Just Do It! The Kaizen Approach to Health Care Performance ... · Kaizen at Beaumont •Not a...
Transcript of Just Do It! The Kaizen Approach to Health Care Performance ... · Kaizen at Beaumont •Not a...
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April 14, 2018
Dorothy Bernard, RN, MSADirector, Specialty Programs
Sam Flanders, M.D.Chief Quality Officer
Just Do It!The Kaizen Approach to Health Care
Performance Improvement
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Beaumont HospitalRoyal Oak, Michigan
UPDATE SLIDE
• 1,100 beds• 58,555 admissions• 130,733 ER visits• 51,248 surgeries• 6,872 births• >450 residents/fellows
• Magnet designated• 9 U.S. News & World Report
national rankings• Part of Beaumont Health,
Michigan’s largest health system
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Beaumont’s Reality in 2008
• New hospitals in primary service area
• 2008 economic collapse
Resulted in …
• Record operating loss
• Significant drop in cash on hand
• Bond rating downgrade
• Position reductions
• Freeze on pay raises
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Prior Approach to Improvement
• Projects prioritized by committee
• Participants trained in classroom setting - specific
tools and techniques
• Events led by trained PI experts
• Extensive data analysis prior to implementation
• Projects extended over several months
• “Best Practices” spread to everyone
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• Projects prioritized by committee
• Participants trained in classroom setting - specific
tools and techniques
• Events led by trained PI experts
• Extensive data analysis prior to implementation
• Projects extended over several months
• “Best Practices” spread to everyone
NEW Approach to Improvement
• Projects defined by area, based on business need
• Learn by doing – no reliance on classroom-based
tools and techniques
• Front-line staff and managers make the change
• Data used to prioritize; no extensive data analysis
• Changes made in the moment, based on
observation
• There is no “best” practice, only better
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Established “Rules for Change”
If someone has an idea that is….
• Low risk to safety and quality
• Low cost
• Easy to implement
• Easy to reverse
They MUST be allowed to try it!
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“Good change”
“the process of deliberate,
continual improvements”
Kaizen
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Which way can’t a sailboat sail directly?
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Current Condition
Target Condition • Often can’t go directly
from current to target
condition
• Does Kaizen idea get us
closer?
– YES … try it
• “1,000 small Kaizen are
better than one Kaizen
worth 1,000”
Reaching Our Destination with Kaizen
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Patient
Flow
Human
Efficiency
Quality
Safety
Financial
Strength
Experience
Patient
Centered
Actions
1. Culture of Safety
2. Risk Adj. Mortality
1. Overall Score (HCAHPS)
2. Responsiveness
1. Contrib. Margin ($$) / Case
2. Expense / Discharge
Kaizen Focus Impact Targets Outcome Metrics
Quality Improvement Philosophy(Rapid Change, Broad Engagement)
Low Cost Low RiskEasy to Install
Easy to Restore
Rapid Change
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How Did We Get Started?
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Example: 5 North
• 80-bed Medical/Surgical Unit
• New manager; eager to try something new
• Poor staff engagement, safety culture, patient satisfaction scores
• Target condition - increasing time nurses can spend with patients
Initial time spent with patients = 23%
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First Hours of Observation
• Team member follows a nurse
– What prevents them from spending more time with
patients?
