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Leading High Reliability Organizations in Healthcare

Richard Morrow, MBA, MBB

Author/Founder

RPM Exec (847) 989-3333

rpm@rpmexec.com

www.rpmexec.com

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Baseline Performance – Healthcare Compared

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Organizations Excelling in Reliability

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Payers are driving value by redistributing* $1.9B in reimbursement through Value-Based Purchasing

Today’s Lesson: How to Become Paul

*CMS FY2018 IPPS Final Rule estimate

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Reimbursement is Shifting to Reliability =Clinical Outcomes and Value

Source: CALHIIN

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How Much Is At Stake for Your Organization?

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Then, Paul can lose it all in readmission and hospital-acquired conditions penalties

The cost of poor reliability comes to healthcare

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Becoming a High Reliability Healthcare Organization

▪ What is reliability?

▪ How bad is it today?

▪ What causes poor reliability?

▪ What improves it?

▪ How do we sustain it?

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HIGH RELIABILITY is:

CAPABILITY IN ACHIEVING THE

EXPECTED OUTCOME

THROUGH TIME

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High Reliability is Not…

▪ Just about safety

▪ Six wrong site surgeries every week

▪ Patient and caregiver satisfaction below national median

▪ Readmissions being big business for you

▪ Entertaining your State Inspectors

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Comparing Complexity and Reliability Skills

INDUSTRY HEALTHCARE

HEALTHCARE INDUSTRY

If this is true, how are you going to compete and win the margins to sustain your mission?

Complexity

Reliability Skills

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Required: Systems Approach to High Reliability

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Step 1: Safety Engineering - Leadership’s Role

“I was absolutely amazed that the NASA people I argued with against the launch…

didn't even mention to other members of the mission management team that there was a concern…”

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High Reliability Healthcare

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Step 2: Reliability Engineering principles taught to leadership and staff (Yellow – Master Level)

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High Reliability Organizations Utilize 3Ms:

1.Measure daily

2.Manage to that measure

3.Make it easy to do the right thing

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Utilize the 3Ms of Performance Reliability

1. Measure the Process - Daily

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Failure Mode and Effects Analysis the Right Way & the Healthcare Way

Healthcare Starts FMEA

Process FMEA

HRO Starts FMEA

Bad Event

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2. Manage to the Measure – Every Day

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Don’t accept failureThe movie, “Lincoln,” Directed by Steven Spielberg

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3. Make it easier for teams to solve problems

The movie, “Lincoln,” Directed by Steven Spielberg

“Circulate among followers consistently,”

Abraham Lincoln

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Favo

rab

le

What Can Be Achieved

Imp

rove

men

ts Begin

85th %

40th %

• Benchmark for clinical outcomes – Center of Excellence• Top 5% in Value-Based Purchasing with Zero Penalties• Leads the market and wins the margins

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How to Build Reliability Skills - Example of a High Reliability Training System

1 2 3 4 5 6 7 8 9 10 11 12

Culture

People

Process (Improvement)

ClinicalTechnology

Reliability and Teamwork Training

Population Health (System Reliability)

Human/Technology Interface

Just CultureReporting

CultureLearning Culture

Informed Culture

Flexible Culture

Workflow that utilizes technology effectively

Leadership’s Four Critical

Success Factors for

High Reliability

Quality fundamentals

Leading High Reliability Organizations

Preoccupation with Failure

Reluctance to Simplify

Sensitivity to Operations

Commitment to Resilience

Deference to Expertise

Mindfulness

Supplier Resource Management

Reliability Principles for Healthcare

Safety Culture

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Get a Roadmap to Improve Reliability in Healthcare

Utilizing3Ms

LeadingChange ExploreTogether Explain Celebrate

KeyQuestions:Whatisour

purpose?

Issue?Defect?

Whoarethe

customers,who

areinvolved?

Whatisthe

Voiceofthe

Customer?

DesignCriteria?

Whatdoes

demandlook

like?

Primarily

improvingquality

orproductivity?

Dataanalysis

potential?

CanImeasure

thedatawell?

Ismyprocess

stable?

Currentprocess

capabilityof

meetingthe

customer'sneeds?

Whatarethe

validatedroot

causes,

contributing

factors?

Bestcounter

measures?

Counter-

measures

successful?

Isthistheright

way?

Willprocess

continue

reliably?

Cadenceof

Accountability

Reinforced

Improvementwith

ourpeopleandin

thevaluestream?

Tools:Charter

template

Stakeholder

Analysiswithplan

toimprove

engagementand

minimize

resistance

Surveys,Quality

Function

Deployment

(QFD),Pugh

Matrix

Demandrate

from

customers.Takt

time.

