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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Beyond Lean/Six Sigma Managing Change and Spreading Innovation
Nidia Williams, CCC-SLPDirector, Quality OutcomesSix Sigma Master Black BeltSouthcoast Hospitals [email protected]: 508.679.7397
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Who We Are
Charlton Memorial HospitalFall River
St. Luke’s HospitalNew Bedford
Tobey HospitalWareham
Southcoast Health System800+ physicians & 6,300+ employees
serving 719,000 people in 33 communitiesdating back to 1884.
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Why & How We Got Started
• Be ahead of the curve
#1: Improve Quality
#2: Find Savings
• Started before the economic downturn• Improve operating margin for hospital & system
before going to bond market for project financing
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Why & How We Got Started
• Seek sustainable methods & processes —not just cuts
• A lifestyle change — not just a diet
• Increased focus on “real-time accountability”
• Use data to drive decision-making
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Why & How We Got Started
• Why do both Lean & Six Sigma?
• Improve the way we do things —not just to generate cuts/savings
• Create immediate savings through elimination of waste & hard-wiring improved processes with Six Sigma
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Action
Mobilize the entire organization
• Board• Senior Leadership• Middle Management• Physicians• Front line staff
Activate engagement
• Set targets and deadlines up front
• Set financial targets• All levels held
accountable• Include front-line staff• Communicate
Communicate Communicate
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Getting Started / Communication
• Basic set of standardized terms• Posted on intranet
• Discuss at Open Forums• Open discussion with all employees• Ask staff for brainstorming
• Communication cascades
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Improvement Cycle
• 120-day cycle with 30-day check-ins
• Disciplined, focused engagement
• Built database tracker to promote accountability & adherence to timelines
Lean
Every director/manager expected to present Waste Walk efforts
Six Sigma
Every Six Sigma team presented one DMAIC phase every 30 days
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Six Sigma …
• Certified Belts• 26 Green Belts• 4 Black Belts• 1 Master Black Belt• Yellow Belt training for ALL leadership
• Bringing the resources in-house is necessary for expanding and maintaining the Six Sigma culture
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Surprise, Surprise …
Applying Six Sigma to yourexisting processes
is an
eye-opener
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Six Sigma Project TrackerSix Sigma Project Tracker
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Improvement REQUIRES Change
• The “I” in DMAIC really means CHANGEneeds to be implemented, facilitated and managed.
• Won’t happen by CHANCE!
• Should be managed as its own sub-project
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Develop a Solution and Action Plan
“It is not so much that we are afraid of change or so in love with the old ways, but it’s that place in between that we fear... It’s like being caught between trapezes. It’s Linus when his blanket is in the dryer. There’s nothing to hold on to.”
– Marilyn Ferguson
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Develop a Solution and Action Plan
STAGES OF TRANSITION
Neutral Zone
ENDING
NEW BEGINNING
Ending - Process of letting go of the old way before beginning the new.
Neutral Zone – The period between the ending and new beginning. The wilderness.
New Beginning - New status quo takes shape.
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Develop a Solution and Action Plan
• “Been there…Done That…”• Resistance to change• Managing People’s Expectations• Communication strategies
• Which of the reasons for change resistance are the most likely causes of resistance in this organization or for this change?
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Develop a Solution and Action Plan
• Value Resisters Because . . .
• They clarify the problem
• They identify other problems that need to be solved first
• They force change leaders to think before they implement the change
• Their tough questions can strengthen and improve the change
• They let us know who opposes the change
• They slow down the change
• They may be right, it is a dumb idea!
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Develop a Solution and Action PlanHuman Nature . . .