• Findings (via OBSERVATION)
– Missing equipment / supplies
– Interruptions
– Missing medications
– Transporters arrived unannounced
• Patients not ready
– Many others
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Pill Cutter Example
Observation
• Nurse needed to split pill; med room missing pill cutter
Problem
• Nurse had to walk to other med room to get pill cutter
Kaizen
• Anchor pill cutter to wall in med room
Result
• Pill cutter always available
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Turn Teams
Observation
• Bed-bound patients not consistently turned q2 hours
Problem
• Increased risk of pressure ulcers
Kaizen
• Created turn team; use turn clocks as visual cue
Result
• Consistent turning of patients
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23%
45%
49%
53%55%
59%
65% 65%63%
65%63%
0%
10%
20%
30%
40%
50%
60%
70%
Nurses time at bedside
Nurses time at bedside
5 North Results – Time at Bedside
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0
0.5
1
1.5
2
2.5
3
3.5
1Q11 2Q11 3Q11 4Q11 1Q12 2Q12 3Q12 4Q12
5 North Unit-Acquired Pressure Ulcers
5N
5 North Results – Pressure Ulcers
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Units Display Kaizen Improvements
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5 North
Pharmacy
Transportation
Other Nursing Units
Dietary
Environmental
Emergency Center
Heart & Vascular
Radiology
TMS Access Center
Supply Chain
Surgery
PT/OT CPD
Troy
Accreditation
Physicians
Clinical Decision Support
Care Management
MQPM
Finance
Oncology Services
How Beaumont Connected
Missin
g m
ed
s
Access to supplies
Un
ex
pe
cted
Pt
Mo
ve
me
nt
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Typical Beaumont Kaizen “Event”
• Twice monthly
– Each team works for 2 days
• 4-8 teams working in different areas
– e.g., ER, nursing units, Radiology, Pharmacy
– Each with team leader
• Multidisciplinary
• Experienced coaches round on teams
• Brief kickoff in AM
• Report out in PM with senior leaders
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Sweating The “Small Stuff”
• Kaizens typically target small problems that interfere with human efficiency or patient flow
– Unable to print to some printers
– Supplies in patient rooms - instead of walking to supply closets
– Equipment not available where needed
• Hundreds (maybe more) of these exist
– Staff typically works around these problems
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Hospital-wide Results
3/19/2018 22
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ER “Door to Doc” Discharged Adult Patients
BETTER
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Severity-Adjusted Mortality (O/E ratio)
Beaumont, Royal Oak vs Vizient AMCs
Severity-Adjusted Mortality (O/E
ratio)(Beaumont, Royal Oak vs Vizient/UHC AMCs)
Severity-Adjusted Mortality (O/E
ratio)(Beaumont, Royal Oak vs Vizient/UHC AMCs)
Beaumont, RO Vizient AMCs
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Direct Cost Index Decline
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Length of Stay Decline
Severity-Adjusted Mortality (O/E
ratio)(Beaumont, Royal Oak vs Vizient/UHC AMCs)
Severity-Adjusted Mortality (O/E
ratio)(Beaumont, Royal Oak vs Vizient/UHC AMCs)
1. Transition of care notes
2. Complex Care Committee
3. Plan of Care created
4. Care Huddles
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ICU Length of Stay12 months pre and post Early Mobility Implementation
(monthly average)
• Total LOS savings: 0.79 days
• Total $ savings: $1,023,240
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Mortality Index 2017(observed/expected)
Severity-Adjusted Mortality (O/E
ratio)(Beaumont, Royal Oak vs Vizient/UHC AMCs)
Severity-Adjusted Mortality (O/E
ratio)(Beaumont, Royal Oak vs Vizient/UHC AMCs)RO
0.00
0.20
0.40
0.60
0.80
1.00
1.20
1.40
1.60
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76 79 82 85 88 91 94 97 100103106
Vizient Academic Medical Centers Mortality Index
January 2017 - December 2017
Beaumont, Royal Oak had the 6th lowest overall mortality index
among Vizient academic medical centers in 2017.
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Direct Cost Per Case Index – 2017(observed/expected)
Severity-Adjusted Mortality (O/E
ratio)(Beaumont, Royal Oak vs Vizient/UHC AMCs)
Severity-Adjusted Mortality (O/E
ratio)(Beaumont, Royal Oak vs Vizient/UHC AMCs)
RO
0.00
0.20
0.40
0.60
0.80
1.00
1.20
1.40
1.60
1.80
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76 79 82 85 88 91 94 97 100103
Vizient Academic Medical Centers Direct Cost per Case Index
January 2017 - December 2017
Beaumont, Royal Oak had the 33rd lowest overall direct cost per case index
among Vizient academic medical centers in 2017.
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Ignore This Advice
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Things Aren’t Always What They Seem
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Sweat The Small Stuff
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Sweat The Small Stuff
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Kaizen at Beaumont
• Not a “program” – it’s how we approach achieving business results
• Not a quick fix – it’s a long-term commitment• Events used to accomplish work, but aim is
PEOPLE DEVELOPMENT
• “Kaizen Spirit” is the goal• Improvement happens every day, everywhere• As part of day-to-day work
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Getting Started
• It’s about PEOPLE DEVELOPMENT and CULTURE of continuous improvement
• Define clear set of objectives that everyone is working towards
• Simple decision rules for empowering staff (“4 rules”)
• Weekly progress checks
• Coach people outside of their comfort zone
• Top executive leadership support
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Reflection Points
• This is a journey to change our culture
– Not a set of tools/techniques
• Kaizen process created an avenue to identify the
leadership capabilities of our leaders and staff
– They “bubbled up” in the organization
• Has changed our approach to problem solving
– “Let’s go look at” versus having meetings and discussing
in a conference room
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Questions & Discussion