Mark Graban ILC / MGMC Event 2016
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Transcript of Mark Graban ILC / MGMC Event 2016
FromtheBoardroomtotheFrontLine:AlignmentthroughLeanManagementSystems
PlanDoStudyAdjust
Startfromneed.
Whatproblemarewetryingtosolve?
What’saManagementSystem?• Whatareleadersexpectedtodo?• HowareleadersexpectedTOBE?
– Isthereclearalignment?Aretheregaps?– Or"justgetresults"???
• Howisthistaught,modeled,andreinforced?– Whathappenswhentherearegaps?
WhyaLeanManagementSystem?
StrategyDeploymentinHealthcare(Scott & White)
WhatisStrategyDeployment?• Aka"Hoshin Kanri"
– Hoshin ="compass"– Kanri ="management" or"control"
• "Aprocessforembeddingstrategyandaligninganorganizationtowardcommongoals"
• DevelopedbyDr.YojiAkao– (YokogawaHewlett-Packard)
StrategyDeployment=PDSA
• UsingPDSAcyclesto:– Creategoals– Choosemeasurementpoints– Linkdailyactivitiestohighlevelgoals
– Driveresults&learning
FromGoalDeploymentto"CatchBall"
Source:LeanHospitals,Graban
TheRoleofLeaders• Definepurposeclearly• Identifythebiggestobstacles• Createanatmosphereconducivetoinitiativeandcreativity
• Reducehassle• Leadbyexample!Modelbehaviors.Teach
Source(1-4):Andy&MeandtheHospital(Dennis)
"TrueNorth"• Broadgoalsanddirection
– "Briefexpressionofdirection,purpose,commitment,andvalues"
– "Whatweshould do,notwhatwecando"– Speakstotheheart
"TrueNorth" Statements• "Nowait,noharm."• "Eliminateallunnecessarydeathorillness."• "Measurablybettervalue."• "Toprovidehigh-qualityhealthcaretoall,regardlessof
theirabilitytopay."• "____willcareforpatientsthewaywewantmembersof
ourownfamiliestobetreated,whileadvancinghumanity'sabilitytoalleviatehumansufferingcausedbydisease.Wewillprovidetherightcareintherightenvironmentandattherighttime,eliminatingwasteandmaximizingvalue."
StrategyDeploymentasaSeriesofHypotheses
Hypothesis#1:
Ifwefocusourimprovementeffortsandcloseperformancegapsinthesefour(orfive)areas,wewillthereforeperformwellasanorganization,thisyearandoverthelong-term.
http://www.leanblog.org/SD1
"TrueNorth" FocusAreas
Source:ThedaCare
SAFETY&QUALITY PEOPLE PATIENT
SERVICE FINANCIAL
TRUENORTHWALL
BuildingConsensus
LessonsLearned• Don’tcopyothers’TrueNorth• Gothroughtheprocessofgainingconsensusaroundwhattheseshouldbe
• TrueNorthmustresonatewithyourpeople• "Thebeststrategydeploymentsystemintheworlddoesn’tmakeupforthewrongstrategy." (Toussaint)
StrategyDeploymentasaSeriesofHypotheses
Hypothesis#2:
Ifwecanimproveandcloseourperformancegapsinthesekeyperformanceindicators,wewillsatisfyourneedforimprovementinourkeyfocusareas,andthereforewewillbesuccessfulasanorganization,overall.
http://www.leanblog.org/SD1
"TrueNorth" Metrics
Source:ThedaCare
SystemLevelMetrics
Source: Thinking Lean at ThedaCare (DVD)
AnnualPDSACycles
• Goals&Metrics– Howdidweperform?– Whydidwehavethatperformance?– Werethosetherightgoals?– Arethesestilltherightgoals?
