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OAHHS LEAN WEBINAR NOVEMBER 11, 2014
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• A3 Improve Key Components • Improve tools • Deeper dive into a tool • Questions?
Overview
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DMAIC
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Date: Project Title and Area: Organization:
Authors:
Defin
e M
easu
re
Impr
ove
Cont
rol
Project Y Project charter SIPOCS VOCS (SWOT; Affinity; CTS; Kano) Communication Plan
Pre-
Hoshin Kanri VOCS VSM
Data collection plan Gemba MSA Process flow charts Spaghetti diagrams Scatter plots
Set Goal – “SMART”
Quantifying the waste & variation Visual display of current process
Define the problem
Future State Map Hypothesis Testing Correlation Regression Gap analysis (current/future) Root cause – why gaps exist
Understanding the waste & variation Y = f(x)
Control Plan Visual controls Kan ban 2 bin systems Poke yoke
Preventing recurrence of the waste and variation
Select Project
Removing the waste & variation
Target state Prioritize solutions Impact/Effort Affinity Multi-voting List Reduction
Anal
yze
Pie charts; Bar graphs Control Charts Pareto Process capability (DPMO; Sigma score) Takt time; cycle time
Fishbone; 5 Why Opportunity prioritization Risk/Frequency Affinity diagram Multi-voting/List Reduction families of variation
Team Selection Exec sponsor Process owner
Gantt chart Kaizen newspaper Small tests of change PDCA Quick change-over Cellular layout 5-S
Gantt Chart
Standard Work
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The Improve phase
• Establish the Target state • Identify the necessary changes to achieve the
Target state • Pilot as necessary • Execute implementation plans
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Small test of change
• Done quickly • Small scale • Anticipating the next cycle • Be prepared to respond quickly to problems
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The Model for Improvement
• What are we trying to accomplish? • How will we know when a change is an
improvement? • What changes can we make that will result in an
improvement?
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Before and After Improvement “ Confirm the change really improved the process”
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Date: Project Title and Area: Organization:
Authors:
Defin
e M
easu
re
Impr
ove
Cont
rol
Pre-
Set Goal – “SMART”
Define the problem
Understanding the waste & variation
Preventing recurrence of the waste and variation
Select Project
Removing the waste & variation
Anal
yze
What x’s and processes were measured to understand the stated problem?
Why this problem?
How does this project move the organization to its goals?
Quantifying the waste & variation
1. Business case has been explained 2. Problem statement in measureable terms 3. Data provided to describe the problem 4. Performance gap is described 5. Metrics are specified
1. Current state performance is described 2. Visual representation of process is shown 3. Data describing problem/process is provided 4. Project objectives/goals are specified
1. Proposed changes are specified 2. Visual representation of Target State is shown 3. Implementation plan is detailed 4. Results of Implementation are specified 5. Spread is in Implementation Plan if applicable
1. Primary obstacles and barriers are specified 2. Root causes are specified 3. Method of identifying root causes is shown 4. Goals regarding root causes are shown
1. Process owner is specified 2. Plans for follow up monitoring is detailed
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Project management is the discipline of planning, organizing, securing, and managing resources to bring about the successful completion of specific project goals and objectives.
Source wikipedia.org on 7/21/2011
Improve Phase - Project Management
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The Project Management Cycle
Initiating Planning
Executing Controlling
Closing
Initiating Planning Executing Controlling Closing
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Initiating Phase – Revisit the Project Charter
• Objectives • Scope • Project plan and status • Deliverables • Stakeholders • Assumptions and constraints
Initiating Planning Executing Controlling Closing
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Project Planning
Creates the workable approach to accomplishing the project objectives
Initiating Planning Executing Controlling Closing
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Outputs of the Planning Phase
• Specify tasks/activities • Determine schedule • Establish responsibility • Confirm the budget
Initiating Planning Executing Controlling Closing
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Task Analysis
Identify and describe for the tasks: • Start/stop or duration • Milestones • Dependencies • Sub-projects • Responsible party • Critical path
Initiating Planning Executing Controlling Closing
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Scheduling/ Gantt Chart
Initiating Planning Executing Controlling Closing
Task Start End Who 1/1 1/8 1/15 1/22 1/29 2/5 2/12 2/19 2/26
First task 1/1/11 2/1/11 Don
Second task 1/15/11 2/1/11 Sally
Third task 1/21/11 2/15/11 Tammy
Fourth task 2/7/11 2/18/11 Tammy
Fifth task 2/7/11 2/11/11 Don
Sixth task 2/15/11 2/28/11 Tammy
Seventh task 2/25/11 2/28/11 Don
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Executing
• Managing Risk • Anticipate delays • Keep the project going according to plan
Initiating Planning Executing Controlling Closing
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• Project control for status reporting - Compare actual to planned - Change is inevitable - Adjusting the plan
• Communications – With the team – With Leadership/management – With organization
Initiating Planning Executing Controlling Closing
Controlling
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• Acceptance of project results • Redeployment of resources • Closure of cost accounts • Turnover of project results
Initiating Planning Executing Controlling Closing
Closing the Project
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Roles and Responsibilities
• Project Manager • Sponsor • Stakeholders • Team • Others
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Lessons learned from Project Management
• Communicate, communicate, communicate • Overcoming resistance • Facilitating the team members • Accountability to achieve targets • Managing expectations • Leadership and Motivation • It takes discipline
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Brian Hudson, MS, LSSBB | Senior Advisor – Lean Six Sigma 765-496-0099 (office)|765-404-3255 (mobile)
[email protected] Purdue Healthcare Advisors | Purdue University
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QUESTIONS?
