Lean Webinar: Leader Standard Work (LSW) - c.ymcdn.comc.ymcdn.com/...F407...Leader_Standard_Work_(FINAL).pdf · Lean Webinar: Leader Standard Work (LSW) Judy ... She partners with

1/18/2016

1

1 Proprietary & Confidential Creating a Sustainable Future for Healthcare Organizations

Lean Webinar: Leader Standard

Work (LSW)

Judy Krempin, MS, CPHQ Manager

Quality, Safety, and Performance Improvement

2 Proprietary & Confidential

You can ask a question by clicking the

blue “?” icon or “speech bubble”

icon.

1/18/2016

2


Evaluate this Session!

• Please help us improve our educational sessions by completing an evaluation of this program. You will have two opportunities to complete an evaluation and receive a completion certificate: At immediate conclusion of webinar

Post event: within two business days of the webinar, you will receive an email containing links to the online evaluation and a recording of this webinar

• Upon completing the online evaluation, you will receive an email with a link to access your completion certificate.

• If you have questions or need assistance, please contact [email protected].


Today’s Presenters

Judy Krempin, MS, CPHQ Manager, Quality, Safety, and Performance Improvement

Judy is a data driven, outcomes-oriented performance improvement specialist with 20 years of hospital experience. She holds a master's degree in Applied Anatomy and Physiology, is a Certified Professional in Healthcare Quality, and is a Lean Black Belt.

Judy approaches each encounter with a focus on the organization’s mission, vision and goals. She partners with leaders and teams to streamline processes, resulting in evidence based, sustainable, patient-centered care delivery systems.

Most recently, Judy was the Director of Performance Improvement at Steward Health Care System based in Boston. In this role she led patient safety collaborative efforts, developed and spread the foundation for advance care planning programs, coached teams to reach top tier surgical core measure performance, and significantly reduced the incidence of harmful events through the Failure Mode and Effects Analysis (FMEA) process.

1/18/2016

3


Greetings and Introductions


• Participants will be able to:

Define Leader Standard Work

Describe several activities and tools that assist leaders to systematically drive improvement

Initiate a plan for incrementally building Leader Standard Work into daily work

Objectives

1/18/2016

4


1. Why Leader Standard Work (LSW) is necessary in healthcare today

2. Actions you can take to build your LSW routines

3. Examples of LSW for a CNO, a COO, and a department manager

4. Getting started

5. Measuring LSW

Agenda


Pace in the Healthcare System

1/18/2016

5


How Do We Get Past the Organizational Performance Plateau?

Goal

Current performance


Human Systems Require Focus and Teamwork to Meet Objectives

“If you want to go fast, go alone. If you want to go far, go together.”

1/18/2016

6


Lean:

A philosophy and approach to work, that focuses each person in the organization on the systematic identification and elimination of waste, creation of value, and pursuit of perfection from the customer’s perspective.

Achieve Safe, Reliable Processes with Lean


1. Set direction for the organization

2. Develop organizational capacity

Keys to Leadership for Continuous Improvement

1/18/2016

7


Lean Implementation Building Blocks

Communicate reason for

change

Learn Lean, Engage

Employees

Quality Improvement

Committee

Rapid Improvement Events (Large cross-functional

improvement events several times/year)

Daily Tests of Change (Led by managers, carried out by front line, process/outcome

measures, daily)

Daily Shared Learning (Visible data at front line, discussion at huddles & manager meeting, daily)

Leader Focus & Leader Standard Work (Daily Leader Huddle, Reduce Waste, Promote Flow, Develop People, Gemba Walk, Mitigate Barriers, Reflection)

Lean Infrastructure (Voice of Customer, Huddles, Improvement Boards, Visual Management, Gemba Walk, Standard Work)

Alignment With Medical

Staff

Lean Tenants: Respect for People & Continuous

Improvement


• Leader Standard Work (LSW) is the set of leadership routines that advance the organizational strategy by helping the workforce reliably complete their standard routines & focus on delivering value to customers

• The practice of leader standard work requires leaders to frame problems, manage priorities, develop people, learn, and remove barriers

Executive LSW: ~10% Department Leaders LSW: ~ 50%

Leader Standard Work Defined

Strategy Deployment

• Daily Leadership huddle: focus, daily metrics, team reflection/ learning

Individual Growth & Planning

• End of day pause/ reflection and organization for tomorrow

Seeing & Coaching

• Gemba walks to see the truth at the front line and coach department leaders

1/18/2016

8


• OUTCOMES - Resolves problems with efficiency - with lasting solutions

• Absence of communication gaps

• Collaboration is more effective across departments/ facilities

• Development of people - Succession planning is “built in”

• Increased employee pride in work & increased loyalty to company - “My supervisors/ leader care about me”

What Can LSW Accomplish?

