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Lean at Denver Health: Saving Lives, Saving Money, Saving Jobs Phil Goodman Director, Lean Systems Improvement Denver Health Denver, Colorado.

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Presentation on theme: "Lean at Denver Health: Saving Lives, Saving Money, Saving Jobs Phil Goodman Director, Lean Systems Improvement Denver Health Denver, Colorado."— Presentation transcript:

1 Lean at Denver Health: Saving Lives, Saving Money, Saving Jobs Phil Goodman Director, Lean Systems Improvement Denver Health Denver, Colorado

2 Lean At Denver Health: Saving Lives, Saving Money, Saving Jobs Denver Health Lean Principles and Tools Application of Lean Results – Pre-Hospital – Inpatient – Outpatient – Public Health Financial Impact

3 Non medical Detox Correctional Care Denver Health Medical Center Family Health Centers Regional Poison Center & Nurseline Denver Health Medical Plan School- based Health Centers Rocky Mtn Center for Medical Response to Terrorism Public Health Rky Mtn Regional Trauma Ctr Employed Physicians HIT 3

4 Improve Patient Safety and Quality of Care Improve Patient Access Reduce Cost The Holy Grail of Process Improvement in Health Care Is it possible to drive all three goals simultaneously? Hint: Try eliminating waste, and see what happens!

5 What Waste? Underutilized Human Talent Waiting Inventory Transportation Defects Motion Overproduction Processing

6 Lean Tools Lean Tools to Identify Waste: Process Mapping Time Observations Takt Time Spaghetti Diagram Communication Circle Waste Walk Voice of the Customer Root Cause Analysis Lean Tools to Eliminate Waste: 6S Standard Work Poke Yoke Heijunka A3 Thinking Visual Management Quick Change Kanban Framework for Using Lean Tools in a Focused Manner: Value Stream Analysis 2P/3P Rapid Improvement EventVertical Value Stream Analysis

7 Pillars of Lean Transformation Continuous Improvement Respect for People

8 Principles of Lean The customer defines value Deliver value to the customer on demand and without waste Standardize to solve and improve Transformational learning requires a deep personal experience Mutual respect and shared responsibility enable higher performance

9 Pre-Hospital: Denver Health Paramedic Value Stream

10 Total Personnel, Operating Expenses and Revenue Note Revenue >Operating Expense

11 Improving Inpatient Safety and Quality of Care

12 Improving Inpatient Safety and Quality of Care

13 Improving Inpatient Safety and Quality of care

14 Hospital Flow and Readmissions Improving Inpatient Safety and Quality of Care

15 UHC Quality and Accountability Aggregate Score Improving Inpatient Safety and Quality of Care

16 Improving Inpatient Safety and Quality of Care

17 Community Health Services Improving Patient Access

18 Community Health Services Improving Efficiency

19 Improving Outpatient Safety and Quality of Care

20 Community Health Services Improving Outpatient Safety and Quality of Care

21 Community Health Services Improving Outpatient Safety and Quality of Care

22 What About Applying Lean in Public Health?

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 done Developed by the people who actually do the work Not optional

24 Value Stream Mapping in Public Health Adapted from: Natl Network of Public Health Institutes 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 Peterson 2 1 University of Colorado-Denver, Anschutz Medical Campus, 2 Denver Public Health, Denver, USA Reason for Action: Poor coordination of FASD prevention and treatment services within Denver Health Initial Condition: Relevant work being done in silos of departments Target Condition: Integration of services to provide best care efficiently, utilizing existing resources well Gap Analysis: Silos across multiple departments with poor coordination of services/referrals Solution Approach: Including methods gained from Practice Collaborative training and forum with other sites Rapid 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. Completion Plans: Arrange trainings with clinics to coincide with the new EMR in Jan, 2013 Confirmed State: 16% of women attending the DPH clinic were both drinking at high-risk levels and not using effective contraception (816/4976) ObGyn Pre-natal Care High-risk Deliveries Contraceptive Care Family Practice Pre-natal Care Low-risk Deliveries Kids Care Adult Care Contraceptive Care Pediatrics Kids Care Child Advocacy Contraceptive Care Outpatient Behavioral Health Services Substance Abuse Treatment Services Other Mental Health Care Denver Public Health Maternal Child Health Program STD-CHOICES Demonstration Project Contraceptive Care Data Analysis Expertise Larger Community COFAS FASD Education Legislative Policy Other Health Care Systems Et cetera CityMatCH 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 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. Applying Lean to Business Processes at Denver Public Health

29 Applying Lean at Colorado Dept of Public Health Created standard work to eliminate redundancies (re-work) in: Licensing of Health Facilities Background checks and CEUs required for certification of EMS professionals Implemented andon (red flags) to prevent actual issuance of inappropriate license Source: 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 Healths Lean Initiative

31 Summary Lean is a philosophy and tool set that fits for healthcare Eliminating waste improves quality of care Lean tools are intuitive Frontline staff must be respected because they understand where the waste exists and how best to eliminate it Lean 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 Prize for Operational Excellence LEAN

32 Judith Shlay MD, Denver Public Health Karen L. Peterson MD, Denver Public Health Dean McEwen, Data Applications Supervisor, Denver Public Health Andrew Yale, Administrative Director, Denver Public Health Nancy McDonald, Director for Medical Facilities and Emergency Medical Services Division at Colorado Department of Public Health and Environment Acknowledgements and Thank Yous!


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