Cancer Treatment Centers of America ® The Transformation of Healthcare Forum OCHI-CSC Presented by: Lynn Valz, MBB Director, Lean Six Sigma Operations October 22, 2013

Culture of Innovation and Continuous Improvement Lean Six Sigma Operations © 2013 Rising Tide 2

3 Our Mission CTCA is the home of integrative and compassionate cancer care. We never stop searching for and providing powerful and innovative therapies to heal the whole person, improve quality of life and restore hope. Our Vision To be recognized and trusted by people living with cancer as the premier center for healing and hope. CTCA specializes in treating complex and advanced stage cancers

Who We Serve 4 – Personalized attention – Control over their healthcare – Best chance to beat cancer – Cutting edge treatments – Compassion and hope Cancer Patients In Search Of: MOTHER STANDARD of CARE MOTHER STANDARD ® of CARE Provision of the same level of care that you would want for your own mother, father, brother, or sister “Winning the fight against cancer every day” © 2013 Rising Tide

“It is always, and only, about the patient.” Richard Stephenson, Chairman and Founder © 2013 Rising Tide Mary Brown Stephenson Lean Six Sigma helps us deliver and continuously improve the Mother Standard ®

Patient-Driven Leadership Patient testimonial to start each board meeting Patient input on hospital renovation or new building Patient Empowered Care SM (PEC) model Change based on patient feedback – Patient Advisory Council Lean Six Sigma improvement to Patient Experience © 2013 Rising Tide 6

Strategic Deployment © 2013 Rising Tide 7

Lean Six Sigma at CTCA "I cannot teach anybody anything, I can only make them think." - Socrates Embed the expertise within the hospital…. © 2013 Rising Tide 8

Lean Six Sigma at CTCA The Efficient Translation of Customer Desires into Patient Loyalty Efficient – Best way not the fastest way – Identify and eliminate non value add activities – Total involvement LSS culture at CTCA fostered through: Lean Daily Management System A3 Process Improvement Program Green Belt Training Program Kaizen Events Strategic Improvement Mapping (SIM) Events Key Performance Indicators (KPI’s) Reward and Recognition Program © 2013 Rising Tide 9

LSS Deployment Tactics © 2013 Rising Tide 10 A3 Performance Improvement SM Continuous Incremental Improvement High Volume Focused on Lean tools Kaizen Event 2-5 day facilitated rapid improvement event Breakthrough results Focused on key business value streams LSS Green Belt Direct link to strategic plan 4 month cycle time High Impact

Problem statement Objective statement Current state Root cause analysis Future state Imple- mentation plan Results Follow-up What is an A3 Project? A3 Performance Improvement SM Foundational Offering Fosters a culture of Lean Thinking and “Learning to See” Learn by doing, hands on application Lean tool training Projects focused on incremental improvements Projects typically stem from VOC information and pain points Methodology 8 week course, 2 hours/session 1 hour “homework” per week Complete 1 project Graduation ceremony to Senior Leadership Continue Solving Coach & Sponsor © 2013 Rising Tide 11

A3 Project Examples Reduced the TAT to process a Rehab order from an average of 20 minutes to 10 minutes by June 1, –(Process an Order = time order is identified to ready to schedule.) Reduced the TAT to schedule a patient for an Oncology Rehab appointment from an average of 19 minutes to 8 minutes by June 1, –(Schedule a Patient = having an accurate order and speaking with patient to collaborate schedule time.) Reduced the TAT for trash removal in the Culinary department from a daily average of 3 hours to less than 1 hour. © 2013 Rising Tide 12

A3 Project Examples Reduced the number of Amifostine doses wasted from an average of 5 per month to 1 or less per month, and improved the percentage of patients receiving Amifostine within the optimum window from 82% to 94%. Improved the timely identification and prevention of nutrient deficient patients with a history of GI surgery / resection by 95%. Decreased the time for Nursing to complete appropriate care plans for inpatients from an average of 17 minutes per patient to less than 10 minutes. © 2013 Rising Tide 13

