Phil Goodman & MedAmorphosis 1 Background & Experience 2 - - PowerPoint PPT Presentation

Phil Goodman & MedAmorphosis

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Background & Experience What is Lean? MedAmorphosis Options

Where are you experiencing pain?

Phil Goodman

▪ 30+ years at Denver Health ▪ Healthcare clinician ▪ Started & sustained DH’s Lean program ▪ Co-authored Lean book with DH CEO Patty

Gabow

▪ Shingo Research & Professional Publication

Award Winner

▪ Bronze Shingo Prize 2011 ▪ $195 million saved, June 2005 – December

2012

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Introductions

▪ Amy Lueb, BSME, MBA

✓ 6 years in healthcare process & continuous improvement

▪ David Spiciarich, BSME

✓ 20+ years in manufacturing quality and management

▪ Ron King, BSCE, MS

✓ CEO of healthcare marketing & management firm 23+ years

What is Lean?

▪ Post-war Toyota Production System

gave birth to waste elimination in manufacturing, then healthcare

▪ Less waste in healthcare =

✓ better clinical outcomes ✓ cost savings ✓ increased income

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MedAmorphosis Team

▪ Hospitals & ambulatory clinics

with >10 specialties

▪ Government & contracting ▪ Commercial & industrial manufacturing ▪ Engineering & MBA degreed

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50 years combined experience

MedAmorphosis Team

▪ Services to healthcare systems & clinics

✓ Denver Health (DH) ✓ Centura ✓ UC Health

▪ Achievements

✓ > $1M savings for the OBGYN department ✓ > $400K for Behavioral Health Services at DH

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MedAmorphosis Team

▪ Lean ▪ Six Sigma ▪ A3, 8D, PDSA, DMAIC, … ▪ TPS, TQM, SMED, … ▪ Meeting set-up & facilitation ▪ Training for frontline to executives

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46 years of training experience

Our Approach

Rapid Cycle Development (RCD)

RAPID CYCLE DEVELOPMENT EVENT IMPLEMENTATION & COACHING

Focused improvement activities done by frontline staff Execution of action plan Sustainment Activities

PRE-WORK

Key Stakeholders

• Interview
• Survey

DIAGNOSTIC

• Onsite
• bservations
• Staff shadowing
• Data gathering

& analytics

1 RCD Cycle = 3 Months

3 – 4 days (4– 5 hrs/day)

Previous Outcomes

▪ Incoming call reduction ~50% ▪ Call abandonment rate of 26% lowered to <10%

✓ Estimated annual revenue increase of $492K

▪ Eliminated written patient complaints about

scheduling appointments

▪ Created capacity for incoming surgeons

Neurosurgery, Neurology & IR Clinic Merger

▪ Established work cells & Takt Times ▪ More accurately estimated Rx turn-around

time (TAT)

▪ Changed hours of operation to serve the

patient more effectively & reduce labor costs

▪ Increased customer value based on pre &

post surveys

Previous Outcomes

OP Pharmacy

▪ Reduced employee injury rate by 82% ▪ Decreased patient falls with injury by 77% ▪ Pressure ulcers reduced by 23% ▪ Earlier patient ambulation led to 5%

reduction in length of stay (LOS)

Previous Outcomes

Acute Care Safe Patient Handling

▪ Reduced Length of Stay (LOS) by 40% to < 15

hours

▪ Created algorithm for treatment ▪ Opened up communications between ED staff

& Cardiologists

▪ Used NPs/ PAs to their full scope of practice

Previous Outcomes

ED & Observation Low Risk Chest Pain

Option A

A La Carte

• Training
• Meeting facilitation
• Change Management
• Department diagnostic
• Gemba Walk

A3 Process Mapping 5S / 6S 8 Wastes DOWNTIME Fishbone 5 Whys Mistake Proofing Poka Yoke Visual Management SIPOC Standard Work PICK Charting FMEA

Option B: Rapid Cycle Development

RCD Cycle(s)

• Engage frontline staff
• Focused, structured A3

Methodology

• Introduces staff to Lean

Culture

• Mentoring & Coaching
• 1. Reason For Action

(Chief Complaint)

• 4. Gap Analysis

(Diagnosis)

• 6. Adopt & Adapt

(Treatment)

• 2. Initial State

(Symptoms / Vitals)

• 5. Solution

Approach (Tests / Labs)

• 7. Completion Plan

(Plan of Care)

• 3. Target State

(Desired Physical State)

• 8. Lessons Learned /

Celebration

D S/C A P

Option C

Hoshin Kanri

• Full strategic planning
• Develop tactics
• Align goals & action
• Catchball
• Shared vision
• Primary Responsibility

○ Secondary Responsibility

Resources

HOSHIN PROCESS OWNER'S NAME HERE

Hoshin Kanri X-Matrix

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3 - 5 year Breakthrough Objectives 1 year Objectives Year 1 Improvement Priorities Targets to Improve (Metrics) Improvement Project Owners

• ○

Mock JCo Audit

○

• ○

○

• ○

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Perform Internal Magnet Audit

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• ○

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RCD: Current State of Magnet

• ○
• ○

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RCD: Current State of Stroke Program

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Hire Magnet Coordinator

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Determine Lead for Stroke Center Cert

• Assemble Employee Satisfaction Committee
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• RCD: ED LOS for admitted patients
• Know Magnet deficits

Preliminary Assessment of Stroke Center Rq Get 1st year employee turnover < 20% Pass JoCo Re-Cert w/ < 3 type 2 findings Move from 120 to 100 or better ED LOS (Admitted Patients) Goal < 3 hours Employee Turnover Rate (year 1) Goal < 20% Internal Magnet Assesment Score Mock Audit Score < 3 findings Internal Stroke Assesment Score ED Director HR Director CNO Chief of Neurology Magnet Coordinator Director of Quality

○

• Become a top 50 Hospitals (Truven Health)

○ ○ ○ ○ ○ ○

• Reduce first year Employee Turnover to < 10%
• Primary Responsibility

○

• ○

Become a Comprehensive Stroke Center

○

• ○ Secondary Responsibility
• ○

Obtain Magnet Certification

• ○

Resources

Process Owner: Hosptial X CEO

Hoshin Kanri X-Matrix

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3 - 5 year Breakthrough Objectives 1 year Objectives Year 1 Improvement Projects Targets to Improve (Metrics) Improvement Project Owners

Options # of RCD Cycles Coaching & Mentoring Duration Data Analysis Deliverable Training Included Cost Range (Scope & Complexity) A: A La Carte No 1 – 2 days

(possibly more depending on the # selected)

Only if a Diagnostic is selected Tools to run your

• wn project

Yes, & bundled in various ways $1,000 - $12,000 B: RCD 1 Yes, for 4-6 wks post RCD 3-4 months Yes A3: Roadmap to Where you have been, where you want to go & how to get there No stand alone training $50,000 - $70,000 C: Hoshin 4 Yes, throughout the entire year 1 year Yes X-Matrix: Extreme makeover blueprint for unprecedented performance Yes, 2 day A3 training (Class size < 20) $175,000 - $250,000 Diagnostic: 1 Process or Department, 60 day engagement, report & presentation of findings (i.e. Targeted Data Analysis, Leadership Interviews, List of JDIs, Patient / Staff / Information Flow Maps) $10,000 Value

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