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Lean At Denver Health: Saving Lives, Saving Money, Saving Jobs Phil Goodman Director Lean Systems Improvement.

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Presentation on theme: "Lean At Denver Health: Saving Lives, Saving Money, Saving Jobs Phil Goodman Director Lean Systems Improvement."— Presentation transcript:

1 Lean At Denver Health: Saving Lives, Saving Money, Saving Jobs Phil Goodman Director Lean Systems Improvement

2 What is LEAN? LEAN can be defined as a systematic approach of continuous improvement, based on the Toyota Production System (TPS) of lean principles and lean tools, used for the identification and elimination of waste.

3 Two Pillars Continuous Improvement Respect for People LEAN Pillars of Transformation

4 LEAN Values Waste is disrespectful of Society because it wastes scarce resources Waste is disrespectful of individuals because it asks them to do work with no value - President of Toyota Waste is disrespectful to patients by asking them to endure processes with no value Waste is disrespectful to taxpayers for asking them to financially support processes with no value

5 Two-Pronged Approach of Deploying Lean at Denver Health Two-Pronged Approach of Deploying Lean at Denver Health 247 DH Black Belts (BBs): 48 hours lean training Day to day lean RIE team leads Quarterly reports BBs embedded throughout clinical and non-clinical areas 36 Master BB’s Rapid Improvement Events (RIEs) RIE is 4.5 day team event 7-9 team members RIEs are based on Value Stream Analysis 16 Value Streams Each Value Stream will conduct 8 RIEs per year Each value stream is assigned to an executive staff member

6 Black Belt Projects Creative, Innovative, and Productive! DH Black Belts are using lean everyday, in every way….here’s an example: Engineering: $457,000 reduction in supply expenses

7 Black Belt Project Example: Common Canister Inhalers for Asthma and COPD: Combivent, Albeterol, Atrovent, and Flovent

8 Pharmacy/Respiratory Therapy “Common Canister” Black Belt Project: Pre Lean: 6,624 canisters/year

9 Post Lean: 2,381 Canisters/year Savings in Acquisition Costs: $363,000! (75% Reduction)

10 Rapid Improvement Event (RIE) –Using Lean Tools in Focused Manner Day 1 Mon Examine a process/function or area Identify areas of waste, non-value added steps Identify metrics Day 2 Tues Develop new process, standard work and communication to eliminate identified waste and increase value Design rapid experiments Day 3 Weds Implement the new processes, standard work Monitor production board and communicate standards Observe new process and any change in metrics Day 4 Thurs Adjust and fine tune new standard work Day 5 Friday Celebrate! 10 minute team reports

11 RIE Employee Engagement YTD August 24, 2012 415 Rapid Improvement Events 2,055Employees participated on RIEs 16 Value Streams 247 Black Belts

12 2012 Value Streams Revenue Cycle1 st Floor Managed CareNursing RMPDC- Patient Access OB/Gyn RMPDC- Drug & Product Safety Community Health Services I Specialty ClinicCommunity Health Services II Clinical ProcessBehavioral Health PharmacyPerioperative Services EducationHuman Resources

13 Examples of Clinical and Non-Clinical Lean Events Facility Bill Clean Claim Rate Improve Internal Processing Turnaround Time Reduce # of accounts on front end work lists DVT Prophylaxis Cancer Screening Chronic Opiate Therapy Surgical Site Infection Rehab Utilization Provider Flow Cells Problematic Rx

14 Surgical Site RIE Case Study 1.Reason for Action SCIP II requires abx within 60 minutes of “first cut” 2. Initial Condition Prophylactic abx in OR within 60 mins < 80% of cases 3.Target Condition Prophylactic abx in OR within 60 mins in 100% of cases 4.Gap Analysis Abx given “OCTOR” Variable abx APC Frustration OR Frustration 5.Solution Approach Conduct waste walk Map process RIE to include IC Chart review 6.Rapid Experiment Change OCTOR to “Abx delivered in OR by anesthesiologist” Abx guidelines 7.Completion Plans Change order forms Monitor data 8.Confirmed State Per Dr Lockrem: “We’ve changed our practice” 9.Insights The problem was definitely the process, not the people!

15 Clinical RIE Case Study Results RIE June, 2005

16 Enterprise Transformation Alignment Aligning System Metrics with Value Stream Metrics Value Stream Metrics and RIE Metrics

17 Enterprise Metric Alignment: OB ED/ AU CC Spec Clinic Rev Cycle HRMCRxBHSRM PD C Para medi cs NSG CPMed D/C CHS RIE QualityDelivery (Access) ProductivityFinancialHuman Development Nosocomial Infections ED DivertVisits per Session Expense per D/C or Encounter Employee Engagement System Level Metrics Value Stream Level Metrics RIE Level Metrics

18 Achieved with no layoffs and no reductions in patient services!


20 Standard Work: Metric Monitoring RIE Team Lead/Process Owner Lean Facilitator Sr. Financial Analyst Associate CFO Review CFO Review CEO Review

21 Transparency At Denver Health Example: Human Resources (HR) Value Stream HR RIE Level Metrics Posted “In the Gemba ” HR Value Stream Level Metrics Near Greg Rossman’s Office HR Metrics Posted at the Enterprise Level in Sabin

22 Summary Lean is a philosophy and tool set that fits for healthcare Eliminating waste improves quality of care Lean tools are intuitive Frontline staff must be respected because they understand where the waste exists and how best to eliminate it Lean has the power to change culture because it truly empowers employees to break down silos, rapidly implement change and own the process!

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