Lean Applications to Healthcare: Transforming Care and Care Delivery Suneela Nayak Director of Operational Excellence, MMC September 29 th , 2017 1
In our time together • A brief history of Lean • Why Lean Transformations now at MMC? • Getting started: Engagement, Daily Management, Infrastructure and Operations • Caring for a Transforming Culture: The role of leaders and frontline teams • Transforming Care Delivery: How this translates to value for patients and for ourselves • Q & A 2
A Brief History of Lean 3
A History of Improvement 2002 ThedaCare and Virginia Mason Begin Exploring Lean 2008 Founding of: Virginia Mason Institute teaching the Virginia Mason Production System AND ThedaCare Institute for Healthcare Value teaching lean and daily management MaineHealth OpEx 2013 PenBay 2014 SMHC, LCH 2015 MH Corp, MMC, NorDx, Memorial, IS 2016 MBH, MMP, Franklin WW2 4 Source: Healthcare Operations Management, McLaughlin and Hays, 2008,Health Administration Press
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Arsenal of Venice 6
Arsenal of Venice 7
A History of Improvement REDUCE CULTURE OF VARIATION 2002 ThedaCare QUALITY = DATA BASED and Virginia Mason COMPETITIVE Begin Exploring DECISION EDGE Lean MAKING (TAKES TIME) 2008 Founding of: HEALTHCARE REDUCE Virginia Mason ORGANIZATIONS Institute teaching MOTION THAT SUCCEED the Virginia Mason TOOLS EXIST GO BEYOND THE Production System TO SUPPORT AND TOOLS ThedaCare THE CULTURE Institute for Healthcare Value VISUAL teaching lean and HEALTH CARE daily management MANAGEMENT BUILD QUALITY CAN QUALITY INTO BENEFIT FROM YOUR MaineHealth OpEx THESE TOOLS 2013 PenBay CULTURE 2014 SMHC, LCH WORKFLOW 2015 MH Corp, MATTERS MMC , NorDx, Memorial, IS 2016 MBH, MMP, Franklin WW2 8 Source: Healthcare Operations Management, McLaughlin and Hays, 2008,Health Administration Press
Why now? 9
Healthcare Reform Tidal Wave Healthcare Reimbursement Reform Public Reporting Demand for Healthcare Redesign 10
The Perfect Storm We are at the end of an unsustainable trend line....this is not a tempest in a teapot 11
How best to improve quality? The Hard Work of Health Care Transformation Richard Bohmer. NEJM 375:8 NEJM.org August 25, 2016 12
Daily Management System at Maine Medical Center 13
Daily Management System • A disciplined, daily process of gathering data and assessing performance to key metrics in real-time. • The assessment process is done with the same intent to take immediate action that corrects performance issues – not just an information sharing session. • Without fail, this creates a culture of seeing and solving the organization’s daily issues in a quality and timely manner. 14
Daily Management System Daily Huddle • Attendance • Team Report Outs • Huddle Board Gemba Walks • Leadership, Physician Participation • Walk Etiquette KPI Boards • Staff Report Outs • Data Collection & Action Plans • Consistent Visual Presentation 15
MMC Gemba Walk The Gemba Walk is a central element of our Daily Management System at MMC. Leaders “walk” to the place where value is created for patients and families, and interact with the people and process in the spirit of changing for the better. 16
Caring for a Transforming Culture: The role of leaders and frontline teams 17
TRADITIONAL CULTURE of Operational CULTURE Excellence Functional Silos Interdisciplinary Teams Managers direct Frontline Leaders coach, enable, Benchmark to justify performance Seeks improved performance, reduce waste Punitive, Blaming Seeks root cause Rewards individuals Rewards group Guards information Shares information Volume reduces cost per unit Adds value, removes waste, cost, Internal focus Customer focus Expert driven Process driven
Aligning People and Process Leading and Managing your Team People Process PURPOSE “We aren’t just solving problems, we’re developing problem solvers” Matt Long Herman Miller Company
