1. TWI: The Link to Lean In Healthcare Joan Ching, RN, MSN Administrative Director Hospital Quality and Safety Virginia Mason Medical Center TWI Webinar Oct. 13, 2009

2. Our Strategic Plan

3. Copyright 2008 Virginia Mason Medical Center All Rights Reserved. Any further use of these materials is prohibited. Standards “Without standards, there can be no improvement.” -Ohno Standards provide stability. Stability provides visibility. Visibility provides targets for kaizen. (purrier) © 2009, Virginia Mason Medical Center

4. Copyright 2008 Virginia Mason Medical Center All Rights Reserved. Any further use of these materials is prohibited. Standard Work Benefits: Insures that work and expectations are safe and reasonable Allows you to see abnormal conditions as soon as they occur Serves as a basis for future improvement efforts Makes it easier to train staff Ensures that we are creating value for every customer, every time A prescribed, repeatable sequence of operations assigned to a single team member.

5. Select Right Topic Tied to Organizational Goals An Important Problem to Solve High Visibility Hand Hygiene and Patient Falls

6. When to Train SEPTEMBER SundayMondayTuesdayWednesdayThursdayFridaySaturday SundayMondayTuesdayWednesdayThursdayFridaySaturday 13141516171819 20212223242526 12:00 AMMartha P. 12:00 AM 1:00 AM 2:00 AM 3:00 AM 4:00 AM 5:00 AM 6:00 AM 7:00 AM 8:00 AM 9:00 AM 10:00 AM Debbie Kelly Martha Purrier Janine W. 10:00 AM Martha Purrier Janine W. 11:00 AM 12:00 PM 1:00 PM Fe Schanz 1:00 PM Fe Schanz 2:00 PM Charlene Tachibana 2:00 PM 3:00 PM 4:00 PM Janine W. Arni Verkler Alenka Rudolph 4:00 PM Alenka Rudolph Arni Verkler Janine W. Charlene Tachibana 5:00 PM Joanie Ching 5:00 PM 6:00 PM Joanie Ching Arni Verkler 7:00 PM 8:00 PM 9:00 PM 10:00 PM

7. Time Table: Units 1. Hand Hygiene - Soap and Water 2. Han Hygiene - Gel July 26th - Aug 1st Aug 2nd - 8th Aug 9th - 15th Aug 16th - 22nd Aug 23rd - 29th Aug 30th - Sept 5th Sept 6th -12th Sept 13th - 19thSept 20th - 26th Changes in Schedule Job Name:3. Hourly Rounding Department(s):17,16,15,14,10,9,8,7 Date:Summer 2009 Level 9 XXX Level 14 XXX Level 8 XXX Level 7 XXX Level 17 XXX Level 16 XXX Level 15 XXX Level 10 XXX Turnover Work Performance

8. Time Table: Staff Job Instruction Training Timetable - Healthcare Unit Training Minutes Left: 1860 Name: Barnes Group: RN Dept: Neuro/Neph/Uro Date: June/July 2009 Training Minutes Left Breakdown # Hand Hygiene Soap/WaterHand Hygiene GelHourly Rounding Name Training F/U #1F/U #2F/U #3F/U #4F/U #5 Training F/U #1F/U #2F/U #3F/U #4F/U #5 Training F/U #1F/U #2F/U #3F/U #4F/U #5 Miranda Livermore60 Karen Gormley60 Christine Holbrook60 Mariano Lara60 Valentina Calabia60 Mina Wirth60 Sharon Veith60 Derrek Dunn60 Ana Hernandez60 Debbie Lafave60 Susan Lamar60 Theresa Lehan-Anderson60 Kristyn Albornoz60 Mandi Cantera60 Kevin Garcia60 Lisa Oehl60 Karen Symens60 Diem Tran60 Emily Cate60 Debra Cavinta60 Cindy Allen60 Lori Anderson60 Christopher Klein60 Miaoduan Lu60 Lori Marlenee60 Claire Otebele60 Elizabeth Field60 John Berquist60 Linda Hardin60 Klayton Johanson60 Jenna Stephens60

9. Engage the Leadership Certified Leaders’ Collaborative- Certified Leaders in VMPS Monthly Managers’ Meeting- all VM Managers and Leadership for the organization Quarterly KPO Update- whole organization KPO “Stand Up” Meetings Grand Rounds- Physician Cont. Ed.

10. Engage Unit Leaders Unit Leaders trained early or first Unit trainers utilized as well as external trainers Leaders taught how to conduct follow up Packets on units to track progress Frequent updates included progress (#s) as well as stories

11. 3 rd Quarter Focus: Safety/Quality Defect Falls Falls University, Falls Collaborative Multiple PDSAs

12. Results “For a long time now, I’ve taught my staff that the majority of patient falls occur during the toileting process. Knowing, however, wasn’t enough to hardwire actions to prevent patient falls. TWI provides the hardwiring and rigor … toileting is planned for & built into my staff’s work flow. It’s really made a difference on Level 8.” Rowena Ponischil, Director, Levels 7/8 With the implementation of hourly rounding using TWI methodology, a unit that consistently averaged 1-2 falls/week has gone 45 days without a fall. It’s too soon too tell but appears promising.

13. Results “Recently I entered a patient's room on Level 10. From her bed, this patient watched me wash my hands. The patient remarked, "That is so interesting! EVERYBODY coming in here washes their hands the exact same way! I've never seen anything like it!" Ellen Noel, Med-Surg CNS