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Laguna Honda
Lean Transformation
FY17 – 18Laguna Honda
Strategic Performance Management
November 2018
Background, FY16-17
2
Jul 2016 Oct 2017
Oct 2016 Jan 2017 Apr 2017 Jul 2017
Jul-16
Intro to Lean Rollout
Feb-17
VSM #1-Kaizen 1: Pre-Admission
Mar-17
Pharmacy 5SApr-17
Nursing 5S- Phase 1
Apr-17
VSM #1- Kaizen 2: Clinical Assessments
Jun-17
VSM #1- Kaizen 3: Room Readiness
Jul-17
Nursing 5S- Phase 2
Jul-17
VSM #2: Discharge
Aug-17
Nursing 5S- Hospital Wide Rollout
Sep-17
Lean EHR Prep Workshop- Cohort 1
Aug-16
LHH Leadership & Rona Plan Lean Transformation
Sep-17
VSM #2- Kaizen 1: Care Planning
Jun-17
Monthly DMS Training
Nov-16
VSM #1- New Admissions
Sep-16
3-Day Executive Education
Nov-16
Intro to A3 Thinking Jan-17
Start of A3Workshops
Training & Coaching
Value Stream Map & Hoshin KanriKaizen Workshops
5S Workplace Organization
EHR & Lean Preparation
Key
Hoshin Kanri
Few Critical Initiatives
Alignment & Cascading Priorities
Strategy Deployment
DPH & SFHN
LHH
Develop our People
Implement EPIC
Value Based Care
3
Our Lean Transformation, FY17 – 18
4
Training & Coaching
Value Stream Map & Hoshin KanriKaizen Workshops
5S Workplace Organization
EHR & Lean Preparation
Key
Develop Our People
Executive Education ~ By the Numbers
6
Workshops for practicing leadership behaviors through improvement tools
8
Cohorts that lasted for 6 months throughout 2017 & 20182
LHH employees who attended the workshops22
LHH employees who received an executive education certificated through a “teach back” session
20
Lean Leadership Development
WhatParticipants learn, build, and practice new tools and skills. Teams are supported by internal LHH coaches and Rona consultants.
Who & When Cohort 1 (May – Nov 2018)
4 Nursing Units and Dept. of Education & Training
Cohort 2 (Nov 2018 – May 2019)
2 Nursing Units and 3 Clinical Depts.
Tool Box Making time for improvements Leader standard work
Daily status report Weekly status report
Improvement huddles Visual management of metrics
Process observations
7
Lean Leadership Development
9
EHR Readiness
EHR Readiness Workshops
Oct 2017 – Nov 2017
10
EHR Prep
Lean Leadership
Provided a series of Lean
Workshops to 3 cohorts
from Oct 2017 – Nov 2017
Participants included
from Nursing, MDS,
Nursing Education,
Activity Therapy, Rehab,
Health at Home, and HIS
49 of 60 LHH Subject
Matter Experts (SMEs)
received Lean training
prior to EHR Direction
Setting
11
Practiced the application
of different Lean tools
with real problems
identified by participants
Focused on prioritizing
workflows to close
potential gaps
EHR Readiness Workshops
Oct 2017 – Nov 2017
12
EHR Current State Discovery Workgroups
March 2018
MDS Documentation
DNCR Documentation
Change of Condition
Med Administration (Rx)
Med Administration (Nsg)
Value Based Care5S Workplace Management
5S – Workplace Management
14
4 Day 5S Workshop took place in January 2018- 2 pilot units
Interdisciplinary team included Nursing, Pharmacy, EVS, Quality Management, Nursing Education, DPH KPO, and Strategic Performance Management
Completed rollout to all 14 Nursing units May 2018 – August 2018
Scope: Medication Rooms (26), Medication Carts (55), and Treatment Carts (29)
5S – Workplace Management
15
5-Min 5S
5S – Workplace Management
The Process
16
5S – Workplace Management
Standard Layouts
17
5S- Workplace Management
Before & After- Med Rooms
18
5S- Workplace Management
Before & After- Med Carts
19
5S- Workplace Management
Before & After- Treatment Carts
20
Value Based CareImprovement Workshops
Value Stream Map #2:
Discharge Process
22
Problem
• Some short stay residents who have housing remain at Laguna Honda beyond their skilled nursing need, which contributes to a waitlist and backup in the network.
