Go Slow to Go Fast P R E S E N T E R S Dennis Stone, Robert Corson, Leigh Snow & Chee Keong Lin OCTOBER 18, 2017 C A P T U R E A N D L E V E R A G E T H E L E A N A D V A N T A G E
Presenters Robert Corson Leigh Olson Snow Dennis Stone Chee Keong Lin Exeter Hospital TRO TRO SmithGroup JJR Facilities Architect Healthcare Planner Project Manager Engineer Lean Process Facilitator Principal-in-Charge Process Leader
Learning Objectives This case study will: Demonstrate the value of Going Slow To Go Fast in a project setting Show how to use the Lean A3 problem-solving process to structure a pre-design exploration and set the stage for an informed design process. Show how to use the PDCA cycle and continuous improvement to facilitate a large group investigation. Inspire and equip participants to apply these principles and tools in other project settings. 3
Agenda 1. Background: Exeter 2020 2. Inspiration: Go Slow to Go Fast 3. Content: Lean A3 Problem-Solving 4. Process: Plan-Do-Check-Act Workshops & Tours 5. Next Steps 4
1. Background: Exeter 2020
Project Description Exeter 2020: Pre-design study Multidisciplinary team exploration Inpatient care models and innovations Spanned 8 months Team 17 Exeter Hospital staff members 5 TRO designers / planners / engineers 6
Exeter Hospital Background Independently-owned Community Hospital and Health System 42 acre main campus Serves 46 communities in NH 100 inpatient beds in 5 units 5 years into Lean journey 3 Operational Excellence practitioners on staff 7
2. Inspiration: Go Slow to Go Fast
Inspiration: Why Do this Study? What makes a small community health system sustainable? Operational improvements that support the Triple Aim (+ one) + Organizational Sustainability 9
Inspiration: Why Do this Study? Inpatient care is changing Current state of Inpatient Units does not support Triple Aim objectives: Aging infrastructure Discreet and separate units Patient rooms below industry standard Inadequate support space Distance from support services Not conducive to standard work 10
Inspiration: Why Do this Study? Concepts behind Exeter 2020 Sustainable value-added process Building alignment throughout the team Common goals & values Shared knowledge & vocabulary Change management Go Slow to Go Fast Stakeholders involved from the start STAKEHOLDERS INFLUENCE OVER TIME 11
Facilities Architect -Instigator RN - Nurse Leader Facilities planner Infection Prevention Designer RN - Nurse Manager MD Hospitalist RN - Nurse Systems Engineer Material Management VP Acute Care Lean Director Interior designer Information Technology Interior Designer Patient Experience Advocate Architect RN - Nurse Planner/Architect Sr VP Clinical Operations Lean Leader Patient Experience Advocate C A P T U R E A N D L E V E R A G E T H E L E A N A D V A N T A G E Team of stakeholders: 22 Laura 12
3. Content: Lean A3 Problem-Solving
A3 Process 14
Mission Statement embodies A3 Process We re a multidisciplinary team that is studying the future of inpatient care delivery at Exeter Hospital. We re starting by understanding the current state, exploring trends elsewhere and envisioning our ideal future state. Together we ll develop a road map for next steps towards our vision of optimizing patient and staff experience. 15
4. Process: Plan-Do-Check-Act
Initial Proposal 17
Overlaying the A3 Process 18
Engaging Stakeholders Effectively 19
Actual Process Workshop Multidisciplinary Team Current State Future State & Trends Analysis Next Steps 1 Process, Scope, Goals 2 Learning to See & Going to Gemba 3 HealthCare Design Conference 4 Defining the Problems 5 Root Cause Analysis 6 Countermeasures; Prep for Tours Facility Tours 7 Assimilation & Next Steps 20
4. Process: Workshops & Tours
Workshop 1: Process, Scope & Goals Summary Introductions & team building Defined scope and process Rated the Keys to Success Discussed current state Envisioned future state Key Lean Principles Multidisciplinary Team all voices Defining value by the clients needs Outlined process PDCA and A3 Go slow to go fast entire day workshop on setting the foundation for the study Key Takeaways Defined parameters of study Developed shared conditions of satisfaction keys to success 22
Workshop 2: Learning to See & Going to Gemba Summary Developed Mission Statement. Learned ways to look at space and healthcare design principles Addressed how to read drawings Five hours of observation in existing Exeter inpatient units Key Lean Principles Looking at flow process improvement mindset Going to Gemba Key Takeaways Deep understanding of Current State Process improvement mindset Identified the need to tour more hospitals (more Gemba walks) 23