• CNO and nursing department leaders found that they didn’t need as many weekly/ monthly meetings - they were resolving more issues in real time

• Orthopedic surgeon was surprised to see CEO in OR and was pleased to have “engagement of administration”

Expected Results Unexpected Results


Strategy Deployment




Seeing & Coaching


1/18/2016

9


A Daily Senior Team Huddle Proactively Addresses Operational and Learning Needs within the Organization

Why take 10 minutes to huddle as a leadership team each day?

•Communication

•Communication is twice as important in a growing, changing environment; otherwise “you don’t know what you don’t know”

•Timing

•Timely spread of important safety, quality, cost, and service information

•Planning

•Proactive actions are less costly and time-intensive than reactive actions

•Focus

•Targeting key priorities is more effective than trying to improve many at once

•Development of Staff

•Use time with the senior team to share lessons learned and successes as you foster the problem solving and critical thinking skills of the managers/ directors

Daily Leadership Discussion Topics (Standing agenda requires customization by the leadership team)

•Events (1min)

•High impact events: meetings, visitors, pending decisions

•Needs/ Planning (3 min)

•Clear obstacles for managers/ departments

•Planning for “off hours” coverage/ potential issues

•Data/ Strategy Deployment (3min)

•Discuss/ update key metrics

•Identify each leader’s priority focus today, to advance the strategic plan (based on 5-6 known organizational priorities)

•Learning/ Reflection (3min)

•Wins

•Good catches

•Learning in progress

•Manager development efforts (building effective managers through coaching)

•Thank you communications


A Department Shift Huddle Proactively Addresses Operational and Learning Needs among the Team

Daily Department Huddle

• Who – All available staff in the department

• When – Same time, every shift

• Duration - 2-5 minutes/ huddle

Daily Department Discussion Topics (Standing agenda requires customization by department team)

• Today’s Operations: Anticipate/ troubleshoot issues related to safety, scheduling/ flow, staffing, level loading, equipment, safety, unique customer needs

• Today’s Continuous Improvement Focus:

• Review/ update daily metrics

• Connect to purpose

• Continuous improvement reflection questions include:

• How did it go yesterday? (specific to what was expected to be learned or tested)

• What went well? Why?

• What was difficult? Why?

• What might be the next step?

1/18/2016

10


Strategy Deployment




Seeing & Coaching



• Gemba means “the actual place” Where work is done, value created

“Front line”

• General purposes of the Gemba Walk are to: See and understand the current situation

o Process (purpose, steps, reliability)

o Worker knowledge and experience

o Wastes/Successes

Develop people (coaching)

Definition and Purpose of the Gemba Walk

1/18/2016

11


Gemba Walk


•Management must be on the Gemba

See what is actually happening – get familiar

Familiarity facilitates one’s ability to ask the right questions about progress and barriers

Get the Unbiased Facts at the Source

1/18/2016

12


First Several Gemba Walks along a Value Stream: Observe and Reflect

Schedule Observe PI

Board & Observe Process

Thank Staff Reflect


Routine Gemba Walks: Observe, Reflect, and Coach

Schedule Observe PI

Board & Observe Process

Thank

Staff Coach and

Reflect

1/18/2016

13


• Plan Questions What did we try to improve? Why is this process important to customers now? (Safe, timely, equitable, efficient, effective, person-centered)

What is the cost of poor quality? How did we learn about the problem in order to discover root causes?

• Do Questions How did we learn about the problem? (Who did what?) How were the issues different by shift or day of week? What further barriers and root causes of the problem were discovered? How did we select a test of change?

• Study Questions What worked well? Why was it easy? What barriers to the improvement did you discover? What are the data telling us today?

