Minnesota Enterprise Lean

Enterprise Lean  A coordinated state government initiative for improving organizational performance and results in Minnesota's state government agencies

Approach  Lean/Kaizen events –Six Sigma tools –TQM philosophy  Tools and training to help state government work better for its customers and employees.

What is LEAN?  Maximize customer value  Minimize waste  Empower workers  Derived from Toyota Production System

Foundational Elements of Lean  7 wastes  5S  Standard work

7 Wastes  Overproduction  Waiting  Transportation  Processing  Inventory  Motion  Defects

5s  Method for organizing work space –Sort –Shine –Set in order –Standardize –Sustain

Before 5S

After 5S

Standard Work  A simple written description of the safest, highest quality, and most efficient way known to perform a process or task.  The only acceptable way to do the process it describes.  Expected to be continually improved

Kaizen = change for the better  Identify the current state  Develop the future state  Implement improvements immediately  Standardize the process  Train on the new process  Track sustainment

Selecting a Kaizen project  Affects many stakeholders/customers  Consumes a lot of resources  Is highly visible to stakeholders/ customers  Is clearly not working well  Is a core business process  Has leadership support  Has worker support

A Kaizen team  Facilitator  Sponsor  Team leader  Members  No rank – all members have equal voice

Kaizen process  Day 1 – current state swim lane map  Day 2 – future state swim lane map  Day 3 – make and document changes  Day 4 – document and train on standard work  Day 5 – present results

Swim Lane Map

 Define the scope  Walk the process  Document the process  Characterize the process  Include time, people, tasks

Swim lane tips  Move chronologically left to right  Use post-it notes  Hand-offs indicate a lane change  Hand-off usually indicates wait time  Assign average times to tasks and waits

Sustain Improvement  Overall improvement plan  Visible and engaged management  Clear roles and responsibilities  Accountability for work  Communication about improvement  A system to support standard work

Newborn Screening Kaizen Event Ensure that infants who screen positive for metabolic, genetic, or hearing disorders are  referred for diagnostic confirmation  receive appropriate intervention and  receive long-term follow-up services. It will start at the point that the lab provides a presumptive positive.

Current state Dried Blood Spot Process CurrentFuture QtyTimeQtyTime Tasks hrs Waits2151 days Handoffs36 Decisions11 File/stores26 Total time52.5 days

Early hearing detection and intervention process CurrentFuture QtyTimeQtyTime Tasks hrs Waits days Handoffs35 Decisions12 File/stores32 Total time58.3 days

Observations of Current State  Lots of handoffs  Lots of double storage  Lots of re-entry of data  Redundancy – some good, some bad  We are contacting the same people  There are necessary waits in the process  We are waiting on people outside our agency  It is hard to completely map these processes  There is a lack of trust in the data systems

Recommendations  Set up tools (Quickplace, sharefolders, case conferences) to promote better communication  Redesign the process, train staff in LIMS, and document standard work  Develop Access database. Long-term create a functional, child-based, interoperable system for MDH and its stakeholders.  Clarify roles in the process and share key information  Institute case conferences

Future State Dried Blood Screening Process CurrentFuture QtyTimeQtyTime Tasks hrs hrs Waits2151 days723 days Handoffs3615 Decisions112 File/stores268 Total time52.5 days23.65 days

Improvements from new process  59% reduction in tasks  66% reduction in waits  58% reduction in handoffs  81% reduction in decisions  69% reduction in file/stores  56% reduction in cycle time

Future state hearing detection/intervention CurrentFuture QtyTimeQtyTime Tasks hrs hrs Waits days days Handoffs3523 Decisions126 File/stores3211 Total time58.3 days22.7 days

Improvements from new process  49% reduction in tasks  54% reduction in waits  34% reduction in handoffs  50% reduction in decisions  65% reduction in file/stores  61% reduction in cycle time

Benefits of Future State  Save some trees and staff sanity  Families are better and more efficiently served  Will be able to move forward with more initiatives  Will have more time to be proactive instead of reactive  Laid the groundwork for future changes  Staff will be used more effectively, and less frustrated

day Action Plan ActionwhowhenComplete Provide LTFU access to Update Registry Chris X Training in LIMS for LTFUAmy X Assure LTFU staff have access to LIMS Barb X Update and/or create audio-related forms Kirsten X Create LTFU Access databaseMaggi e X – Aug 09 Create standards for data itemsAllison X Determine if GCs can track in RegistryAmy X

day Action Plan, Continued Actionwhowhencomplete Create Work Space rooms for blood spot transfers/hearing QA /H & V Amy X – hearing not possible Write a SOP for the HPRs for Blood Spot Julie X Update SOP for the HPRs for Hearing Chris X Write script for HPRs to find PCPAmy X Finish SOP for LTFU hearingNicole Yaoli X Standardize availability/location of procedures Chris/Bar b X Case conference/set up schedule for future Amy X -ongoing Implement new processChris/Bar b X - ongoing

What must we and the agency do to implement and sustain this effort?  We need to have follow-up meetings of this group through implementation and evaluation of the new process  Maintain respectful and open communications at all levels  We need management and staff support  We need some IT resources to implement new process

For more information… Kim McCoy Office of Public Health Practice Minnesota Dept of Health

Service Contracting Kaizen Event Erin Barkema Iowa Department of Public Health 33 Quality Improvement in Iowa

Why a Kaizen event? 34 Customer concerns about the service contracting process Grant application process Issuance of contracts Reimbursement of expenses

Pre-event activities 35 Identified a facilitator Identified participants Developed a charter Scope Objectives Goals Gathered data

The Event - November 2-6, Agenda Overview of Kaizen Flow charting Brainstorming Identifying a new process Results Assigning homework Gaining buy-in from leadership

Flowcharting 37

Brainstorming 38 7 ideas for improvement 7 different ways to implement main idea

Brainstorming 39 Small groups Discuss options Identify solutions Prioritize solutions IIII IIIV IMPACTIMPACT DIFFICULTY

New Process 40

Homework 41 Twenty-three steps identified on a variety of topics Training curriculum Policies and procedures Standardized forms Use of technology Communication plan Measures to determine change or improvement Assigned to members of the team Due dates established

Buy-in 42 Report outs to Deputy Director throughout the week. Presented the results of the week to the IDPH Executive Team. Developed a newsletter to keep people informed of the progress.

Post-event activities 43 HOMEWORK, HOMEWORK, HOMEWORK!!! Follow-up meetings 30 day* 60 day* 90 day* 120 day 150 day 6 month* Communication C ELEBRATION !

Accomplishments & Lessons Learned 44 Accomplishments Implemented an electronic document library Provided training to over 101 IDPH staff on the new service contracting process Completed 90% of homework assignments to date Lessons learned Kaizen was a great team building experience. Large scale quality improvement work takes time. Improved processes and increased satisfaction will be worth all of the hard work!

Questions 45

Information 46 Service Contracting Process Contact Information: Erin Barkema Iowa Department of Public Health (515)