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4 th Annual Advancing Philanthropy Conference LEAN: Working Smarter Not Harder by Chuck Derus, MD.

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Presentation on theme: "4 th Annual Advancing Philanthropy Conference LEAN: Working Smarter Not Harder by Chuck Derus, MD."— Presentation transcript:

1 4 th Annual Advancing Philanthropy Conference LEAN: Working Smarter Not Harder by Chuck Derus, MD

2 Advocate Good Samaritan Hospital: Who We Are Part of Advocate Healthcare 333 bed hospital Downers Grove, IL 2,700 associates, 950 affiliated physicians and 500 volunteers Community hospital with level 1 trauma and level 3 NICU 46,000 ED visits, 156,000 outpatient visits and 19,500 admissions

3 Advocate Good Samaritan Hospital: Who We Are

4 Who We Are Thompson Reuters Top 100 Hospital Midas Platinum+ Award Patient satisfaction ≈ top decile Associate satisfaction 91 st percentile Physician satisfaction 96 th percentile 17% market share growth 106% operating income growth

5

6 Problem Solving Versus Fire Fighting The story of the missing supply… Hunt, gather and assume the problem is solved What if you… 1.Get what you need to fix now 2.Ask how and why did this occur? 3.Ask how can we prevent this (make a change) from happening again?

7 Leaning Objectives To learn the 8 wastes To learn a systematic, repeatable approach to problem solving (A3 PDSA) To hopefully go back to your offices and apply this systematic repeatable approach to a problem in your area and to improve that process

8 The Eight Wastes DEFECTS Inspection and rework 1 OVERPRODUCING Too much and too early 2 WAITING Queuing, idle time 3 NOT BEST USE OF TALENT Not using problem solving skills of people 4 TRANSPORTING All patient, staff and material movement 5 INVENTORY All stock and corresponding control systems 6 MOTION Reaching, bending, searching... 7 EXTRA PROCESSING Unnecessary activities, Over-complicated 8

9 Defects Definition: A product or service needing repair to fulfill customer requirements blemishfallacymisprint blooperfalse stepmisstep blot stainfaultmistake blotchfaultymuff blunderflawoff the beam bobbleflubomission bonerfoul-upoversight boo-boofumblerough spots botchgoofscare deformity breachhuman errorscratch bugsillogicalscrew-up bungleimperfectionshortage clinkerimpreciseshortcoming clunkerinaccuracyslip-up cockeyedinadequacysnafu crackincompletesnags defectincorrectspot deficiencyinexacttear drawbackkinkstrip errorleakunsound failinglouse-upweak point failuremiscueweakness Characteristics: Medication error Wrong patient Wrong procedure Missing information

10 Overproduction Definition: –Producing more than needed –Working ahead –Producing at a faster pace than needed Characteristics: –Pills given early to suit staff schedules –Testing ahead of time to suit lab schedule –Treatments done to balance hospital staff or equipment workload

11 Waiting Definition: –Idle time in which no value added activities take place –People wait time –Product wait time Characteristics: –Bed Assignments –Admission to ED –Patient lab test results –Discharge

12 Not Best Use of Talent Definition: –Work-related personnel injuries –Lack of training inhibits flow of services –Not encouraging creativity and use of problem-solving skills Characteristics: –Injured personnel –Poor flow of services –Nurses supplying

13 Transportation Definition: –Any unnecessary material, patient or staff movement Characteristics: –Moving samples or specimens –Moving paperwork –Moving patients for testing or treatment –Moving equipment

14 Inventory Characteristics: –Pharmacy stock –Lab supplies –Specimens waiting analysis –Paperwork in process Definition: – Any unnecessary supplies or materials that do not support just in time delivery

15 Motion Definition: –Any movement of people which does not add value to the product Characteristics : –Searching for meds –Searching for patients –Reaching for charts –Handling paperwork

16 Extra Processing Definition: –Unnecessary process steps Characteristics: –Multiple bed moves –Excessive paperwork –Unnecessary procedures –Multiple testing –Scrap

17 Exercise: Identify eight wastes in your work

18 Systematic, Repeatable Improvement Approach The PDSA cycle is shorthand for testing a change by: 1. Developing a plan to test the change (Plan), 2.Carrying out the test (Do), 3.Observing and learning from the consequences (Study), 4.And determining what modifications should be made to the test (Act).

19 What Is A3? A3 is 16.5 x 11.7 inches

20 A3 PDSA - Problem Solving/Teaching Tool Executed on A3 size (11 x17) paper 9 steps (boxes) that make problem solving visual Fast, effective consensus building An “artifact” that tells the change story 1 2 3 4 5 6 7 8 9

21 How to Achieve A3 Thinking Process is as inclusive as possible –Hand drawn –Pictures and text Work step-by-step –Work with consensus –Distill thoughts to fit each box –Capture the essence –Tell the story without “interpretation”

22 Where does it apply? A3’s work for all types of activities –Personal development –Sharing ideas/proposing change –Problem solving/decision making –Strategic planning –Should become the default way of making improvements