Actions
• Created a script for A&E and each discipline to acknowledge short stay
• Documented reason resident not present in RCC note
• Discussion with referring sources re: start discharge plan.
Results
• 3 Kaizen/Rapid Improvements: (1) care planning, (2) discharge preparation and, (3) discharge day
VSM #2 – Kaizen Workshop 1
Care Planning
23
Problem
• There are no estimated discharge dates for Short Stay residents due to unclear ownership in care planning
Actions
• Revised the Resident Care Team meeting notes form
• Standardized physician work flow for Short Stay referrals to LHH’s specialty clinics
Results
Average length of days
from admission to the
initial resident care
conference (RCC)
Expected date of d/c
is NOT documented in
resident’s chart at the
end of the initial RCC
Residents are NOT
present at the initial RCC
The surrogate decision
maker is NOT present at
initial RCC(if appropriate)
Baseline: < 14 Days
Target: <7 Days
Current Status: 6.4 Days
Baseline: 67%
Target: 0%
Current Status: 14%
Baseline: 25%
Target: 20%
Current Status: 20%
Baseline: 100%
Target: 20%
Current Status: 50%
VSM #2 – Kaizen Workshop 2
Discharge Preparation
24
Problem(s)
• Residents are often unaware of their discharge plans & timeline
• Medication education and documentation is inconsistent;
• Home evaluations with DME procurement are often done without adequate lead time.
Actions
• Created a Discharge Checklist
• Created a Resident Discharge Information Sheet
• Standard Work for DME Ordering – HWII, Therapist & SW
Results
% of Home Evals NOT completed >2 weeks
prior to discharge (Non PMS)
% of residents unaware of where to find
discharge information
Baseline: 90%
Target: 0%
Current Status: 0%
Baseline: n/a
Target: 0%
Current Status: 33%
VSM #2 – Kaizen Workshop 3Operationalizing Discharge Identification and Planning
25
Problem
• Laguna Honda is not able to effectively manage service code information and establish a sustainable short-stay program to operationalize short-stay residents discharges.
Actions
• Created a Discharge Huddle Guide Sheet
• Consolidated discharge reports and created a Discharge Huddle Worksheet
• Created a Discharge Planning Timeline
Results
% of non-discharge ready
residents identified on
consolidated list
% of residents in short stay
service codes with LOS greater
than 100 days
Average cycle time per patient in
discharge huddle
Baseline: 10%
Target: 0%
Current Status: 25%
Baseline: n/a
Target: 0%
Current Status: 44%
Baseline: n/a
Target: 5 Minutes
Current Status:3 mins
Discharge Planning Timeline
19
Return on Kaizen for VSM #2
27
Category Kaizen Measure Data % Change
Time Savings Care Planning Average length of days
from admission to Initial
RCC
Baseline: 14 days
↓54%Result: 6.4 days
Operationalizing
Discharge
Identification and
Planning
Average cycle time Per
patient in Discharge Huddle
Baseline: 5 minutes
↓40%Result: 3 minutes
Defects Care Planning Missing documentation for
expected discharge date
post Initial RCC
Baseline: 67%
↓79%Result: 14%
Care Planning Percentage of times the
resident is NOT present at
the initial RCC
Baseline: 25%
↓20%Result: 20%
Discharge
Preparation
Percentage of Home
Evaluations completed less
than 2 weeks prior to
discharge (non PMS)
Baseline: 90%
↓100%Result: 0%
Safe Resident Handling Kaizen
28
Problem
• The number of injuries associated with resident handling tasks has increased significantly over the last three years
Action
• Improvement of the buddy system
• A new competency checklist for performing pivot transfers
• Introduction of a slide sheet for repositioning and transferring our heaviest residents
• Standard work for Unit Clerks to follow up on work orders to ensure that functioning equipment is always available for transfers
Results
• All countermeasures were successfully piloted on S5 with no injuries so far. Have begun hospital-wide spread in October
• Will not see impact until the end of fiscal year
Looking Ahead
29
9
Developing Our People
Continue spreading Lean Leadership Development (LLD)
EHR
Close Epic gaps identified by High Value Target (HVT) in Long Term Care (LTC)
Value Based Care
Close operational gaps identified by HVT in LTC
Strategic Performance Management Team
30
• Health Program Planner
Elizabeth Schindler
• Administrative Analyst
Vincent Lee
• Administrative Analyst
Olivia Thanh
