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Oregon Healthcare Lean
Community of Practice
September 12, 2014
Norm Gruber, CEO
WELCOME
Why the Decision to Adopt Lean
• The changing healthcare environment
• Need for culture change
• Involvement of our Board of Trustees
• Commitment of senior leadership
• Opportunity to develop a long term system for quality and safety improvement in the healthcare environment
• Lean as an integral part of an effective strategy deployment process
Plan 1 Current
Approach to Lean
Transformation
Conduct RPIWs in
product lines of
Inpatient, Surgical
Services, ED,
Ambulatory,
Corporate Svcs
Conduct 3P events
Training for leaders
in “Kanban” and
“3P” methods
Strategy Deployment to develop
alignment in the organization
Standardize and Stabilize by
implementing Lean Fundamentals such
as: 5S, Visual & Daily Management,
Leader & Frontline Standard Work,
Quick & Easy Kaizen, Four-Step
Problem Solving
Two Approaches
Lessons Learned
• How to involve the medical staff is a big
hurdle in Healthcare
• Without senior leaderships ongoing
support and involvement, Lean will fail
• Lean is about culture transformation
Leadership
• People often equate “Lean” with the tools used to create efficiencies and standardize processes
• Implementing tools is 20% of the effort in Lean transformations
• 80% of the effort is changing leaders practices and behaviors, and ultimately their mindset
Mann, D. (2009). The Missing Link: Lean Leadership. Frontiers of Health Services Management
LEAH MITCHELL, VICE-PRESIDENT,
KAIZEN, QUALITY & SAFETY
Kaizen Quality and Safety Division
StructureContinuous
Improvement
Quality & Safety
Service Excellence
Corporate Integrity
Kaizen,
Quality &
Safety
Division
• Care Management
• Kaizen Promotion Office
• Project Management Office
• Employee Health
• Infection Prevention
• Peer Review
• Patient Safety
• Accreditation
• Clinical Decision Support
• Service Excellence
• Interpreter Services
• Patient Advocates
• Pastoral Care
• Risk
• Corporate Integrity
• Safety
• Institutional Review Board
Lean Management System
Lean Processes
Strategy
Deployment
/A3 Thinking
Respect for
People Respect for
Time
Continuous
Improvement
Lean
Fundamentals
* 5S
* Visual
Management
* Huddles
* 4SPS
* Quick
and Easy
* Leader
Standard
Work
* Mental
Models
* Standard
Work
Role of Lean
Leader
Reinforce
Company
Values and
Standards
(Rounding)
Develop
Capability in
Team
Value for the
Patient
Quality Care
at Affordable
Cost
Deliver
Business
Results in
Q&S,
Finance, Pt
Exp, Engage
Strategy Deployment– Aligned with heart of Lean system: create value for the patient
– Development and execution of guiding strategic principles
– PDCA Cycles
– Deployment is the hard part
Dennis, P. (2006). Getting the Right Things Done
Selection
Deployment
Selection
Deployment
Salem Health Strategy Deployment Model
Strategy Deployment Process
AlignmentHoshin
Quality and SafetyFinancial
PerformancePatient Experience Engagement
Quality and SafetyFinancial
PerformancePatient Experience Engagement
B A3
B A3
B A3
AP
AP
R&I
B A3
B A3
B A3
AP
AP
B A3
B A3
B A3
AP
AP
B A3
B A3
B A3
AP
AP
7 Year Plan
CEO, BoT
VP of Strategy
5 Year Plan/SD
Plan
VP
Annual SD Plan
Deployment
Leader
Baby A3s &
Action Plans
Strategy
Captains
Divisional
Annual A3
Director
R&I “Bucket”
- From R&I
Process
- Local R&I work
- Goals
COO site
Operational A3
Organizational Alignment and Achievement of Business Results
Specialty Practice Teams
Division A3s
Unit Level A3/Action PlansUnit Level
Annual A3 or
Action Plan
Manager
Mother A3 Mother A3 Mother A3 Mother A3 Mother A3
Baby 3 or Action Plan
Division
A3
Unit A3 or Action Plan
COO
Dashboard
Strategy
Deployment Visual
Management Board
Leadership
Connected
Checking Tool
• Lean Fundamentals expectations
Leadership Connected Checking Tool- Page 1
Example: Strategy Deployment Visual
Management Board-pg 1 Expectation
Leadership Connected Checking Tool- Page 2
• Individual leader expectations
Executive Rounding Standard Work
GO AND SEE: VISIBILITY ROOM
AND TO THE GEMBA LATER
