Maximizing ROI During A Lean Transformation

Typical ROI Parameters

CostStartupRecurringConsultantsPersonnel

Expected Returns/BenefitsGenerally $$$Could be outcomesCustomer/Employee Satisfaction

TimeWhen will we achieve benefits to cover costs

To Accelerate ROI

↓ Expense or Cost↓ Time Modify Goals – Focus on areas with greatest opportunity

Lean Transformation

Built in ROI“Only improvement methodology which doesn’t rely on a catastrophic event as a catalyst for change”“Ongoing continuous improvement through the relentless elimination of waste”

True Lean ROI

Dependent on:Staff EngagementCultural ChangeSuccess of Kaizen EventsSustainment of Improvement

Cultural Transformation

Cultivating an entire staff of “Wasteologists”The value of an engaged and aware workforce working in the least-waste way is immeasurable and invaluable

$$$$$$

Staff SatisfactionStaff Satisfaction Patient SatisfactionPatient Satisfaction

Patient SafetyPatient Safety$$$$$$

Staff SatisfactionStaff Satisfaction Patient SatisfactionPatient Satisfaction

Patient SafetyPatient Safety

QUALITYQUALITYImproved processImproved process

Improved flowImproved flowImproved informationImproved information

Transformation Theory

Transformation Theory vs. Healthcare Challenges of TodayIncreased pressure to maximize returns due to reductions in reimbursements and ever changing healthcare standardsDemand ROI that are measureable, sound, profitable, and immediate

Jacobi Medical Center Campus

FY10 Jacobi NCB

# of Beds 479 243

Discharges 22,100 9200

Outpatient Practices

Visits

386,000 200,000

Emergency Department

Visits

113,400 61,000

Ambulatory Surgery Cases

9,500 2,700

Statistical Profile

Jacobi Specialty Programs

• Emergency Medicine

• Regional Snakebite Center

• Level 1 Trauma Center

• FAA-Approved Helipad

• Pediatric Trauma Center

• PICU

•Hyperbaric Chamber

•NYS-Designated Regional

• Perinatal Center

• Level III NICU

• Burn Service

• NYS-Designated Stroke Center

• Medical Oncology Program

• Breast Service

• Rehabilitation Medicine

• Pediatric Surgery

• Craniomaxillofacial Surgical

Institute

• Cardiac Cath Lab

• Bariatric Surgery Program

Lean Kaizen Events

0100200300400500600700800

2008 2009 2010

StaffParticipation

# of Kaizen Events # of Staff Participation

149 1478

Examples of Jacobi Improvements

Reduced Dwell Time in ED 3 hoursIncreased volume of surgeriesIncreased billing due to a better registration processIncreased Medicaid applicationsReduced patient travel, improving patient safety

OPD Revenue Cycle: Reason For Action

OPD Revenue Cycle:Initial State

Year 1 - 11 RIEs

OPD Revenue Cycle Value Stream:Confirmed State

OPD Revenue Cycle Metrics

JacobiMonthly Breakdown OPD

1000

3000

5000

7000

9000

11000

Month

Cas

h R

ecei

pt

FY08FY09FY10FY11Linear (FY08)Linear (FY10)Linear (FY09)FY08 5392 5128 4603 1339 3509 4021 4384 4197 10087 5599 5487 5764

FY09 4881 5082 4948 4293 4357 5329 4766 5440 6300 10227 5529 6210

FY10 4680 7137 6944 4948 5353 6245 5638 5084 6727 6594 11739 5876

FY11 5796 5436 5416 5768 9010 8428 5951 5830

July August September October November December January February March April May June

