Introducing Your Organization to Lean and Clinical...

Introducing Your Organization to Lean and Clinical Business

Intelligence Simultaneously April 15, 2015

Doug Stahl, PhD, MBA

Kim Carli, MSHS, CSSBB

DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

Conflict of Interest Doug Stahl, PhD, MBA

Has no real or apparent conflicts of interest to report.

Kim Carli, MSHS, CSSBB

Has no real or apparent conflicts of interest to report.

© HIMSS 2015 2

Learning Objectives

1. Recognize how alignment of Lean and Clinical Business Intelligence (CBI) initiatives position a healthcare organization to build the necessary analytic skills and capacity to support enterprise continuous performance improvement

2. Describe the challenges associated in introducing Lean and CBI to the organization simultaneously

3. Illustrate the process used by a prominent healthcare system to leverage the advantages and overcome the obstacles of introducing Lean and CBI together

3

An Introduction to the Benefits Realized for the Value of Health IT

http://www.himss.org/ValueSuite

S: Satisfaction

• Patient Satisfaction/HCAHPS improvements

• Call Center Service Level improvements

• Employee Satisfaction- engagement through the

performance management framework

E: Electronic information/data

• Data sharing and reporting drives process

ownership and improvement

S: Savings

• Accountability and visibility for budget management

4

Getting to know our audience…

• How many of your organizations currently have?

– A mature, fully functional BI program

– A mature, fully functional Lean performance improvement program

– Something in-between

– None of the above

• For those with a mature, fully functional BI program, where is it aligned on your org chart?

– IT

– Operations

– Elsewhere

• For those with a mature, fully functional Lean performance improvement program, where is it aligned on your org chart?

– Quality

– IT

– Operations

– Elsewhere

5

Origins of Our Philosophy and Perspectives

• Experience and lessons learned in our organization

• Interactions with national Lean and Clinical Business Intelligence networks

6

About City of Hope

• Founded in 1913

• Fifty years of leading-edge biomedical research

• NCI-designated Comprehensive Cancer Center

• Founding member, National Comprehensive Cancer Network

• Beckman Research Institute established in 1983

• 193 beds, ~6,500 IP cases and 160,000 OP visits per year

• Community Practice Sites expanding, including Antelope Valley, South Pasadena, Santa Clarita, Simi Valley and Palm Springs

7

Key City of Hope Accomplishments

• Among the first to perform bone marrow transplantation (BMT); now one of the world’s largest, most successful programs

• Third-largest breast cancer program in California

• Last year, City of Hope conducted more than 300 therapeutic clinical trials enrolling more than 5,000 patients

• We raise more than $100 million each year

• Millions benefit from scientific and medical advances developed from City of Hope technologies, including synthetic human insulin, human growth hormone, Rituxan, Avastin, Erbitux and Herceptin

• COH Lean journey has been underway for approximately five years

• COH CBI journey began informally three years ago and was formally announced in Feb. 2013

8

Simultaneous Lean + CBI Guiding Principles

• CBI isn’t an end, it’s a means to a performance improvement end

– An enabler for continuous performance improvement

• Mindset, Skillset, Toolset – in that order

• The Lean Startup as a reference model for CBI program development

9

COH Dashboards,

Scorecards

and KPIs

10

COH Dashboards,

Scorecards

and KPIs

11

COH Dashboards,

Scorecards

and KPIs

12

The Lean Startup

• Recommended by two different colleagues:

– a Lean Sensei

– a member of the Clinical Business Intelligence Network (CBIN)

• What is a Lean Startup?

– “an organization dedicated to creating something new under conditions of extreme uncertainty”

– can be small or large

– “what they all have in common is a mission to penetrate the fog of uncertainty to discover a successful path to a sustainable business”

15

The Minimally Viable Product (MVP)

• A Minimally Viable Product (MVP)

– The smallest and / or fastest prototype you can create and deploy to visionary early adopters

• Contrary to long development and testing periods that strive for product perfection before initial deployment

– Helps entrepreneurs start the Build-Measure-Learn feedback process as quickly as possible

• What do customers really care about?

