(Changing to Excellence)

Improving the Patient Experience

Oct 10, 2014

Waste Not, Want NotConducting a Lean

Assessment

2014 Annual Healthcare

Symposium: Lean Strategies in

Transforming Patient Care

Challenges facing Healthcare

Basic concepts and philosophy of Lean

Waste in Healthcare

Case Studies

Managing Change

Today’s Talking Points

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It is not necessary to change. Survival is not mandatory.

- W. Edwards Deming

Challenges Facing Healthcare

Shortage of healthcare professionals

Financial challenges

Declining volumes

Changing needs

Changing health care systems

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Physician wait times up, expected to keep increasing

A growing physician shortage, payment decreases and adoption of electronic health records may be to blame as

patients wait longer for care in doctors’ offices.

Affordable Care Act (Obamacare)

What is Lean?

Based on…

What is Lean?

The Deming Cycle - PDCA

Implement themethods

Do

If goals were achieved adoptthe new methods permanently.If not, determine root cause of failure and return to ‘Plan’

Adjust

Examine the results

Check

Determine goals to be achievedand the methods to reach them

Plan

Based on…

What is Lean?

The Deming Cycle - PDSA

Implement themethods

Do

If goals were achieved adoptthe new methods permanently.If not, determine root cause of failure and return to ‘Plan’

Adjust

Examine the results

Study

Determine goals to be achievedand the methods to reach them

Plan

1. Define value from the customer’s perspective and express value in terms of a specific product

2. Map all of the steps…value added & non-value added…that bring a product of service to the customer

3. The continuous movement of products, services and information from end to end through the process

4. Nothing is done by the upstream process until the downstream customer signals the need

5. The complete elimination of waste so all activities create value for the customer

LeanThinking

Womack & Jones

What is Lean?

Shifting from Traditional to Lean Healthcare

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Improving the quality of patient care

Eliminating non-value added waste

Reduce non-value added cost

Improving the Patient Experience

Environment transformation

What is Lean Thinking?

“Lean is not a program; it is not a set of quality improvement tools; it is not a quick fix; it is not a responsibility that can be delegated.”

“Rather, Lean is a cultural transformation that changes how an organization works . . . It requires new habits, new skills and often a new attitude throughout the organization.”

Dr. John Toussaint, CEO, ThedaCare Center for Healthcare Value Leonard Berry, Professor, Texas A&M

A New Way of Thinking

Get Creative

New Knowledge

Question Everything

Look Beyond Traditional Metrics

What is over-valued and under-valued at your organization?

Waste in Healthcare

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20-30% of health spending is "waste"

with no benefit to patients, because of

overtreatment, failure to coordinate care, administrative

complexity and fraud

Waste in Healthcare

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Once waste has been identified and

removed, and standardization has

been introduced you will begin to see change in your

workplace!

Value and

Waste

Value and Waste

Essential Steps

Change Product or Service

Done Right the First Time

Customer/Business wants and is willing to pay for them

Value-Added Work Non Value-Added Work Value-Enabling Work

Non-Essential Steps

Not done correctly first time

Customer/business doesn’t want them or is unwilling to pay for them

Non-Essential Steps

Allow the Value- Added tasks to be done better and faster

Mandatory from aregulatory standpoint

A Practical Lean Managers Goal is to:Eliminate the Non-Value-Added activitiesMinimize the Value-Enabling WorkMaximize the Value-Added Work

Waste in Healthcare

Eliminating waste will accomplish the following:

Improve patient care and safety

Improve productivity and process efficiency

Improve quality (reduce the opportunity for errors or

mistakes)

Reduce cost to the facility

Reduce wait (queue) time between processes

Make the facility more competitive

Encourage teamwork and staff involvement

Waste in Healthcare

To fully grasp the power of Lean you first need to be able to understand and identify waste.

Waste is a symptom and Lean tools and concepts are used to find and eliminate its root cause(s).

Waste in Healthcare

There are eight major wastes in healthcare

Never mistake activity for achievement.

- John Wooden18

Waste in HealthcareWASTE-An activity that is unneeded, unwanted or involves excess effort

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Repeating Why Five Times

“…the Toyota production system (i.e., Lean) has been built on the practice and evolution of this scientific approach”

Taiichi Ohno – Toyota Production System, Page 17

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Problem: Delays in performing x-rays.

