Lake Health’s Lean Journey

Innovative Improvement for Independence

A little bit about us

Cleveland

Ohio

• Team Members = 3,000

• Inpatient Beds = 270• Adult Admits =

17,000• Births = 1,900• Surgical Cases =

14,000• ER Visits = 76,000

Presentation Roadmap

1. Reason for Action: Why did we decide to embark on this journey?

2. Initial State: Where were we when we started?

3. Target State: Where do we want to be in 3…5…10 years down the road?

4. Identifying Gaps: What are the major barriers that must be overcome?

5. Solutions: What needed to be done to overcome those barriers?

6. Rapid Experiments: Early successes/failures along the way?

7. Completion Plan: Getting started on our journey!

8. Confirmed State: Have we moved the dial?

9. Insights: Lessons learned

Waiting Unnecessary Motion Defects

The practice and process of identifying and removing waste

The concept and practice of continuous improvement

The power of respect for people (Front line decisions)

Toyota Business System

What is LEAN?

1. Reason for Action

3M

Boeing

Avery Dennison

Dow Chemical

General Electric

Ford Motor Company

Sears

GlaxoSmithKline

GEICO

US Army, Navy, Air Force and Marines

Virginia Mason

Mayo Clinic

ThedaCare

Denver Health

Stanford Hospital & Clinics

Lake Health!!

Organizations Practicing LEAN?

1. Reason for Action

1. Reason for Action

Desire to remain an independent, community-based health system

Recognition that the status quo or incremental changes in quality, cost and patient experience would not be sufficient to achieve goals

Require a shared disciplined approach to innovative improvement, that will transform the way we do business

Success of the transformation will ultimately depend on the participation of all team members, volunteers and physicians

Why did we decide to embark upon this journey?

7

1. Reason for Action

May 14-16, 2012 Leadership Retreat

2. Initial State

Operating in a dynamic/competitive market Desiring to improve clinical quality and patient experience. Needing to extend focus beyond acute episodic care to

continuum of care Reimbursement not keeping pace with increasing expenses Mediocre team member engagement Average community perceptions

Where were we when we started?

3. Target State

Improved patient and family value through:

higher quality lower cost improved safety

Waste eliminated from processes Instill a culture of continuous improvement

Where do we want to be in 3…5…10 years down the road?

4. Identifying Gaps

What are the major barriers that must be overcome?

Availability of space

Staff Support

Budget

Structure

“Program of the Month”

Conflicting Priorities

5. Solutions

Identify potential areas to begin Identify the criteria for areas selected Number of patients touched Opportunities for improvement Highest impact on the organization Select ones that complement each other

Deciding where to begin…

If We: Then We:Identify and harvest value streams #7, #8, Metrics will improveUtilize A3 thinking #1, #2, We will hardwire PIDevelop a lean office #1, #3, #6, #7Track results to True North metrics #1, #8, What gets measured gets

resultsCreate steering teams for guidance (enterprise, value streams)

#2, #4, #6, #7, #8

Provide coaching to leadership team #1, #2, #6, #7Have leaders participate on RIE’s, every year

#1, #5

Communication Plan #1, #2, #5, #7, #8Physician engagement #1, #2, #5, #7, #8Develop common terms/language #1, #2, #3, #4, #5, #6, #7, #8

What needed to be done to overcome those barriers?

5. Solutions

5. Solutions

Addressing Space/Staffing

5. Solutions

Addressing Structure

Pre-work Lean overview Observations Stakeholder

analysis RIE planning

Define Measure Analyze Improve Sustain

RIEReview Pre-workValidate

observationsBrainstorm

solutionsTry-storm solutionsValidate

improvements

Follow-up Educate Tweak final

changes Sustain new

process Continuously

improve through MDI

RIE – Change Based on Knowledge of the World’s Greatest Experts

Those doing the work

5. Solutions

Addressing Structure

MondayCurrent

ConditionGembaWaste

Observation

TuesdayWaste Analysis

Map Future State

Generate Solutions

Wednesday

Run Rapid Experiments

Problem Solving

ThursdayRun New Process

Document Standard Work

FridayReport Out

6. Rapid Experiments

Early successes/failures along the way?Nurse to Nurse Handoff

Initial:• Average time from ED to inpatient bed 79 minutes and up to 250• ED staff took patient to inpatient unit then had to find the nurse

Solution: • Inpatient nurses pull the patients from the ED within 15 minutes• Developed new clinical summary screen to facilitate face to face

handoff

Benefit: • Reduced time to inpatient bed from 79 minutes to 40• Improved perception of care from patients • Improved quality and safety of hand off. Second Pass improvements Solution:• Time reduced an additional 20 minutes!

6. Rapid Experiments

Early successes/failures along the way?Periops

Initial:• Increasing Cost/UOS• Different patient types cared for by same staff • Causing uneven patient flow through SDS• Need to expand SDS area to support patient volume $3M project

Solution:• Developed flow/standard work based on procedure • Identified specific locations in SDS for each patient type

Benefit:• Improved flow avoided need for additional SDS beds.  • Saved $2.5M in capital.

6. Rapid Experiments

Early successes/failures along the way?

Physician First

Initial:• Median time Door to Doc was 40 minutes• Protocol Care creating excessive ordering• Patient satisfaction for arrival less than desired

Solution:• Implement Physician first concept at peak volume times• Triage by physician• Earlier implementation of care

Benefits:• Patient satisfaction with arrival improved by 57%• Door to Doctor time decreased by 48%

7. Completion Plan

Never complete…

Review the System-wide Transformational Plan of Care

Integrate into System-wide plan.

Looking to expand to new areas within the system

Expanding the number of facilitators

Implemented Management for Daily Improvement Boards

Managing for Daily Improvement (MDI) is focused on implementing a management system that creates, accommodates, and sustains a culture of continuous improvement

The MDI System facilitates an ongoing transformation to a data driven, action oriented, engaged & empowered lean organization

Manage “Flow” of process outputs (Visually)

Identify and prioritize anomalies of performance and make improvements

Encourage associates to identify and eliminate waste

Create an environment where associates are responsible for identification (and assisting in the elimination) of waste

Daily Activities

7. Completion Plan

Convert from being a reactive firefighter, whose attention and priority is focused on the self- perpetuating, never-ending fires whenever they occur (always on the edge of out of control)

TO…

A proactive Lean thinker who is managing and controlling his priorities and ultimately his destiny

21

MDI Goals

7. Completion Plan

Incremental daily improvement supplemented with Rapid Improvement Events

Event based improvement

Incremental Daily Improvement

(coupled with events)

RIE Events

Daily MDI Activity

RIE EventsImprovement

Level

7. Completion Plan

8. Confirmed State

Have we moved the dial? 20 months into our journey…

$5.9M in Hard Dollar Savings Patient satisfaction with the arrival

process improved by 57% Avoided $2.5M in capital expense by

improving patient flow Falls reduced by 55%

9. Insights

1. Reason for Action: Leadership focus on the “what” not the “how”

2. Initial State: Must have 100% commitment from all (especially physicians).

3. Target State: Double the good…or…half the bad

4. Identifying Gaps: Focus on the process…not the people

5. Solutions: - Creativity over capital

6. Rapid Experiments: The best laid plans…

7. Completion Plan: A disciplined approach

8. Confirmed State: Hope is not a strategy…countermeasures

9. Insights: Some people will want to get off the bus…let them.

Lessons Learned?

“Committed and trained senior leadership, without question, is the key component in successfully transforming an organisation through lean initiatives”

9. Insights

“Having a great partner, like Simpler, is essential to guiding an organization through such a transformative process.”