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Next Hill Consulting Hugh Hufnagel, Next Hill Consulting, Oct 25, 2013.

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Presentation on theme: "Next Hill Consulting Hugh Hufnagel, Next Hill Consulting, Oct 25, 2013."— Presentation transcript:

1 Next Hill Consulting Hugh Hufnagel, Next Hill Consulting, Oct 25, 2013

2 Next Hill Consulting  Share lessons-learned from working with 56 primary care physician practices in Michigan  Share observations with each other  Learn how to be more successful more quickly with less wasted effort

3 Next Hill Consulting 1. Positioning lean 2. Practice recruitment 3. Lean leadership 4. Planning and starting lean work 5. Staff engagement, communication 6. Value Stream Mapping projects 7. Metrics 8. Sustaining lean 9. Most common mistakes and danger signs

4 Next Hill Consulting  Present Do’s and Don’ts for each topic area * Some will seem obvious to you, others will not  Ask you to share a few of your own experiences in each topic area

5 Next Hill Consulting Practice SizeTotal # of Practices Hospital Employed Independent Practices Solo Physicians404 2 – 4 Physicians34295 5 – 9 Physicians15411 10+ Physicians321 TOTALS563521

6 Next Hill Consulting  56 practices, 287 physicians plus PA’s and NP’s  Specialties: FP, IM, Peds, OBGYN  62 total VSM cycles  Mix: Full and half-day VSM events  Mix: Single practice events and multiple practice “collaborative” events

7 Next Hill Consulting VSM focus areas included:  Office visit flow  Office visit preparation (including chart prep)  Diabetes patient management  Asthma patient management  Preventive care  EHR implementation prep  Telephone inquiry management  Prescription refill process  Scheduling process

8 Next Hill Consulting Tensions  Primary focus: Add value or eliminate waste?  Goals: Patient focused: Altruistic Staff focused: Selfish  Reality: Work can’t be compartmentalized, eg helping patients also helps staff and vice versa

9 Next Hill Consulting Tie to practice values * Patient first * High quality care; continuous improvement * Truth, Trust, Honesty, Integrity * All staff members are respected and valued Tie to practice culture * Culture = living the values every day * Teamwork * Staff communication, growth * Fun place to work

10 Next Hill Consulting  Lean is a journey, not a destination  Lean is a set of tools to help you do things that are already on your “to do” list  Improved staff morale is a by-product of successful lean work

11 Next Hill Consulting  Position lean as a quick fix to deep management problems  Position lean as a “set of solutions”  Position lean as a way to eliminate jobs * LEAN = Less Employees Are Needed

12 Next Hill Consulting  View lean as another item to add to your “to do” list  Expect people to understand lean without experiencing it first-hand  Position lean as a short-term project

13 Next Hill Consulting  What positioning strategies have worked well for you? Why?  What positioning mistakes have you seen made?

14 Next Hill Consulting  Get PO help for independent groups * “Sell” lean to practices even if decision to participate is made by medical group mgt.  Set clear expectations * Work required * Desired outcomes  Assess practice readiness  Look for willingness to change

15 Next Hill Consulting  Look for willingness to * Standardize (but not “cookbook”) * Pay/share cost  Get practices to talk honestly * About their problems and wishes  Make sure all physicians know what is being done * Neutrality if not support

16 Next Hill Consulting  Start lean when * Other major problems, challenges * Physician cohesion issues * Physician sabotage is possible  Offer services at no cost * Money is a good proxy for commitment  Begin when the practice is “forced”

17 Next Hill Consulting  What other practice recruitment tactics have you found successful?  What tactical mistakes have you seen?

18 Next Hill Consulting  Identify a physician to lead * Actively promote work to his/her peers * Secure buy-in (or at least neutrality) from all physicians in the practice  Secure office manager leadership  Secure a long-term commitment * One year suggested

19 Next Hill Consulting  Respect all staff perspectives * Follow-through on all promises to staff  Identify and address objections to lean * Directly and quickly

20 Next Hill Consulting  Delay addressing physician resistance  Promote lean as short term “project”  Ignore staff recommendations  Regularly postpone deadlines or meetings

21 Next Hill Consulting  Think about a good lean physician leader. Why was s/he good?  Think about a poor lean physician leader. Why was s/he bad?

22 Next Hill Consulting  Focus on waste first * To find time for value-added work  Set two types of goals * Altruistic (patient-focused) goals * Selfish (staff-focused) goals

23 Next Hill Consulting  Identify an internal process improvement champion * List duties and expectations in writing * Train, mentor this person  Learn from others * Who have already addressed your topic

24 Next Hill Consulting  Focus solely on the patient  Add PI champion duties to the office manager  Expect staff members to “find” extra time to do lean work * Specific time each week should be identified * Off-load some tasks temporarily

25 Next Hill Consulting  If you had a mulligan (ie “do-over”) for starting work with one group you have worked with, what would you do differently? Why?

