1. Lean Health Care at UMHS: Update on Plans for “Michigan Quality System” February 2005

2. Use of Lean Thinking in Health Care at UMHS 1.“Michigan Quality System” concept 2.GM Agreement 3.Two tracks: Model lines Internal awareness and training programs 4.Coordination across UMHS 5.Issues and feedback

3. Lean Thinking – The endless transformation of waste into value from the customer’s perspective 5 Principles of Lean (Womack and Jones) Specify value from customer’s perspective, by product line Identify the value stream for each product –How do we add value from the customer’s perspective? Make value flow without interruptions Let the customer pull value from our process Pursue perfection – apply continuously

4. “Michigan Quality System” MQS Concept Adapt lean thinking concepts for use at UMHS as a consistent approach to quality and process improvement Incorporates quality, safety, efficiency, and appropriateness Leads to Michigan Value

5. Uniform process improvement across UMHS –Across Missions: education, research, clinical/service med students in clinic flow –Across Goals: -Quality - Efficiency -Safety- Appropriateness a VSM created to improve “efficiency” can be used in an effort to improve “safety” (root cause analysis following an adverse event) –Spread to Adjacent Areas: merging projects ED => Radiology => OR –Training Synergy Transferability of training received for one project when working on other projects

6. GM Agreement Project facilitation: –Help facilitate 6 “lean” model lines Education: –Access to GMS training at Pontiac –Visits to GM’s premier “lean” facility (Lansing Grand River) –Assist developing UM education materials

7. MQS Model Line Projects What are they? Why use them? –Institutional examples of lean in healthcare –Proof of concept at UMHS –Can expand upstream, downstream and laterally Why not train all managers first? –Best way to learn: Learn Lean By Doing –Training long before use is less valuable

8. MQS Model Line Selection Process and Criteria Model line criteria: Institutional priority/visibility Potential for creating an exemplar Opportunity to expand upstream, downstream, sideways Opportunity for improvement (access/waits/bottlenecks, financial, satisfaction, errors) Process dependence Existence of a “clinical champion” Selection: Denton and Spahlinger = selected areas Project leads = determined scoping and sequence

9. MQS Model Line Sequence Vascular access – “Right line at the right time” Orders Management Project (OMP) – Pharmacy end-to-end ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Radiology – CT or timing of inpatient studies Emergency Department – Ideal patient flow OR –? 3 Head and Neck rooms (clinic through OR) –? “ADP one day LOS” throughput Care transition –Discharge planning –Cross silo patient flow

10. UMHS Awareness and Training GM Lansing Grand River Tour (9/04) GMS training in Pontiac: 18 staff/faculty trained (2004) “Pontiac in Ann Arbor” (February 3) 24 staff/faculty Coordination with Leadership Development Program: –Bill Lovejoy’s session for LDP 3 –Lovejoy’s LDP 1 & 2 alumni session (Feb 9) –LDP 3 Group Project: Clinic Access Improvement Leadership Day (May 26) –Keynote: Gary Kaplan “Lean in Healthcare at Virginia Mason” –Hands-on exercise: Value stream mapping Long/Ebbitt (GM)

11. UMHS Internal Training Planned: Just-in-time training for model line project teams –will learn value stream mapping at Day 1 of workshop Engineering course, 5 day Lean Healthcare –April 18-22, 2005 (some places are available) Internal development of UMHS training program HR: Integrated with Leadership Training Pyramid, Masters Series topic for more seasoned managers

12. MQS Training Development Goal: Build training for wide application of lean thinking to projects and daily problem solving in UMHS Levels: General awareness, team member, facilitator… Long Term Goal: Manager’s job: optimize the value stream map of their product line Resources: –Current 4-hour CQI training plus past courses (Deming-PDCA) –Patient safety and risk management training programs –GM training materials (4-hour, 8-hour, 3-day) –John Long, M.D. 8-hour workshop curriculum, ? Virginia Mason Work Group: –Jack Billi (EVPMA/Medical School) –Richard Coffey (Program and Operations Analysis) –Deb Guglielmo (CQIP) –Judy Hallas (Organizational Effectiveness) –Van Harrison (Medical Education) –Jeanne Kin (Medical School) –Jeanne Rizzo (HHC, ACA)

13. MQS Issues for Discussion 1. How best to coordinate across UMHS groups with Process Improvement expertise and resources: –CQIP (Hospital’s QI program) –Program Operations and Analysis –OCA/Safety/Risk Management –Faculty Group Practice –Departmental expertise

14. MQS Issues for Discussion 2. How do we encourage wide acceptance of one philosophy and set of tools for quality and process improvement to allow synergy across projects? –Med Education projects in clinical areas –“Clinical research – clinical flow” interface –Cross-silo or cross-department improvement

15. MQS Issues for Discussion 3. “Value stream improvement is management’s responsibility”. (Rother & Shook) What steps can facilitate us moving toward MQS being the way that UMHS managers view their role? “Management has to understand that its role is to see the overall flow, develop a vision of an improved, lean flow for the future and lead its implementation. You can’t delegate it. You can ask the front line to work on eliminating waste but only management has the perspective to see the total flow as it cuts across departmental and functional boundaries”. Learning to See. Rother and Shook

16. MQS Issues for Discussion 4. What is optimal coordination model/location within Health System for: –Ongoing training –Project management selection, assignment of facilitator/coach, actual day-to-day management and coordination (especially for cross-silo projects) OIC? Amb Care? FGP? CQI Program? POA? Decentralized? –LDP 3 (Ortho Access) –Departmental initiatives (Livonia ACS) –Line Managers (Denton, Calarco, Rizzo, Spahlinger)

17. Other Feedback?