1. Tools to Achieve Performance Excellence

2. Winona Health’s Continuous Systems Improvement (CSI) Lean 2.0 -Activities to Results! Linda Wadewitz Director of Continuous Systems Improvement Winona Health

3. Activity to Results Strategy not aligned Sustainment issues Lack of Standard Work Discipline/Accountability Leaders Std Work RCA-Frontline ……thus LEAN 2.0

4. CSI as a Strategy Focus on Principles of: Belief this strategy is key to a successful future for transforming our culture at Winona Health

5. Winona Health Golden Circle

6. CSI Goals Deployment of Lean 2.0 Integration of the LMS enterprise wide A3 (PDCA) Thinking Strategy cascaded to Frontline Patient focused – outcomes and results Coaching and Mentoring

7. What is Lean 2.0? Strategy Deployment/Enterprise Obeya Visual Management/PDCA/FB Cascading metrics Daily Management – Leadership Discipline Standard Work - 80/20 Leaders Standard Work Frontline A3 Problem Solving Coaching and Mentoring Results Driven – Course Corrections Thus…Activity to RESULTS with lean 2.0

8. WH’s Lean Management System

9. Customer Value Patient/Resident Satisfaction - True North – Principle 1 – True North drives - Hoshin – Value Stream mapping – starts with patient flow – Process mapping – Kaizen, CIP’s – A3 Problem solving – Visual Management FOCUS Boards PDCA Boards

10. Hoshin Management = Strategy Deployment Statement is the CONSTANT GUIDE for the Team HoshinKanri Direction/Needle Management Hoshin Kanri – Leadership Driven – Level 1- Organization – True North/3 year Strategic Goals – Level 2 – Service Line or Support – Level 3 – Value Streams/Departments – Linkage from Level 1 to Level 2 to Level 3 – Catchball between all levels

11. Hoshin Kanri

12. Hoshin Kanri Cascade

13. “Catchball” Process CEO/Service Line Leaders/Directors Discussions between Leadership levels – Need to limit the “How”/# of Tactics Level 3 catchball includes frontline Improves ownership/engagement at all levels Integrated goals cascade from Level 1 - Level 3 Alignment and focus

14. Level-1 Level-2 Level-3 4 3 2 1 #1 lags everything #2 is leading to #1 but lagging to #3 #3 is leading to #2 but lagging to #4 #4 is leads everything Proposal A3’s Metrics

15. Rotation in Hoshin

16. Linkage Validation

17. Value Stream Mapping Map Current State Review Inputs SFP/ Patient Determine Ideal State Map Future State RCA and Identify Barriers Prioritize Gaps and Events Kaizen CIP 3P A3’s JDI’s Std Work Sustaining Results Evaluate and Improve

18. Forecasting – Ties to Level 1 Hoshin

19. Forecasting - What We Did Eliminated Annual Budget Process Implemented Quarterly Forecasting – Designed overall process – Operationalize software – Initiated Quarterly Senior Leader meeting

20. Forecasting - Why We Did It Agility – annual budget process is out of synch – Pace of change in the industry – Winona Health management system – Lead Time too long – 17 months

21. Forecasting - Why We Did It Noise – Budget becomes noise that gets in the way of real-time continuous performance improvement

22. Forecasting – Why We Did It Waste – time and resources

23. Observations/Impact/Lessons Learned Start with Long-Term Financial Forecast to determine targets Use Quarterly Forecasting to evaluate progress on Long-Term targets Close the Loop on gaps between Quarterly Forecast and LT Targets This is primarily a top-down exercise, resist creating a quarterly budget process

24. Observations/Impact/Lessons Learned Quarterly Forecasting meeting has created enhanced dialogue among Senior Leaders Preparation for the quarterly meeting has triggered a more meaningful interaction between finance and operations Operating leaders are asking more and better questions You have to learn to walk again

25. Observations/Impact/Lessons Learned Quarterly Forecasting: – Is about performance improvement – Is not about precision or paper clips The point of forecasting is not creating numbers to “hit”. It’s about designing operations to deliver better performance.

