The Role of Leadership in System

Transformation

November 2012

Leading Lean

• Overview of Denver Health

• Why is healthcare transformation needed?

• Transformation Journey

• Why Lean

• Implementing Lean

• Outcomes

• Lessons learned

2

Non

medical

Detox

Correctional

Care

Denver

Health

Medical

Center

911

Family

Health

Centers

Regional

Poison

Center &

Nurseline

Denver

Health

Medical Plan

School-

based

Health

Centers

Rocky Mtn

Center for

Medical

Response to

Terrorism Public Health

Rky Mtn

Regional

Trauma Ctr

Employed Physicians

HIT

3

4

Denver Health Patients

Denver Health cares for approximately 176,000 individual patients – almost one third of Denver County’s population

37% of Denver’s babies are born at Denver Health

40% of Denver children use Denver Health

70% of patients are ethnic minorities

75% of patients are below 185% FPL

42% of the patients are uninsured

Leading Lean

6

Quality of Care

Overall mortality is one of the lowest among academic health centers

Immunizations – 90% of one year olds fully immunized

Hypertension – 70% controlled

Leading Lean

Leading Lean

• If we are doing so well, why consider system transformation?

– American health care has serious problems in:

• Access

• Cost

• Quality/Safety

– The cost of health care contributes significantly to the deficit, impacts America’s ability to invest at home and be competitive abroad.

7

Scores: Dimensions of a High Performance Health

System 75

70

67

52

69

67

73

71

57

53

71

65

70

75

55

53

69

64

0 100

Healthy Lives

Quality

Access

Efficiency

Equity

OVERALL SCORE

2006 revised

2008 revised

2011

Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2011. 8

* Note: Includes indicator(s) not available in earlier years.

*

*

Leading Lean

Change in American healthcare will require new American models

New American healthcare models will require transformation at individual system levels

System transformations require institutional leadership that focuses on and delivers change

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Leading Lean

• The Role of Leadership – Defining the journey

• Create the vision • Define the path

– Implementing the journey • Teach the path • Create structure – Build the road • Walk the path

– Commitment to outcome • Measure performance • Provide feedback • Create transparency

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Leading Lean

• Role of Leadership – Define the Path

• Literature review • External steering committee • Site visits • Employee focus groups • Patient focus groups • Detailed examination of processes • Chose the path

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©

Right

Person

Right

Environment

Patient and

Family

Right

Process

Right Reward

IT

Right

Service

Right

Communication

Leading Lean

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Waste is disrespectful of humanity because it squanders scarce resources

Waste is disrespectful of individuals because it

asks them to do work with no value Past President Toyota

Waste is disrespectful to patients by asking them to endure processes with no value

Leading Lean

Transformation

Con

tin

uou

s

Imp

rovem

ent

Res

pec

t fo

r

Peo

ple

Lean Pillars of Transformation

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• Role of Leadership – Implementing the Journey

– Teach the Path • Executive Staff and Directors of Service (Chairs) – 4

hours Lean 101

• Mid-Managers – 2 hours overview

• 2 hours first Lean tool (5S)

16 Gabow, 2012

Leading Lean

Leading Lean

• Role of Leadership – Implementing the Journey – Teach the Path

• All mid managers do 5S project

• Report with metrics to CEO

• Provide a rapid Lean results applicable to clinical and support areas—fun/useful

• Large number of employees involved

• Immediate results

• Begins spread of Lean

• Is foundational

17 Gabow, 2012

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Unit 1, Basement, Bedroom, Plumbing (BEFORE)

Frank Ortega 4/19/06

Leading Lean

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Unit 1, Basement, Bedroom, Plumbing (AFTER)

Frank Ortega 5/2/06

Leading Lean

Engineering 5S Project Results

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Engineering Expense Trend

Supply Expense

2004 1,034,631

2005 1,155,500

2006 869,734

2007 707,223

2008 714,993

2009 711,505

2010 906,285

2011 811,329

6 yr avg savings per yr is $526,196

Lean Deployment at

Denver Health

DH Black Belts (BBs):

• 250 Black Belts

• 48 hours lean training

• Day to day lean

• Bi-Monthly reports

• BBs embedded throughout clinical and non-clinical areas

Rapid Improvement Events (RIEs)

