2 You Say Kaizen, I Say “Core Value” Lean Consortium Matthew Schreiber MD VP of Operations for Acute Care Health Spectrum Health May 20, 2016

Lean in One Slide Kaizen Culture is a “Management Operating System” [leadership lifestyle] Time is the currency of success Value is from the perspective of the customer. Improve value by removing waste Go to the Gemba A3 Thinking to identify gaps, create action plans, monitor and measure for success Improvement can only begin once there is a platform of standard work One Piece Flow is gold standard practice Use visual management tools [Kanban, 6S, MDI boards] to error proof [Poke- yoke] Spread learnings [yokoten] 3

Safety Culture in One Slide Safety as a core value is a leadership lifestyle Safety is Don’t Harm Me, Heal Me, Be Nice to Me *What’s good for our patients is good for our employees [who become our patients when injured] Reliability is how often we do what we say we’re going to do Collegial Interactive Teams are the antidote to complexity Make it easy to do the right thing and hard to do the wrong thing Outcomes depend on the dynamic interface between imperfect people and imperfect process Speed the learning cycle by learning from other’s experiences as if they were our own 300%* Accountability Use Cause Analysis to move from reactive improvement to predictive models Don’t just want zero events—want zero risk of zero events 4

Kaizen is Change for the Better Continuous improvement at the lowest possible level, Under the guidance of a mentor or teacher, Utilizing the scientific methodology. 5

Safety as a Core Value Safety is the price of entry for healthcare Safety trumps all When faced with a choice, choose safety Reliability predicts safety and safety produces quality, but converse is not true 6

7 Summary – Myth vs. Reality of SHPIS What SHPIS Is Not:  A tangible recipe for success  A management project or program  A set of tools to implement  A short-term or mid-term solution What SHPIS Is:  A consistent way of thinking  A total management philosophy  Focus on total customer/patient satisfaction  An environment of teamwork and improvement  A never-ending search for a better way  Quality built-in process  Organized, disciplined workplace  Evolutionary

What Safety Isn’t Be more careful Try harder Blame management Project Clinical problem Hospital problem 8

What Safety IS A lifestyle change A Leadership method Prioritization/focus delivery schema Continuous improvement philosophy Patient/employee/leadership activation Outcome measure Reliability platform that supports all necessary efforts Intrinsic accountability 9

10 Summary – SHPIS vs Safety A consistent way of thinking A total management philosophy Focus on total customer/patient satisfaction A never-ending search for a better way An environment of teamwork and improvement Quality built-in process Organized, disciplined workplace Evolutionary What SHPIS Is:What Safety Is: A leadership lifestyle Prioritization/focus delivery schema Continuous improvement philosophy Patient/employee/leadership activation/shared responsibility Outcome measure Reliability platform that supports all necessary efforts Intrinsic accountability for greatness

11 Two Pillars of SHPIS – Lean Respect for People Continuous Improvement PEOPLEPEOPLE CONTINUOUS CONTINUOUS IMPROVEMENTIMPROVEMENT Respect for all people is a foundational value

Two Safety Axioms Safety Message Must Be Genuine Safety is Hard because it takes 100% of the people 100% of the time 12

Summary – SHPIS vs Safety SHPIS Respect People Continuous Improvement is a leadership responsibility Safety Safety Message Must Be Genuine Safety is Hard because it takes 100% of the people 100% of the time 13

Value Added (VA) Definition – Any activity that contributes directly to satisfying the needs of a Customer Non-Value Added (NVA) Definition – Any activity that takes time, space or resources, but does not contribute directly to satisfying the needs of a Customer Need Met Time Value Added vs. Non-Value Added

Ultimate Safety Metric? Time from decision to seek care until definitive care is rendered 15

Summary – SHPIS and Safety Time is the currency of success 16

Summary – SHPIS and Safety Improve value by removing waste Simpler is Safer Complexity is the enemy 17

SHPIS and Safety Standard Work: Hard to know if something is unexpected if “usual” is highly variable 18

SHPIS and Safety Inspiration is the work of leadership 19

20 Ultimately, SHPIS is about…the people “It is a system designed to provide the tools for people to continually improve their work. “The Toyota Way means more dependence on people, not less. It is a culture, even more than a set of efficiency and improvement techniques. You depend upon workers to reduce inventory, identify hidden problems, and fix them. The workers have a sense of urgency, purpose and teamwork...” Jeffrey Liker, “The Toyota Way,” p. 36

Living Example—Cause Analysis Root Cause Analysis = A3 Thinking and Documentation 21