Laguna Honda Lean Transformation - SFDPH · Laguna Honda Lean Transformation Laguna Honda Strategic...

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Laguna Honda Lean Transformation Laguna Honda Strategic Performance Management November 2017

Transcript of Laguna Honda Lean Transformation - SFDPH · Laguna Honda Lean Transformation Laguna Honda Strategic...

Page 1: Laguna Honda Lean Transformation - SFDPH · Laguna Honda Lean Transformation Laguna Honda Strategic Performance Management November 2017. Background 2 SEE IT Remove wastes ... Nursing

Laguna Honda

Lean Transformation

Laguna Honda

Strategic Performance Management

November 2017

Page 2: Laguna Honda Lean Transformation - SFDPH · Laguna Honda Lean Transformation Laguna Honda Strategic Performance Management November 2017. Background 2 SEE IT Remove wastes ... Nursing

Background

2

SEE IT

Remove wastes

Create

standard work

Respect people

SAY IT

MAKE IT

BETTER

FIX IT

1.

Identify problem and

value

2.

Map out allsteps in the

process

3.

Create bestwork flow

4.

Do the work and make it

happen

Perfo

rmance Im

pro

vem

ent

Quality

Assura

nce

Page 3: Laguna Honda Lean Transformation - SFDPH · Laguna Honda Lean Transformation Laguna Honda Strategic Performance Management November 2017. Background 2 SEE IT Remove wastes ... Nursing

2017 Staff Satisfaction Survey Responses

3

“Offer more opportunities for

professional development.”

“Create a culture to value the input of line

staff for problem solving by increasing participation.”

“Improve communication between depts…

continuous improvement by way of lean methodology.”

“Involve frontline staff in improvement

projects/work.”

“Balance the changes from lean culture.

Everybody is talking about it but we don’t

know what it is.”

“Better communication between lean staff

(Administration) and frontline staff. Get more

input.”

“Continue w/ lean transformation.”

“Continue with lean transformation as this

gives structure and organization to enhance

good working environment.”

“Spreading lean continuous improvement

principles.”

Page 4: Laguna Honda Lean Transformation - SFDPH · Laguna Honda Lean Transformation Laguna Honda Strategic Performance Management November 2017. Background 2 SEE IT Remove wastes ... Nursing

Objectives

4

Improve

Enable

Align

Support strategic goals by

aligning initiatives, projects and

metrics at all levels

Facilitate Lean initiatives that

focus on improving flow,

quality, safety, resident

experience & setting standards

Provide training, coaching,

and support for Lean systems

& tools. Develop lean leaders

around data driven performance

As an organization, we need to move from a culture of

compliance, to a culture of improvement.

Page 5: Laguna Honda Lean Transformation - SFDPH · Laguna Honda Lean Transformation Laguna Honda Strategic Performance Management November 2017. Background 2 SEE IT Remove wastes ... Nursing

Challenges

5

Developing a Lean culture is a slow process

Exposure of Lean initiatives

Teaching Lean methods and tools to all departments and shifts

Engagement at all levels

Sustaining improvement efforts

Page 6: Laguna Honda Lean Transformation - SFDPH · Laguna Honda Lean Transformation Laguna Honda Strategic Performance Management November 2017. Background 2 SEE IT Remove wastes ... Nursing

Our Tools

6

Value Stream Mapping(VSM)

• A technique used to illustrate, analyze and improve the steps required to deliver a product or service

Kaizen Workshops

• Workshop attended by owners & operators with intent of improving a specific process

Gemba Walks

• Personal observation of the work

A3 Thinking

• Root cause analysis; a systematic approach to problem solving

5S Workplace Management

• Standardize workspaces to eliminate unnecessary items and improve organization

Page 7: Laguna Honda Lean Transformation - SFDPH · Laguna Honda Lean Transformation Laguna Honda Strategic Performance Management November 2017. Background 2 SEE IT Remove wastes ... Nursing

Our Lean Journey

7

Training & Coaching

VSM’s & Hoshin Kanri

Kaizen Workshops

5S

Jul 2016 Oct 2017

Oct 2016 Jan 2017 Apr 2017 Jul 2017

Jul-16

Intro to Lean Rollout

Feb-17

VSM #1-Kaizen 1: Pre-Admission

Mar-17

Pharmacy 5SApr-17

Nursing 5S- Phase 1

Apr-17

VSM #1- Kaizen 2: Clinical Assessments

Jun-17

VSM #1- Kaizen 3: Room Readiness

Jul-17

Nursing 5S- Phase 2

Jul-17

VSM #2: Discharge

Aug-17

Nursing 5S- Hospital Wide Rollout

Sep-17

Lean EHR Prep Workshop- Cohort 1

Aug-16

LHH Leadership & Rona Plan Lean Transformation

Sep-17

VSM #2- Kaizen 1: Care Planning

Jun-17

Monthly DMS Training

Nov-16

VSM #1- New Admissions

Sep-16

3-Day Executive Education

Nov-16

Intro to A3 Thinking Jan-17

Start of A3Workshops

Page 8: Laguna Honda Lean Transformation - SFDPH · Laguna Honda Lean Transformation Laguna Honda Strategic Performance Management November 2017. Background 2 SEE IT Remove wastes ... Nursing

