Implementing A Balanced Lean Six Sigma Operating System In A Healthcare Organization

Implementing a Balanced Lean Six Sigma Operating System in a Healthcare Organization

Process improvement through people development™Copyright Children's Hospital Medical Center of Akron

Doug Dulin, Akron Children’s HospitalLean Master, Master Black Belt

A Balanced Lean Six Sigma Operating System


Part 1

Speaker: Doug DulinBio: Doug Dulin is the Senior Director for Akron Children's

Hospital Center for Operational Excellence. He is a proven leader with extensive experience transforming manufacturing and healthcare organizations utilizing Lean Six Sigma fundamentals based upon the Toyota Production System. Throughout his career, Doug, has held such positions as Director Lean Six Sigma, Business Unit Manager, Plant Manager, Lean Site Leader and Lean Master. He earned his Lean Six Sigma Master Black Belt Certification from Honeywell International. Earlier in his career, he learned the Toyota Production System from Aoyama Seisakusho, a Tier One Supplier to Toyota Motor Manufacturing.


Balanced Lean Six Sigma Operating System

Shigeo Shingo – “Know how alone isn’t enough! You need to Know-why”! All too often, people visit other plants only to copy their tools and methods.”

“Think in terms of categorical principles.”

Tools Systems Principles



Goals of this presentation• Introduce to the elements of a Balanced

Lean Six Sigma Operating System• Case Study Review: Learn about Akron

Children’s Hospital Balanced Lean Six Sigma Operating System



Elements of a Balanced Lean Six Sigma Operating System

Baseline Event

LEAN SIX SIGMA PRINCIPLES

A3 for Healthcare Transformation

Kaizen for GoodPatient Care

Build your Daily Management

System

Balanced Lean Scorecard

Connecting yourBoard Directors

Baseline Kaizen Events

Internal Lean Sensi Team

Lean Six Sigma Belt Program

Tools Systems Principles



Internal Lean Sensi Team> Team of Internal Organization Stakeholders leading the culture and

process transformation using Lean Six Sigma Tools, Systems and Principles

> Development driven through outside learning, internal cycles of learning managing projects and leading enterprise wide improvements

> Internal Lean Team should include a range of experienced employees, Physicians, Nurses and key leaders within the organization

> Use of outside consultants should be used to help begin a program, introduce new advanced lean six sigma tools or off set a head count issue for a short term period

Internal Lean Sensi Team



Baseline Kaizen EventsA baseline is a starting point. The baseline process will allow us to gain a defined

understanding of our current state. Without a baseline, we cannot be certain what or where to improve. Baseline deliverables include: An understanding of the current and future states, Identification of the gaps between the two, and A plan to close the gaps.

Organization Development OperationsOD Baseline understands:•Human Capital Current State•Creates the Future State and links it with Strategy•Determines and Creates Go Forward Action Plan

Operations Baseline understands:•Current State of all Operations•Creates the Future State and links it with Strategy•Determines and Creates Go Forward Action Plan



Baseline Kaizen Events



“Essence of Lean”• Staff driven• Bottom up• Enabling process• Numerous but small projects

Methodology– 8 week course– General Lean Tools– 2 hours per class– 2 hour “homework”– 15-30 students– Offered twice per week– Complete one project using A3 story

telling visual board– Graduation ceremonywith executive leadershipTeam

http://leanforhaiti.org/





71645750433629221581

0.25

0.20

0.15

0.10

0.05

0.00

_P=0.1307

_P=0.1132

_P=0.0483

UCL=0.1967UCL=0.1895

UCL=0.0906

LCL=0.0648

LCL=0.0368

LCL=0.0061

Pre-Implementation/ Implementation ControlControlBaseline

Flash Sterilization Rate by LSS Project Phase (P Chart)[Excl Procedures Outside ORs; Oct 2007-present; Target < 3%]

Tests performed with unequal sample sizes

Description> Projects link with program or

enterprise strategic plan> Data driven projects> Advanced training in Lean Six

Sigma Tools> Advanced training in project

management> Advanced training in soft skills> Projects range from 6 to 9 months> Advancement program includes

Green, Black and Master Black Belt> Development tools for future leaders

and Physicians



Kaizen for Good Change for Patient Care

Kaizen for GoodPatient Care

Description• Drive Business strategic plan

quickly using lean six sigma tools

• Significant and rapid change (rapid improvement week)

• Short term intensive concentrated effort by frontline stakeholders, physicians and nurses

• Enterprise should support 20 to 30 per yearProcess improvement through people development™

Copyright Children's Hospital Medical Center of Akron


Building a Daily Management

System

Build your Daily Management

System

Tier 3VPsDirectorsSupporting Functions

Tier 2DirectorsManagersSupporting Functions

Tier 1Area ManagerArea Stakeholders

Each metric should be applicable to team … Winning or Losing at a Glance

Metrics … ↑ Visibility … Dig @ source of issue …Countermeasures!