1.Why are the x-rays delayed?Because the exam takes longer than scheduled

2.Why does the exam take longer?Because the rad tech is busy with other things

3.Why is the rad tech busy? Because they have to answer the phone4.Why do they have to answer the phone?

Because there’s a phone that rings in the area5. Why does the phone ring in the area?

Because it hasn’t been programmed to ring at the clerk’s station…

5 Whys

5 Whys

See if you can drill down to the root cause of the problem – go beyond the symptom

Avoid the easy answers – “because we don’t have enough staff” or “because the computer system is bad”

Collect data on the identified root cause – is it really a problem?

If you can't describe what you are doing as a process, you don't know what you're doing.

- W. Edward Deming

Consisted of two on-site visits by our team

Over thirty (30) hours of observation

Used Lean tools to identify and gather information

Background of Assessments

Case Study Review

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All we are doing is looking at the timeline. From the moment the patient gives us a complaint to the point of care. And we are reducing that timeline by removing non value-added wastes.Adapted from Taiichi Ohno’s book “Toyota Production System”

Case Study A - Observations

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Signage need to be updated. Rural Health Clinic or a Family Practice?

Case Study A - Observations

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This is a Band-Aid not a

solution to a problem in the

process.

Case Study A - Observations

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A quick inspection of all exam rooms showed that supplies varied depending

on the room.

Hidden supplies can lead to over ordering.

Case Study A - Observations

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Cluttered cabinets lead to time wasted looking for

materials.

Unorganized. Materials/supplies randomly placed on the shelf.

Case Study B - Observations

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Case Study B - Observations

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Case Study B - Observations

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Impact Dollar ImpactImplementing Lean will increase:1.Staff Satisfaction2.Clinical quality3.Clinic productivity – without adding staff4.Patient experience

a. Access/Flowb. Patient Satisfaction

As visits increase the Cost Per Visit will decrease allowing for more patients to be seen with a minimal rise in costs. $ 27.71 Decrease in cost per visit The clinic would see approximately 480 more Medicare patients at the reduced cost per visit rate $ 12,000Emergency Room supply expense decrease for level 1 visits $ 5,000We estimate the Clinic would have 440 additional Medicaid visits $ 32,000Volume increases for all other insurances/self-pay $ 48,000

Estimated cost of additional RHC visits $ (9,000) Total Impact - Cost/Reimbursement $ 88,000

Potential Impact - Case Study A

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Potential Impact - Case Study B

Impact Dollar ImpactImplementing Lean will increase:1.Staff Satisfaction2.Clinical quality3.Clinic productivity – without adding staff4.Patient experience

a. Access/Flowb. Patient Satisfaction

As visits increase the Cost Per Visit will decrease allowing for more patients to be seen with a minimal rise in costs.

$ 13.66 Decrease in cost per visit

The clinic would see approximately 236 or 590 more Medicare patients at the reduced cost per visit rate $2,000 $3,000We estimate the Clinic would have 577 or 1,443 additional Medicaid visits $65,000 $163,000Volume increases for all other insurances/self-pay $91,000 $229,000

5S of the exam and supply rooms $10,000 $10,000

Estimated cost of additional RHC visits $(10,000) $(10,000) Total Impact - Cost/Reimbursement $ 158,000 $390,000

Why Initiatives Fail

Complacency

Failure to create a sufficiently powerful guiding coalition

Under-estimating the power of the vision

Under-communicating the vision by a factor of 10 (or 100 or 1,000)

Why Initiatives Fail

Permit obstacles to block the new vision

Fail to create short-term wins

Declare victory “too” soon

Neglect to anchor changes firmly in the corporate culture

Why Initiatives Succeed

Simplicity

Active and visible executive sponsorship

Structured approach

Why Initiatives Succeed

Frequent and open communications around need for change

Dedicated resources for change management

Total Employee Involvement

“We don’t have enough time or resources to do it right the first time……we only have enough time and resources to do it over again, again, and again when we’ve done it wrong the first time.”

Why Lean?

A New of Way of Thinking

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Leaders need to think and manage differently!

Questions

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Resources

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Coming Soon Winter 2014

Questions

Todd SperlManaging Partner

Lean Fox Solutions, LLC248.798.7984

tsperl@leanfoxsolutions.com

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“If your actions inspire others to dream more, learn more, do more and become more, you are a leader”

John Quincy Adams