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Change management at the Karolinska University Hospital using Lean transformation Birgir Jakobsson CEO Karolinska University Hospital 2013-04-25.

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Presentation on theme: "Change management at the Karolinska University Hospital using Lean transformation Birgir Jakobsson CEO Karolinska University Hospital 2013-04-25."— Presentation transcript:

1 Change management at the Karolinska University Hospital using Lean transformation Birgir Jakobsson CEO Karolinska University Hospital

2 Global Health Care Challenges Health Care costs vs BNP per capita

3 Lean Method in University Hospital Setting. Helsinki April 2013 Lack of quality Lack of integration between academia, industry and health care Restricting rules and regulations Insufficient clinical pathways Accidents and mistakes Inefficiency Demography Differences in culture and conflicts of interests Local Health Care Challenge Some challenges are Health Care inhouse challenges

4 The Doctor. Sir Luke Fildes, The Tate Gallery, London.

5 Lean Method in University Hospital Setting. Helsinki April 2013 Cardiac surgery. (Foto 2003 © Johan Garsten, Karolinska Universitetssjukhuset). 5

6 Lean Method in University Hospital Setting. Helsinki April 2013 Sir Cyril Chantler: “Medicine used to be simple, ineffective, and relatively safe. Now it is complex, effective, and potentially dangerous.” Lancet. 1999; 353(9159): , p

7 Lean Method in University Hospital Setting. Helsinki April 2013 according to Amalberti, R. Safety Science, High Risk Organizations Health care organizations with high risk profile

8 Lean Method in University Hospital Setting. Helsinki April 2013 If we want different results – we have to do things differently

9 Huddinge University Hospital Lean Method in University Hospital Setting. Helsinki April 2013

10 LEAN – a strategy for improvement ABCDABCD R ABCDABCD R Flow- Principles Principles of Improvement Lean Method in University Hospital Setting. Helsinki April 2013 See the whole pictureFocus on patient valueEliminate waste

11 Capio S:t Görans Hospital Lean Method in University Hospital Setting. Helsinki April 2013

12 Reg. Kassa SpotCheck Disken bed prio. av ssk Läkare unders. Leaves E&A Prover EKG Konsult Rtg Prover Ny bed av läkare * ** Treatment time 2:43 Nr of pat kl 16: 7,5 Remiss Svar Klar Parts of patient’s way through the E & A where waste (time) can be identified and refused by us Important decisions Ord Beh Ord 40Hem 29 Inl. 10 Wait for dr 1:19 Nr of pat kl 16: 3,7 Am- bulans Triage min min min min Where is the waste? Flow Chart of Emergency Surgery Identified waste = 130 min

13 Lean Method in University Hospital Setting. Helsinki April 2013 Prototype for a new work procedure

14 Karolinska University Hospital Lean Method in University Hospital Setting. Helsinki April 2013

15 SolnaHuddinge Karolinska University Hospital

16 Lean Method in University Hospital Setting. Helsinki April 2013 Number of patients seen by doctor per hr Number of patients per hr Patients way through E & A

17 Lean Method in University Hospital Setting. Helsinki April 2013 Inpatients arrive to E&A Patients leave ward unit Patients arrive to ward unit Patient flow to and from an in ward unit

18 Lean Method in University Hospital Setting. Helsinki April 2013 How should we bring about CHANGE ? Lean transformation Strategic plattform Leadership

19 Lean Method in University Hospital Setting. Helsinki April 2013 To improve patient value 1.Create more effective processes with better patient flow, shorter lead times, less faults and less waste 2.Create effective team work with safer communication 3.Secure that we use effective methods (EBM) Method (EBM) ProcessTeamwork Staffing and rules R&D What did we want to improve?

20 Where do we start to improve? Emergency flow Imperative flow Planned flow

21 Lean Method in University Hospital Setting. Helsinki April 2013 E&AWard 12 3 We wanted to improve the processes with an ”end-to-end”- perspective - but one step at a time In which order should we improve?

22 Lean Method in University Hospital Setting. Helsinki April 2013 E&AWard 1.Wait for doctor: 40 min 2.Through time E&A 4hrs: 90% 3.Nr of patients at 16 PM: 80 1.Patients to ward <4hrs: 90 % 2.Discharge before 12 AM: 33 % 3.Shorter AVLOS: 15 % Goals and KPI’s?

23 Lean Method in University Hospital Setting. Helsinki April 2013 E&AWards X-rays/ lab X-rays/ lab Surgery Early involvement of support processes

24 Lean Method in University Hospital Setting. Helsinki April 2013 E&AWards X-rays/ lab X-rays/ lab Surgery Management team Flow leader Improvement groups How to create a mixture of top-down and bottom-up?

