1. Medical Staff Engagement &Lean Management Diane BissendenDirector, Population and Family Health Vancouver Coastal Health RichmondDr. Brenda WagnerChair, Richmond Medical Advisory CommitteeClinical Associate Professor, Obstetrics & GynaecologyUniversity of British ColumbiaLaura Sato Coordinator, Lean Transformation ServicesVancouver Coastal HealthFebruary 28th, 2013

2. Burning PlatformHow do you engage medical staff in yetanother administrative process to drivepatient safety and quality improvement?How do you ensure sustained medicalstaff engagement in system redesign thatis based on Lean principles? 3. Medical Staff Engagement:Current StateInitial State:StateFeedback from Medical Medical staff disengagement Staff as have lived through There is lack of multiple administrativephysician engagement change efforts Management should Improvements have beenmake the changes and tried before and notleave us alone sustainable Everyone else around Long standing issues thatthe table is paid for being have not been resolved andhere except for people didnt believe thephysicians issues could be changed 4. Medical Staff Engagement:Ideal StateIdeal State:State Target State: Medical staff engagement in One medical staffLean as a unique and member from eachsuccessful change relevant discipline willmanagement process engage in the process i.e. Improvements are family practice, midwifery,sustainableobstetrics, paediatrics, Long standing issues are and anaesthesiaresolved and medical staff Process inspires ongoingbelieve they are part of the engagementchange 5. Birth Centre Initiative:Goals and Area of Focus 6. Birth Centre Initiative: Deliverables Increase capacity to do Caesarean Birthsand recovery in the Birth Centre Build processes to manage surges Provide timely outpatient services Triage, assessment, non-stress tests &inductions of labour, etc. Standardize processes from decision toCaesarean Birth 7. Birth Centre Initiative:Engagement of People Medical Staff Allied Health Staff Obstetricians Respiratory Family PhysiciansTherapists, Social Paediatricians Work, Laboratory Midwives Services Anaesthesiologists Support Services Nursing Staff Housekeeping, Unit OR/ PACU/ BirthAides, Sterile Centre/ NICU/ StaffProcessing Aides, Unit Support Coordinators Clerks, Medical OfficeAssistants 8. Medical Staff Engagement Strategies Physician co-sponsor on the team Funding for medical staff time spent in Lean initiatives Off site obstetrician & anaesthesiologist meeting on CodePink & Skin to Skin in Operating Room Ad-hoc meetings during down times with on-call medicalstaff (end of the day) Hallway conversations (1:1) Feedback obtained duringobservations (1:1) 9. Medical Staff Engagement Strategies Arrange Working Group Meetings around medical staffschedules: Lunch times & end of the day Organize meeting agendas so physicians can attend at times when their key issues will be highlighted Mixture of 2 hour, full day & day workshops Piggyback on existing medical staff meetings Provide ample notice for meeting invitations Invite medical staff in person Invite on-call medical staff 10. Medical Staff Engagement in Lean Management Process improvements occurring in tandem with LeanManagement Using Lean Management approach based on ThedaCare Model Three physicians attended Lean Management education Applying Lean principles to clinical office setting Organization investing in physician education inorder to support improved patient care Physicians feel part of the team 11. Lean in Action:What is Code Pink ? 12. Code Pink: Standard Work 13. Birth Centre Initiative: Code Pink Mock SessionInitial Mock Post - Actual Code PinkNoisy lots of talkingCalm & quietRepeating questions multiple times Staff know what to doDuplicated work- # of people doing the Roles and responsibility claritysame thingLots of double checkingTrusting environmentToo many people in the room 14. Medical Staff Testimonials Keeping mothers and babies together after birth encouraged me to participateBest thing was seeing the capacity we have within our frontline staff to make changesDoctors see thehappen. This is the power I see Lean harnessing satisfaction their patients that I have never seen harnessed before. and babies are kept together. This satisfaction is encouraging the doctors...If you want to show us this isdifferent, fix the problem no one has Sessional been able to fix in 20 years - payments are I have beenemergency caesareans. This helpful andblown awayphysician now states with meaningful by the enthusiasm that LEAN is making aimprovements big difference and we are being during the past successful. year 15. Birth Centre Outcomes IndicatorBaseline % Target Outcome Reduce the Birth Centre 3:30 h by 50% 1:30 hOR Turnaround time (138%)% of Caesarean Births27% by 50%75%done in BC OR(185%)Code Pink Response30~ minutes 18 minutes*Time (Decision to Baby( 40%)born)Medical Staff4 per by 200% 400%Engagementengagement opportunity*30 day data 16. Reasons for Success Strong physician, director & manager leadership Strong relationship between medical staff andclinical resource nurse (over 20 yrs) Operational and medical staff leadership Walkthe Talk Engaged and stable team (low turnover) Project leadership share successes Organizational commitment in form of individualswith expertise in lean thinking 17. Operational SponsorsExperience Setting the stage at the beginning of every session, nomatter where you are in the process Simple is usually complex Dont get discouraged when things get messy trustthe process Medical staff participation in all aspects of the BirthCentre quality improvement initiative adds value andstrengthens team relationships Deeper level of engagement and pride in the change,through doing together Continuous improvement is embedded in the culture ofthe Birth Centre 18. Physician SponsorsExperience Be flexible with meeting times Invite people personally Sometimes a different venue can overcome obstacles Projects identified by frontline staff as unfixable willconvert the hard of heart Practice, Practice, Practiceembed, embed, embed