Our LEAN Journey Presented by:
Craig Vercruysse, COO/WBR CPO Vernon Giang, MD Medical Director of Hospitalist Services CPMC September 13, 2012
• Underperformance on Dashboard Metrics
• Low EOW Scores on “Efficient Operational Processes”
• Inability to sustain improvements (e.g. patient satisfaction)
• Nationwide healthcare reform and Healthcare IT stimulus
LEAN, why change?
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What is LEAN? • CPMC’s brand of the Toyota Production System (aka Quality
Delivery System)
• Create value from the patient’s perspective
• Philosophy – continuous learning and improvement (kaizen), respect and challenge people and partners, long term thinking, eliminate waste
Culture Change
Leader Development
Focused Improvement
• Quality Improvement • Patient satisfaction • Staff satisfaction • Regulatory compliance • Risk Management • Survey-readiness at all times • Financial soundness
Effective system for:
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Relentless Focus on Eliminating Waste
overproduction
waiting
transport
defects
inventory
motion
overprocessing
The Toyota Production system provides the best quality , lowest cost, and shortest lead time through the elimination of waste.
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• Patient Safety Alert System
• Inpatient (PAC) - “Perfect Care-Zero Defects”
• Medication Flow
• Stroke/Neuro Service - “Best Stroke Care for All”
• Women’s & Children’s Maternity Services - “Delivering Perfect Care-Zero Defects”
• Revenue Cycle - “45 Days” • Registration/Billing
• Coding
• Surgical Services - “On Time Every Time”
• Emergency Services - “In and Out in 90 Minutes”
Value Streams
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History - Quality Delivery System August 2008 – August 2012
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Sep 2010
QDS Fellowship Program Announced
Nov 2009 - Jan 2012
WBR Education Waves 1, 2, 3, 4, 5, 6 (~ 35 Physicians)
Oct 2010
Defined Priority Focus Areas
for Improvement
Jan 2012
New Employee Orientation
Feb 2012
New Manager OrientationSep 2009
Engagement Starts
Sep 2008 - May 2009
Study of LEAN/Virginia Mason
Dec 2009 - Jun 2010
First 8
Value Streams Mapped*
Mar 2010 - May 2012
Kaizen Workshops (115)
House-wide 5S Program Launch
Apr 2012
May 2012
QDS for Leaders
Jul 2009
Day 1 of our LEAN Journey Mar 2011 - Aug 2011
Med Room Replication
Kaizen Events (x20)Aug 2008
EHR Workflow Walkthrough
*Strongly aligned Physician leaders in ER Services, Inpatient Services, Patient Safety Alert System, and Surgical Services
Eliminating Waste in Medication Rooms
Needed and unneeded items mixed together.
What goes where?
How do you find what you need?
The 5S’s: Sort, Set in Order, Shine, Standardize, Sustain.
Standard work surface
Patient meds delineated by room
Bin with item specific label.
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60
90
120
150
180
210
240
270
300
Jan-1
0
Feb-1
0
Mar-1
0
Ap
r-10
May-1
0
Jun
-10
Jul-1
0
Au
g-10
Sep-1
0
Oct-1
0
No
v-10
Dec-1
0
Jan-1
1
Feb-1
1
Mar-1
1
Ap
r-11
May-1
1
Jun
-11
Jul-1
1
Au
g-11
Sep-1
1
Oct-1
1
No
v-11
Dec-1
1
Jan-1
2
Feb-1
2
Mar-1
2
Ap
r-12
May-1
2
Jun
-12
Monthly Average Length of Stay (minutes): Pacific (PAC)
215
The Stable Admit
Divert Alert
Triage & "The Blue Patient"
Cellular Flow
256
215
The Stable Admit
Divert Alert
Triage & "The Blue Patient"
Cellular Flow
256
Emergency Services: In and Out in 90 Minutes
8
60
90
120
150
180
210
1/1
4/2
01
2
1/2
1/2
01
2
1/2
8/2
01
2
2/4
/20
12
2/1
1/2
01
2
2/1
8/2
01
2
2/2
5/2
01
2
3/3
/20
12
3/1
0/2
01
2
3/1
7/2
01
2
3/2
4/2
01
2
3/3
1/2
01
2
4/7
/20
12
4/1
4/2
01
2
4/2
1/2
01
2
4/2
8/2
01
2
5/5
/20
12
5/1
2/2
01
2
5/1
9/2
01
2
5/2
6/2
01
2
6/2
/20
12
6/9
/20
12
6/1
6/2
01
2
6/2
3/2
01
2
6/3
0/2
01
2
7/7
/20
12
7/1
4/2
01
2
Tim
e (
Min
)
Week
Weekly Average Length of Stay: St. Luke's (STL) & Davies (DAV) DAV STL
Good Bad
**Goal**
127
140
Emergency Services: In and Out in 90 Minutes
The Stable Admit (DAV)
The Stable Admit (STL)
Telepsychiatry (DAV)
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QDS Structural Requirements
• QD Promotion Office Team ─ 2 Fellows ─ 6 Specialists ─ 2 Coordinators
• Organizational Teacher (Rona Consulting) • Education Curriculum and Standardized Workshops • Friday “QD Report Outs” • Weekly Sr. Management Report to CEO/COO • Measurement Discipline • “Book of Knowledge” on Intranet
QDS By The Numbers 150 Leaders and Physicians in QDS Certification 126 Completed Kaizen Workshops and Events
500+ Employee and physician participants in Kaizen
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LEAN Curriculum
• QDS Certified Leader Training: 27 day intensive and in-depth training
• QDS for Physicians/Residents/House Staff: Six 45 minute modules with project
• QDS for Leaders: Mandatory 1 day class for all management with reading assignment, simulations and practicum
• 5S Class: 2 hour module specific class on 5S
• Leading Our Way into the Future: 90 minute module at New Manager Orientation
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• Deepening commitment during time of great change • Culture Shift
–Communication, employee and physician engagement
• “Fail Forward Quickly”– take risks • Time commitment
– Learning – Teaching – Abandoning wasteful meetings
• Learning a new language (kaizen, gemba, muda)
No one said this is easy…
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