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Lean at Denver Health: Saving Lives, Saving Money, Saving Jobs

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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 Goodman Director, Lean Systems Improvement Denver Health Denver, Colorado

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

3 HIT Employed Physicians Denver Health Medical Center
Rky Mtn Regional Trauma Ctr Rocky Mtn Center for Medical Response to Terrorism 911 Public Health Regional Poison Center & Nurseline Family Health Centers Denver Health Medical Plan School-based Health Centers Correctional Care Non medical Detox 3

4 The Holy Grail of Process Improvement in Health Care
Improve Patient Safety and Quality of Care Improve Patient Access Reduce Cost 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 P/3P Rapid Improvement Event Vertical Value Stream Analysis

7 Pillars of Lean Transformation
Respect for People Continuous Improvement

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 Pre-Hospital: Denver Health Paramedic Value Stream
Note Revenue >Operating Expense Total Personnel, Operating Expenses and Revenue

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 Hospital Flow and Readmissions

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

16 Improving Inpatient Safety
and Quality of Care

17 Community Health Services
Improving Patient Access Community Health Services

18 Community Health Services
Improving Efficiency Community Health Services

19 Improving Outpatient Safety and Quality of Care

20 Community Health Services
Improving Outpatient Safety and Quality of Care Community Health Services

21 Community Health Services
Improving Outpatient Safety and Quality of Care Community Health Services

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: 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, USA Reason for Action: Poor coordination of FASD prevention and treatment services within Denver Health Gap Analysis: Silos across multiple departments with poor coordination of services/referrals Completion Plans: Arrange trainings with clinics to coincide with the new EMR in Jan, 2013 Initial Condition: Relevant work being done in silos of departments Solution Approach: Including methods gained from Practice Collaborative training and forum with other sites Confirmed 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 well 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. Outpatient Behavioral Health Services Substance Abuse Treatment Services Other Mental Health Care ObGyn Pre-natal Care High-risk Deliveries Contraceptive Care Family Practice Pre-natal Care Low-risk Deliveries Kids’ Care Adult Care Contraceptive 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 Pediatrics Kids’ Care Child Advocacy Contraceptive Care 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 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 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 Health’s Lean Initiative

31 for Operational Excellence
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 Acknowledgements and Thank Yous!
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


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