Phil Goodman & MedAmorphosis 1 Background & Experience 2 What is Lean? 3 MedAmorphosis 4 Options
Where are you experiencing pain?
Phil Goodman 1 ▪ 30+ years at Denver Health ▪ Healthcare clinician ▪ Started & sustained DH’s Lean program ▪ Co-authored Lean book with DH CEO Patty Gabow ▪ Shingo Research & Professional Publication Award Winner ▪ Bronze Shingo Prize 2011 ▪ $195 million saved, June 2005 – December 2012
Introductions ▪ Amy Lueb, BSME, MBA ✓ 6 years in healthcare process & continuous improvement ▪ David Spiciarich, BSME ✓ 20+ years in manufacturing quality and management ▪ Ron King, BSCE, MS ✓ CEO of healthcare marketing & management firm 23+ years
What is Lean? 2 ▪ Post-war Toyota Production System gave birth to waste elimination in manufacturing, then healthcare ▪ Less waste in healthcare = ✓ better clinical outcomes ✓ cost savings ✓ increased income
MedAmorphosis 3 Team 50 years combined experience ▪ Hospitals & ambulatory clinics with >10 specialties ▪ Government & contracting ▪ Commercial & industrial manufacturing ▪ Engineering & MBA degreed
MedAmorphosis 3 Team ▪ Services to healthcare systems & clinics ✓ Denver Health (DH) ✓ Centura ✓ UC Health ▪ Achievements ✓ > $1M savings for the OBGYN department ✓ > $400K for Behavioral Health Services at DH
MedAmorphosis 3 Team 46 years of training experience ▪ Lean ▪ Six Sigma ▪ A3, 8D, PDSA, DMAIC, … ▪ TPS, TQM, SMED, … ▪ Meeting set-up & facilitation ▪ Training for frontline to executives
Our Approach Rapid Cycle Development (RCD) RAPID CYCLE IMPLEMENTATION & DEVELOPMENT EVENT PRE-WORK DIAGNOSTIC COACHING • Onsite Focused observations Key Stakeholders improvement Execution of Sustainment • • Staff shadowing Interview activities done by action plan Activities • • Data gathering Survey frontline staff & analytics 3 – 4 days (4 – 5 hrs/day) 1 RCD Cycle = 3 Months
Previous Outcomes Neurosurgery, Neurology & IR Clinic Merger ▪ Incoming call reduction ~50% ▪ Call abandonment rate of 26% lowered to <10% ✓ Estimated annual revenue increase of $492K ▪ Eliminated written patient complaints about scheduling appointments ▪ Created capacity for incoming surgeons
Previous Outcomes OP Pharmacy ▪ Established work cells & Takt Times ▪ More accurately estimated Rx turn-around time (TAT) ▪ Changed hours of operation to serve the patient more effectively & reduce labor costs ▪ Increased customer value based on pre & post surveys
Previous Outcomes Acute Care Safe Patient Handling ▪ Reduced employee injury rate by 82% ▪ Decreased patient falls with injury by 77% ▪ Pressure ulcers reduced by 23% ▪ Earlier patient ambulation led to 5% reduction in length of stay (LOS)
Previous Outcomes ED & Observation Low Risk Chest Pain ▪ Reduced Length of Stay (LOS) by 40% to < 15 hours ▪ Created algorithm for treatment ▪ Opened up communications between ED staff & Cardiologists ▪ Used NPs/ PAs to their full scope of practice
Option A A La Carte Process A3 5S / 6S Mapping 8 Wastes Fishbone 5 Whys DOWNTIME Mistake Visual • Training Proofing SIPOC Management • Meeting facilitation Poka Yoke • Change Management • Department diagnostic • Gemba Walk Standard PICK FMEA Work Charting
Option B: Rapid Cycle Development RCD Cycle(s) 6. Adopt & Adapt 1. Reason For Action 4. Gap Analysis (Treatment) (Chief Complaint) (Diagnosis) D P S/C A 7. Completion Plan 2. Initial State (Plan of Care) (Symptoms / Vitals) • Engage frontline staff 5. Solution • Focused, structured A3 Approach Methodology (Tests / Labs) • Introduces staff to Lean 3. Target State 8. Lessons Learned / (Desired Physical Culture Celebration • State) Mentoring & Coaching
Option C Hoshin Kanri X-Matrix Hoshin Kanri Year 1 Improvement Priorities 3 Targets to Improve (Metrics) 1 year Objectives 2 4 Improvement Project Owners • Full strategic planning • Develop tactics 1 • Align goals & action • Catchball 3 - 5 year Breakthrough Objectives Resources • Shared vision ● Primary Responsibility ○ Secondary Responsibility HOSHIN PROCESS OWNER'S NAME HERE
Hoshin Kanri X-Matrix ● ○ ○ ● ○ ○ ● Mock JCo Audit ● ○ ○ ● ○ ● Perform Internal Magnet Audit ● ○ ○ ● ○ ● RCD: Current State of Magnet ● ○ ○ ● ● RCD: Current State of Stroke Program ○ ○ ○ ● Hire Magnet Coordinator ● ○ ○ ● Determine Lead for Stroke Center Cert ● ● ● Assemble Employee Satisfaction Committee ○ ● ● ● RCD: ED LOS for admitted patients Preliminary Assessment of Stroke Center Rq Employee Turnover Rate (year 1) Goal < 20% Year 1 Improvement Projects ED LOS (Admitted Patients) Goal < 3 hours Improvement Project Owners Pass JoCo Re-Cert w/ < 3 type 2 findings Get 1st year employee turnover < 20% Internal Magnet Assesment Score Internal Stroke Assesment Score Targets to Improve (Metrics) Move from 120 to 100 or better 3 Mock Audit Score < 3 findings 1 year Objectives Know Magnet deficits Magnet Coordinator Chief of Neurology Director of Quality HR Director ED Director 2 4 CNO 1 3 - 5 year Breakthrough Objectives ○ ● ○ ○ ○ ○ ○ Become a top 50 Hospitals (Truven Health) Resources ○ ● ● ● Primary Responsibility Reduce first year Employee Turnover to < 10% ○ ● ○ ○ ● ○ Secondary Responsibility Become a Comprehensive Stroke Center ● ○ ● ○ Process Owner: Obtain Magnet Certification Hosptial X CEO
Cost Range # of RCD Coaching & Data Training Options Duration Deliverable (Scope & Cycles Mentoring Analysis Included Complexity) Yes, & 1 – 2 days Only if a Tools to run your bundled in $1,000 - (possibly more A: A La Carte 0 No Diagnostic is own project various $12,000 depending on the # selected selected) ways A3: Roadmap to Yes, for 4-6 Where you have No stand $50,000 - B: RCD 1 wks post 3-4 months Yes been, where you alone $70,000 RCD want to go & training how to get there X-Matrix: Yes, Extreme Yes, 2 day throughout makeover A3 training $175,000 - C: Hoshin 4 1 year Yes the entire blueprint for (Class size < $250,000 year unprecedented 20) performance Diagnostic : 1 Process or Department, 60 day engagement, report & presentation of findings (i.e. Targeted Data Analysis, Leadership Interviews, List of JDIs, Patient / Staff / Information Flow Maps) $10,000 Value
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