• 16 Value Streams

• 8 RIE’s/yr/vs

• RIEs coordinated by 9 Lean Facilitators

• 7-9 members per team

• >400 RIEs

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2012 Value Streams

First Floor (ED,DECC,

AUCC)

RMPDC – Drug and Product

Safety

Nursing Clinical Process

Managed Care Revenue Cycle

Specialty Clinic OB/GYN

Human Resources RMPDC – Patient Access

Perioperative Services Pharmacy

Behavioral Health Services CHS (x16 RIEs)

Medicine Discharge Education

Leading Lean

Application of Lean to Quality

Diabetes Chronic Care Management

Reducing inpatient laboratory send-out tests

Clinical Guideline 6S Project

Reducing Medical Readmissions

Improved Cancer Screening

Anticoagulation Clinical Quality Project

–VTE Prophylaxis

–Outpatient Anticoagulation Services Redesign

Leading Lean

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• Role of Leadership—Implementing the Journey

• Walk the Path —Role of the Executive Staff

• Create steering committee for VS

• Meet with steering committee to establish RIEs in VS for year

• Attend preplanning—picking team, metrics

• Attend RIE sign out—Monday–Thursday-redirection/remove barriers

• Attend Friday report out

• Participate in two RIE’s per year

Gabow, 2012

Leading Lean

• Role of Leadership – Commitment to Outcome

• Measure Performance

– Define metrics/target all levels

– Metric reporting CEO

• Provide feedback

• Create transparency

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• Define metrics

– Black Belt target -- $30,000

– Value Stream target

• Financial

• Quality

• Human Development

Leading Lean

Financial Benefit Per Black Belt Trend

Value Stream 2012 Financial

Target

Quality Target

Pharmacy $1,200,000 Outpatient

Satisfaction

Managed Care $2,300,000 CMS Safety

Monitoring

Community Health

Services

$1,000,000 Visits to Medical

Home

Revenue Cycle $6,000,000 Aggregate Clean

Registration Score

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Leading Lean

Wall with Value Streams

30

$133,474,232

$42,265,651

$-

$20,000,000

$40,000,000

$60,000,000

$80,000,000

$100,000,000

$120,000,000

$140,000,000

$160,000,000Jul-0

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RIE + Blackbelt Financial Benefit Trend Cumulative Through July 31, 2012

RIE Total Savings Black Belt Savings

31

$175,739,883

$-

$20,000,000

$40,000,000

$60,000,000

$80,000,000

$100,000,000

$120,000,000

$140,000,000

$160,000,000

$180,000,000

$200,000,000Jul-0

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2

RIE + Blackbelt Combined Total Financial Benefit Trend Cumulative Through July 31, 2012

Breast Cancer Screening

Colorectal Cancer Screening

Post Operative DVT

Overall Inpatient Mortality Index

36

247

PEOPLE

WALKED

OUT

ALIVE

Leading Lean

37

I have participated in an RIE 44%

I see the benefits of the LEAN process in driving Right Process at DH.

69%

I understand the LEAN philosophy and how it reduces waste in our organization.

83%

Impact of Lean on Culture Employee Survey– 85% response

2012

Leading Lean

• Engagement

• Pride

• Focus on Success

• Communication

• Career Planning

• Talent Selection

• Quality

• Investment

• Trust and Listening

• Relationship

• Patient Centricity

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Relationship Between RIE participants and

Dimension of Culture 2012

RIE participants were statistically (<0.01) higher in all

Dimensions

Dimensions

• Transformation Lessons Learned – Transformation requires integrated components – no silver

bullet

– A clear process is necessary for transformation

– The process needs to be applicable to all places where work is done

– Leadership from top is needed to create transformation

– Cultural transformation requires entire workforce engagement

– Need a pace that produces transformation

– Patience and steadfastness are needed

39

Leading Lean

Operating Principles of

Change and Improvement

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Lean Lessons Learned • Organizational 5S a good start

• Black Belts are an asset

• Project approach not optimal path

• Structure is important

• RIE’s require power transfer

• Handling push back

• Sensei are valuable

RaThank you to Denver Health teams Lean Department Department of Quality and Safety Staff

Leading Lean

• Thank-you

• Questions

• LEANacademy@dhha.org

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