Connecting your Board of Directors to your Lean Operating System

Daily Management

CorporateStrategy

Deployment

ExecutiveTeam

ManagementTeam

Front LineLeaders

StakeholdersConnecting yourBoard Directors



Balanced Lean Operating Scorecard

Balanced Lean Scorecard

Benefit Category Result

Patient wait time reduced (days)

42,831

Staff non-value added time reduced (hours)

24,056

Appt access times reduced (days)

74,608

Financial Impact (directand indirect)

$9,177,222

Overview> Enterprise wide metrics linked

directly to strategy of organization> Metrics could include $s direct and

indirect savings> Patient centered metrics included in

scorecard> Simple tracking of metrics possible> More advanced lean six sigma

metric tracking available on the market to improve process through the journey



What makes a successful Balanced Lean Six Sigma Operating System

Project Program EnterpriseStrong support from Champions and Physician Leaders

The people and managers do the work Support of top executives includingphysicians

Full Engagement of team by going to the Gemba

Support of top executives by going to the Gemba and asking questions

Vocal and Visible Support from whole leadership team by going to the Gemba

Visibility & Communication Support of physicians No-Lay off policy for Lean initiatives

Use data that supports reality Use data that supports reality Use data that supports reality

Must have project follow-up and re-adjustment

Begin to use balance tools, processes and systems within a value stream

Use balanced tools, processes and systems

Continuous Improvement is foundation Learn from other areas and companies Dedicated, trained resources – with most of the team being internal candidates

Team Engagement is Key Continuous Improvement is foundation Continuous Improvement is foundation



Akron Children’s Hospital Balanced Lean Six Sigma

Operating System


Case StudyPart 2

Blue Belt Program A3 Program

Kaizen EventsLean Six Sigma

Belt Program

ACH Lean Operating

System


DEFINE

MEASURE

ANALYZEIMPROVE

CONTROL

• Day Nursery in 1890 to independent stand-alone teaching hospital

• Largest pediatric health care system in northeast Ohio

• 253 bed hospital – Main campus• 32 bed hospital – Youngtown• offering services at 80+

locations across the region. • 579,000 outpatient visits each year

• 10,000 admissions


About Akron Children’sHospital

• 4,000 + employees• Gold Seal of Approval from the Joint

Commission • Magnet Recognition Status from American Nurses Credentialing Center• Stable Leadership


William H. Considine President & Chief Executive Officer

About Akron Children’sHospital

COO Led• Wanted to better the patient

experience (decreasing patient wait times, access times)

• Looked for a sustainable way for a hospital to improve operations


Mark Watson

About Akron Children’s Lean SixSigma Journey

Center for Operations Excellence:The mission of the Center for Operations Excellence is to

develop and use in-house talent to improve the healthcare experience of our patients and families, while improving the working experience of our staff.

Currently staffed by 8 individualso 1 Senior Directoro 5 Deployment Directorso 1 data analysto 1 office coordinator

21Process improvement through people development™Copyright Children's Hospital Medical Center of Akron

ACH Center for OperationsExcellence Group

Process Improvement Through People Development TM


ACH COE Philosophy

23

DMAIC Methodology (Define, Measure, Analyze, Improve, Control)•Kaizen Events

• Rapid Process Improvement Week- anywhere from 2 to 5 day events • Strategically driven by Executives• Belts = project leaders; team of 5 – 10 from dept & from dept’s customers

•Green Belt and Black Belt Projects• 6 - 9 month projects • Strategically driven by Executives – VPs, C suite, etc. • Project leaders are COE staff, or trained belts• Team of 5–10 from the department

•A3 Projects• 8 week long projects, usually within the boundaries of the participants’ home dept• Driven by the line staff doing the work, and supported by their manager

•Blue Belt• Manager training to include Gemba Walks, implement daily metrics boards and daily

huddles, coaching for staff, etc.


ACH Lean Six Sigma OperatingSystem

• A3: 8-week formal training program which teaches front-line staff the basics of Lean, culminating in the completion of a project in the participant’s home department


ACH Lean Six Sigma OperatingSystem – A3

25

Akron Children’s Hospital A3 Project Overview

A3 Projects•Burn Center

•Reduction in the number of inaccurate burn dressing cards

•Pediatric Psychology•Reduce missed number of MACSIS forms for Medicaid clients

•Laboratory•Reduce the QNS rate for patients 3 months and older by 40% for sweat tests

•Nursing•The amount of unused linen in empty rooms on the 7th floor will be decreased from up to 31 pieces to 0 pieces

•Food Services•Reduce non Nursing non value added time and variation in fortified breast milk preparation.