25 Lean Method in University Hospital Setting. Helsinki April 2013 How to lead the improvement work?

26 FAS 1 Framtagning och test Tid FAS 2 Implementering FAS 3 Ständiga förbättringar FAS 0 Överenskommelse Q Lean Method in University Hospital Setting. Helsinki April 2013 Systematic approach to establish, standardize and improve work procedures

27 Lean Method in University Hospital Setting. Helsinki April 2013 Values Principles Way of working Results Flow rules Flow- principles Go and seeStandards How to avoid too much focus on results?

28 Lean Method in University Hospital Setting. Helsinki April 2013 Mål Waiting for doctor, 5 days a week, , in Huddinge

29 Lean Method in University Hospital Setting. Helsinki April 2013 Turn-around time <4hrs 5 days a week, 08-16, in whole hospital

30 Lean Method in University Hospital Setting. Helsinki April 2013 % % of patients in ward within 4hrs from arrival to E&A, 12 wards

31 Lean Method in University Hospital Setting. Helsinki April 2013 % % discharged before 12 AM,12 wards

32 Saved time in comparison with prioritized time (24h) 2010 to 2013, mars Lean Method in University Hospital Setting. Helsinki April 2013

33 Principles Way of working Results Wright from beginning Standardisation Visualisation Values Mutual values Teamwork Wright competence in wright time Continuous improvement Safety Quality Accessability Working environment Efficiency Change of culture Silos Hierarcies Single work Sequensial Variation Unpredictable Future Present For whom are we here Predictable Lean Method in University Hospital Setting. Helsinki April 2013

34 Three important challenges Values Flow efficience/ resource efficiency Leadership Lean Method in University Hospital Setting. Helsinki April 2013

35 Karolinska´s strategic plattform Our assignment Our Vision Present state Long term strategies Our values Long term goals 35 Lean Method in University Hospital Setting. Helsinki April 2013

36 Our vision The patient always first We provide care of excellent quality and safety We are accessible, effective and provide individual care to our patients We are role models within R&D and education 36 Lean Method in University Hospital Setting. Helsinki April 2013

37 Our values Accountability HumanityHolistic attitude Vi tar ansvar för våra patienter, uppgifter och varandra. We speak up if we think something is wrong. Vi möter våra patienter och varandra med omtanke och respect. Vi utgår från varje patients unika behov. Vi arbetar tillsammans över gränser för att ge bästa möjliga vård. We value each others work and ask for help when needed. 37 Lean Method in University Hospital Setting. Helsinki April 2013

38 Values = tools to change culture Performance Attitudes and behaviour ! 38 Lean Method in University Hospital Setting. Helsinki April 2013

39 New Karolinska? Quality/Cost/Health Flow efficiency Quality/Cost/Health VC/Resources VC/Flows Resource efficiency Lean Method in University Hospital Setting. Helsinki April 2013

40 Flow efficiency versus resource efficiency Resource efficiency Flow efficiency High Low High Low Start 40 Lean Method in University Hospital Setting. Helsinki April 2013

41 1. Esatablish best standard 2. Standard should be folowed 3. Challence and support imrovement of standard Educates and motivates Accountable for reaching goals Lean and leadership Lean Method in University Hospital Setting. Helsinki April 2013

42 Systems for learning, continuous improvement and long-term sustainability Medarbetar e 1:a linjechef Verksamhetschef Divisionsch ef Sjukhusdirekt ör Q Patient value Problemlösning på rätt nivå Visualisering Eskalering av problem som ej kan lösas på egen nivå Värdeskapande aktiviteter Ständiga förbättringar och dagligt lärande Efterfråga resultat och skapa förutsättningar Lean Method in University Hospital Setting. Helsinki April 2013

43 Karolinska will not only focus on results – we also have to build ”Health” HealthResults Our ability as an organisation to continously question and challenge ourselves in order to reach sustainable results ”Coninuous improvement” What do we achieve, production of care at the wright quality within balanced economy Lean Method in University Hospital Setting. Helsinki April 2013

44 Decrease in outpatient waiting times Mål <300 0 Mål <400 0 Totalt utbetalt vite 2012: 18,9Mkr

45 Decrease in outpatient waiting times - Pediatrics

46 Lean Method in University Hospital Setting. Helsinki April 2013 Patient satisfaction, E&A %

47 47 Development of leadership Lean Method in University Hospital Setting. Helsinki April 2013

48 48 Staff satisfaction Lean Method in University Hospital Setting. Helsinki April 2013

49 49 Karolinska University Hospital – economic results Mkr

50 Conclusion Standardisation Transparence – visualisation Patient value Learning from errors Continuous improvement The developing leadership Focus on quality/cost Lean Method in University Hospital Setting. Helsinki April 2013

51 Contact information Birgir Jakobsson, CEO Karolinska University Hospital Stockholm Sweden


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