Presentation on theme: "Lean at Denver Health: Saving Lives, Saving Money, Saving Jobs"— Presentation transcript:
1 Lean at Denver Health: Saving Lives, Saving Money, Saving Jobs Phil GoodmanDirector, Lean Systems ImprovementDenver HealthDenver, Colorado
2 Lean At Denver Health: Saving Lives, Saving Money, Saving Jobs Lean Principles and ToolsApplication of Lean ResultsPre-HospitalInpatientOutpatientPublic HealthFinancial Impact
3 HIT Employed Physicians Denver Health Medical Center Rky Mtn Regional Trauma CtrRocky Mtn Center for Medical Response to Terrorism911Public HealthRegional Poison Center & NurselineFamily Health CentersDenver Health Medical PlanSchool-based Health CentersCorrectional CareNon medical Detox3
4 The Holy Grail of Process Improvement in Health Care Improve Patient Safety and Quality of CareImprove Patient AccessReduce CostIs it possible to drive all three goals simultaneously?Hint: Try eliminating waste, and see what happens!
5 What Waste? Underutilized Human Talent Waiting Inventory TransportationDefectsMotionOverproductionProcessing
6 Lean Tools Lean Tools to Identify Waste: Process Mapping Time ObservationsTakt TimeSpaghetti DiagramCommunication CircleWaste WalkVoice of the CustomerRoot Cause AnalysisLean Tools to Eliminate Waste:6SStandard WorkPoke YokeHeijunkaA3 ThinkingVisual ManagementQuick ChangeKanbanFramework for Using Lean Tools in a Focused Manner:Value Stream Analysis P/3PRapid Improvement Event Vertical Value Stream Analysis
7 Pillars of Lean Transformation Respect for PeopleContinuous Improvement
8 Principles of Lean The customer defines value Deliver value to the customer on demand and without wasteStandardize to solve and improveTransformational learning requires a deep personal experienceMutual respect and shared responsibility enable higher performance
9 Pre-Hospital: Denver Health Paramedic Value Stream
10 Pre-Hospital: Denver Health Paramedic Value Stream Note Revenue >Operating ExpenseTotal Personnel, Operating Expenses and Revenue
23 How Can Lean Help? Identify and eliminate waste Develop and Implement Standard Work:The currently best known, least waste way of getting the work doneDeveloped by the people who actually do the workNot optional
24 Value Stream Mapping in Public Health Adapted from: Nat’l Network of Public Health Institute’s Public Health Performance Toolkit
25 Application of Lean in Public Health to Improve Services to Clients ETOH Screening Current State Process in STD Clinic and Community Health Services at DH
26 PREVENTING ALCOHOL-EXPOSED PREGNANCIES IN UNDERSERVED WOMEN ATTENDING A SAFETY-NET INPATIENT/OUTPATIENT HEALTHCARE SYSTEM P Gillen,1 K Peterson2 1University of Colorado-Denver, Anschutz Medical Campus, 2Denver Public Health, Denver, USAReason for Action: Poor coordination of FASD prevention and treatment services within Denver HealthGap Analysis:Silos across multiple departments with poor coordination of services/referralsCompletion Plans:Arrange trainings with clinics to coincide with the new EMR in Jan, 2013Initial Condition: Relevant work being done in silos of departmentsSolution Approach: Including methods gained from Practice Collaborative training and forum with other sitesConfirmed State: 16% of women attending the DPH clinic were both drinking at high-risk levels and not using effective contraception (816/4976)Target Condition: Integration of services to provide best care efficiently, utilizing existing resources wellRapid Experiments: DPH took leadership in creating a collaborative at DH, with technical assistance provided by CityMatCH. Two half-day planning sessions utilizing LEAN methods identified the current siloed state of prevention efforts and care at DH, analyzed the gaps, and developed solutions. DPH clinic data were used to assess the prevalence of high-risk alcohol use in reproductive age women, defined as 4 or more drinks on one occasion or 8 or more in a week, and their rates of effective contraception.Outpatient Behavioral Health ServicesSubstance Abuse Treatment ServicesOther Mental Health CareObGynPre-natal CareHigh-risk DeliveriesContraceptive CareFamily PracticePre-natal CareLow-risk DeliveriesKids’ CareAdult CareContraceptive CareDenver Public HealthMaternal Child Health ProgramSTD-CHOICES Demonstration ProjectContraceptive CareData Analysis ExpertiseLarger CommunityCOFASFASD EducationLegislative PolicyOther Health Care SystemsEt ceteraPediatricsKids’ CareChild AdvocacyContraceptive CareCityMatCH Practice Collaborative to Reduce the Risk of Alcohol-Exposed Pregnancy
27 Applying Lean to Business Processes at Denver Public Health Implemented standardized billing for Public Health Services which traditionally has not been done. Examples include:Billing for certain lab tests ordered out of the TB clinic;A collaboration between the TB clinic and DU to test their foreign born students for TB which resulted in a small profit for the clinic;Created standard work for billing of insured walk-in patients in our STD clinic;Billing third party payor sources for immunizations given in our Immunization Clinic and during immunization outreaches including outreaches occurring in Denver Public Schools.
28 Applying Lean to Business Processes at Denver Public Health Automated ways of pulling and sharing data: Retrieving STD lab data from the main lab to be automatically loaded into our STD Electronic Medical Record. Before this was created the results (18k per year!) had to be manually entered by clerical staff.
29 Applying Lean at Colorado Dept of Public Health Created standard work to eliminate redundancies (re-work) in:Licensing of Health FacilitiesBackground checks and CEUs required for certification of EMS professionalsImplemented “andon” (red flags) to prevent actual issuance of inappropriate licenseSource: Nancy McDonald, BS, RN: Director for Medical Facilities and Emergency Medical Services Division at Colorado Department of Public Health and Environment(and former Assistant Director of Lean Systems Improvement, Denver Health
30 Financial Impact: “Hard Green Dollars” from Denver Health’s Lean Initiative
31 for Operational Excellence SummaryLean is a philosophy and tool set that fits for healthcareEliminating waste improves quality of careLean tools are intuitiveFrontline staff must be respected because they understand where the waste exists and how best to eliminate itLean has the power to change culture because it truly empowers employees to break down silos, rapidly implement change and own the process!March, 2011: DH first Healthcare Organization recipient of Shingo Prizefor Operational ExcellenceLEAN
32 Acknowledgements and Thank Yous! Judith Shlay MD, Denver Public HealthKaren L. Peterson MD, Denver Public HealthDean McEwen, Data Applications Supervisor, Denver Public HealthAndrew Yale, Administrative Director, Denver Public HealthNancy McDonald, Director for Medical Facilities and Emergency Medical Services Division at Colorado Department of Public Health and Environment