26 Next Hill Consulting  Develop a written staff engagement plan  Educate all staff before starting * What is being done and why * What lean is and is not (eg less employees)  R eally listen to staff * Make sure everyone talks * Listen harder to those who talk less

27 Next Hill Consulting  Survey staff to get input  Educate all staff on lean tools * They can use themselves * Examples: PDCA, 5-S, huddles, visual mgt, standard work/checklists, metrics * Lunch and Learns are a good format  Make the work fun

28 Next Hill Consulting  Remember physicians are “fixers” * They use scientific problem-solving every day  Recognize that practices are complex * Change in one area affects other areas  Keep staff engaged and informed regularly * Make lean a regular staff meeting agenda item

29 Next Hill Consulting  Put staff in the position of having to guess what is happening  Let one or two people dominate discussions  Let physicians confuse standard work with cookbook medicine  Limit lean work to a VSM team

30 Next Hill Consulting  What was your most successful staff engagement strategy? * Why was it successful?  What was your least successful staff engagement strategy? * Why didn’t it work as planned?

31 Next Hill Consulting  Select a positive or neutral physician to lead the team  Select “right” staff for lean team * Clarify expectations * Educate them  Develop a clear problem statement

32 Next Hill Consulting  Get direct patient input * FTF meetings, surveys  “Chunk” the current process * For better team understanding  Research or “go see” before drawing future VSM

33 Next Hill Consulting  Present VSM’s to physicians and staff * Let each team member present something * Helps secure understanding and buy-in  Choose only 2-3 goals/90 day cycle  Use Action Registers * Goals, metrics, tasks, what, who, when  Build-in one hour per week * For each team member to do work

34 Next Hill Consulting  Let staff perceive lean as only value stream mapping  Select too small of a project * L arge enough to justify time spent on work * But not too large to overwhelm the team  Do VSM work on evenings or weekends

35 Next Hill Consulting  Let a week slide by * With no work done on the project  Confuse the end of a lean cycle with the end of lean work

36 Next Hill Consulting  What is the funniest thing you saw happen during a VSM event?  What was the biggest VSM project failure you experienced?

37 Next Hill Consulting  Educate staff * Difference between process and outcome metrics * Metrics (numbers) vs milestones (words)  Ask each staff member to collect a process metric  Collect “before” metrics before starting * To measure amount of improvement

38 Next Hill Consulting  Collect real metrics for current VSM * Process time, delay time, lead time, % C/A * Guesses should be replaced with actual data  Collect metrics in periodic “snapshots”  Create a process metrics dashboard

39 Next Hill Consulting  Confuse metrics with milestones  Rely only on outcome metrics  Guess at process metrics  Believe that all metrics need to be collected all the time

40 Next Hill Consulting  Why do you think that practices have such a difficult time with identifying, collecting and reporting process metrics?

41 Next Hill Consulting  Link lean to the values of the practice * Patient focus, quality care, teamwork, individual growth, respect, fun place to work, integrity * Lean is walking the talk  Create a lean leadership team * Meet monthly to review overall efforts * Evaluate efforts honestly  Be persistent and long-term focused

42 Next Hill Consulting  Identify, discuss, resolve problems promptly  Use visual management * To keep lean work in front of the entire staff  Celebrate lean successes  Continue all staff lean education * Lunch & Learns

43 Next Hill Consulting  Postpone or cancel lean meetings often  Push too quickly through obstacles * Without understanding why they appeared  Give up if you are not successful the first time

44 Next Hill Consulting  What things have you seen physician groups do to successfully sustain lean efforts?  What are “warning signs” that a group will probably not sustain their lean work?

45 Next Hill Consulting 1. Lack of strong physician leadership 2. Not focusing on waste elimination soon enough 3. Not allocating time for staff to do work 4. Failure to view lean as long-term 5. Not gathering metrics to prove value

46 Next Hill Consulting 1. Lead doctor not attending lean meetings and visibly supporting lean work 2. Lean meetings being cancelled or routinely postponed 3. Failure of each team member to regularly work one hour/week on lean 4. Failure to collect process metrics 5. Lean work limited to lean VSM team

47 Next Hill Consulting  What would you add to the “most common mistakes” list?  What would you add to the “danger signs” list?

48 Next Hill Consulting  For listening and participating in the discussion Hugh Hufnagel 616-430-1419

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