• Avoid building products and features that nobody wants

• MVP Hypothesis

– Process delivers a big vision in small increments

– Visionary adopters will “fill in the gaps” on missing features if the MVP solves a real problem

• Therefore, any effort beyond what is required for a MVP is considered waste because it wasn’t driven by a response to the marketplace

16

Early “Business Intelligence”

17

Early “Business Intelligence” efforts exist without Lean

– Fragmented, inconsistent, partially redundant efforts

• IT, finance, quality, research

informatics

– Similar reports from multiple

sources

• Many with conflicting content

• Multiple symptoms of Master Data

Management deficiencies

– Enterprise Data Warehouse version

1.0 driven primarily in support of

clinical / outcomes research

• Many operational indicators not

included

18


– Serves a reporting purpose

– Data presented “at” people

– Everything pushed by e-mail

• Actual information usage

unknown

• Some reports are never

read or reviewed

19


– Countless monthly reports

in tabular format

• Little to no visual support for

trend and pattern recognition

• Distributed in MS Word or

Excel

– Some created with MS Paint

– No mindset or skillset

development agenda

• Combined with a primitive

toolset

20

Lean at City of Hope

21

Lean Basics… • Lean principles: Toyota Production System (TPS)

• Key Elements of Lean Management System include:

– Customer defines value

– Eliminate waste

– Rapid experiments with measurable outcomes

– Continuous improvement

– Engage staff, managers and executives

– Standard Work

– Leaders gain insights from time in the gemba (where work is done)

– Speak with data, identify root causes and corresponding countermeasures

22

Lean at City of Hope

• Started in 2009

– ~4 years before creation of

our BI department

– Originally aligned within

Quality and Patient Safety

• Early emphasis on

outpatient flow and

experience

– Over 95 Rapid

Improvement Events (RIE)

/ Kaizen activities in the

first 3 years

• Week-long Rapid

Improvement Events

(RIEs) focused on:

– Process analysis

– Visioning, experimentation

and development of

process improvements

– Exposing staff and

physicians to Lean thinking

– Promoting culture change

23

Rapid Improvement Events: Post-It Notes, Gembas, Report Outs

24

25

How Lean Has Driven Performance at COH: Early Projects

86.6

90.8

84

85

86

87

88

89

90

91

92

FY09 Q2 FY11 Q2

Me

an

Sco

re

Outpatient Satisfaction

49

0.5 0

5

10

15

20

25

30

35

40

45

50

Baseline Sustained Outcome

Ho

urs

Time From First Patient Call to Appointment

13%

90%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Baseline Sustained Outcome

Per

cen

tage

External Records Available for New Patient Appointment

Lean Challenges Without BI

• Events supported with whatever data you could find

• Lots of manual effort “Excel heroism”

– Pre-event analysis

– Post-event sustainment (sustainability challenges)

26

Lean Challenges Without BI

• Difficult to create compelling calls to action

– Hard to find meaningful segregations and stratifications

– Hard to see process improvement opportunities and quantify process improvement successes

• Many challenges associated with incomplete / incorrect / inconsistent datasets

• Don’t know what you don’t know about data completeness and correctness

• Risk associated with a perceived lack of progress – can’t fix what you can’t see

27

Aligning Lean & BI

28

Organizational Re-alignment

– Aligning the agendas…

• Within and between departments

• With Lean Startup principles

– MVP deployment

• With enterprise cultural transformation initiatives

– Collaborating to achieve successful outcomes

– Learning to evolve Lean and BI capabilities simultaneously through experience and customer feedback

29

Alignment Success Stories

Performance Management Framework

Patient Satisfaction

New Patients “First Call to Appointment”

Call Center Service Levels

Monthly Operating Reviews

30

Installed Performance Management Centers and Framework

• Lean Management System

• Performance Boards

• Problem Solving Huddles with Frontline Staff

• Leadership Rounding

• Continuously improve standard work

31


Leader Doers

Performance

Problems

Responses

Standard

Work

Training to

Standard

Work

Adherence

to Standard

Work

Provides baseline for

improvement activities

and basis for problem

solving huddles

32

PDSA / A3

Everything is linked to

strategic objectives

“True North”