What is a LSS Green Belt Project? Six Sigma Projects are directed toward reducing defects and variation to improve processes and quality of patient care Use of data and statistical analysis to drive improvement Multidisciplinary involvement and collaboration 4-8 months to complete Include ~80 hours of instructor led training Completion of 1 project demonstrating breakthrough improvement of metrics © 2013 Rising Tide 14

Lean Six Sigma Green Belt Framework © 2013 Rising Tide 15 4 weeks 4 -8 weeks 4 weeks Stabilize Process- 2-3 months

Lean Six Sigma Green Belt Project Examples Decreased chemotherapy waste by 57% and enhanced patient safety Reduced patient wait time from clinic visit to medical support treatment by 20 min and travel distance by 600 feet per patient Decreased “missed” pulmonary consults and procedures from 25% to <10% Decreases hospital acquired pressure ulcer rate by 60% Decreased pyxis discrepancies in Surgery by 63% © 2013 Rising Tide 16

Lean Six Sigma Green Belt Project Examples Goal: Decrease patient wait time to receive Chemotherapy, from appointment time to first medication administered, by 25% © 2013 Rising Tide minutes to 20 minutes 29% Improvement

What about Variation with each patient experience? © 2013 Rising Tide 18 Sep- 12 Oct-12 Nov- 12 Dec- 12 Jan-13Feb-13Mar-13Apr-13 May- 13 Jun-13Jul- 13Aug-13Sep-13 N = Total Average TAT 21.5 (M) 20.5 (M) 21.4 (M) 24.0 (M) 24.7 (M) 20.5 (M) 22.0 (M) 16.8 (M) 19.3 (M) 19.7 (M) 18.5 (M) (M) 17.8 (M) % within 30 min 79.4%81.2% 72.8%76.6%84.4%76.6%89.9%86.0%85.0%89.6%88.1%87.3%

1. Define the Problem or Opportunity 2. Go to GEMBA document process & collect data 3. Root Cause Analysis 4. Implement Improvements Reduce/ Re- order/ Revise 5. Monitor and Control Order not available at time of appointment Chemo not ready at time of appointment There is not an available chair There is not an available nurse Nurse work flow Patient showed up early or late How did we do this? © 2013 Rising Tide 19 Pilot changes Change Management Full Implementation Scheduling Practices and lack of real-time visibility Physician work flow, batching Pharmacist work flow, batching / schedule Patient expectations Nurse work flow Real Time schedule One piece flow “Just-In-Time” per schedule Schedule guidelines Nurse work flow and partnership Checks & Balances to “Error Proof” Communication & Education 28 minutes to 20 minutes 29% Improvement Waste Defects Overproduction Waiting Underutilization Transportation Inventory Motion Excess processing

Lean Six Sigma Green Belt Project Examples Goal: Drive a 50% turnaround time reduction from Imaging procedure to result available to the patient © 2013 Rising Tide hours to 6.4 hours 42% Improvement 6.4 hours to 3.7 hours 42% Improvement

What is Kaizen? Kaizen = “Good Change” Hospital strategic plan Top down Creates breakthrough and rapid change (3-5 day event) Short term intensive concentrated effort by a cross-functional team 4-6 week preplanning 50% of improvements are made during the event days for additional actions implementation 2-6 month follow-up to Monitor and Sustain © 2013 Rising Tide 21

Kaizen Framework © 2013 Rising Tide 22 Initiation 4-6 weeks Planning 2-3 weeks Event Up to 5 days After Event Stabilize & Monitor Process- 2-6 months Timeline for implementing add’l solutions days

Kaizen Event Examples Reduced Scheduling complaints by over 60% Reduced the turn around time for new patients from scheduling to treatment date by 20% Reduced denial rate for PET scans by 20% Designed a Survivorship program, including definition, guidelines, and process to capture 100% of patients at the appropriate point of their experience © 2013 Rising Tide 23

Celebration Executive Leadership Report out Certifications Rewards and Recognition program Hospital Wide sharing © 2013 Rising Tide 24

Thank You! © 2013 Rising Tide 25 Questions? Lynn Valz, MBB Director of Lean Six Sigma Operations Cancer Treatment Centers of America® at Southwestern Regional Medical Center Tulsa, OK