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LEAN HEALTHCARE: Preventing Pressure Ulcers on the Medical/Surgical Unit
St. Charles Redmond Medical Center
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About Us St. Charles Redmond Medical Center
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Our Lean Project
Pressure Ulcer Prevention
• Pressure ulcers are a national concern due to patient morbidity, treatment cost, and reimbursement issues.
• Previously, St. Charles Redmond Medical Center had not implemented any best practices for pressure ulcer prevention (PUP).
• AIM: implement PUP best practices for 100% of cases by December 31, 2014 .
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Project Team Pressure Ulcer Prevention Team Members and Roles
Name Job Title Lean Project Role
Adam Angeles, MD Wound Care Physician/Plastic Surgeon
Physician Champion
Susan Boucher, RN Wound Care Nurse Team Member
Laura Grasle, RN Quality Improvement Coordinator
Lean Facilitator
Kelly Kindle, RN Med/Surg Supervisor Process Owner
Bethany Klier, RN Wound Care Nurse Team Member
Natasha Luff, RD Nutritionist Team Member
Karen Sagner, RN Med/Surg Nurse Process Owner
Pam Steinke, RN Executive Sponsor Executive Sponsor
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Define
In May 2014, the IHI best practices for pressure ulcer prevention were implemented in only 77% of Medical/Surgical Unit cases at St. Charles Redmond Medical Center.
Preventing Pressure Ulcers in the Medical/Surgical Unit at St. Charles Redmond Medical Center Implementation of Best Practices -- May 2014 Audit Results
Best Practice Number of Best Practice-Implemented Patient Cases
Total Number of Patient Cases
Best Practice Implementation Rate
Conduct a Pressure Ulcer Admission Assessment for All Patients 20 30 66%
Reassess Risk for All Patients Daily 28 30 93% Inspect At-Risk Patient Skin Daily 3 6 50%
Manage Moisture: Keep the At-Risk Patient Dry and Moisturize Skin 6 6 100%
Optimize At-Risk Patient Nutrition and Hydration 2 6 33%
Minimize Pressure around the At-Risk Patient 6 6 100%
Total 65 84 77%
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Measure
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Analyze
High-Risk Barriers: • Variation in skin assessment occurrences and techniques • Lack of RN confidence in completing skin assessments and staging pressure ulcers • Variation in Nutrition Consult ordering decisions; variation in EMR ordering processes • Lack of communication related to pressure ulcer prevention • Lack of patient engagement related to pressure ulcer awareness and skin self-care
Root Causes: • Low incidence of pressure ulcers/short patient length-of-stay • No standard procedure or tool for conducting skin assessments • Deficits in staff knowledge/training related to skin assessments and pressure ulcer prevention • No standards or standard processes for ordering Nutrition Consults • Lack of focus on pressure ulcer prevention throughout the St. Charles Healthcare System
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Improve
Goals: • Conduct standard daily skin assessments for 100% of at-risk patients • Order Nutrition Consults for 100% of patients with “poor” Braden Assessment nutrition
scores
Outcomes: • In September 2014, standard daily skin assessments were conducted for 98% of at-risk
patients. • In September, Nutrition Consults ordered for 100% of patients with “poor”
Braden Assessment nutrition scores.
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Control (Sustainability/Spread)
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Advice to Others & Lessons Learned
• PUP Advice: Survey nurses/frontline caregivers (VOCS) for help identifying barriers to PUP best practice implementation.
• Key Learning: Our multidisciplinary team was almost too multidisciplinary and motivated, making it hard to keep the project in scope.
• Advice (Based on Key Learning): At team meetings, include only those team members with a direct relationship to the agenda/project task.
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Contact Information
Laura Grasle Quality Improvement Coordinator St. Charles Redmond Medical Center
541-526-6523 [email protected]
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QUESTIONS?