• People want to maintain control over their actions
• People develop self-confidence and psychological health by building stable and effective relationships with others
• Our sense of control, comfort, and well-beingresults from the degree of certainty we have about our life and our future
• Change disrupts our ability to predict what’s in store for us
• The more a change disrupts our ability to envision our future, the greater our confusion, fear, anxiety, and self-doubt
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Determining the Solution
• Reliance on Six Sigma, Lean or other methodology and/or tools
• Should be selected after measuring positive impact on outcome (data-driven decision)
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Goal• Helps the team develop practical solutions and an action
plan to effectively address the root cause(s) of a problem, and produce a desired effect or outcome
• Generate potential solutions• Select the most effective solution• Generate all possible tasks that can be done to
implement the solution• Anticipate likely problems and develop possible
countermeasures• Create an action plan
Develop a Solution and Action Plan – including targets for improvement
The Improvement Process
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Improvement Strategy
Alternatives
• Pilots• Process Mapping• Mistake Proofing• Brainstorming• Benchmarking & Best Practices• Simulation• Generate Alternatives• Assess Risks• Test Alternatives Through Pilots or Simulation• Evaluate and Select the Best Solution
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Improvement StrategyChoose Improvement Strategy
Optimize process flow issues
Standardize the process
Develop a practical solution to the problem
My improvement strategy is . . .If . . .
... my vital Xs are process flow issues
... my vital Xs stem from a lack of standardized operations
... I have identified a specific problem
My Xs are Alternatives
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Improvement Strategy
• Eliminate Obvious Sources of Variation
• People in Self-Control
• Means for knowing what they are supposed to do?
• Means of knowing what they are doing?
• Means of regulating their work?
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
NEW BEGINNING
ENDINGS
Neutral Zone
Time
Reactions to Transition
Denial
Anger
Fear
Shock
Frustration
Confusion
StressCreativity
Skepticism
Acceptance
Impatience
Hope
Energy
Excitement
Implement the Solution
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Implement the Solution
Leadership Responsibility• Agree to the change• Communicate support• Ensure resources, time, money
Motivate• Address Barriers• Focus, Focus, Focus• Support the organization through the change
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Implement the Solution
1. Use Communication Skills
2. Monitor the Implementation Plan
3. Manage frequent and Effective Meetings
4. Use Data and Analyze
5. Data-Driven Decision Making
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Implement the Solution
• Review root cause(s) data, and verify if improvement will be effective
• Determine if improvement will achieve project goals
• Develop a flow diagram to illustrate how the improvement will operate
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Process Instruction
Document Process Instructions• Standard Operating Procedures• Instructions• Operational blue prints
If it’s not in writing, it does not exist
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
• Simple & clear
• No novels
• Involve the “Do-ers!”
• Limit the text
• Process Map
• Involve those responsible for implementation
• Be realistic
Process Instructions
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Managing Change is an Art and a Science
The devil is in the details… and the details involve PEOPLE
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Considerations for Managing Change
• People often feel they need to “agree” with every detail, or they will not submit to authority
• Resistance is often subtle• People may hold onto the history of
how change was managed in the past• Cultural Obstructions• Focus on customer needs!
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Culture as an Obstacle to ChangeCan contribute to resistance
• Self Interests• Sense of entitlement and process
ownership• Fear of unknown• Differing perception and vision• Lack of purpose driven focus• Lack of respect for leadership and position
of authority• Conservatism
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Cultural Obstacles
In today’s work world, it seems if we do NOT agree with authority or
change, we can CHALLENGE it with complaint or protest
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Reasons for Rebellion to Change
• Unclear vision, competing visions• Lack of purpose-driven focus• Demand for compliance versus
commitment
• Failure for leaders to communicate- “what’s in it for me?”- “where are we going?”- “why are we going?”
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Leaders Need to do Things Differently
• What do you think leaders need to do?
• What to leaders typically fail to address and consider?
• How can leaders assist with managing and addressing the cultural obstacles?
• What communication strategies need to be considered and/or addressed?
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Change is a ProcessJourney, not a destination• More than creating or designing a new way• More than drafting procedures• More than writing policies• More than determining best practice• More than sending emails• More than training sessions
The above are all tasks – not processes, not process changes, and only part of what needs to be managed and considered
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Requirements to Managing Change
• Stakeholder Analysis – examine and learn from past history of change
• Sponsors and Champions – a must!
• Examination of Skill Set – necessary for targeted group, addressed “fear” and for the CHANGE agents, ie. leadership
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Motivational Considerations
• Provide these up front!• Paint a picture of the future state• Communicate consequences of failure• Economic realities need to be transparent• Alliance with strategic plans and objectives• Customer demands
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
GPS Guidance for the Journey
• Document the process plan in advance and share it• Include ALL the details, and identify all the
stakeholders, roles and responsibilities• Manage the process as its own project• Address and plan for controls re: obstacles
identified for consideration• Wrap the package with a purpose-driven focus
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
People do NOT Reject Their Own Ideas
• Early collaboration and involvement with stakeholders
• Listen to concerns and ideas• Validate feelings• Buy-In will only help!