A3 Example from a Project


• Lean Six Sigma Belt Program: Formal training program and project which lasts 6-12 months, following the DMAIC (Define, Measure, Analyze, Improve, Control) format


ACH Lean Six Sigma OperatingSystem – LSS Green Belt Program

28

Green Belt Projects•Flash Sterilization

•Problem statement•The Sterile Processing Department cannot currently meet case demand for surgical instruments without a weekly 13.1% flash sterilization rate

•SMART Goal•Reduce weekly flash sterilization rate in the OR to ≤ 3%

•Results•Reduced weekly flash sterilization rate from 13.1% to 2%



71645750433629221581

0.25

0.20

0.15

0.10

0.05

0.00

_P=0.1307

_P=0.1132

_P=0.0483

U CL=0.1967U CL=0 .1895

U CL=0.0906

LCL=0.0648

LCL=0.0368

LCL=0.0061

P re-Imp lemen tatio n / Imp lemen tatio n C o n tro lC o n tro lBaselin e

Flash S terilization Rate by LS S Project Phase (P Chart)[Excl Procedures Outside ORs; Oct 2007-present; Target < 3%]

Tests p erfo rmed w ith uneq ual samp le sizes



• Black Belt: 12-month projects involving large value streams which utilize more advanced tool of Lean Six Sigma via OSU


ACH Lean Six Sigma OperatingSystem – LSS Black Belt Program

Center for Operations ExcellenceProject CharterLocust Pediatrics 3PBackground/Problem Statement:Locust Pediatrics Care Group is going through the following changes throughout 2010: 1. Potential for more patients to the daily schedule: The clinic has become the primary

medical home for patients in the care of Summit Children’s Services Board (CSB), eventually adding on a projected 400 visits per month t(20 visits/day) to its schedule.

2. Additional new staff: 1 RN, 1 CNP, 1 MA, and new 2 PSR’s have joined the staff to help care for the additional patient volume.

3. Additional space: The clinic has gained much of Suite 380’s 3,500 square feet of space and operations are changing which might lengthen the visit times.

4. EPIC (electronic medical records) implementation in the last half of 2010. Extra movement , searching, and rework is interfering with the staff’s ability to care for the children

in the daily schedule and the additional kids cared for behind the scenes.

Goal Description:

•Run a 2-day 3P exercise that will create the plans for the best utilization of space, resources, & staff in the Locust Pediatrics Suite 380 space.

Scope:• Maintain and even improve quality of care at all points of time during a visit•Only the new space (previously Rheumatology; Suite 380) during the 3P event will be considered.•Exceptions might be duplication or centralization of a potential med area, supply area, and lab area that may lead the team to look at Suite 390.• Long term plans would include potentially duplicating the gains realized from Suite 380 to Suite 390.

Benefits:• Optimize the Suite 380 space (previously Rheumatology) in terms of patient flow, staff flow, and information flow. • Help to shorten the patient door to door visit in Locust Pediatrics Note: As of April 2010, the current average visit length for sick visits (door to door) for patients in the Locust Pediatrics Group is still 70 minutes (approximately the same as 2009). • Help establish a model for the Department of Pediatrics to allow departments to understand how an ideal clinic should look and flow, especially when bringing on new providers.

Project Y: Key Metrics:• See Metrics (no project Y necessary)

• A completed renovation plan for Suite 380 space. As promised by Mark Watson and Lin Gentile, all renovations will be completed by June 30th.

Team Members: Stakeholders:Executive Sponsor: Mark Watson, COOChampions: Cindy Dormo, Dr. Norm ChristopherProcess Owner: Dr. Cooper WhiteTeam Members: Cindy Kovacich, Lee Orin, RN, Holly Ross, CNP, Missy Sommers, RN, Jessica Anders, Erica Walters, Angie McCreery, Russ MaroniProject Leaders: Anne Musitano, RPh, PharmD, Kris Grayem, RN, CNPExpert Advisors: Sherrie David, RN, Tim Tomayko, Cliff Greive COE staff: Sherry Valentine, RN, Mike Antochow

Patients and families Locust Pediatrics staffCSB Department of Pediatrics

CURRENT STATE VALUE STREAM MAP – AFTER VSM WORKSHOP – 2/15/10


TOTAL TIME IN CLINIC FOR SICK VISITS FOR 2010

86 83 8081

75 7365

0

10

20

30

40

50

60

70

80

90

100

January February March April June July July

Total Time in the Locust Clinic for Sick Appointments


Akron Children’s Hospital’s Lean Six Sigma Operating System

• Black Belt: 12-month projects involving large value streams which utilize more advanced tool of Lean Six Sigma via OSU


34

Locust Black Belt Project – Through a series of Kaizens and A3-based projects, the Locust team identified and implemented a number of improvements that reduced patient in-clinic time from 70 minutes (2009) to 43 minutes (2011).

