Embed Size (px)
Citation preview
Lean Applied in Healthcare in the USA 2013 HASA Conference
David Munch M.D. IHI Faculty
Chief Clinical Officer Healthcare Performance Partners
Develop “True North” and align the organization to that pursuit
Strategy development and deployment Develop systems and structures
Develop and support all staff in continuous improvement
Developing Lean Leaders A3 Deployment
Organizational Development and Learning
Engage staff in surfacing and
solving problems
A3 Problem Solving Safety Culture
Eliminate waste and make the
right work easier to do
Leadership Standard Work
Visual Management Kaizen
5S
`
How we measure improvement within the System: The Value Diamond
Our services: INCREASE Revenue
DECREASE Costs IMPROVE Quality,
Satisfaction, and Safety
Time Capacity, Wait Times, LOS, TAT
Satisfaction Patient, Staff,
Physician
Quality Core Measures, Quality Goals,
Service Issues, 1st Time 100% Accurate
Financial Materials, Capital,
Revenue Cycle
4
Disciplined Problem Solving
Problem Cause Solution Action Measurement
A3 Process Follows
Scientific Method
Similar To Healthcare
Familiar PDCA
The 8 Wastes Everything the organization
does needs to be treated as a process that serves the patient/
customer.
Steps that don’t directly provide better care to the patient/customer
must be considered Non-Value added or WASTE!
l Defects l Over-Production l Waiting l Not Clear
(Confusion) l Transporting l Inventory l Motion l Excess Processing
Direct Patient Care 19%
Indirect Patient Care 24%
Regulatory 12%
Waste45%
RN Time Distribution
Insanity
7
What you can do in a short amount of time
8
The Problem: Unnecessary COPD Hospitalizations
9
MD gives patient prescription for inhaler, but no training
Patient gets inhaler from pharmacy, but no training
Patient fails to use inhaler properly, leading to hospitalization
Patient is treated with nebulizer during hospital stay
Patient is discharged without training in use of inhaler
Improving Quality Metrics PA Urban Medical Center (NFP)
48% decrease in readmissions
(sustained and improving)
The concept of built in reliability Lean is about knowing normal from abnormal right now and responding right now
Time
Harm or Damage
Determining Cause
High
Low
Defect: E.g.. Adverse Event
Prob
ability
Adapted from slide by John Shook: U. Michigan
The Power of Coaching JCAHO Transforming Care
12
Understanding The Problem
Manager Coach Training
Manager Coaching
13
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Rate
of C
ompl
ianc
e Weekly Hand Hygiene Rates October 2008-December 2010
P UCL Average LCL
Outcome Measures Does all this washing make a difference?
HAI Prevalence Correlated with Hand Hygiene Compliance
0.00
0.50
1.00
1.50
2.00
2.50
3.00
1/1/082/1
/083/1
/084/8
/085/8
/086/8
/087/8
/088/8
/089/8
/08
10/8/
08
11/8/
08
12/8/
081/1
/092/1
/093/1
/094/1
/095/1
/096/1
/097/1
/098/1
/099/1
/09
10/1/
09
11/1/
09
12/1/
091/1
/102/1
/103/1
/104/1
/105/1
/106/1
/107/1
/108/1
/109/1
/10
10/1/
10
11/1/
10
12/1/
10
HAI P
reva
lenc
e
0
20
40
60
80
100
120
Hand
Hyg
iene
Com
plia
nce
HAI Prevelance per 1,000 pt days Hand hygiene percent compliance
Case Example: A3 Deployment Winona Healthcare
A3 Problem Solving Deployment - Schedule
1. Train 22 A3 Problem Solving Coaches
2. Train 75 A3 Problem Solvers
3. A3 Coaching Skills Transfer
4. Begin integrating problem solving A3
selection with 2013 Hoshin Planning
5. Implement Improvement Tracking
System
6. Implement systematic Improvement
Recognition System
7. Implement systematic Value Realization
practices
November – December 2012
January – February 2013
November 2012 – May 2013
March 2013
January 2013
April 2013
April 2013
A3 Volume
Total Completed A3s 61
A3 Strategically Alignment • Satisfaction • Safety • Quality • Financial • Time
26 16 26 29 6
A3 Problem Solving Deployment – A3 Volumes 2013 YTD Completed A3s
Financial and Staffing Impact Projected First Year Value Completed A3s - 2013
Hard Dollar Revenue
Enhancement
Hard Dollar
Savings
Soft Dollar
Savings
Time Saved Hours/Year
Access – Eliminate Text Messages $396,000
Ortho Clinic Therapy Referrals $141,192
Screening Mammogram Access $110,000
Access – Scanning Referral Notes $98,000
Access – Provider Mail Processing $79,200
Access – No Shows $26,100
Charge Write Offs/Denials PR-227 $9,000
Podiatry Lost Charges $4,800
Access – Prior Authorizations $4,800
Medication Ordering $23,651
Specialty Clinic Sterilization $2,340
Blanket Warmers in Imaging 259
Registration Errors Client Accounts 162
Lab and Client Billing 96
Tracking Dialysis Adequacy Values 50
Total $869,092 $23,651 $2,340 567
David Munch M.D. Faculty IHI Chief Clinical Officer Healthcare Performance Partners