The Start of Our Lean Journey

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Jul 2016 Oct 2017Oct 2016 Jan 2017 Apr 2017 Jul 2017

June 2016

• Strategic Performance Management Team developed a plan to introduce lean methodologies to all departments at Laguna Honda

July 2016

• Laguna Honda leadership received formal introductory training on the basic principles of lean

August 2016

• LHH Executive Team met with Rona Consulting to discuss approach for the organization’s lean transformation

• Projects were selected based on the needs of the San Francisco Health Network

September 2016

• 3-Day Executive Education

Page 9: Laguna Honda Lean Transformation - SFDPH · Laguna Honda Lean Transformation Laguna Honda Strategic Performance Management November 2017. Background 2 SEE IT Remove wastes ... Nursing

Value Stream Map (VSM) #1:

New Admissions

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Jul 2016 Oct 2017Oct 2016 Jan 2017 Apr 2017 Jul 2017

Problem

• The existing admission process was flawed causing many delays and creating a long waitlist for approved patients.

Actions

• Improved Resident Care Team notification & communication

• Mapped new PASRR workflow to eliminate waste

• Set standards for timely completion of H&P documentation for coding

Results

• 3 Kaizen/Rapid Improvements: (1) Preadmission, (2) Clinical Assessments and, (3) Room Readiness

Page 10: Laguna Honda Lean Transformation - SFDPH · Laguna Honda Lean Transformation Laguna Honda Strategic Performance Management November 2017. Background 2 SEE IT Remove wastes ... Nursing

VSM #1 – Kaizen Workshop 1:

Pre-Admission

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Jul 2016 Oct 2017Oct 2016 Jan 2017 Apr 2017 Jul 2017

Problem

• The pre-admission and screening process was very inefficient and community partners had expressed their concerns to our organization.

Actions

• Developed guidelines for SNF requirements in the new standard Laguna Honda admission application

• Developed standard work for screening, reviewing and responding to applications.

Results

# of Incomplete

Applications Received

per month

Time for Clinical

Decision of New Apps.

# of Apps. reviewed by

Screening Committee

per Month

71% to 3.3% 5.5 days to 2.6 days 134 to 27

Page 11: Laguna Honda Lean Transformation - SFDPH · Laguna Honda Lean Transformation Laguna Honda Strategic Performance Management November 2017. Background 2 SEE IT Remove wastes ... Nursing

VSM #1 – Kaizen Workshop 2:

Clinical Assessments

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Jul 2016 Oct 2017Oct 2016 Jan 2017 Apr 2017 Jul 2017

Problem

• The length of time for all Resident Care Team members to complete their initial clinical assessments could take 7 to 14 days.

Actions

• Implemented Pharmacy chart preparation process

• Improved Resident Care Team communication

• Created standard work with expectations to complete initial clinical assessments w/in 48hrs of admission

• Created Admission Kits for clinical assessments and ADLs kits for residents

Results

Social Services

Assessments, n=82

Rx Chart Prep

Process

82% compliance

rate

process time & did not

decrease med rec errors

Clinical Nutrition

Assessments, n=82

72% compliance

rate

Activity Therapy

Assessments, n=82

4% compliance

rate

Page 12: Laguna Honda Lean Transformation - SFDPH · Laguna Honda Lean Transformation Laguna Honda Strategic Performance Management November 2017. Background 2 SEE IT Remove wastes ... Nursing

VSM #1 – Kaizen Workshop 3:

Room Readiness

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Jul 2016 Oct 2017Oct 2016 Jan 2017 Apr 2017 Jul 2017

Problem

• Vacant rooms are scheduled for a new admission within 24 hours of discharge. However, the process of cleaning & repairing a room can take several days.

Actions

• Facilities, Nursing, and EVS collaborated to create a “Room Readiness Checklist”

• Implemented new method to send notifications when discharges are confirmed

• Created standard work & mapped new workflow with sequencing and time requirements

Results

July 2017 – Aug 2017

Vacant Rooms Prepared

w/in 24hrs, n = 24

50% Compliance

Rate

Sep 2017 – Oct 2017

Vacant Rooms Prepared

w/in 24hrs, n = 30

77% Compliance

Rate

Page 13: Laguna Honda Lean Transformation - SFDPH · Laguna Honda Lean Transformation Laguna Honda Strategic Performance Management November 2017. Background 2 SEE IT Remove wastes ... Nursing

Return on Kaizen for VSM #1

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Category Kaizen Measure Data % Change

Motion

Pre Admission

# of steps taken to transfer the

Admission Application to the clinical

screener

Baseline: 500 steps by

Admission Cord.↓ 100%

Result: 0 steps by

Admission Cord.