OPD Revenue Cycle Metrics

400004500050000550006000065000700007500080000

FY08 FY09 FY10 FY11

JMC

200002200024000260002800030000320003400036000

FY08 FY09 FY10 FY11

NCB

** FY11 ↑ 8% Vs FY10 YTD

** FY11 ↑ 5% Vs FY10 YTD

AED Hospital Wide Flow: Reason For Action

AED Hospital Wide Flow: Initial State

AED Hospital Wide Flow: Target State

Year 1: 11 RIE’s

AED-Hospital Wide Flow:Confirmed State

CY11 5.5 LOS

Current Value Streams at Jacobi Medical Center/NBHN

Nursing - 8 RIEsRadiology – 6 RIEsPeri-Operative Services – 11 RIEsAdmitted Patient-Medicine – New Value StreamAdmission/Readmission – 4 RIEsAdult ED Flow – 16 RIEsBehavioral Health Services/Rehabilitation – 1 RIE

Current Value Streams at NCB Medical Center/NBHN

Nursing - 4 RIEsRevenue in Process – 5 RIEsWomen’s Health Services – 10 RIEsPeri-Operative Services – 7 RIEsMedicine – 4 RIEsBehavioral Health Services – 6 RIEs

Maximizing your ROI

Directly related to the success of Kaizen Events

Stacking the Deck for Success

Enterprise Goals

Goals and Targets should be well defined, inter-related, and support each otheri.e. if financial performance ↑ but patient safety ↓, is this ok?

Leadership

Senior Leadership should be “All In”Setting goals and participating activelyEncourage and support true transparencyIntegrate Lean into all hospital-wide strategic planning

“You don’t know what you don’t know”

Choosing Lean Leader (Transformation Officer)

Respected in the organizationWell-KnownHave established credentials

“If you want something done, give it to a busy person to do”

Integration of Lean Message

Consolidate meetings utilizing Lean Metrics and hospital wide dataAgenda at all:

Hospital Wide MeetingsService Line MeetingsExecutive MeetingsAffiliateCAB MeetingBoard Meetings

Integration of Lean Message

Not the “Flavor Of the Month”“Lean is the way we work, not in addition to how we work”

AdvertiseCommunicate

Educate

Integration of Lean Message

Ongoing Lean CurriculumPart of New Employee OrientationStaff Engagement is critical and is the key component to maximizing ROIAs time ↑ and more staff are actively practicing Lean, improvement will become the way you work and good won’t be a barrier to great

Aim for Early Success

“Low Hanging Fruit”, “Fruit on the Floor”Sustainment will fertilize the treeEarly successes will support spread and enhance the Lean transformation

Metrics for Success

Metrics should be easily defined and measurable using existing data“Figures don’t lie, liars figure”

Understand the genesis of the data and how it originates

Driver Metrics

Use driver metrics:# of steps saved# of completed

registrations# follow-up phone calls

To ultimately reach targets:Length Of Stay

ReductionRevenue

Length Of Stay

# of Steps # of handoffs

The best Kaizen Events are….

Events that are well choreographedTransformation should not be a random sequence of events with the results dictated by chancePlan, Plan, Plan

Select proper staff, times, and dataPre-meetings, targets, metrics

“The more I practice the luckier I get”- Gary Player

Scoping Events

Scope the Kaizen Events as tightly as possible“A mile deep and an inch wide”“Do not boil the ocean”It is the collective changes and dovetailing of events that will bring the greatest returnsSelect subject matter experts at all levels

Lean Words to Live By

Listen! Listen! Listen!Walk Around!Observe!

You don’t know what you don’t know, but your staff does

Sustainment

Sustainment is the key to a successful transformation and greatly accelerates ROIStandard work is the critical linchpin for sustainmentDemand It!

Ensuring Lean Success

Assign strong, responsible parties to monitor past event progress/completion plans and follow upsHave regular scheduled program reviews

Target adjustmentsIdentify new areas of focusPriority shiftsFuture schedules

Lean Lessons to Share

Creativity Before CapitalFlexibility over rigidityThere are no “Bad” EventsAvoid the “doing more with less” trap

Creates resentment, excuses, makes bad processes more inefficient, and promotes mediocrity

Don’t Be Shy!!!

Celebrate your successDon’t be afraid to highlight true progress

Questions? Comments?