Implementing Lean in Healthcare Organizations Methods and Results John Beakes, Jr. President and CEO Operational Performance Solutions, Inc.

Denver Health Results from Lean, 2006-2011

Dr. Berwick on Lean “If you doubt that we know what to do, visit Denver Health or ThedaCare or Virginia Mason, and see the Toyota principles of lean production learned, mastered, adapted, and deployed through entire systems and into the skills and psyches of entire workforces. The result, over $100 million in savings at Denver Health while vastly improving the experience and outcomes of patients.” Observation from Donald M. Berwick, MD at the Keynote Presentation at IHI’s 23rd Annual National Forum on Quality Improvement in Health Care December 7, 2011 Orlando, Florida 3

Kaizen Lean Gkanban Six Sigma JIT Ggemba MBB FMEA Poka-yoke 5S A3 RIE GSMED

Transformation Has Two Elements Technical and Social The Path to Lean Technical Tools and Techniques Pursuit of Perfection Value Stream Thinking Disconnected Process Improvement Tools Deployment Social Tools and Techniques Learning Organization Advanced Teambuilding Employee Empowerment Employee Engagement 5 5

Quality “True North”

Quality Patient Satisfaction Employee Morale “True North” Safety Cost

Lean Deployment Guide 10

Healthcare People “Get” Lean Healthcare is the diagnosis and treatment of illness Lean is the diagnosis and treatment of processes The goal is to give healthcare professionals a new way to look at their processes using a small Lean toolset

Lean System Models

Denver Health Results from Lean, 2006-2011

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Ref: Going Lean In Healthcare. Institute for Healthcare Improvement 16

A Medical Center Management System Model The Erie VAMC Lean Model has been developed to provide the vision for all employees of the System that will be used to guide the implementation and sustainment of Lean in our organization. This is our Lean model, developed by the team here at Erie VAMC and adapted to our unique situation. While we have reviewed all the best Lean literature and consulted with highly experienced Lean practitioners in developing the Model, it is 100% our local adaptation of all this information. We will be introducing the Model to all current employees in the coming months, and it will be taught to all new employees in the future. In this manner, the Model will become a simple visual memory aid that helps the entire organization internalize the principles of Lean and the manner in which we will implement it at Erie VAMC. While the widespread acknowledgment of the Model is important, it is even more important that all employees understand and can describe each element. Once we have all embraced and understand this approach, we will introduce new tools to help with the implementation of each Model element. Always keep in mind we are going to develop OUR lean system, not that of any other group. It will most likely take several years to accomplish and we will need a visual to keep us always on True North for our system. Medical Center 17

Benefits of a System Model Provides an integrating framework Clarifies system interactions Facilitates communications Embodies “the story” Promotes consistency of purpose Enhances new employee training

Benefits of a System Model Provides an integrating framework Clarifies system interactions Facilitates communications Embodies “the story” Promotes consistency of purpose Enhances new employee training KEY TO SUSTAINMENT

Quality Patient Employee Morale Satisfaction Safety Cost © Copyright 2008-2012. Operational Performance Solutions, Inc. Patient Satisfaction Employee Morale “True North” PDCA Safety A3 Problem Solving Value Stream Analysis Process (VSAP) Cost Mistake Proofing Pull Systems Continuous Flow 5S/Visual Management Standard Work The Lean System of Patient Care Principles Patient Centered Quality at the Source Standard Processes Engaged Employees Pursuit of Perfection Supplier Partnerships Objectives Defect Free Without Waste Just-in-Time Continuous Flow Continuous Improvement Leadership Commitment and Support Go See Ask Why Show Respect - Culture Centered on Patient Care - Servant Leadership (EPIC) - Employee Engagement - Cascading Annual Planning Process

Quality “True North”

Quality Patient Satisfaction Employee Morale “True North” Safety Cost

Quality Patient Employee Morale Satisfaction Safety Cost © Copyright 2008-2012. Operational Performance Solutions, Inc. Patient Satisfaction Employee Morale “True North” PDCA Safety A3 Problem Solving Value Stream Analysis Process (VSAP) Cost Mistake Proofing Pull Systems Continuous Flow 5S/Visual Management Standard Work The Lean System of Patient Care Principles Patient Centered Quality at the Source Standard Processes Engaged Employees Pursuit of Perfection Supplier Partnerships Objectives Defect Free Without Waste Just-in-Time Continuous Flow Continuous Improvement Leadership Commitment and Support Go See Ask Why Show Respect - Culture Centered on Patient Care - Servant Leadership (EPIC) - Employee Engagement - Cascading Annual Planning Process

Quality Patient Employee Morale Satisfaction Safety Cost © Copyright 2008-2012. Operational Performance Solutions, Inc. Patient Satisfaction Employee Morale “True North” PDCA Safety A3 Problem Solving Value Stream Analysis Process (VSAP) Cost Mistake Proofing Pull Systems Continuous Flow 5S/Visual Management Standard Work The Lean System of Patient Care Principles Patient Centered Quality at the Source Standard Processes Engaged Employees Pursuit of Perfection Supplier Partnerships Objectives Defect Free Without Waste Just-in-Time Continuous Flow Continuous Improvement Leadership Commitment and Support Go See Ask Why Show Respect - Culture Centered on Patient Care - Servant Leadership (EPIC) - Employee Engagement - Cascading Annual Planning Process

