The Outstanding Organization Colloque Lean Santé 2016 Saguenay, Québec, Canada 1
To Err is Human Institute of Medicine, 1999 Up to 98,000 deaths annually due to medical errors. Goal: Reduce by 50% in 5 years. 2
Something Is Terribly Wrong Progress has been slow. Journal of the American Medical Association 2009 180,000 Medicare patients die annually from medical errors. Office of the Inspector General 2010 33% hospitalized patients are harmed; 7% result in permanent injury or death. Health Affairs 2013 Medical errors the third leading cause of death in America. How Many Die from Medical Mistakes in U.S. Hospitals? ProPublica 2005 Annual death toll from medical errors is closer to 200,000. Dead by Mistake Heart Newspapers Special Report 2010 No significant change in rate of preventable errors. New England Journal of Medicine 2011 200,000-400,000 deaths per year due to preventable harm in hospitals. Journal of Patient Safety 2014 3
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Traits of Outstanding Organizations From The Outstanding Organization 2016 The Karen Martin Group, Inc. 9
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Go & See. Ask Why. Show Respect 13
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Inpatient Flow Current State Value Stream Map Customer EPIC CARE LINK MUSE PAC S EPIC AllScripts (ECIN) Admit Patient ED Phys HUC 1 Handoff Patient 2 ED Phys Admitting Phys 3 Enter Orders To Admit Admitting Phys Assign Bed Bed Control 4 5 Discuss Bed Assignment TCC CC 6 Handoff from ED to Floor ED RN Floor RN 7 Transport & Admit To Room Transporter Assigned RN 8 Execute Diagnostic Evaluation Lab, Imaging, PT, OT, RT, SLT 9 Execute Treatment Plan Attending Phys 10 Perform Tests and Procedures Ancillary Depts 11 Initiate Discharge Process Attending Phys 12 Clear Patient for Discharge Attending Phys; Consults 13 Correct Med Rec Nursing, TCC, PT ED Transport Patient 14 Volunteer, Ambulance Service Enter D/C Disposition TCC RN 15 Clean Room EVS 16 LT = 8 mins. PT = 7 mins. %C&A = 99% LT = 20 mins. PT = 5 mins. %C&A = 90% LT = 35 mins. PT = 20 mins. %C&A = 95% LT = 35 mins. PT = 10 mins. %C&A = 60% LT = 15 mins. PT = 5 mins. LT = 45 mins. PT = 5 mins. LT = 150 mins. PT = 90 mins. LT = 48 hrs. PT = 120 mins. LT = 48 hrs. PT = 90 mins. LT = 4 hrs. PT = 60 mins. LT = 91 mins. PT = 90 mins. LT = 2 hrs. PT = 30 mins. LT = 2 hrs. PT = 60 mins. LT = 4 hrs. PT = 15 mins. LT = 22 mins. PT = 2 mins. LT = 1 hrs. PT = 45 mins. 8B Initiate Consults 9B Visit Pt; Conduct Hi Risk Assess. Attending Phys Case Mgmt 9C Begin Creating D/C Plan CM, MD, PT, OD, Dty, RN, IOS, Pharm 0.1 hrs. 0.0 days 0.0 days 0.0 days 0.0 days 0.0 days 2.5 hrs. 2.0 days 2.0 days 4.0 hrs. 1.5 hrs. 2.0 hrs. 2.0 hrs. 4.0 hrs. 0.0 days 0.0 days Total LT = 4.8 days 0.1 hrs. 0.1 hrs. 0.3 hrs. 0.2 hrs. 0.1 hrs. 0.1 hrs. 1.5 hrs. 2.0 hrs. 1.5 hrs. 1.0 hrs. 1.5 hrs. 0.5 hrs. 1.0 hrs. 0.2 hrs. 0.0 hrs. 0.8 hrs. Total PT = 10.9 hrs. Activity Ratio = 9%
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Measuring In-Process Quality: Percent Complete & Accurate (%C&A) Quality of Input? 60% Customer Quality of Output? Process 1 Process 2 Process 3 70% 85% 50% 90% Process 4 17
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Distraction Kills
There is no such thing as multitasking.* * For cognitive tasks. 2016 The Karen Martin Group, Inc. 20
Focus Law #1: STOP DOING Focus Law #2: DO FEWER THINGS AT ONCE 2016 The Karen Martin Group, Inc. 21
A Key to Apple s Success? saying no to 1,000 things to make sure we don t get on the wrong track or try to do too much. it s only by saying no (or not now) that you can concentrate on the things that are really important. Steve Jobs 22
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The Power of Focus: Organization A Projects Completed 20 12 12 Projects Started Projects Completed 3 Pre-Focus Post-Focus 24
Organization B: Completed Projects Per Year 73 24 No additional resources Higher quality products launched Pre-Focus Post-Focus 25
Annual Hoshin Planning (Strategy Deployment) Builds consensus around TRUE NORTH. Creates organizational focus on what matters most
Strategy Deployment Key Feature: Catchball What? Who? When? Executive Team Year 1 What? Who? When? Senior Mgmt Year 2 Year 3 What? Who? When? Middle Mgmt What? Who? When? Frontline 27
Step 1 - List what you could do on 3x6 post-its. Gain consensus. Now Maybe Step 2 - Categorize them. Gain consensus. Step 3 - Decide what you will do. Gain consensus. Later Never 28
Now Maybe Step 4 Create Work Plan Later Never 29
