MCHC Leaders At All Levels Go Lean! – Standardizing Work For Daily Problem Solving March 6, 2012

Main Objectives Of The Session: - Learn what led the University of Michigan Health System (UMHS) to develop a complementary lean deployment model - Review the Lean In Daily Work Model and the approach taken to design standard work for daily problem solving - Share implementation examples/success stories from across UMHS - Review next steps at UMHS for ongoing model implementation and spread

Root Cause Analysis Of Lean Deployment Challenges

Comparison of Lean Deployment Models Original diagram – Michel Balle Altered to show the relationship between LIT and our Current Lean Deployment Model Lean In Daily Work Model People Development Strategic Deployment Process Improvement Lateral Spread Strategy Alignment VSM Workshop Value Stream Map (Problem Solving) Workshops Strategic Deployment Process Improvement Strategy Alignment

Strategic Area Passionate Pro-Active Leadership Ideal Pilot Area Pilot Area – Recommended Selection Criteria Passionate Pro-Active Leadership Area has direct reporting relationship to a leader with a passion for improvement Leader has demonstrated a high degree of follow through and accountability related to past improvement efforts Strategic Area Area directly connected to core UMHS Strategies Strategic connection may include but is not limited to: a Destination Program, early adopters for Patient Access and Financial Clearance and / or Service Excellence, Transitional Care Pilot area, connection to Strategic Value Streams such as Medical Admission Stream, Surgical Stream etc. (Area has 75 or less faculty & staff members)

Current Lean In Daily Work Model Sites

Key Metrics: Define, Measure, & Display Routine Interactions to Identify Problems Problem Solving Approaches Transfer Knowledge for Shared Learning *Links to strategic deployment *Part of daily standard work*Design and run experiments*Share across organization Hourly / daily key operational metrics and targets Daily / weekly cumulative counts of complex problems Daily team huddles at visual board Daily leadership walks in the gemba (also wkly/mthly) Monthly review & problem prioritization by team leads “Just Do It” no written plan needed “Everyday Lean Ideas” structured form (8.5”x11”) “A3 Problem Solving” structured form (11”x17”) The Lean In Daily Work Model: Standard Work for Daily Problem Solving Assessment of Problem Complexity Triage based on problem complexity Low High Med. Share learning from experiments across UMHS *Takes place in the gemba Problems

The Lean In Daily Work Model is a System Visual Metrics in the Absence of Team Huddles & Leadership Gemba Walks Quickly Becomes Wallpaper… Team Huddles & Leadership Gemba Walks in the Absence of Visual Metrics Quickly Becomes a Social Event…

Metric Management, Team Huddles & Problem Solving (An Integrated Approach)

Key Measures Of Success ImpactUMHS Strategic Alignment Lean In Daily Work Infrastructure Sustained Monthly audits taking place in each LIT Pilot area, surfacing necessary correction actions Sustaining Gains # of Lean Solutions Implemented & Documented 200 Everyday Lean Ideas Implemented Since 10/2009 (Many more in queue!!!) People Development, Process Improvement, Service Excellence & Lateral Spread Improvement & Sustaining of Value Metrics Up to 80% Improvement to team’s Value Metrics Strategic Deployment, Process Improvement & Service Excellence Improvement in Lean Culture Survey Score 51% Improvement In Overall Score 115% Improvement In “Willingness to Recommend” People Development & Service Excellence Evidence of Model Spread Yes - Evidence of active Mentoring of new LIT areas Lateral Spread Key Measures of Success / Strategic Alignment

*Urology Value Metric *while spending the same or more time with Patient (increase value!) Change% Improvement FUDS visits within 45 minutes25% to 68%172% Pediatric surgeries scheduled within 1 day of appointment34% to 72%112% Pediatric visits within 60 minutes32% to 62%94% Adult patients placed in room within 15 min. of arrival48% to 81%69% Number of symptom calls in all CareWeb Nurse Inboxes855 to 34260% Adult patients visits completed within 60 minutes39% to 57%46% Adult surgeries scheduled within 3 days of appointment64% to 96%41% Charge entry complete within 1 day of appointment65% to 91%40% New patients scheduled within 4 weeks60% to 79%32% Nurse calls complete within 72 hours63% to 80%27% Sustained Improvement Of Value Metrics (Urology Clinic Summary)

LIT Resource Page Username – unique id Password – level 1 kerberos password

Questions / Comments Contact Information: Brendon Weil Lean Coach, University of Michigan Health System