Leadership Commitment and Support

Leadership Commitment and Support Go See Ask Why Show Respect

Leadership Commitment and Support Go See Ask Why Show Respect Culture Centered on Patient Care Servant Leadership (EPIC) Employee Engagement Cascading Annual Planning Process

Principles Patient Centered

Value Stream Thinking and Organizational Structure

ED Pharmacy LAB Radiology Imaging Hospital Floor

ED Pharmacy LAB Radiology Imaging Hospital Floor

Hospital Floor Pharmacy Radiology Imaging LAB ED Performance Review; Professional Recognition; Promotions ED Pharmacy LAB Radiology Imaging Hospital Floor

Patient Hospital Floor Pharmacy Radiology Imaging LAB ED Performance Review; Professional Recognition; Promotions ED Pharmacy LAB Radiology Imaging Hospital Floor Patient

Patient Hospital Floor Pharmacy Radiology Imaging LAB ED Performance Review; Professional Recognition; Promotions ED Pharmacy LAB Radiology Imaging Hospital Floor Patient W W W W W W= WASTE

Value Stream Analysis Process Performance Review; Professional Recognition; Promotions ED Value Stream Analysis Process Pharmacy LAB Radiology Imaging Hospital Floor Patient W W W W W W= WASTE

Principles Patient Centered Quality at the Source Standard Processes

Standard Work Chart & SPD Lead Checklist 38

Principles Patient Centered Quality at the Source Standard Processes Engaged Employees

Medication Sorting After ----->

Medication Sorting <----- Before After ----->

Principles Patient Centered Quality at the Source Standard Processes Engaged Employees Pursuit of Perfection Supplier Partnerships

Objectives Defect Free Without Waste

Current Rounds made by a Floor RN

Roaming Supply Cart Frequently needed supplies are stored in drawers. Dietary items (i.e. spoons, applesauce, straws, thickener) are located in drawers separate from the linens.

Objectives Defect Free Without Waste Just-in-Time Continuous Flow

Decontamination 47

Decontamination After Before 48

Objectives Defect Free Without Waste Just-in-Time Continuous Flow Continuous Improvement

Continuous Improvement Lower the water level Find rocks Remove them Find new rocks Etc., etc… Seek perfection (a never-ending process) 50

Denver Health Results from Lean, 2006-2011

Quality Patient Employee Morale Satisfaction Safety Cost © Copyright 2008-2012. Operational Performance Solutions, Inc. Patient Satisfaction Employee Morale “True North” PDCA Safety A3 Problem Solving Value Stream Analysis Process (VSAP) Cost Mistake Proofing Pull Systems Continuous Flow 5S/Visual Management Standard Work The Lean System of Patient Care Principles Patient Centered Quality at the Source Standard Processes Engaged Employees Pursuit of Perfection Supplier Partnerships Objectives Defect Free Without Waste Just-in-Time Continuous Flow Continuous Improvement Leadership Commitment and Support Go See Ask Why Show Respect - Culture Centered on Patient Care - Servant Leadership (EPIC) - Employee Engagement - Cascading Annual Planning Process

The Key Processes for Lean Healthcare A3 Problem Solving Value Stream Analysis Process

Quality Patient Employee Morale Satisfaction Safety Cost © Copyright 2008-2012. Operational Performance Solutions, Inc. Patient Satisfaction Employee Morale “True North” PDCA Safety A3 Problem Solving Value Stream Analysis Process (VSAP) Cost Mistake Proofing Pull Systems Continuous Flow 5S/Visual Management Standard Work The Lean System of Patient Care Principles Patient Centered Quality at the Source Standard Processes Engaged Employees Pursuit of Perfection Supplier Partnerships Objectives Defect Free Without Waste Just-in-Time Continuous Flow Continuous Improvement Leadership Commitment and Support Go See Ask Why Show Respect - Culture Centered on Patient Care - Servant Leadership (EPIC) - Employee Engagement - Cascading Annual Planning Process

Building a True Lean Culture Means winning “one heart and soul at a time” Each individual comes to a full commitment at their own individual pace Be patient - some who embrace it slowly become the strongest advocates You know you’re there when all employees engage in identifying and eliminating waste every day

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Quality “True North”

Quality Patient Satisfaction Employee Morale “True North” Safety Cost

Quality Patient Employee Morale Satisfaction Safety Cost © Copyright 2008-2012. Operational Performance Solutions, Inc. Patient Satisfaction Employee Morale “True North” PDCA Safety A3 Problem Solving Value Stream Analysis Process (VSAP) Cost Mistake Proofing Pull Systems Continuous Flow 5S/Visual Management Standard Work The Lean System of Patient Care Principles Patient Centered Quality at the Source Standard Processes Engaged Employees Pursuit of Perfection Supplier Partnerships Objectives Defect Free Without Waste Just-in-Time Continuous Flow Continuous Improvement Leadership Commitment and Support Go See Ask Why Show Respect - Culture Centered on Patient Care - Servant Leadership (EPIC) - Employee Engagement - Cascading Annual Planning Process

Denver Health Results from Lean, 2006-2011

Contact Information Operational Performance Solutions, Inc. 77 East Main Street, Suite 402K Westminster, MD 21158 (410) 871-0995 info@OPSgroupinc.com www.OPSgroupinc.com 63