Presentation on theme: "Conflict of Interest Ann Dohn – No conflicts of interest to disclose"— Presentation transcript:
1Conflict of Interest Ann Dohn – No conflicts of interest to disclose Nancy Piro – No conflicts of interest to disclose
2SES:065 Using C-Suite Business Models and Tools to Address Issues faced by DIOs/GME in the New Era of Healthcare ReformAnn Dohn, MADIO, Director of Graduate Medical EducationStanford Health CareNancy Piro, PhDEducation Specialist/Program Manager
3BackgroundThe adoption of business models and metrics historically found in the corporate world are now being widely used by Healthcare C-Suite executives.This places DIOs/GME leaders in a vulnerable position. We must learn new ways of communicating and process thinking that align themselves with philosophies such as “Streamlining” and “Lean".We need to think in terms of empirical data, metrics, quality indicators, dashboards, A3s, fishbone diagrams, etc.However, the C-Suite models and processes actually can enable the DIO /GME to better advocate for resources based on data, empirical evidence, and focus on high priority areas for the institution.
4Objectives & Session Focus This session will focus on use of available data tools as well as evaluation metrics that enable DIOs/GME to communicate effectively with the C-Suite.Participants will be exposed to the A3 tool, which is extremely useful in solving inter-departmental problemsOther tools, e.g., scorecards, fishbones, paretos, and trend analyses will be incorporated into the presentation.At the conclusion, participants will be able to apply the A3 model to challenging institution specific situations and discuss available metrics and development of an approach to resolution the situation.
5Understanding C-Suite Priorities STANFORD OPERATING SYSTEMPurposeMission, Vision, ValuesStrategiesComplex Care, Coordinated CareObjectivesGoals, Operating Plans, DashboardsPerformanceImprovement and Management
6Understanding C-Suite Language “Hot – Spots” RVU’sVisibility WallKAIZEN – Continuous ImprovementGEMBAproblems are visible (or make them visible) and the best improvement ideas come form going to the genba – leadership goes to the departments/wards to look for waste and opportunities to improve or practice kaizen.Five Whys – ask why 5 x’s to get to the ….RCA – Root Cause Analysis4 M’s5 S’sA3sSMARTFishbone Diagram – Ishikawa Chart
7Understanding C-Suite Language: “Lean” – Focus and Tools Make problems visible – not hide them or “not talk about mistakes/problems”Fix problems permanently – get to the “root cause” and eliminate it.Focus on the value and respect for people.Lean ToolsKaizenGradual, unending continuous improvement of processesProcesses must be improved to get improved resultsBy improving and standardizing activities and processes, Kaizen aims to eliminate wasteGEMBA – make problems visiblethe best improvement ideas come form going to the genba – leadership goes to the departments/wards/units to look for waste and opportunities to improve or practice kaizen.Elimination of WASTE - 3MsProblem Solving – A3s5 WhysFishbone Diagrams (Ishikawa Charts)4 Ps / 4 Ms5 Ss
8Kaizen BasicsFocus is on small, incremental change (not necessarily huge leaps, innovation)Quality Control = quality of people“A company that is able to build quality into its people is halfway to building quality outcomes”Respect for People“Only people produce improvements…machines only degrade over time””
9Lean Tools: 3M’s All about Waste- Identifying it and Removing it MURI = Waste of overburdening people or equipment/resourcesMURA = Waste of unevenness, variability in processesMUDA = Waste of using resources without creating added value
10Five Why’s Problem Solving Method Keep asking ‘Why’ until you discover the root cause of the problemNo magic in 5 –might be 3, or 7, or 10Why do we? (conduct orientation in person, fill out multiple forms, take on line training for non MDs)Developed at Toyota
11Lean Tools: – Fishbone Charts using the 4Ms – 4 Ps Manpower/PersonnelMaterialsMethod(s)Machines / EquipmentPeopleProcessPolicyPrinciples
12Ishikawa Diagram of ER Prolonged Wait Times MaterialsMethods/ProcessWHY?WHY?xxx hr wait time in ERWHY?WHY?Manpower/PeopleMachine\Equipment
15Very simply….a piece of paper that is 11” in height and 17” in width What is an A3?Very simply….a piece of paper that is 11” in height and 17” in width
164 Steps of A3 Thinking: The Simple A3 2. What causes are preventing us from meeting our target(s)? What are the “root” causes?What is the problem or gap? (What are we trying to improve?)CauseGapCauseTargetCauseEffect/ProblemCurrent PerformanceCauseCauseCause4. Which actions will address the most important causes?3. Based on data, what are the causes in order of importance?Goals (Cause)By Who & WhenActionsCause #1Cause #2Cause #3Cause #4
174 Steps of A3 Thinking: The Simple A3 What is the problem or gap? (What are we trying to improve?)2. What causes are preventing us from meeting our target(s)? What are the “root” causes?4. Which actions will address the most important causes?3. Based on data, what are the causes in order of importance?Goal (Cause)ActionsBy When/ By Who
19Presenting the A3 fosters consensus to move forward Why Use an A3?Creating the A3 encourages systematic problem solving and a standardized method of communicationPresenting the A3 fosters consensus to move forwardDiscussing the A3 fosters critical analytic skills, communication, respect
20When to use an A3?Determining when to use an A3 can be as simple as asking the following questions:Is the situation difficult enough to warrant using the A3 to provide structure?Will there be ongoing discussion for some time so the report has communication value?Is there a good reason to document and capture the knowledge in some fashion?
