Creating Healthy Disruption with Kata Our Lesson in Employee Engagement, Leadership Development and Organizational Transformation Joseph P. Ross, President & CEO 3rd Annual Kata Summit February 21, 2017

Meritus Organizational Overview Environment Meritus Health: Patient population of 244,642 Approximately 3,000 Employees Meritus Medical Center (“MMC”) 251 bed, 511,834 square feet, general service facility opened on December 11, 2010, 100% private rooms 52 bed Emergency Department 18 room inpatient behavior health unit Meritus Medical Group (“MMG”) 9 primary care practices 10 specialty physician practices Lean Office 3 Coaches (Managers) Project Coordinator Director Meritus Medical Center

Seismic Shift Fee for Service (Volume) to Value The seismic shift from value to value set the stage for the creation of Meritus Health’s continuous improvement initiative in 2011. Challenge: Achieve top decile in quality measures and deploy LEAN methodologies to our workforce to get there. till did not have a lean culture (everybody, everyday)! Developed a Just Culture: rewarded individuals for “Stopping the line” to prevent medical errors from reaching a patient.

LEAN Plateau Everybody, Everyday Despite countless Kaizan/3P events, as well as a shift to A3 problem solving and the creation of Just Culture, we were still unable to sustain gains and truly move LEAN into the workforce. We ran over 20 events in two years and still did not have a lean culture (everybody, everyday)! Felt like a top-down approach and it did not transform our culture into a learning environment as we had hoped. Needed a better way to stay ahead of the volatile business course of healthcare.

Introduction of Kata What do we want problem solving to “look like?”

The “Aha!” Moment Enter Kata Introduced to the Toyota Improvement Kata. Began by incorporating Kata into daily nursing huddles on one of our medical-surgical units. Nurse manager practiced the problem-solving skill in front of her team during the daily huddles. We soon took Kata outside of the huddle. Nurses continued to use daily huddles as a way to talk about the “experiment of the day.” The moment we saw nurses engaged in the problem-solving routine, we knew we had to train other leaders in Kata and make this a catalyst for change at Meritus.

Kata Rollout First Year Results QIC Composite Score MHAC Patient Safety Patient Experience

Meritus QIC Composite Score Data source: Quality Forum/QIO Composite Score Worksheet

Reduction of MHAC from 2013 to 2016 Data source: CRISP MHAC report Note: 2016 data is not complete (Jan-Nov)

Overall Patient Safety Grade

Patient Experience Data Source: NRC picker 1/24/17 data, annually

Lessons Learned Innovators appear in the strangest places and some superstars are lousy at daily improvement. Kata is a more democratic approach to problem solving – which is what today’s workforce expects. Little problems to the CEO are big problems to the front line. Kata helps with physician engagement. A script increases the velocity of learning because it’s a structured narrative to achieve the work.

Rounding: Leader Standard Work 5 minute talk time/unit Leader rounding does not replace kata coaching. It is a kata walk. We are verifying that the coaching is taking place by seeing in the learner has answers.

Lessons Learned Daily rounding increases learning and adoption. People respond to attention. Kata success begins with strong leaders. Kata empowers others to be change agents. Committees are successful at communicating accomplishments, but daily experimentation achieves real improvement.

Lessons Learned Kata builds trust. Kata is a leadership development tool. We can prepare for the future even though we don’t know what situations the future will bring.  We can get comfortable with challenging goals and navigate the unpredictable zone between here and there.

Kata’s Big Bang Conclusions We learned that Kata isn’t just a problem solving tool - it’s a leadership development program. Thanks to Kata, we have executives who are not only intimately familiar with what problems are being solved - but how well our managers are able to solve the problems. Thanks to Kata, we have engaged physicians, clinical staff, managers and frontline employees who are embracing a culture of continuous improvement, problem solving and collaboration.

Questions or Comments? THANK YOU!