Patient Care Team Members PRINCIPLES Leaders Frontline Leaders Frontline Team Establish Direction Organizing & Translating ALIGN Setting & Achieving Goals Develop a vision and Establish a structure to Create value for the strategies to achieve that achieve the plan. patient Identify meaningful goals vision. that directly affect the Organize and allocate Create constancy of the Set high but reasonable overall vision and strategy. resources. purpose Daily report on status and targets. Monitor structure to ensure Think Systemically needed support. Communicate the direction consistency and alignment to on a regular basis. plan. EMPOWER Empower, Involve & Coach Develop & Share Motivate, Mentor, Inspire Empower authority to Be a self-developer. Find Energize people to develop Lead with humility improve and solve opportunities to grow and and overcome barriers to problems. Break-down silos develop to better support Respect every individual change. Daily be in the by involving crossing- the organization. work area to listen to Learn continuously functional teams to solve understand. Embrace Share what is working and value stream issues. Coach failure; celebrate success. what is not. problem solving daily. IMPROVE Focus on process Monitor & Maintain Break- through Thinking Adapt & Adjust Embrace scientific Predictability Continuously learn by thinking Making incremental listening, seeing and Monitor systems to ensure adjustments that all agree standard outcome. Understand & manage translating observations. with. Tools are not a Continuously challenge the Support new models of care variation solution. Structurally solve process to identify areas of delivery developed by front area problems. Assure quality at the improvement. line. source Taken from: Institute for Enterprise Excellence
Transforming Care Delivery: How does this translates to value ? 21
MMC: Our Purpose 22
Program Status To Date Data updated September 6th, 2017 • 411 Champions Trained Engagement • 4000+ Activated Employees • 315 Leaders Trained • 600 Closed Action Items Daily • 855 Closed KPIs • ~235 Open KPIs Management • 20+ Gemba Coaches • Patient Advisor on Walks • 18 Training Waves, 3 Infrastructure Campuses • 90 KPI Boards, 100 Teams & Operations • 11 Gemba Walks • 0500 Walk Real time responsiveness to the needs of the frontline! 23
Sustained Strategic Alignment 24
AIP Alignment in Action • Dept: Palliative Care • Dept: Mother Baby • Driver: Department Specific • Driver: Employee Engagement • KPI: A daily afternoon “gratitude • KPI: 100% of the time, breast pump gathering” will be held to share parts will be cleaned and dried by positive experiences from the day, patients according to providing peer-to-peer support recommendations • Dept: Inpatient Pharmacy • Dept: Gibson • Driver: Financial Performance • Driver: Communication between Team Members • KPI: 100% of the time, there will be zero duplicate ipratropium and • KPI: 100% of the time, RNs will not budesonide/fomoterol inhalers sent be interrupted during medication daily safety hour 25 25
Values in Action 26
Embodying Core Values SCU 2, 3, 4 100% of the time, quiet hour will be observed from 1300-1400 SPD, Bramhall & SSC Leaders in fostering interdepartmental KPIs Facilities Development & Engineering Removing barriers to care: responding to 20% of all Action Items! Nutrition & Food Services 100% of the time, there will be no missing items on patient meal trays Patient Access & ED Registration “Admitting with precision, compassion, & getting patients to where they need to be!” Interpreter Services Daily interpreter rounds for Limited English Proficient (LEP) inpatients 27
Gemba Coaches Cristy M. Koffler, RN Float Nurse, Unit Based Educator Corey Fravert, MHPM Director, Neuroscience Justin Michaud, BSN, RN Nurse Manager, PICU Sarah Thompson, MSN, RN, CPN Mohit Shukla Nurse Manager, BBI & Pediatric Healthcare Management Engineer, CPI Short Stay 28
Operational Excellence Fellow Amy Sparks Operational Excellence Fellow Program Coordinator, Psychiatry 29
Same Day Closure of Action Items 30
Provider Engaged Clinical KPI Boards 31
Core Values- Closed KPI (YTD by FY Quarter) 32
Closed KPI by Strategic Priority 33
KPI Assessed for ROI 34
Questions? 35
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