• Act Questions

When will the team be ready to fully adopt a new standard practice? Which of our old standards of practice can we give up?

What might be the unintended consequences of dropping old practices? What visual management will we use with this process? Who else needs to be aware of this change? How will the team spread the lessons learned? What is the plan for reliable sustainment?

Executive Gemba Walk with Coaching: Begin the practice of coaching conversations with one open-ended question

In contrast, department leaders will

spend time on these questions and additional time auditing standard work at the Gemba


Strategy Deployment




Seeing & Coaching


1/18/2016

14


• The Pause to Reflect

Where do I need to spend some time in the next week?

o to share a story linking cost and quality

o to build trust with medical staff

o to foster development in a department leader

o to understand the impact of a change

Which team do I need to acknowledge tomorrow?

o for growth

o for teamwork

o for safety

What did I learn today?

o about the team

o about myself

End of Day Pause


• 5S is a strategy to keep the workplace safe and organized for efficiency

Sort necessary/ unnecessary

Set in order

Sweep for missing items

Standardize

Sustain

• What is the priority for tomorrow?

5S Personal Space

1/18/2016

15


LSW for COO


LSW for CNO

1/18/2016

16


LSW for Department Leader


Tiered Huddles – A Small Hospital Model

• Focus: Operations, assignments, safety, quality

• Team: Each department team/ manager (every shift)

• Duration: 3-5 minutes/shift

7am Department

Huddle

• Focus: Operations, safety, quality

• Team: All Managers + One senior leader

• Duration: 5 minutes/shift

8am Manager Huddle

• Focus: Operations, communication, pertinent safety/ quality issues from Managers, priority measures, how to clear obstacles and move forward

• Team: Senior leaders including quality leader

• Duration: 5-15 minutes/day

8:30am Senior Leader

Huddle

1/18/2016

17


Tiered Huddles - A Cross Functional Groups Model

COO & Quality Leader meet with Leads from Clinics, ED, Lab, Imaging, IT

CNO meets with leads from Nursing,

Hospice, LTCC & Hospitalist

CFO meets with Business Office,

Patient Access, Call Center

Senior Team Huddle

Department Huddle

7am 7:20am 8:30am

Department Huddle

Department Huddle

Department Huddle

Department Huddle

Department Huddle

Department Huddle

Department Huddle


• Gemba Walk (Go See) Get familiar

Coach the people that report to you

• Huddle Evaluate key operational metrics

Acknowledge/plan/ learn

• Individual prep at end of day

Create the Infrastructure to Support LSW

• “No meeting zone between 8 and 10am”

• Improvement Board with priority metrics

• Brief, dedicated time to reflect (scheduled thinking) and 5S (organize) for the following day

Leader Action Infrastructure to Facilitate Action

1/18/2016

18


For Executives: Turn motivation into a plan

• A study of motivation and implementation, suggests that success of execution is linked to how we protect and use our time

• Therefore:

Start small

Set a specific plan

Protect your time in your calendar

First Steps for Executives – Create a plan Exercise study (to prevent heart disease) in which three groups were asked to exercise 38% Successfully exercised in the Control Group

• They were asked to exercise

35% Successfully exercised in Experiment Group 1 • They were asked to exercise • Given detailed information about why exercise is important to

health (i.e., angina, inability to walk for short distances, risk of fatality)

91% Successfully exercised in Experiment Group 2

• They were asked to exercise • Given detailed information about why exercise is important to

health (i.e., angina, inability to walk for short distances, risk of fatality)

• Asked to commit to exercising at a specific place, on a specific day at a specific time of their choosing.

Source: Milne S, Orbell S, Sheeran, P. Combining motivational and volitional interventions to promote exercise participation: Protection motivation theory and implementation intentions. British Journal of Health Psychology. 2002. 7, 163-184.


For Department Leaders: If capacity to make change is at all time low, first identify the non-value added tasks

and meetings for yourself and the team that reports to you (as a team)

Set criteria for what is “value added” before initiating exercise

This will help identify whether or not the team is aligned with department goals and cut unnecessary activities before coordinating a new approach

First Steps for Department Leaders – Create capacity

Activity Non Value Added Business Required Non Value Added

Value Added

Criteria: Criteria: Criteria:

Activity #1

Activity #2

Activity #3

1/18/2016

19


Individual Leader

1) Choose one question for end of day reflection

2) Organize your desk at end of day so the following morning begins with efficiency (sustain 5S)

Senior Team 1) Initiate a simplified Leadership Huddle

What are the top three metrics we need to track every day to advance the strategic plan?