23 Blank A3 Form

24 Starting an A3 1.Fill in Description, Process Owner, Sponsor 2.Fill in Start Date (start of A3) and Current Date (Date and Rev) 3.Record the Team members 4.Select the review team (team that will support the A3 team with relevant knowledge & guidance) P-D-S-A

25 Box 1 – Reason for Action What is the problem (no causes or solutions!) and why do I care?What is the problem (no causes or solutions!) and why do I care? Who has the problem?Who has the problem? What is the scope and are there any limitations?What is the scope and are there any limitations? What are the stop and start “fence posts”?What are the stop and start “fence posts”? P-D-S-AP-D-S-A Reason for Action: The insurance payment posting process is inefficient and is costing us more to do. In Scope: The process begins with submissions of insurance claims to payers and ends with the accurate posting of these payments in the billing system. Out of Scope: The process does not include the patient statement process or Collection Agency process. Trigger: Submissions of insurance claims to payers Done: The accurate posting of these payments in the billing system

26 Box 2 – The Initial State What is happening now in bullet points and a picture?What is happening now in bullet points and a picture? Express the situation in time and units that can later “prove the case”Express the situation in time and units that can later “prove the case” Graphically present initial state with metrics when possibleGraphically present initial state with metrics when possible P-D-S-AP-D-S-A Initial State People: I am clear about my role and the roles of others in my department. 2.5 (scale 1–5) Quality and Safety: MD - “At the start of the visit I had all information needed to provide care. 2 (scale 1-5) MA – “I had the information needed to assist patient at check out.” 60% (0-100%) Cost: Call cost per encounter (based on June encounters & phone stats). 2.67 calls/encounter @ $4.21 per call = $11.24 cost/encounter. Service: Average speed of answer 187 sec. Growth: Market share in primary service area based on last 2 quarters is 18.5%

27 Box 3 – The Target State Record required target not what we ‘think’ we can achieveRecord required target not what we ‘think’ we can achieve Double the good or half of the badDouble the good or half of the bad Wherever possible use voice-of-the- customerWherever possible use voice-of-the- customer Graphically present Target ConditionGraphically present Target Condition P-D-S-AP-D-S-A Target State People: I am clear about my role and the roles of others in my department. Target 4.0 Quality and Safety: MD - “At the start of the visit I had all information needed to provide care. Target 4.5 MA – “I had the information needed to assist patient at check out.” Target 90% Cost: Call cost per encounter Target $6.00 Service: Average speed of answer 90 sec. Growth: Market share in primary service area based on last 2 quarters is 26%

28 Exercise: Write a problem statement for box one and identify a metric for box two

29 Close the Gap Waste Eliminate the Waste Ideal Target State Target State Initial State Initial State Clearly Defined Problem

30 Box 4 – Gap Analysis Root Causes! Identify all possible causes for the situationIdentify all possible causes for the situation Conduct an investigation find “root causes”Conduct an investigation find “root causes” Ask the “5 whys?”Ask the “5 whys?” Cause and effect diagramsCause and effect diagrams 8 wastes8 wastes P-D-S-AP-D-S-A 4. GAP ANALYSIS:

31 Box 5 – Solution Approach Use the “If we did this, then we would achieve this” approach to possible solutionsUse the “If we did this, then we would achieve this” approach to possible solutions Use a 2x2 priority index to “rack and stack”Use a 2x2 priority index to “rack and stack” P-D-S-AP-D-S-A 5. Solution Approach: HardEasy Small Payoff Big Payoff

32 Box 6 – Rapid Experiments Ties to solution approaches based on actionable, impactful root causesTies to solution approaches based on actionable, impactful root causes What happened when we tried stuff? Did it work?What happened when we tried stuff? Did it work? Conclusion?Conclusion? P-D-S-AP-D-S-A Rapid Experiments 1.Communication of flow and signage throughout the department 2.Move printer closer to check out desk 3.Standardize and sort check out area to cut down on motion waste 4.Test standard work for the secretary 5.Redesign the prep work space for X-rays 6.Standardize check out process and train MA

33 Box 7 – Completion Plan List activities by projects, events, do-its, and stop-itsList activities by projects, events, do-its, and stop-its List ‘What, Who and When’ and track progressList ‘What, Who and When’ and track progress P-D-S-AP-D-S-A

34 Box 8 – Confirmed State Relates all the way back to target condition in box 3Relates all the way back to target condition in box 3 Have we achieved and closed the gapHave we achieved and closed the gap Does the confirmed state in box 8 = the target state in box 3?Does the confirmed state in box 8 = the target state in box 3? P-D-S-AP-D-S-A

35 Box 9 – Insights Lessons earned/ breakthroughs/ reflectionsLessons earned/ breakthroughs/ reflections What new things have we learned?What new things have we learned? P-D-S-AP-D-S-A INSIGHTS:

36 Completed A3

37 Exercise: go back to work and execute an A3 of your own

38 It’s Time for Jeopardy!!!

39 Thank You! For questions, contact me at charles.derus@advocatehealth.com charles.derus@advocatehealth.com Are You Solving the Right Problem? by Dwayne Spradlin, HBR, September 2012 Leading the Lean Enterprise by Koenigsaecker


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