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Henry Ford Medical Group Primary Care Lean Experience
“The Journey and Destination” March 12, 2010
Suma Sukumaran
The Journey
History of LEAN With Primary Care
2007 Advanced Medical Home Workshop– Sponsored by BCBSM as part of PGIP– Goal: Apply Lean management techniques to
re-engineering clinic practice with special regard to the care of patients with chronic conditions
– Facilitated by consultants from LEAN Transformations Group (from U of M)
The Workshop
Taylor and K-15 Pilot Sites
4 days (7/23 – 7/26)
6 hours each day from 12p-6p
Each clinic created their own current state map
Together they created a single future state map with a 90-day action plan
Workshop Outcomes
Pilot Sites at Taylor & K-15– Pilots continue and are expanding to more sites– Process refinements continue as new concepts
are introduced
BCBSM Lean CQI Initiative
2009 Primary care chooses to participate in additional BCBSM Lean CQI Initiatives
Three LEAN Workshops would be sponsored (two have been completed)
Training five coaches to be LEAN Workshop Facilitators (in addition to their role within the CCD dept.)
2009 eTEF Lean Workshop
1st 3 Day workshop (4/21 - 4/23)
5 Clinics + Contact Center– DNW (site not supported by Contact Center)– K15 (MH Pilot Site)– Taylor (MH Pilot Site)– Troy (MH Pilot Site)– Southland
2009 eTEF Lean Workshop
Issues / Problems (as Identified in Scoping Session)
– Too many messages with unclear purpose that cannot be resolved or take too long to resolve
– Too many handoffs– Consuming too many resources/time– Unhappy customers/patients– Too many repeat calls
Outcomes From Workshop
Improved relationship between clinics and contact center
Contact Center advocates gaining access to clinic workgroup inboxes
Clarifying / Expanding Contact Center Advocates' role
– read normal test result letters to caller– advise patients of denied script refill
Still working on the project
Learnings from Workshop
Workshop participants need preparation before Kaizen event
Easier to have small scope with less clinics involved
Set ground rules early in workshop – everyone needs to respect each other’s opinions
Need to step back and engage leadership to transform culture
Learnings From Workshop
Workshop participants need preparation before Kaizen event
Easier to have small scope with less clinics involved
Set ground rules early in workshop – everyone needs to respect each other’s opinions
Need to step back and engage leadership to transform culture
Learnings From Workshop
Workshop participants need preparation before Kaizen event
Easier to have small scope with less clinics involved
Set ground rules early in workshop – everyone needs to respect each other’s opinions
Need to step back and engage leadership to transform culture
Engaging Leadership
Getting key physician leadership buy-in
September 2009 - 1 day LEAN Bootcamp with all Primary Care leaders (physicians & support staff)– Exposure to LEAN tools & concepts– Identified “what they think needs to be
improved”– Next Lean Workshop topic chosen
November 2009 - 5S contest announced– Get people to try the tools– Staff would see immediate results
February 2010 – Clinic Discharge Process Workshop– Lakeside Peds, Canton & Hamtramck
What we did different this time– More prep for participants – held Lunch n’
Learns at each site– Smaller – scope & number of clinics participating– Set ground rules early in workshop– Went to clinics on Day 2 for
observations/discussions with co-workers not involved in workshop
January 2010 – 5S Contest
– People picked what they wanted to work on– Incorporated fun & competition
What we learned
– Keep it simple - feedback has been to teach them 1 way to do process improvement that works and nothing more
– Give time to apply or practice the tools as they learn them - want real life experience trying them out with opportunity to discuss outcomes
– Keep leaders involved and accountable to help drive it
5S Contest Winner
Japanese Housekeeping atSterling Heights –
Pediatrics
5S contestHenry Ford Medical Group
Sterling Heights Pediatric Staff
Project Goals
Work together on a team project
Do a 5 S audit on the South Nurse’s Station
Have Nurse’s station ready for Vascular Lab by 1/4/2010
Win the prize for our site!!
The origin of 5SThe Japanese concept for HousekeepingThe Japanese concept for Housekeeping
1.) Sort (Seiri) – put things in order 2.) Straighten (Seiton) ‐ proper arrangement
3.) Shine (Seiso) ‐
clean
4.) Standardize (Seiketsu) – perpetual cleaning 5.) Sustain (Shitsuke) – commitment/habit
The secret to LEAN?
Eureka!!!
Before
Before
Before
Team/ResourcesResources allocated to this projectPeople
Andrea Coleman MA I, A Hang Dipko MA II, Bobbi Dwornick RN Supervisor, Melissa Piotrowski MA II, Theresa RidingsSecretary III, Dr. Francisca Soliven and Julia VanTorre CSR IIEquipment
Digital Camera, Cart w/ wheels, hand truck and cleaning wipesSupport services
Maintenance and Housekeeping staff
What did we learn?
0
51015202530354045
Use Move Store Discard
Results
Results
Results
Examples
Sort – 48 hour rule
Straighten
–
Vascular Lab, Residents and Support Staff now have designated work areas they “own”
Shine – Area free of dust and cleaning materials are easily accessible
ExamplesStandardize – Each work group does a 3 S daily to their work area. Common duties have been assigned.
Sustain – Weekly 5 S tour assigned.(Assignment rotated among staff)
Safety – SMDA posted, all equipment calibrated and no cords in walk path
The 10 Commandments of ImprovementOur CommitmentOur Commitment1. ABANDON fixed ideas2. THINK of ways to make it possible3. NO excuses needed4. Go for the SIMPLE solution, not the perfect one5. CORRECT mistakes right away6. Use your WITS, not your wallet7. Problems are OPPORTUNITIES8. Repeat WHY? Five times9. Seek ideas from many PEOPLE10. There is NO END to improvement
Gamba Research
Sterling HeightsPediatrics 5S Team
The Destination
Where We Are Going
January - Primary Care Leaders learned a new tool (A3) and contest announced to get staff to use the tool– One known project is to reduce labor and supply
costs involved in the printing and hand-collating of OMR and Green service memo forms (billing sheets for charges)
May 2010 – A3 Contest will be conducted– Learn new tool – Standard Work– Announce new Contest
Where We Are Going
Incremental learning/trying– Continue to roll-out tools one at a time– Celebrate successes– Identify physician and support staff
“champions” to help lead efforts
Continue large, Kaizen events
Encourage & support more advanced training
Change the culture - help people see that they can make work better for themselves and our patients
Questions From The Group