What time of day is best to meet?

What information will we have at the huddle? (Who attends, information from earlier huddles, any reports)

2) Take a single Gemba Walk with a manager to observe the work and get familiar Look to see if the “big” goals for that department have

been segmented into much smaller and more attainable process goals

Look to see if managers know how to use daily metrics and visual management to facilitate continuous improvement

Initiating Leader Standard Work


Evaluation of Effectiveness (annual) Steady progress on prioritized

department/ organizational process measures for cost, quality, experience

Reduction in “carry over” agenda items between meetings (leaders are able to answer more questions because they are familiar with root causes of process success and failure)

Improved scores on employee engagement survey

How Do We Measure LSW? Getting Started Checklist Individual LSW tasks

selected

Huddle Team identified

Time of day selected for huddle, gemba walk, reflection

Huddle duration limit selected

Huddle standing agenda drafted with team

Communication plan completed

First Month Assessment

Huddle attendance rate (>80%)

Number of edits to process (multiple plan-do-study-act cycles)

Percent of department leaders and senior leaders who have drafted their own LSW (>90%)

1/18/2016

20


• Abbs K, Ullman S. Avoiding the Pitfalls of Leader Standard Work. October 6, 2015.

• Barnas, K. Beyond Heroes. 2014.

• Barnas, K. ThedaCare’s Business Performance System: Sustaining Continuous Daily Improvement Through Hospital Management in a Lean Environment. The Joint Commission. Journal on Quality and Patient Safety. September 2011. Vol 37. No 9.

• Marchwinski, C. Lean Enterprise Institute. Interview with Dr. Jack Billi. 1/19/09.

• Milne S, Orbell S, Sheeran, P. Combining motivational and volitional interventions to promote exercise participation: Protection motivation theory and implementation intentions. British Journal of Health Psychology. 2002. 7, 163-184.

• Murli, J. Lean Management System Course. Lean Enterprise Institute. May 2013.

• Murli, J. Standard Work for Lean Leaders: One of the Keys to Sustaining Performance Gains. 12/4/2013.

• Womack, J. Gemba Walks. Version 2.0. Oct 2013.

Resources


1/18/2016

21


Lean Webinars • Physician Engagement

February 18, 2016 10:30 am Central Time • TAKT Time

March 17, 2016 10:30 am Central Time • Case Studies on Cost of Poor Quality

April 21, 2016 10:30 am Central Time

Classroom Programs • Lean Boot Camp

March 1-3, 2016 (Brentwood, TN)

Register at www.qhrlearninginstitute.com

Upcoming Programs


Quorum Learning Institute Recordings and Videos: Come Visit Our Library

http://videos.qhr.com/

http://www.qhrlearninginstitute.com/

1/18/2016

22


• Thank you for joining us today. We value your feedback and hope that you will take a few minutes to evaluate this program so that we may continue to improve and bring you the quality educational programming you expect.

• As a reminder, you will have two opportunities to complete an evaluation and receive a completion certificate:

At immediate conclusion of webinar

Post event: within two business days of the webinar, you will receive an email containing links to the online evaluation and a recording of this webinar

• Upon completing the online evaluation, you will receive an email with a link to access your completion certificate.

• If you have questions or need assistance, please contact [email protected].

Program Evaluation


1/18/2016

23

45 Proprietary & Confidential Creating a Sustainable Future for Healthcare Organizations

For More Information

Contact:

[email protected]

(800) 233-1470, ext. 4513


Creating a Sustainable Future for Healthcare Organizations

Intended for internal guidance only, and not as recommendations for specific situations. Readers should consult a qualified attorney for specific legal guidance.

Documents

Lean Webinar: Leader Standard Work (LSW) - c.ymcdn.comc.ymcdn.com/...F407...Leader_Standard_Work_(FINAL).pdf · Lean Webinar: Leader Standard Work (LSW) Judy ... She partners with