Lbcg cmho lean for child youth mental health organizations

Lean Six Sigma for Child and Youth Mental Health

Organizations

CMHO Webinar Series

October 26, 2016

LBCG CMHO Webinar Series

Introductions

Michael Schiel is a Director at Lough Barnes with 17 years of experience in community, healthcare and broader public sector focusing on process improvement, transformation and change management. He is certified in Lean Six Sigma, Change Management, Project Management, and IT Services. Michael has completed Lean Six Sigma and Quality Improvement projects for CMHO organizations, Ministries, Community Health Centers, and other Community Services organizations.

Mark L. Fraser is the Director of System Management and Quality at the Child and Family Center. Mark is a registered psychotherapist with the College of Psychotherapists of Ontario with over 16 years of clinical and research experience working with complex children, youth and families within the children’s mental health and child welfare sectors, he holds a Master’s in Applied Psychology, and Bachelor Degrees in Psychology (H.B.A.) and Biochemical Sciences. Mark is the lead at CFC for the Lean Intake Redesign Project.

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Today’s Objectives

What You Will Learn Today:

How Lean Six Sigma fits into the quality picture

What is Lean Six Sigma

5 Key parts of Lean

What Lean Six Sigma means for CMHO organizations

Case Study: Child and Family Center and Intake Redesign

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Refresher: Why Quality?

Some major trends are acting as drivers for changes in community and broader public sector:

• Continued drive to push service deliver closer to the community

• Desire to see demonstrated value for money

• Increasing expectations for access and equity of services

• Increasing expectations of service efficiency and effectiveness

Quality models help you to define quality for your organization, assess quality challenges, and to improve quality outcomes

Quality Drivers

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Quality Improvement Models

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No one model is better than others

Most models have:

• A statement of the quality vision you are trying to achieve

• A defined process for how QI will be conducted

• Approach to determining quality issues/challenges

• A list of improvement goals or priorities that are specific, measurable, achievable, relevant, and time bound.

• Who is responsible and accountable (team, individual, etc.)

• A plan to collect and report the performance

• A plan for how the results (and the goals) will be evaluated

• A process for determining next steps

Where Does Lean Six Sigma Fit?

There are literally hundreds of approaches, tools and applications you can use related to quality improvement

• The American Society of Quality has a list of over one hundred (http://asq.org/service/body-of-knowledge/tools)

• The IHI also has a page on tools (http://www.ihi.org/resources/Pages/Tools/default.aspx)

We are recommending tools by where you are in the process journey:

• Planning

• Quality assessment

• Implement change

• Continuous process improvement

Plan Assess Implement CPI


Lean Six Sigma can help with assessing quality challenges, and

figuring out how to improve

http://asq.org/service/body-of-knowledge/tools





http://www.ihi.org/resources/Pages/Tools/default.aspx

http://www.ihi.org/resources/Pages/Tools/default.aspx

What is Lean Six Sigma, and Why Should You Care About it?

What is Lean?

Some definitions of Lean:

The core idea is to maximize client value while minimizing waste

Use of continuous process improvement techniques to increase productivity, reduce wasted time and activities, find efficiencies, improve service reliability and…

Improve staff morale and customer service

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What is Lean?

Lean is NOT:

An acronym

Only for manufacturing

About staff or service reduction

A silver bullet or a “fix all your problems” fad

A temporary fix

Fast and easy

The same as Six Sigma


Why Should You Care About Lean?

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Benefits of Implementing Lean

Improved client experience and satisfaction

Faster response to client needs

Improved, standardized and repeatable processes

Improved service quality

Reduced service delivery costs

Ability to focus resources on more value-added activities

Improved asset utilization: people, equipment & technology

And….

Increased job satisfaction/reduced stress for staff


Lean Vs. Six Sigma


Both seek to create the most efficient system possible

Biggest difference is in the “how”:

• Lean practitioners seek to eliminate “waste” that comes from unnecessary steps in the production process that do not add value to the finished product

• Six Sigma focuses on reducing variation within the process (that causes waste in its own way)

5 Main Lean Principles

5 principles of Lean

Value - specify what creates value from the client’s perspective.

Value stream – identify all the steps along the process chain.

Flow - make the value process flow.

Pull - make only what is needed by the customer (short term response to the customer’s rate of demand).

Perfection - strive for perfection by continually attempting to produce exactly what the customer wants.


Value and Waste

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Steps in any process can be…

A step is value-added if:

• The client/end user recognizes the value

• It transforms the product or the service

• It is done right the first time

• Steps that are required due to legal, fiduciary, fiscal, compliance, etc. reasons

• Contributes to running the organization

• Steps do not contribute directly to fulfilling customer needs

Value added (for the client)

Necessary but not Value added (for the

organization)

Waste

Our goal is to…

• Eliminate waste • Minimize the time

required to do organization value-added steps


Client Point of View

Who Is Your Client or End User?