• Over-Communication is impossible!
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Spreading the Change
• Our tools (DMAIC, Lean, etc.) may give us solutions.. But implementation is still required.
• A systematic and process driven, managed approach had to be developed as part of the change management process
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Spreading Solutions Across Southcoast
• Hardwiring and managing solutions from Six Sigma
and Lean project teams
• Implementing corrective actions based on
TapRooT® investigation results
• Managing and evaluating best practice and
operational processes for new services
• Cannot be left to chance, needs a detailed
deployment process
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
LINC Team Concept Leaders Innovating and Navigating Change
LINC Team
Six Sigma Team
Solutions
Kaizen Event
SolutionsLean
Solutions
TapRooT Corrective
Action Plans
Other Processes Requiring Deployment
across Sites/Departments
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Ingredients for Successful Deployment Projects
• Senior Leadership support (commitment to standardize)
• Key Stakeholder meetings
• Weekly/Biweekly meetings during implementation
• Project Management at organizational and local project
level
• Post-spread control plan with metrics and check-ins
• Skilled facilitation and accountability
• Project Charter and Service Level Agreement (SLA)
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
LINC TeamFour driving principles
• Collaboration (each team will consist of site-specific sub-groups) and weekly/bi-weekly meetings
• Pull vs Push• Project Management, Defined
Communication Plan and Stakeholder Analysis
• One-on-One Support – BB Travels to each site to visit and provide leadership during the implementation project
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
LINC Membership
• Black Belt w/Project Management Training
• Site Process Owners
• Executive Champion
• Team Members – selected by above, representing
current stakeholders in process at each site
• Rapid Cycle Deployment Plan 90-120 Days
Updates at monthly check-ins and QSC
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
LINC Flowchart
LiNC Team Planned
BB verifies solutions from original project
Solutions Significant?
Sr. Leaders delay start until significance and results are proven
BB measures baseline process performance at each site
Sr. Leaders articulate and introduce project at each site at leadership mtgs
Yes
No
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
LINC Flowchart
Sr. Leaders verify Champion support for deployment
Needed Resources Available?
Sr. Leaders delay start until resources are available or identified
LiNC Team identified and drafts project charter, completes stakeholder analysis
BB schedules and facilitates team meetings
Sr. Leaders ID Champion and Process Owners at each site
Yes
No
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
LINC Flowchart
LiNC team determines live dates and trials for process changes at each site. Communication plan defined
LiNC team continues with on-site visits and working bi-weekly mtgs – Work on completing SLA
LiNC Team discuss, revise SLA items and issues
LiNC Team fully implements SLA
BB and LiNC team visit sites and meet regularly, discuss implementatio plans and processes
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
LINC Flowchart
LiNC Team identifies control plan
Process owners transition to oversight and monitoring for 90 days
LiNC Team project closed
BB and LiNC team conduct on-site audits every 30 days to verify solutions are hard-wired and effective. SLA fully implemented
End of Deployment
Project
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Other Considerations
• Outside of BB on-site visits, mtgs can be
teleconferenced or by phone
• BB uses DMAIC method and key improvement tools
to facilitate team innovation for spread of plan
• Only address proven X’s and root causes for
standardization across sites
• Ongoing communication with Executive Champion
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Our Keys to Success …
• Pick the right problems to tackle & the right people to tackle them withdefined accountability expectations
• Hard-wire the changes – good data is key
• Build strong, organization-wide, top-down commitment to keep philosophies moving forward
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Hard Lessons Learned..
• Share yours!• Most difficult component of change to
manage?• What is difficult to master?• What is difficult to plan?• What MAJOR component do you feel is
most difficult to manage or most likely to lead to failure?
• When do we acknowledge failure? And once we do…then what?
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SOUTHCOAST HOSPITALS GROUP | Charlton Memorial Hospital | St. Luke’s Hospital | Tobey Hospital
Questions?
Feel free to contact me for more information and discussion!
Nidia WilliamsDirector of Quality OutcomesSix Sigma Master Black BeltSouthcoast Health System
508-679-7397