Our LEAN Journey Presented by:

Craig Vercruysse, COO/WBR CPO Vernon Giang, MD Medical Director of Hospitalist Services CPMC September 13, 2012

• Underperformance on Dashboard Metrics

• Low EOW Scores on “Efficient Operational Processes”

• Inability to sustain improvements (e.g. patient satisfaction)

• Nationwide healthcare reform and Healthcare IT stimulus

LEAN, why change?

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What is LEAN? • CPMC’s brand of the Toyota Production System (aka Quality

Delivery System)

• Create value from the patient’s perspective

• Philosophy – continuous learning and improvement (kaizen), respect and challenge people and partners, long term thinking, eliminate waste

Culture Change

Leader Development

Focused Improvement

• Quality Improvement • Patient satisfaction • Staff satisfaction • Regulatory compliance • Risk Management • Survey-readiness at all times • Financial soundness

Effective system for:

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Relentless Focus on Eliminating Waste

overproduction

waiting

transport

defects

inventory

motion

overprocessing

The Toyota Production system provides the best quality , lowest cost, and shortest lead time through the elimination of waste.

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• Patient Safety Alert System

• Inpatient (PAC) - “Perfect Care-Zero Defects”

• Medication Flow

• Stroke/Neuro Service - “Best Stroke Care for All”

• Women’s & Children’s Maternity Services - “Delivering Perfect Care-Zero Defects”

• Revenue Cycle - “45 Days” • Registration/Billing

• Coding

• Surgical Services - “On Time Every Time”

• Emergency Services - “In and Out in 90 Minutes”

Value Streams

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History - Quality Delivery System August 2008 – August 2012

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Sep 2010

QDS Fellowship Program Announced

Nov 2009 - Jan 2012

WBR Education Waves 1, 2, 3, 4, 5, 6 (~ 35 Physicians)

Oct 2010

Defined Priority Focus Areas

for Improvement

Jan 2012

New Employee Orientation

Feb 2012

New Manager OrientationSep 2009

Engagement Starts

Sep 2008 - May 2009

Study of LEAN/Virginia Mason

Dec 2009 - Jun 2010

First 8

Value Streams Mapped*

Mar 2010 - May 2012

Kaizen Workshops (115)

House-wide 5S Program Launch

Apr 2012

May 2012

QDS for Leaders

Jul 2009

Day 1 of our LEAN Journey Mar 2011 - Aug 2011

Med Room Replication

Kaizen Events (x20)Aug 2008

EHR Workflow Walkthrough

*Strongly aligned Physician leaders in ER Services, Inpatient Services, Patient Safety Alert System, and Surgical Services

Eliminating Waste in Medication Rooms

Needed and unneeded items mixed together.

What goes where?

How do you find what you need?

The 5S’s: Sort, Set in Order, Shine, Standardize, Sustain.

Standard work surface

Patient meds delineated by room

Bin with item specific label.

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60

90

120

150

180

210

240

270

300

Jan-1

0

Feb-1

0

Mar-1

0

Ap

r-10

May-1

0

Jun

-10

Jul-1

0

Au

g-10

Sep-1

0

Oct-1

0

No

v-10

Dec-1

0

Jan-1

1

Feb-1

1

Mar-1

1

Ap

r-11

May-1

1

Jun

-11

Jul-1

1

Au

g-11

Sep-1

1

Oct-1

1

No

v-11

Dec-1

1

Jan-1

2

Feb-1

2

Mar-1

2

Ap

r-12

May-1

2

Jun

-12

Monthly Average Length of Stay (minutes): Pacific (PAC)

215

The Stable Admit

Divert Alert

Triage & "The Blue Patient"

Cellular Flow

256

215

The Stable Admit

Divert Alert

Triage & "The Blue Patient"

Cellular Flow

256

Emergency Services: In and Out in 90 Minutes

8

60

90

120

150

180

210

1/1

4/2

01

2

1/2

1/2

01

2

1/2

8/2

01

2

2/4

/20

12

2/1

1/2

01

2

2/1

8/2

01

2

2/2

5/2

01

2

3/3

/20

12

3/1

0/2

01

2

3/1

7/2

01

2

3/2

4/2

01

2

3/3

1/2

01

2

4/7

/20

12

4/1

4/2

01

2

4/2

1/2

01

2

4/2

8/2

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2

5/5

/20

12

5/1

2/2

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2

5/1

9/2

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2

5/2

6/2

01

2

6/2

/20

12

6/9

/20

12

6/1

6/2

01

2

6/2

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6/3

0/2

01

2

7/7

/20

12

7/1

4/2

01

2

Tim

e (

Min

)

Week

Weekly Average Length of Stay: St. Luke's (STL) & Davies (DAV) DAV STL

Good Bad

**Goal**

127

140

Emergency Services: In and Out in 90 Minutes

The Stable Admit (DAV)

The Stable Admit (STL)

Telepsychiatry (DAV)

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QDS Structural Requirements

• QD Promotion Office Team ─ 2 Fellows ─ 6 Specialists ─ 2 Coordinators

• Organizational Teacher (Rona Consulting) • Education Curriculum and Standardized Workshops • Friday “QD Report Outs” • Weekly Sr. Management Report to CEO/COO • Measurement Discipline • “Book of Knowledge” on Intranet

QDS By The Numbers 150 Leaders and Physicians in QDS Certification 126 Completed Kaizen Workshops and Events

500+ Employee and physician participants in Kaizen

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LEAN Curriculum

• QDS Certified Leader Training: 27 day intensive and in-depth training

• QDS for Physicians/Residents/House Staff: Six 45 minute modules with project

• QDS for Leaders: Mandatory 1 day class for all management with reading assignment, simulations and practicum

• 5S Class: 2 hour module specific class on 5S

• Leading Our Way into the Future: 90 minute module at New Manager Orientation

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• Deepening commitment during time of great change • Culture Shift

–Communication, employee and physician engagement

• “Fail Forward Quickly”– take risks • Time commitment

– Learning – Teaching – Abandoning wasteful meetings

• Learning a new language (kaizen, gemba, muda)

No one said this is easy…

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