Value and service delivery should be based on your users’ needs

What Do They Really Want?

Who are your clients or customers? • Think both internal to your organization and external

• Do you have more than one type?

What are their service requirements? What do they value?

How do you know?

Are You Structured To Meet Their Needs?

Are your processes, approaches, systems set up with the customer’s point of view?

Its important to document who your users are, and what they value – then share this with everyone on the staff for feedback


Value Stream Map

o A value stream map (VSM) is a pictorial representation of how things flow through the system from beginning to end (e.g., intake, assessment, referral, etc.)

o It is used to:

Confirm how the process actually works

highlight any inefficiencies in the current system (i.e., waste, flow issues, examples of variability)

o A VSM provides a great framework for opportunity identification and solution development

Allows the team to “See the flow” of the value stream and wastes in the

flow


Steps for creating a value stream map

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1. Define customer requirements

2. Identify key steps in the process

3. Gather process data

4. Identify additional information including material/information flows

5. Identify value add and non-value add times

6. Determine initial areas of opportunity


Sample Value Stream Map


Sample Future State Map

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Immediate data entry, rather than manual transportation, reduces

errors

AP Staff can review files electronically as they are submitted

Reduced cycle time and lead time


Pull

Push versus Pull

“Push”: service is provided at a set schedule that’s created in advance

• Ford assembly line

• Fast food chains using heat lamps

• Always providing all your services at full service levels every hour every day regardless of client trends

“Pull” services are delivered in response to a client’s request

• Having just enough parts, to create a product “just-in-time”

In some ways, Child and Youth mental health services are “pull” naturally”: you don’t provide the service until the child/youth requires it


Perfection

Lean is not a one-off activity

The journey of continuous improvement ties the process together and make it ever-lasting

Continuous improvement is a mind-set or a culture as much as it is a set of activities or tools


Perfection

Continuous Process Improvement (CPI)

A CPI model is one that allows an organization to plan, implement, measure and sustain its approach to making organizational improvements

Define

Measure Assess

Control


Remember the 8 Types of Waste

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Defects

Overproduction

Waiting (queuing)

Non utilized brainpower

Transport

Inventory

Motion

Extra or complex processing


Examples of Waste

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Waste Example

Defects / Poor service

/ Documentation errors

Overproduction / Multiple assessments

/ Filling out the same information on different forms

Waiting / Waiting to be registered as a client

/ Waiting for a clinician/staff/service

Non-utilized Brainpower / Idle staff

/ Not using staff/resources as input for service delivery, process improvement, etc.

/ Staff working on activities they are over-qualified for

Transport / Moving clients from room to room

/ Poor workplace layouts, convoluted client flow

Inventory / Too much inventory

/ Idle equipment

Motion / Needless movement of workers

/ Needing to get up and go get forms from different offices

Extra or Complex Processing / Asking the patient the same questions multiple times

/ Redundant forms or work-steps


How Do You Know if You Have Waste?

Your staff or clients can tell you!

Typical symptoms of waste:

• Excessive cycle, lead or flow time

• Excessive costs

• Poor quality

• Dependency on work-arounds

• Reactive fire-fighting

• Daily management by exception


Lean Six Sigma and CMHO Organizations

CYMH Organizational Challenges

Some challenges of applying Lean to CMHO organizations:

Value may be different for each client

Service variety and complexity make process standardization difficult

Sometimes services are delivered in partnership with other organizations

Need to consider social value and the equitable provision of services

Balancing high quality service levels with reducing costs, and wait lists


Case Study: Child and Family Centre


Child and Family Centre (CFC) is using Lean to review, redesign and centralize the intake process

CFC is using the Lean methods and tools to:

• Map current state intake pathways and processes

• Centralize intake processes

• Identify barriers

• Find efficiencies and improve overall quality of the intake process

• Engage community stakeholders

Some lessons learned so far:

• Take the time to stress quality as a main principle for the work

• Leverage existing relationships and work completed to date

• Use the process to effectively engage the community

• Need some time to figure out timing of engagement

Thank You!

What You Learned Today:

What Lean is and isn’t;

What Lean means for community organizations like you;

Some lessons learned from other organizations similar to yours;

Ways you may consider using Lean in your organization


Q&A Session


Join us for a live discussion on quality!

Dial in using the following numbers:

Toll Free: 1.855.395.3363

Local: 416.921.8415

Pin: 124 436 9753

tel:1.855.395.3363

tel:416.921.8415

LOUGH BARNES CONSULTING GROUP 439 University Ave., Suite 1920

Toronto, ON M5G 1Y8

T/ 416.977.3811

www.loughbarnes.ca

We are a public sector management consultancy serving the human services sector. Our vision is to build stronger communities through positive social change, a collaborative approach and our Social Investment Fund. Our mission is to contribute to improving human services through high quality consulting and our Social Investment Fund.

http://www.loughbarnes.ca/

Government & Nonprofit

Lbcg cmho lean for child youth mental health organizations