Modified Strategy Deployment Annual Plan 2 1. Increase sales 5%. 3. Achieve 10% profit. X = Planned = Actual Level of Effort/Involvement Required Tactical Priority Goal or Measurable Objective Exec Owner Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Owner IT Mktg Ops HR Bob Fin PE Pario COM CDs / PD PD BMD SWS Direct AMs Rec Mgmt 3,500 units sold by 12/31/2013 through all channels X X X X X X X X X X X X Bob Dana 2 3 3 3 2 3 3 1 1 3 3 1 3 (approx. $700K) 11 Develop & deliver training to top 50 Dealers X X X X X X Bob Rex/Tim 3 3 3 21 Revised course materials by 6/30/2013 X X X Bob Josh R? 2 3 3 2 2 5 8 9 Education: 1 school district spec'd/underperforming COM distributor (25) by 12/31 valued at min $35K each 10 new dealers on board (net) ($500K per dealer this yea r) 5 new distributors bringing $200K annual rev (& 5 terminated) X X X X X X X X X X X X Howard Michael S 1 3 2 3 3 X X X X X X X X X X X X Howard Mike B 2 3 X X X X X X X X X X X X Howard Howard 1 1 1 2 3 17 10 projects spec'd by 12/31; $300K rev by 12/31 X X X X X X X X X X Howard Dana 1 3 3 3 29 20 by year-end X X X X X X X X X X X X Howard Mark H 2 3 3 3 32 TBD X X X Howard Howard 33 TBD X X X X X X X X X Howard Howard 10 Useful reporting and metrics are established and in place X X Jim Randall 3 1 1 1 1 1 1 30 TBD X X X X X Jim Josh 3 31 TBD X X X X X X Jim Josh 1 1 1 3 1 1 1 1 1 1 1 1 1 1 25 TBD Jim Shannon 3 3 1 1 1 1 1 26 System 7.0's in place X X X Jim Randall 3 2 1 2 1 15 20 22 2013 Goals & Objectives Content removed for confidentiality 100% accurate payroll; 100% management satisfaction at April mgmt. meeting Internet task list is simplified and streamlined for PDs then plan is rolled out to PDs Design Calculator is updated successfully and rolled out < Company Name > 2013 Priorities 2. Achieve 50% gross margin. Created: 01-14-13 4. Improve morale (metric TBD). Revised: Plan review dates: X X X Josh Phyllis 1 3 X X X X Michael M Michael M 2 3 2 3 X X X Neall Matt D 3 1 1 3 2 2 3 24 Competitive Analysis complete and distributed for use X X X Neall Dana 2 3 3 3 3 3 3 1 Design changed to solve delam issue long-term X X X X X Susan David R 3 2 3 12 13 30 parts sourced in U.S.; completed plan for managing China-sourced parts Warehouse laid out; kanban revised; Syspro implemented X X X X X X Susan Shannon 3 3 2 2 X X X Susan Shannon 3 14 Lay out complete; equipment installed X X X Susan David R 3 3 30
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Practice vs. Performance Train 90% Perform 99% Perform 10% Train 1% Athletes Businesses Jim Loehr & Tony Schwartz, The Power of Full Engagement 32
Develop hypothesis Refine Standardize Stabilize Conduct experiment Measure results 33
Clarifying the PDSA Cycle Phase Detailed Steps Often 50-80% of the total time Plan Develop Hypothesis 1. Define and break down the problem. 2. Grasp the current condition. 3. Set a target condition. 4. Conduct root cause & gap analysis. 5. Identify potential countermeasures. 6. Develop & test countermeasure(s) Continuous Improvement Adjust Adjust New Problem Do Conduct Experiment 7. Refine and finalize countermeasure(s). 8. Implement countermeasure(s). Study Evaluate Results 9. Measure process performance. Adopt Adapt Abandon Adjust Refine Standardize Stabilize 10. Refine, standardize, & stabilize the process. 11. Monitor process performance. 12. Reflect & share learning. 2015 The Karen Martin Group, Inc. 34
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Who s Minding the Store?
Process Owner Process Doctor 37
Value Stream & Process Oversight Value Stream & Process Ownership ABC Medical Center Value Stream Value Stream Manager Process Process Owner Outpatient Imaging Sally V Scheduling & Registration Bill G Exam & Clinical Reporting Reports to physician Jose C Maria J Inpatient surgery Tonianne S Admission Tom M Clinical stay Discharge Billing Kathleen T Mike M Sylvia S Revenue Cycle Management Bruce T N/A N/A 38
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Engagement Drivers: The Three C s The Outstanding Organization, pp. 155-158 Connection To vision, annual goals, immediate supervisor, peers, customers Full use of talents, capacities, potentialities, & skills Creativity Control Heavy involvement in decisions that influence how they do their work. 40
Leaders develop strategy (what) Workers design tactics (how) 41
Effective error proofing can be very low tech 2016 The Karen Martin Group Inc. 42
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Problem solving and making improvement done properly is a high. 44
What You Can Do to Reduce Chaos 1. Operate with 2-5 visual KPIs in all areas. 2. Manage the work through explicit value stream and process owners. 3. Select 3-7 key improvements needed and focus on those. 45
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www.ksmartin.com ksm@ksmartin.com 47