Continuous Performance Improvementat Seattle Children’s Hospital
Lessons in Leadership: Getting Leaner – Getting Results
March 24, 2011
Our CPI Philosophy
• Focus on the Patient and Family• Involve patients and families in our improvement work• Don’t imagine we know what they want, listen • The uniqueness of our patients should be our only variation
• Support Faculty and Staff in their Work• Give people the opportunity to participate • We are partners to be engaged, not customers to be served• Make it easy to do the right thing• No Layoffs
• Take a Long Term View• Relentless, iterative improvement (PDCA)• Patience, this is generational work• Focus, avoid the squirrel syndrome
Our Approach
● Leader Guidance and Direction: this is our management system, our method of improvement
● Staff (and Family) Participation: this is how we will improve
● Understand the Sequence of Work: map the process
● Identify Waste: reduce or eliminate it
A Few Words About Waste…
Waste comes cleverly
disguised as real work
Waste Comes in Many Forms
Processing Search TimeCorrection Transportation Underutilized People
InventoryWait Time Space Complexity
A Few Words about Leadership
● Presence
● Knowledge
● Participation
● Tenacity
● Patience
Continuous Performance Improvement: Our Results
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
FQ103
FQ203
FQ303
FQ403
FQ104
FQ204
FQ304
FQ404
FQ105
FQ205
FQ305
FQ405
FQ106
FQ206
FQ306
FQ406
FQ107
FQ207
FQ307
FQ407
FQ108
FQ208
FQ308
FQ408
FQ109
FQ209
FQ309
FQ409
FQ110
FQ210
FQ310
Quality – Overall Rating of Care
Lower is better!
• New Ambulatory Clinic and Surgery Center
• Using CPI principles, reduced building size from the architect’s original program by approximately 30,000 sq ft
• $20 million capital cost avoidance, plus• $10 million construction cost savings
Cost
Delivery - Central Line Access
% of Patients with Leukemia Receiving PICC Lines
and Access for General Surgery to Place Elective Central Line(Lower is better)
10
5
2
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
2005 2006 2007
0
2
4
6
8
10
12
% Receiving PICC
Median Days Lead Time for ElectiveLine
Arlene Libby
Updated 12/14/07
Year 1 Year 2 Year 3
Safety - Blood Stream Infections
0
1
2
3
4
5
6
Ra
te p
er
10
00
CL
da
ys
Hospital-Acquired Catheter-Associated Bloodstream Infection RatesHousewide- By Quarters (Fiscal Year)
Series1 Linear (Series1)
Gallup Q12® Engagement Index at Children’s Over Time
19%12% 12% 10% 12% 9% 9% 8% 9% 8%
42% 40% 40%
25%35%
41% 42% 45%50% 50% 50% 51% 52%
56%
53%47% 48% 43%
41% 41%
0%
20%
40%
60%
80%
100%
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
% E
ng
ag
ed
Engaged
Not Engaged
Actively Disengaged
Ratio of Engaged to Actively Disengaged: 1.32:1 2.92:1 3.42:1 4.20:1 3.75:1 5.56:1 5.56:1 6.25:1 5.67:1 6.50:1
Copyright © 2005 The Gallup Organization, Princeton, NJ. All rights reserved.
CPI Can Be Applied Anywhere
March 11, 2011 CPI Report-Outs:
• Dietitian Documentation
• Feeding Tube Management
• Primary Care Clinic Flow
• Cardiac Surgery Scheduling
• Research Grant Invoicing
Lessons Learned
● This is hard work
● Takes time and effort to see results
● Very engaging for staff, faculty and families
● Requires substantial leadership and financial investment
● Learn to fish
CPI at Seattle Children’s Hospital
Thank you