SAFETY&QUALITY
PEOPLE PATIENTSERVICE
FINANCIAL
TRUENORTHWALL
STRATEGYA3
STRATEGYA3
STRATEGYA3
a.k.a."MOTHER"
A3
MEASURE1
MEASURE2
MEASURE3
MEASURE1
MEASURE2
MEASURE1
MEASURE2
MEASURE1
MEASURE2
MEASURE4
MEASURE3
MEASURE3
MEASURE4
TheA3ManagementDiscipline
Heading
PlanDo
Study Adjust
Footnotes
17"
11"
A3(PDSA)StoryBoard
CyclesoflearningandcontinuousprocessimprovementDevelopingpeopleandimprovingprocesses
Plan(Hypothesis)
Do(Try)
Study(Reflect)
Adjust(Act/Adjust/Abandon)
GrasptheSituation
Strategy A3
InitialStrategyA3Work
"BreakthroughA3" - Safety
• Expect 20 to 50% improvement in these breakthrough A3s
TrueNorthCanEvolve
11/1/12 Rev: 10
Safety• System Patient Safety Bundle• D.A.R.T
People• Engagement Index• Health Assessment Score
Customer"Lori"
• Customer Loyalty Score
© 2011 ThedaCare
Financial Stewardship• Operating Margin• Productivity
Quality• Preventable Mortality• 30 Day Readmission
&
ImproveSafety
Inpatient
Med/Surg Telemetry
Outpatient
Clinics
ClinicA
PhysicianA PhysicianB
ClinicB
Surgery
EmergencyDept
Patient&Employee
Sprains&Strains
PatientFalls
TieredMetrics(3Levels)
Source:GroupHealthCooperative
Office
Clinic
PrimaryCareGroup(26clinics)
DailyManagementBoards
LessonsLearned• KPI=KEY PerformanceIndicator
– Trackingmoremetricsisn’talwaysbetter
• Don’tcopy:gainconsensusonthemetrics• Focusonmetricsthatarebestindicatorsofprogress&gap
closure• Isitwortharguingtoomuchoverexactgoals?• Getalignment,noteverybodymeasuringtheexactsamething
StrategyDeploymentasaSeriesofHypotheses
Hypothesis#3:
IfweactuallyexecuteandcompletethesetopXinitiatives,projects,events,andA3s,thenwewillmakethegreateststridestowardclosingthekeyperformancegaps(fromHypothesis#2)andthereforewe’llbemoresuccessfulinourstrategy.
http://www.leanblog.org/SD2
PrioritizationisaMust• Whatarethe"mustdo,can’tfail"initiativesforourorganization?
AGeneralization…• Mostorganizationshavetoomany:
– "Highpriority" or– "Toppriority" initiatives/projects
• Doesanyinitiativegetrejectedorpostponed?
• Howmanyofourtoppriorityprojectsaregettingcompleted??Photo: Dr. John Toussaint
"Deselecting"• Don’t implement every idea at once (Focus)• Deselect if it doesn’t meet immediate value stream project criteria
Source:ThedaCare
Project A3
BABYA3#1
BABYA3#2
BABYA3#3
BABYA3#4
BABYA3#5
BABYA3s
BABYA3#7
BABYA3#8
BABYA3#9
BABYA3#10
BABYA3#12
BABYA3#13
BABYA3#14
BABYA3#15
BABYA3#17
BABYA3#18
BABYA3#19
a.k.a"TACTICALA3"
#20
BABYA3#6
BABYA3#11
BABYA3#16
NursingUnitBoard
Source: Thinking Lean at ThedaCare (DVD)
Six Sigma
Projects
LargeKaizen
MediumKaizen
SmallKaizen
LeanEvents
Circle size is meant to roughly represent relative size of effort; Blue = tracked top initiatives ("Baby A3s")
Com
plex
ity
Daily Kaizen
Women & Children’s
3P
ElectronicMedicalRecord
ImplementationNew
Bed Tower
3 Types of Kaizen
LessonsLearned
• Don’ttakeontoomuch
• Gainingconsensusonthistakesalotoftime,too
• Maybeerronthesideof"toofew" keyinitiatives?
• Stopjumpingtosolutions!
• Don’tlet"alignment"stifleKaizen
StrategyDeploymentasaSeriesofHypotheses
Hypothesis#4:
WeactuallyhavetheorganizationalcapacitytocompletetheseXtopprioritiesinayearoragiventimeframe(andwiththerightquality).
http://www.leanblog.org/SD2
PDSAReviewCycles
• UsingPDSAcyclesto:– Checkprogresson:
• Activity• Results• Lessonslearned
TraditionalApproachGot Results
Didn’t Get Results
LeanApproach
Didn’t follow process Did follow process
Got Results
Didn’t Get Results
Mid-YearReview• Lean/S.D./A3/PDSAApproach:
– If"Red" (notmeetingtarget),ask:• Didwedowhatwesaidwe’ddo,butdidn’tgetresults?
– Doweunderstandwhy?– Whatdidwelearn?
• DidweNOTdowhatwesaidwe’ddo?– Doweunderstandwhy?– Whatdidwelearn?
Mid-YearReview• Lean/S.D./A3/PDSAApproach:
– If"Green" (meetingtarget),ask:• Didwedowhatwesaidwe’ddo,andgotresults?
– Whatdidwelearn?
• DidweNOTdowhatwesaidwe’ddo,butstillgotresults?
– Doweunderstandwhy?– Whatdidwelearn?
LessonsLearned• Don’tbeconfusedbyasingledatapointversusasustainedtrendinresults
• Don’twaituntiltheendoftheyeartosay,"Oops…"• PDSA– Studycapacityandprogress
– Adjustasneeded
• Ifthere’sanew"toppriority" initiative,whatareyougoingtodeselect?
Our4Hypotheses1. Wehavetheright
TrueNorth&categories2. We’vechosenthe
rightmetrics&gaps3. We’vechosenthe
rightinitiatives4. Wehavetherightcapacity
toexecutethem
Q&A/ContactInfo• www.MarkGraban.com• www.LeanBlog.org• [email protected]
www.PracticingLean.com