Workshop 3: HealthCare Design Conference Summary Eighteen team members at national HealthCare Design conference Attended 216 total, 42 unique learning sessions Toured a nearby new hospital (Gemba walk #2) Shared learning amongst the team in a full day session back home Key Lean Principles Exploring Future State and possible countermeasures Team building empowering team Key Takeaways Focused our future learning on doing tours (rather than more conferences) Education built a common understanding of conditions for satisfaction for the new design. 24
Workshop 4: Problem Analysis Summary Collected elements of Future State Gap Analysis Prioritized Problems Key Lean Principles Gap Analysis: Multidisciplinary team Plus delta learning Key Takeaways Established consensus on the problems to focus on solving Shared perspectives on problems 25
Workshop 5: Root Cause Analysis Summary Chose 5 top problems and did a 5-Why analysis Key Lean Principles Root cause analysis Key Takeaways Helped solidify that we should not jump to a solution; study the problems and the data All problems are intertwined root causes are often shared Multidisciplinary team helped us to understand the root causes in a much deeper way 26
Workshop 6: Countermeasures & Prep for Facility Tours Summary Deeper study of countermeasures what are ways we can approach these problems Half day preparation for facility tours study plans and follow patient paths through them Key Lean Principles Simulation of patient care process for 4 different unit layouts Go Slow to Go Fast deep study of the buildings we will tour so we can get more from the experience; prepare questions Key Takeaways Assimilation of learning Preparation for Gemba 27
Facility Tours 3 & 4: Gemba Walks Summary Full day tours of two recent inpatient units: MaineGeneral Hospital Lunder Building at Mass General Hospital Key Lean Principles Going to Gemba (others) Looking at flow Key Takeaways Successful projects had good clarity about goals from the beginning, patient first ideology for everything Lean was very present; process improvement and standardization were strong and effective in both units 28
Workshop 7 Assimilation & Next Steps Summary Summarized each workshop Developed key takeaways Checked back to initial goals Discussed Next Steps Key Lean Principles PDCA Implementation / Action Plan Key Takeaways Summary of our progress and accomplishments Road map for next steps 29
5. Next Steps
June 2017 October 2018 C A P T U R E A N D L E V E R A G E T H E L E A N A D V A N T A G E Next Steps - Road Map Building the Business Case 2017-2018 Organizational Alignment Education/ Learning Strategic Planning IP+OP Demand/ Market Analysis Project Scoping Feasibility Programming Concept Modeling Design & Documentation Construction Facilities Assessment Current State Mapping Future State Mapping Clinical Model Testing 31
Guiding Principles for the Future Design Project Develop and sustain a patient & family centered experience aligned with our community s needs Deliver a highly reliable environment that supports patient and staff safety Create value, defined as highest quality / total cost over a period of time Cultivate a positive culture that promotes staff engagement and retention Make decisions based on qualified data and evidence Eliminate all barriers to collaboration Use lean principles focus on process and flow 32
Recap 1. Background: Exeter 2020 2. Inspiration: Go Slow to Go Fast 3. Content: Lean A3 Problem-Solving 4. Process: Plan-Do-Check-Act Workshops & Tours 5. Next Steps 33
Lessons from Exeter 2020 What would we change / do differently? Have a second physician on team Include patient voice early Make Workshop 4 (Problem Analysis) more digestible Never take notes of a workshop on hospital computer! Make logistics of planning sessions and space simpler Use quantitative data earlier in process Hard to find places to tour (ie. Acuity Adaptable units) How translate lessons from large medical centers to community hospital 34
Lessons from Exeter 2020: Steps for a Successful Project Build multidisciplinary team with shared experiences and vocabulary Develop deeper understanding of Current State Analyze key problems to solve Further define goals for and qualities of Future State Develop knowledge of countermeasures, models of care, and impact of built environment on outcomes Create next steps roadmap 35
QUESTIONS
+ / Δ
Contact Us Robert Corson Dennis Stone Rcorson@ehr.org Rcorson@ehr.org Leigh Olson Snow Chee Keong Lin LSnow@tro-design.com CheeKeong.Lin@smithgroupjjr.com 38
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