Leading A Lean Enterprise Transformation in a Health Care
System
May 8, 2012 Patricia A. Gabow, M.D.
CEO
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Leading A Lean Enterprise
Overview of Denver Health Why is healthcare transformation
needed? Role of leadership Lessons learned
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Non medical Detox
Correctional Care
Denver Health
Medical Center
911
Family Health Centers
Regional Poison
Center & Nurseline
Denver Health
Medical Plan
School-based Health Centers
Rocky Mtn Center for Medical
Response to Terrorism Public Health
Rky Mtn Regional
Trauma Ctr
Employed Physicians
HIT
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Denver Health Patients
Denver Health cares for approximately 176,000 individual patients – almost one third of Denver County’s population
37% of Denver’s babies are born at Denver Health
40% of Denver children use Denver Health
70% of patients are ethnic minorities 75% of patients are below 185% FPL
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American health care has serious problems in:
–Access –Cost –Quality/Safety
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Change in American healthcare will require new American models
New American healthcare models will require transformation at individual system levels
System transformations require institutional leadership that focuses on and delivers change
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The Role of Leadership – Defining the journey
• Create the vision • Define the path
– Implementing the journey • Teach the path • Create structure – Build the road • Walk the path
– Commitment to outcome • Measure performance • Provide feedback • Create transparency
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Role of Leadership • Define the Path
– Literature review – External steering committee – Site visits – Employee focus groups – Patient focus groups – Detailed examination of processes – Chose the path
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©
Right Person
Right Environment
Patient and Family
Right Process
Right Reward
IT
Right Service
Right Communication
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Transformation
Con
tinuo
us
Impr
ovem
ent
Res
pect
for
Peop
le
Lean Pillars of Transformation
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Waste is disrespectful of humanity because it squanders scarce resources
Waste is disrespectful of individuals because it asks them to do work with no value President Toyota
Waste is disrespectful to patients by asking them to endure processes with no value
Waste is disrespectful to taxpayers for asking them to financially support processes with no value.
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Leading A Lean Enterprise
Role of Leadership – Implementing the Journey • Teaching the Path • 25 Black Belts
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Role of Leadership – Implementing the Journey – Teach the Path
• Executive Staff and Directors of Service (Chairs) – 4 hours Lean 101
• Mid-Managers – 2 hours overview • 2 hours first Lean tool (5S)
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Leading A Lean Enterprise
Black Belt Example: Engineering 6S Supply Project
2006-2011
Master Black Belt: John Thompson, Associate Chief of Operations
6S: Sort Set in order Shine Standardize Sustain Safety
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Role of Leadership – Implementing the Journey – Teach the Path
• All mid managers do 5S project • Report with metrics to CEO • Provide a rapid Lean results applicable to
clinical and support areas—fun/useful • Large number of employees involved • Immediate results • Begins spread of Lean
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Unit 1, Basement, Bedroom, Plumbing (BEFORE) Frank Ortega 4/19/06
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Unit 1, Basement, Bedroom, Plumbing (AFTER) Frank Ortega 5/2/06
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Engineering Expense Trend
Supply Expense
R & M Expense
Total Supply/R&M
2004 $1,034,631 $769,364 $1,803,995 2005 1,155,500 1,025,908 2,181,408 2006 869,734 784,212 1,653,946 $527,462 improvement from 2005 2007 707,223 1,000,124 1,707,347 $474,061 improvement from 2005 2008 714,993 862,117 1,577,110 $604,298 improvement from 2005 2009 711,505 856,252 1,567,757 $613,651 improvement from 2005 2010 906,285 884,893 1,791,178 $390,230 improvement from 2005
May 2011 Annualized 973,354 825,060 1,798,414 $382,994 improvement from 2005
Engineering 5S Project Results
Cumulative savings of $2,992,696 achieved while our square footage increased by 35%
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Lean Deployment at Denver Health
DH Black Belts (BBs): • 250 Black Belts • 48 hours lean training • Day to day lean • Bi-Monthly reports • BBs embedded
throughout clinical and non-clinical areas
Rapid Improvement Events (RIEs) • 16 Value streams • RIEs based on Value
Stream Analysis • RIEs coordinated by 9
Lean Facilitators • 7-9 members per team
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Role of Leadership – Commitment to Outcome • Measure Performance
– Define metrics/target all levels – Metric reporting CEO
• Provide feedback • Create transparency
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Define metrics • Black Belt target -- $30,000 • Value Stream target
– Financial – Quality – Human Development
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MDIs Purchased Pre and Post Implementation of Common Canister Protocol
0
200
400
600
800
1000
1200
1400
1600
1800
2000
Q1 Q2 Q3 Q4
Pre ImplementationPost Implementation
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Top 25 Black Belts Metrics
$796,926 $562,678 $529,057 $490,668 $479,830 $365,737 $317,679 $302,165 $288,562
$279,711 $279,413 $276,293 $257,666 $251,659 $236,980 $236,980 $232,400 $200,574 $177,096
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2012 Value Streams First Floor (ED,DECC, AUCC)
RMPDC – Drug and Product Safety
Nursing Clinical Process
Managed Care Revenue Cycle
Specialty Clinic OB/GYN
Human Resources RMPDC – Patient Access
Perioperative Services Pharmacy
Behavioral Health Services CHS (x16 RIEs)
Medicine Discharge Education
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Value Stream 2012 Financial Target
Quality Target
Pharmacy $1,200,000 Outpatient Satisfaction
Managed Care $2,300,000 CMS Safety Monitoring
Community Health Services
$1,000,000 Visits to Medical Home
Revenue Cycle $6,000,000 Aggregate Clean Registration Score
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$158,841,811
$-
$20,000,000
$40,000,000
$60,000,000
$80,000,000
$100,000,000
$120,000,000
$140,000,000
$160,000,000
$180,000,000Ju
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RIE + Blackbelt Combined Total Financial Benefit Trend Cumulative Through March 31, 2012
Leading Lean • Employee Involvement
– 250 Black Belts – 400 RIE’s – 2,000 Employees on RIE’s – TNTC – 5s, consultants
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Leading A Lean Enterprise
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Agree
I have been involved in the Lean Initiative like 5S or RIE 41%
I see benefits of the Lean philosophy in doing right processes at DH 64%
I understand Lean philosophy and how it works in our organization and helps maintain our mission
78%
Impact of Lean on Culture Employee Survey– 85% response
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Lean Lessons Learned – Organizational 5s a goal to start • Black Belts are an asset • Project approach not optimal path • Structure is important • RIE’s require power transfer • Handling push back • Sensei are valuable
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Transformation Lessons Learned • Transformation requires integrated components – no
silver bullet • A clear process is necessary for transformation • The process is applicable to all places where work is
done • Leadership from top is needed to create transformation • Cultural transformation requires entire workforce
engagement • Need a pace that produces transformation • Patience and steadfastness are needed
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