Clinical

Assessments

# of steps taken during Nsg

Assessment

Baseline: 308 steps by Nsg↓ 100%

Result: 0 steps by Nsg

Cost

SavingsPre Admission

Salary spent per month on non-value

added time for unnecessary

screenings & incomplete application

follow up

Baseline: $3,515↓ 100%

Result: $0

Time

Savings

Pre AdmissionTurn around time from receiving

application to admission decision

Baseline: 5.5 days↓ 44%

Result: 2.9 days

Room

Readiness

Turn around time to prepare a

room after discharge

Baseline: 48 hrs↓ 75%

Result: 12 hrs

Defects

Pre AdmissionAdmission Application missing

clinical information

Baseline: 71% (n = 52)↓ 68%

Result: 3% (n = 30)

Clinical

Assessments

Initial clinical assessments

completed w/in 48 hrs

Baseline: 100% (n = 22)↓ 52%

Result: 48% (n = 82)

Room

Readiness

Rooms prepared w/in 24 hrs of

discharge

Baseline: 100% (n= 70)↓ 77%

Result: 23% (n = 54)

Page 14: Laguna Honda Lean Transformation - SFDPH · Laguna Honda Lean Transformation Laguna Honda Strategic Performance Management November 2017. Background 2 SEE IT Remove wastes ... Nursing

Pharmacy 5S – Workplace Management

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Jul 2016 Oct 2017Oct 2016 Jan 2017 Apr 2017 Jul 2017

14 San Francisco Health Network

1. Sort 3. Shine

5. Sustain

2. Set in Order 4. Standardize

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Nursing 5S – Workplace Management

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Jul 2016 Oct 2017Oct 2016 Jan 2017 Apr 2017 Jul 2017

Nursing 5S- Phase 1 Nursing 5S- Phase 2

Before After

Page 16: Laguna Honda Lean Transformation - SFDPH · Laguna Honda Lean Transformation Laguna Honda Strategic Performance Management November 2017. Background 2 SEE IT Remove wastes ... Nursing

Value Stream Map #2:

Discharge

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Problem

• Some short stay residents who have housing remain at Laguna Honda beyond their skilled nursing need, which contributes to a waitlist and backup in the network.

Actions

• Created a script for A&E and each discipline to acknowledge short stay

• Documented reason resident not present in RCC note

• Discussion with referring sources re: start discharge plan.

Results

• 3 Kaizen/Rapid Improvements: (1) care planning, (2) discharge preparation and, (3) discharge day

Jul 2016 Oct 2017Oct 2016 Jan 2017 Apr 2017 Jul 2017

Page 17: Laguna Honda Lean Transformation - SFDPH · Laguna Honda Lean Transformation Laguna Honda Strategic Performance Management November 2017. Background 2 SEE IT Remove wastes ... Nursing

VSM #2 – Kaizen Workshop 1

Care Planning

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Jul 2016 Oct 2017Oct 2016 Jan 2017 Apr 2017 Jul 2017

Problem

• There are no estimated discharge dates for Short Stay residents due to unclear ownership in care planning

Actions

• Revised the Resident Care Team meeting notes form

• Standardized physician work flow for Short Stay referrals to LHH’s specialty clinics

• Created an educational program for staff on short stay goals

Results

• Process Owners will evaluate the outcomes at 30, 60 and 90 days

Page 18: Laguna Honda Lean Transformation - SFDPH · Laguna Honda Lean Transformation Laguna Honda Strategic Performance Management November 2017. Background 2 SEE IT Remove wastes ... Nursing

Moving Forward

18

Training & Coaching

VSM’s & Hoshin Kanri

Kaizen Workshops 5S

Lean Certification

Oct 2017 Jun 2018

Jan 2018 Apr 2018

Oct-17

Lean EHR Prep Workshop- Cohort 2

Oct-17

Monthly DMS Training

Nov-17

VSM #2-Kaizen 2:Discharge Prep

Oct-17

Lean Certification Training

Jan-18

VSM #2-Kaizen 3:Day of Discharge

Nov-17

Lean EHR Prep Workshop- Cohort 3

Nov-17

Nursing 5S- Hospital Wide Rollout

Dec-17

Lean CertificationTraining

Jan-18

Lean CertificationTraining

Jan-18

Hoshin Kanri Mar-18

VSM #3: TBDMay-18

VSM #3- Kaizen 1: TBD

Nov-17

Lean CertificationTraining

Page 19: Laguna Honda Lean Transformation - SFDPH · Laguna Honda Lean Transformation Laguna Honda Strategic Performance Management November 2017. Background 2 SEE IT Remove wastes ... Nursing

Strategic Performance Management Team/

Kaizen Promotion Office

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• Health Program Planner

Elizabeth Schindler

• Administrative Analyst

Vincent Lee

• Jr Administrative Analyst

Olivia Thanh