26. Box Scores – Tie to Hoshin

27. Boxscore Graphs/Charts

28. Proposal A3’s Proposal A3’s-all levels of Hoshin – “HOW” – What tactics we use to accomplish breakthrough objectives and how do you measure for success – Started by leader / finished by area – Burning platform – Also used for CPR’s presented to CEO/CFO

29. Proposal A3 Business Case Current State/Gap Future State Action Plan Measurement/Results

30. Visual Management Enterprise PDCA Enterprise Level – Plan wall Hoshin Level 1 and Level 2’s Proposal A3’s from level 1 Hoshin Long term goals and forecast – Do wall Proposal A3’s from all level 2 Hoshin – Check wall Std Boxscores from every Service/Support Line Charts/Graphs not meeting target Results tracking to forecasting – Act wall Follow-up – Course Corrections

31. Enterprise Obeya

32. Visual Management-PDCA Boards PDCA Boards – Level 2 and 3 (SL/Dept) – New format with Standard Work – Box Score – Vital few – Level 2 and 3 – Reviewed weekly, monthly and quarterly

33. PDCA Board Weekly/Monthly

34. Visual Management FOCUS Boards FOCUS Boards- Daily- every dept – New format with Standard Work – A3 Problem solving at frontline – More meaningful than old version

35. FOCUS Boards - DAILY

37. Standard Work Standard work at the frontline-goal 20% – Based on risk and volume – Critical to quality steps on a scorecard audit – Improves outcomes and quality – Process stable prior to improvement – Decreases variability Standard work for Leadership – Standard set of tasks all leaders or managers perform – Same expectations/outcomes-quality – Accountability – Staff see the same process in all leaders

38. Leaders Standard Work Leaders Standard Work cascaded up from frontline to the CEO Daily, weekly and monthly audits Done with a score card Gemba walks/Rounding Coaching and Mentoring- 4-Patterns Visual Board Rounding

39. Standard Work / LSW LSW Score Card Standard Work Template Risk Matrix

40. Scorecard Requirements Cascaded frontline to CEO Vital few – one on/one off Discipline at all levels Reviewed at 1:1 leaders mtg Follow-up to issues and commitment from either party 4- Patterns guides actions Live tool-changes as needed

41. Frontline Daily Problem Solving 22 Coaches trained 75 Frontline Problem Solvers trained 6 additional groups trained > 200 A3’s since January 2013 > 140 A3’s closed out of the 200 New A3 Format Healthcare sensei December 2012 In addition to FB and JDI’s

42. Problem Solving A3 Background Problem Statement Current State Problem Analysis Gap Target Condition Countermeasures Implementation Plan Follow-up Actions and Metrics Cost Benefit Analysis

43. Recognition Program New-previously not done well, if at all Access Data Base to track results – Hard dollars saved – Revenue enhancement – Hours saved – Satisfaction – lagging – Reports

44. Recognition Reports Executive Summary – Financial and time Weekly Recognition-report detailing closed A3’s – teams are recognized at the FOCUS Boards by the Service Line Leaders. Monthly Recognition – CEO highlights monthly and tells the story…. Annual Celebration

45. Executive Summary Report

46. A3 Revenue Enhancement and Hard Dollar Savings

47. Value Realization Hours saved Reassigned to “new” work A3 Problem solvers/Coaches Have a “no lay off” policy related to “CSI” Attrition Forecasting adjusted if appropriate Hard Dollar Savings 75% adjustment in forecasting Validation required in intervals Forecasting adjusted if appropriate

48. Leadership Academy

49. Why Leadership Academy? Developing out people Respect for our people Use of talent Grown your bench Staff Satisfaction = Increased Patient Satisfaction

50. Results Strategy patient focused, aligned and integrated from Hoshin to the frontline Sustainment with Results using Std Wk/LSW Improved visual management Engagement at all levels with A3 problem solving (critical thinking) and FOCUS/PDCA boards Enterprise results monitored and addressed by the CEO and Senior Leadership Team with course correction and follow-up when needed Results reflected in measurement and metrics

51. Questions? is the CONSTANT GUIDE for the Team