MainStreetand

Avenuesonthe

Roadmap

Measure-

SystemAnalysis

(MSA).Gage

R&R,Attribute

Agreement

Analysis

Statistical

Process

ControlChart

(SPC)visual

management

CurrentState

Capabilityof

charteredmetrics

andkeyprocess

variables.Value

Quotient,Cpk,Ppk,

Sigmalevel

Validatingroot

causesand

contributing

factorsusing

SPC,

Hypothesis

Tests,

Confidence

Interval

Testing,

Piloting

Comparisonof

ideasusing

importantcriteria

Pilotcounter

measures.Design

ofExperiments

Standard

Work,Job

Instruction

Measure

frequentlyand

stopthe

processif

defects

occurring."Stop

theline"

Recognitionfor

benefits

KeyQuestions:DoIhaveall

ofthe

inputs?

Whatarethefew

keyprocess

inputvariables

(KPIV)tofocus?

Whatarethe

probable

causesforthe

keyinput

variation?

Whichdata

measure

currentstate

andvalidatethe

rootcauses?

Whatdoesthedata

show?

Howcanwe

improvethe

inputs?

Significant

differences?

Statistically

significant?

Tools:SIPOC

map

Cause&Effect

Matrixwith

HumanFactors

Analysis

FMEA

Datacollection

planfor

baseline

androotcause

analysis

Histograms,check

sheets,pareto

chartsfornarrowing

ofrootcauses/

contributingfactors

Countermeasure

experiments.

Designof

Experiments

Beforeandafter

comparisons,

histograms,

paretoanalysis,

scatterplots,

stratification

SPC,Hypothesis

Testing,

Confidence

Intervals

KeyQuestions:

Whatisthe

valuestream

andits

flows?

Areastofocus

wastereduction?

Disorganized

workplace?

Isprocess

equipment

operationalwhen

needed?

Layoutallows

continuous

improvement

Flexibilityamong

workers?

Isprocessfail-

safe?

Processwaste

fromset-ups,

turnaroundsand

change-overs?

Flowinsmall

batches

possible?

Canwereduce

lead-timefor

patientand

customer?

Canwesmooth

demandoratleast

internally?

Replenishonly

onpullfrom

customer?

Canthe

processflex

withdemand?

Inventorywastes

present?

Tools:

Value

StreamMap

(Current

State)by

walkingthe

process

Kaizen,8

Wastes,

Spaghetti

Diagram

5S

TotalProductive

Maintenanceand

Operational

Equipment

Effectiveness

Cellularflow,

"focused

factories"

Multi-skilledstaff Mistake-Proofing

Observation,

TurnaroundTime,

internalvs.

externaltasktime,

spaghettidiagram,

5S

One-pieceor

smallbatch

flow

Lead-time

reduction

Demandand

production

smoothing(Mixed-

Model

Sequencing)

Pull

replenishment

(Just-In-Time,

Point-Of-Use,

Kanban)

Quantity

adaptsto

demandfor

capable

service

Inventory

reductionto

improveservice

andreduce

waste

Define

Phase

Tollgatewith

signed

charterand

currentstate

map

MeasurePhase

Tollgatefor

BaselineCapability

AnalyzePhase

Tollgatefor

validated

contributing

factors

Improve

DesignPhase

Tollgatefor

designor

improvements

andpilot

validation

ControlPhase

Tollgatewith

processcontrol

plan,training,

standardwork

RoadmaptoHighReliability

Corequestionsandcommontools.A

lldecisionson"MainStreet"arereq

uired.

Allrisksmanagedto

sustainthegains?

FMEA,Visual

managementwith

SPC,fail-safes,

TeamSTEPPSand

aControlPlan

Prepareforchange-Train,Envision,Engage,EnableandEmpower Experiment,Explore,whilebuildingconsensuswithstakeholders Train,Enable,Empower,HoldAccountable

Measure Managetothemeasure Makeiteasier

ReinforceCILeanSixSigma ImproveandDesign

Achievecapabilityandstability

Productivitymetrics,employeeengagementan

d

enablemen

t"Avenue"

Wherearethekeyareasoffocus

forPerformanceImprovementand

FutureStatevision?

ValueStreamMapsoftarget

wastes(FutureState)

Qualitymetrics&dataanalysis"Avenue"

Definetheissue

Whatdoesthecustomervalue?

Control

Sponsor/ChampionTollgates ©RickMorrow.Allrightsreserved.

Nottobereproduced.

MeasurecapabilityandcontrolofYandXs

Analyzevalidatingcontributingfactors

AcronymsandMeanings

CI Continuous Improvement

VSM ValueStreamMap

SIPOC Supplier,Input,Process,Output,Customermap

SPC StatisticalProcessControl

JIT Just-In-Time

QFD QualityFunctionDeployment

FMEA FailureMode&EffectsAnalysis

)...,( 21 nxxxfY =),( 31 xxfY=

Available free at www.rpmexec.com

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What is your next step to reliability?