Long and short

term trends for

metrics of interest

Daily tracking

where applicable

Top contributors

Countermeasures

and responses

MINDSET

33







35

Patient Satisfaction Improvements

• From limited, standard information distribution

• To more compelling visuals that help identify performance improvements and improvement opportunities

36

-Performance management framework: Huddles, rounding, staff engagement

-Improved visuals through working with customers

-Standard work implementation and adherence

-Medication Education: from 71ST percentile to 97th percentile

Standard Work

Impact of Performance Management Framework

37







38

New Patient “First Call to Appointment”

• Evolution of visuals through MVP process and PI Facilitator interactions with stakeholders

39


• Evolution of meaningful stratifications (e.g. by service and department) using MVP prototypes

40

• Performance improvements for Hematology and Medical Oncology


41







42

Pre- BI/PI Alignment: Call Center

•Monthly report

produced in tabular

format

•Users can also

access daily and

intraday call detail

reports

43

Post - BI/PI Alignment: Call Center •Facilitator works with customers to develop

and refine visual reports (using MVP

approach)

•More meaningful, compelling visuals

created and delivered weekly to managers

who have been trained to use them

•Facilitates rapid identification of

performance improvement opportunities

44

Post - BI/PI Alignment: Call Center

•Result: Aggregate Call Center Service Levels Increased

from 54% to 78% in eight weeks

45







46

Pre- BI/PI Alignment: Operating Review

• Based on a broad range of legacy reports at various levels of breadth and depth. Supported high-level discussion vs. focused problem solving

• Highly variable executive responses. No clearly defined response expectations.

47

MOR 4-Quadrant Approach Post BI/PI Alignment: Operating Review

BI Emphasis

in Quadrants

I and II

delivered to

stakeholders

PI Emphasis

in Quadrants

III and IV

expected from

stakeholders

48

PDSA / A3

CBI as an Enabler for Continuous Performance Improvement

49

Metrics Tracker Summary

50

Total Grant Dollars

51

New Patients

52

Medication Events

53

Financial Performance

54

Learning Objectives

1. Recognize how alignment of Lean and Clinical Business Intelligence (CBI) initiatives position a healthcare organization to build the necessary analytic skills and capacity to support enterprise continuous performance improvement

2. Describe the challenges associated in introducing Lean and CBI to the organization simultaneously

3. Illustrate the process used by a prominent healthcare system to leverage the advantages and overcome the obstacles of introducing Lean and CBI together

55

Advantages and Challenges of Simultaneous Lean / CBI Introduction: Advantages

• Transformation:

– From (incomplete, incorrect,

inconsistent, outdated) data,

presented at people, with unclear

response expectations

– To (more complete, correct,

consistent, timely) information, in

use for collaborative problem

solving and performance

improvement

• Neither team can close the gap on its

own, but Lean and CBI teams together

can deliver results that neither team

could deliver separately

Challenges

• We already knew that PI had BI needs, and we

discovered that BI has PI needs

– Example: PI team working with

stakeholders to validate information

generated from our new data warehouse

• Initially more difficult and time

consuming than anticipated, but high

ROI when compared with prolonged

DIY efforts and “Excel heroism”

– Generating user demand (pull) for better

information while supply issues are being

identified and resolved

• Managing short-term frustration and

impatience to help achieve long-

term enterprise objectives

56

A Review of Benefits Realized for the Value of Health IT

http://www.himss.org/ValueSuite

S: Satisfaction

• Patient Satisfaction/HCAHPS improvements

• Call Center Service Level improvements

• Employee Satisfaction- engagement through the

performance management framework

E: Electronic information/data

• Data sharing and reporting drives process

ownership and improvement

S: Savings

• Accountability and visibility for budget management

57

Questions? Thank You!

• Kim Carli

– [email protected]

• Doug Stahl

– [email protected]

58

mailto:[email protected]

mailto:[email protected]

Introducing Your Organization to Lean and Clinical...

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