Project Specific Example: Creation of Mobile Triage Cart designed by Locust Black Belt Team

XStep 1 – Reduce Triage Room Step 2 – Actual Drawing Step 3 – Actual Triage Cart

• Blue Belt: Training for managers and departmental leaders focusing on daily management in a Lean enterprise through tools, processes, and systems


ACH Lean Six Sigma OperatingSystem – LSS Blue Belt Program

METRIC BOARDS


Staff and Management Engagement- A3 projects

37

A3 Project: Shelly Orr


Akron Children’s Hospital’s Lean Six Sigma Operating System

• Blue Belt: Training for managers and departmental leaders focusing on daily management in a Lean enterprise through tools, processes, and systems


38

Below: Example of Kids Metric Board tracking 4 key area metrics linked to ACH pillars of Quality, Research, Brand and Growth

AREA DAILY TEAM HUDDLES


STAKEHOLDER IDEA BOARDS


• Kaizen: Events lasting 2-5 days which result in rapid implementation of countermeasures


ACH Lean Six Sigma OperatingSystem – Kaizen

Center for Operations ExcellenceProject CharterMRI KaizenProblem Statement:There is currently capacity for additional patients to be scanned on MRI #1 and MRI #2.

Goal Description:

Increase the number of weekly exams (Monday through Friday) performed on MRI #1 and MRI #2 from 86 to 112 by August 24th, 2009. The assumption is that demand is there to meet the goal of 112 exams per week.

Scope:Main campus only; MRI #1 and MRI #2.

Benefits:

• Reduce the backlog of patients requiring MRI services. • Reduce the patient access times for MRI services.• Potential annualized net revenue gained: $1.7M (from increasing the total number of weekly exams Monday through Friday between MRI #1 and MRI #2 from 86 to 112.)

Project Y: Key Metrics:Patient access times for non-contrast, contrast, and sedated MRIs.

# of exams performed per day on MRI #1 and MRI #2 on Monday through Friday

Team Members: Stakeholders:•Kaizen Team Members- Dr. Mike Ruibin, Dr. Azam Eghbal, Carol Arteno, Jason Duncan, Terry Tarray, Shelly Orr, Marie Biasella, Julie Madden, Kim Gresham, Tina Keith•Champions: Lin Gentile, Chis B. •COE Team- Anne Musitano, Mike Antochow, Sherry Valentine, Trauda Gilbert, Dr. David Chand, Chris Weisbrod•On Call Team- Michelle Taylor, Karen Horning, Betsy Cetnarowski

Patients, physicians, and radiology staff of Akron Children’s Hospital

Visibility & Communication and Focus on the Goal

• Keep staff involved with project information• Don’t take your eye off the ball


DATA- LOOK AT THE REALITY!


Strong Support from the Top

45

CEO: Bill Considine

VP: Lin Gentile

COO: Mark Watson


Areas of Opportunity


Go to the Gemba and See!


MRI Schedule- Constantly Evolving in Response to Actual Patient Demand


Sustainability of MRI Kaizen!


•A3•Green Belt•Black Belt•Blue Belt•Kaizen

50

Benefit Category Since COE inception early 2009

Patient wait time reduced (days)

42,831

Staff non-value added time reduced (hours)

24,056

Appt access times reduced (days)

74,608

Financial Impact (directand indirect)

$9,177,222


ACH Lean Six Sigma OperatingSystem – Program Results

• Lean is more than tools or project work• Lean is 90% engagement of people/10% tool knowledge• Hard to deploy with other full time job commitments• A Lean program needs to focus considerable effort on

engagement of the middle management early on in deployment


ACH Lean Six Sigma OperatingSystem – Lessons Learned

52

Keys to Success•C-level support of the Lean Six Sigma initiative•Dedicated full time staff•Front line engagement•Middle management engagement•VP level engagement•Experienced Lean Six Sigma consulting firm for first 2 years

.


ACH Lean Six Sigma OperatingSystem – Keys to Success

LEAN IS A JOURNEY…

ToolsPoint Projects, A3 program, Kaizens(2008-onward)

PrinciplesGreen Belt Program, Blue Belt Program, Black Belts, more Kaizens(2010-onward)

SystemsFurther Development of Tools & PrinciplesStrategy Deployment(2010- onward)

Akron Children’s

Lean Operating

System

53

ACH Lean Six Sigma Operating System

True North


Questions?

Contact information: Doug Dulin

Akron Children’s [email protected] (w)330-697-1682 (c)


mailto:[email protected]

Documents

Implementing A Balanced Lean Six Sigma Operating System In A Healthcare Organization