21A3 Template Title Issue/Problem Statement: Background and Importance: Problem Analysis:Goals/Dashboard Metrics:Future State and Counter Measures:Follow Up:Sustain Results:Implementation Plan:Sponsor:Participants:TitleDate Revised: Version #:Start Date:Revised Date
22What Type of Information is Included in an A3? The Top of the A3 Chart AccountabilityWho is responsible for the project?Sponsors, Team LeadersProject TitleBrief description of the projectProject TeamAll people involved in the development and completion of the projectDraft StatusDate and version
23What Type of Information is Included in an A3? Left Side The left side contains information and discoveries about the current stateIssue (the problem)Objective description with dataStated through the customerBackgroundHistorySignificance (how does this fit within the organizational goals?)BaselineSimple graphic of current stateRequires observationIncludes major pain points (problem areas within the process)Goals / Dashboard MetricsData that will be measured to provide evidence of successProblem AnalysisIdentifies the root cause of current state problemsThe 5 Whys, Fishbone, Pareto, etc.
24What Type of Information is Included in an A3? Right Side The right side develops the vision and action plan for the goalFuture StateThe ideal state you want to achieveCountermeasuresWhat you will need to change to get from current state to the desired future stateImplementation PlanHow the countermeasures will be achievedShow who, what, when and outcome (accountability)Follow-UpWhat will be done to ensure the project is maintainedSustain ResultsThe measured outcome or ongoing measurement of the project’s impactOften the direct measure of the problem
25How Do You Create an A3? 1. Identify a project or problem Write a descriptionBe objective – customer focusMaintain a limited scopeLearn the significance or historyInterview, study, read, etc.2. Observe and draw workflows (process flows)’GembaInterview staffMap the process from A-Z (butcher paper)Identify problem(s) within the processConfirm findings with frontline staff3. Measure the current stateCollect dataManual (i.e. Paper surveys, counts)Database (i.e. EMR)Upstream vs. DownstreamValidate data with frontline staff
26How Do You Create an A3? (Continued) 4. Set goal(s) around measurementsConsider what is idealConsider what is possibleEngage / speak with front line staffBe SMARTS = SpecificM = MeasureableA = AttainableR = RealisticT = Timely5. Analyze the problem and identify root causesInterview stakeholders (ask the 5 Whys)Use measurements to identify biggest problem (Pareto)6. Identify the future state and countermeasuresDescribe/envision the ideal state of the processBrainstorm solutions to root causesSelect countermeasures and list in A3Draw a simple future state diagram
27How Do You Create an A3? (Continued) 7. Determine how countermeasures will be implementedIdentify stakeholders (all persons affected by the changes)Ensure the right people are involved/awareConsider communicationsSet timelines for achieving steps/countermeasures8. Determine the follow-up planIdentify how you will maintain the interventionHow will the intervention be “hard-wired”/What is the visibility plan?Consider future actions required to improve he outcome9. Monitor resultsAllocate time for measuring results after implementationMeasure and analyze resultsReport results10. Continuously review the A3Does the story flow well?Is it easy to understand?Is the report neat/organized?Revise…
28A picture is worth a thousand words… Benefits of Using an A3A3s offer a simple & structured approach to reporting solutions to problemsHelps define a standard for all of the organization to useProvides a clear and concise method of reporting informationContent can be made visible and accessible to allPromotes communication and teamworkLeads to reduction of waste and improved processesSupports continuous improvementA picture is worth a thousand words…
37Report Card Trending Example Complete with auto-fill colors
38Resident Performance Dashboard Complete with auto-fill colors
39Dashboard Summary Data-driven decisions Multiple sources Comparable measures allows for “tiering” of programsInstitutional Review / AIRsTimely, visual and easy to identify trendsPre-emptiveEasy for Leadership “C Suite” to readEasy for CCCs to use