Welcome to the Lean Overview for the Revenue Cycle Christine Fricke, M.A., Training LPI Specialist January 2015

Introductions  Name  Department  Role

Learning Objectives Describe Lean. Understand the six organizational linkage goals. Know Lean Key Terms and Lean Tools. Describe 5S, Gemba Walks, Standardized Work, Visual Management Boards, Everyday Lean Ideas (ELI’s), and Huddles.

Organizational Linkage UMHS initiatives Revenue Cycle initiating

Organizational Linkage Six goals identified to help us prioritize areas of focus for improvement. 1.Service: Improve customer satisfaction in all groups. 2.Financial: Enhance our financial strength and competitiveness. 3.Quality Care: Improve clinical care and service. 4.Academic: Support the University’s health science academic mission. 5.People: Create a safe and healthful workplace. 6.Community: Participate with state and local partners to create healthy communities.

What is Lean? “Lean is a set of concepts, principles and tools used to create and deliver the most value from the customers’ perspective while consuming the fewest resources by fully utilizing the skills and knowledge of those who do the work.” Lean Enterprise Institute

Lean is… “Lean is the endless transformation of waste into value.” Jim P.Womack Founder and Senior Advisor Lean Enterprise Institute

Lean is…

Lean does not only apply to the manufacturing processes Lean does not eliminate jobs Lean does not force people to work harder Lean does not just speed up the pace of work Lean is …

Discuss with others at your table: Are there aspects of your daily personal or work life that seem wasteful or pointless? What stops you from having a productive day? Decide on one or two items from your group to share with the class.

The 5 S Exercise Let’s practice using the 5 S’s tool to see what we can do right now to make improvements!

Lean Tools: 5 S Straighten Sweep Standardize Sustain Eliminate Waste Sort

Lean Overview Summary Before After Closed versus open storage

The Flip Side of Lean … BSBzPI BSBzPI

Summary of Lean Thinking Are we happy with the way we are doing things? Is there a way to do things more efficiently and effectively? Can we fix the problem now? Do we know the root cause(s) of the problem?

Lean Key Terms Why do you need to know the key terms? –Lean –Value –Waste –Root Cause Analysis

Lean Key Tools Why do you need to know these key tools? –SIPOC+R –Gemba Walks –Value Stream Map –Lean Icons –Current State Visual Map –5 Whys –5 S –Future State Visual Map –Huddles –Standardized Work –PDCA –A3 Report –Visual Management Boards –Everyday Lean Ideas –Root Cause Analysis

Summary of Lean Key Terms & Tools Terms and Tools Reviewed: Lean, Value, Waste, Gemba Walks, 5 S, Standardized Work, Everyday Lean Ideas, Visual Management Boards, and Huddles.

Lean Tools: Gemba Walks “Gemba” is a Japanese term meaning “the place where the truth can be found”- for us this means the actual place where the work is being done. Real improvement requires a shop-floor focus based on direct observation of current conditions where the work is done.

Lean Tools: Gemba Walks Three simple rules for going to the Gemba: 1. Go See. 2. Ask Why. 3. Show Respect.

Lean Tools: Standardized Work Group Activity

Lean Tools: Visual Management Many of us already use some forms of visual management systems. Does anyone keep work, school or sports schedules on your refrigerators or in some other central spot in your homes?

Lean Tools: Visual Management  Goal: To make waste, problems, and abnormal conditions readily apparent to employees and managers.  Aim: To expose problems so they can be fixed, as opposed to the old approach of hiding problems to make things look good.  Purpose: To reduce “information deficits” in the workplace. In an information scarce workplace, people ask lots of questions and lots of the same questions, repeatedly.

Personal Visual Management Let’s begin our practice by setting up our own personal visual management sheet. What are things that are important for you or someone in your family to know for today or this week? Are there things you want to accomplish this week?

My Personal Visual Management

Billing Area Visual Boards

LPI Visual Board

Patient Business Services Visual Boards

Payment Posting Visual Boards

Lean Learning / Solution Summary Picture of Problem: Picture of Solution: Description of Problem: Only 1 printer that is located over in the suite. This takes a couple minutes to walk over there every time you print something. Sometimes get interrupted with conversation along the way. Impact of Problem: Wasted time, not very efficient Reporter of Problem: Barb Semanske Description of Solution: Obtained printer and placed in the “cube farm” just a few steps away. Impact of Solution / What Did We Learn? Much quicker to collect printed items making work much more efficient and more lean. Date Solution Implemented: July 2010 Hallway Hallwa y Printer

Lean Learning / Solution Summary Picture of Problem: Picture of Solution: Description of Problem: With the number of applications we received for our job openings, it was difficult to keep all the interviewee’s straight. We kept having to flip through multiple sheets of paper. Impact of Problem: We were hasting time, rereading applications. Plus, we had a greater chance of misplacing important paperwork. Reporter of Problem: Tonya Harrigan Description of Solution: We took our “first string” applicants and placed there information on post it notes. These post it notes were placed on A3 sized paper & kept with the stack of applications. As the applicants came in for their interview, we ranked them and placed them in the order of our preference. Impact of Solution / What Did We Learn? We were able to quickly see applicants scores & area’s of strength. We were also able to later add what training each applicant would need. This was all “at a glance”, which stream lined the process & kept us organized. Date Solution Implemented: 12/20/2010

Lean Tools: My Everyday Lean Idea (ELI)

Lean Tools: Huddles  Huddles are held near the Visual Management Boards.  Brief meetings with the team to discuss results, areas of concern and possible countermeasures.  Team members rotate responsibility of updating the visual management boards and leading huddles.  Team members should be able to speak about their visual management process to others.

Summary of Lean Tools 5S Gemba Walks Visual Management Boards Everyday Lean Ideas (ELI’s) Huddles

Payment Posting Visual Boards

Guiding Principles for Lean Process Respect each other and refrain from making personal attacks. Acknowledge that it is OK to disagree. Listen to others, don’t interrupt. Everyone participates; no one dominates, value the diversity of the group. Honor time limits: be on time, start on time, end on time Recognize that all ideas are potentially good ideas; keep an open mind. Stay on task. Respect confidentiality, what is said in the session should stay in the session. Make arrangements to not be interrupted during the session; turn off cell phones.

Guiding Principles for Lean Process Customer satisfaction will be a driving principle in all of our decisions. We will make decisions based on fact not emotion. We will transcend our traditional silo mentality to do what’s best for our customers. We will make a commitment to actively attend meetings, use Confluence, identify Just- do-it items, and implement process improvement plans. We will work with other departments to help ensure our customers are satisfied.

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