
• Team Members = 3,000
• Inpatient Beds = 270• Adult Admits =
17,000• Births = 1,900• Surgical Cases =
14,000• ER Visits = 76,000
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
Waiting Unnecessary Motion Defects
The practice and process of identifying and removing waste
The concept and practice of continuous improvement
The power of respect for people (Front line decisions)
Toyota Business System
What is LEAN?
1. Reason for Action
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!!
Organizations Practicing LEAN?
1. Reason for Action
1. Reason for Action
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
Why did we decide to embark upon this journey?
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1. Reason for Action
May 14-16, 2012 Leadership Retreat
2. Initial State
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
Where were we when we started?
3. Target State
Improved patient and family value through:
higher quality lower cost improved safety
Waste eliminated from processes Instill a culture of continuous improvement
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?
Availability of space
Staff Support
Budget
Structure
“Program of the Month”
Conflicting Priorities
5. Solutions
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
Deciding where to begin…
If We: Then We:Identify and harvest value streams #7, #8, Metrics will improveUtilize A3 thinking #1, #2, We will hardwire PIDevelop a lean office #1, #3, #6, #7Track results to True North metrics #1, #8, What gets measured gets
resultsCreate steering teams for guidance (enterprise, value streams)
#2, #4, #6, #7, #8
Provide coaching to leadership team #1, #2, #6, #7Have leaders participate on RIE’s, every year
#1, #5
Communication Plan #1, #2, #5, #7, #8Physician engagement #1, #2, #5, #7, #8Develop common terms/language #1, #2, #3, #4, #5, #6, #7, #8
What needed to be done to overcome those barriers?
5. Solutions
5. Solutions
Addressing Space/Staffing
5. Solutions
Addressing Structure
Pre-work Lean overview Observations Stakeholder
analysis RIE planning
Define Measure Analyze Improve Sustain
RIEReview Pre-workValidate
observationsBrainstorm
solutionsTry-storm solutionsValidate
improvements
Follow-up Educate Tweak final
changes Sustain new
process Continuously
improve through MDI
RIE – Change Based on Knowledge of the World’s Greatest Experts
Those doing the work
5. Solutions
Addressing Structure
MondayCurrent
ConditionGembaWaste
Observation
TuesdayWaste Analysis
Map Future State
Generate Solutions
Wednesday
Run Rapid Experiments
Problem Solving
ThursdayRun New Process
Document Standard Work
FridayReport 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
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
Daily Activities
7. Completion Plan
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
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MDI Goals
7. Completion Plan
Incremental daily improvement supplemented with Rapid Improvement Events
Event based improvement
Incremental Daily Improvement
(coupled with events)
RIE Events
Daily MDI Activity
RIE EventsImprovement
Level
7. Completion Plan
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
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.
Lessons Learned?
“Committed and trained senior leadership, without question, is the key component in successfully transforming an organisation through lean initiatives”
9. Insights
“Having a great partner, like Simpler, is essential to guiding an organization through such a transformative process.”