Lean Six Sigma The UMC Journey LISA BARRINGTON, PROCESS EXCELLENCE MANAGER MARK FUNDERBURK, EXECUTIVE VICE PRESIDENT AND COO

Objectives Review why UMC has chosen Lean and Six Sigma as a Performance Improvement methodology. Review our organizational approach to a Lean and Six Sigma implementation strategy. Explore the 2015 Waste Walk including examples of ideas submitted and Lessons Learned. Identify our future trajectory for sustaining the methodology within our organizational culture.

Lean and Six Sigma

Historical Foundation Henry Ford Assembly Lines Pioneers of Statistical Quality Control Toyota Production System Objective Elimination of waste o Over production o Waiting or queuing o Transport o Over processing o Inventory (or storage) o Unnecessary motion o Defects o Underutilized employees

Six Sigma - 6σ Historical Foundation Motorola introduced these principals in 1986 Motorola employee, Mikel Harry, develops the belt naming convention General Electric CEO Jack Welch made the method popular Objective Reduce variation in processes Achieve a Six Sigma level of perfection Graphic display of data Statistical analysis

Quality, Speed, and Cost Create process speed if you want to achieve high quality A process that creates errors cannot maintain speed A slow process is prone to errors Low quality and slow speed are what make processes expensive IHI Triple Aim Patient experience Population health Reduce cost

Teams and Tools Teams Executive Sponsor Physician Sponsor Team Lead/Process Owner Team Members Subject Matter Experts Data Manager Facilitator Tools Project Charters GOYA Process Maps Value Stream Maps 5 Whys HFMEA Visual Controls Error Proofing

Methodology DMAIC D efine the problem and what the customers require M easure the defects and process operation A nalyze the data and discover causes of the problem I mprove the process to remove causes of defects C ontrol the process to make sure defects don’t recur

Organizational Implementation Foundation Hired a dedicated person to manage the program Invested in training for the new individual Engaged a consultant Selected the first 5 projects First Five Projects – 2014 BNursing Non-Value Added Time B+Professionals for the Effective Timing of Antibiotics COR Efficiency Improving Close to Cut Time ADecreasing Lab Tests in the Emergency Center ADischarge Planning: The Voice of the Customer

Organizational Implementation Current Initiatives Lean Forward Training Sustaining the First Five Projects Waste Walk 2015 Projects Lean Daily Management

Lean Forward Training Leadership Training A component of strategic plan Focused on key elements of Lean and Six Sigma Initial focus on hospital leadership (open to everyone) Six hours of training Began in January 2015 – 157 individuals trained to date Leadership Development 2014 – Pathways to Leadership training event 2015 – Leadership Council monthly updates

Waste Walk Ideas will generate $1,000,000 in savings Lean and Six Sigma projects

Waste Walk Learning the Concept Catholic Health Partners – Ohio Lifespan Health System – Rhode Island Floyd Medical Center – Georgia UMC Plan Leadership focused All Directors submit two ideas Learn to see Waste

Waste Walk Total Ideas Wide variety Some Directors submitted multiple ideas Ideas focused on another department Classification System Development Complexity Just Do It Moderate Complexity High Complexity Value Non-Value Added Time Direct Savings Patient Wait Time Saved

Waste Walk Just Do It – 95 Ideas Focused and tangible Within the control of a single Director May not be easy Resource Assistance Saved 62 hours of non-value added time by changing how documents are scanned. $33,735 in employee time savings. Food and Nutrition Purchased a new meat slicer and reduced the amount of ham and turkey used per week. $10,601 in cost savings.

Waste Walk Moderate Complexity – 10 Ideas Can be completed within 6 months Require more than one department to implement Additional review by Administrative staff required Infection Prevention and Control and Environmental Services Frost glass in patient rooms and eliminate privacy curtains. $29,631 in cost savings.

Waste Walk High Complexity – 17 Ideas (11 Ideas Considered for Projects) Uncertain of timeline required to complete Requires multiple departments Possible capital request or multiple FTEs Additional review by Administrative Staff required Revenue Integrity Minimize printing costs by duplexing copies A 17% reduction = $61,250

Waste Walk The Value of an Idea Goal $1,000,000 Value Categories Non-Value Added Time Direct Savings Patient Wait Time Saved

Waste Walk Non-Value Added Time Savings = $453,979 Non-Value added activities are inefficiencies within a process Customers are not willing/should not pay for inefficiency Laboratory Leveraged available technology to auto-verify results $19,198 time saved annually Trauma Services Identified unnecessary data abstraction $6,261 time saved annually

Waste Walk Direct Savings = $1,408,514 Evaluate current work from the perspective of Waste results in cost savings Trauma/Surgical ICU and Burn Burn step down staff now manage all burn wound care independent of Physical Therapy $75,697 in annual savings Nursing Education Nursing departments will no longer pay administrative time for nurses attending class that is not required $6,205 in annual savings

Waste Walk Patient Wait Time Savings = $243,365 Waiting is considered Waste and impacts customer satisfaction 3 West Patients are discharged home after their final physical therapy session rather than returning to their room for nursing to complete the discharge process Patient Flow improvements worth $5,100 Heart Center Increased Cardiology coverage minimizes diagnostic study turn-around times $132,000 in savings

Waste Walk Benefits and Lessons Learned Effective method to influence the development of a Lean culture Identifying Waste is not as easy as it seems Ideas crossing departmental lines require management Identify Waste in your own department is difficult and requires transparency Executive Leadership had to make decisions on some ideas. Administrative Leadership assisted with idea valuation Administrative Leadership has to ensure ideas are implemented and budget changes made

2015 Projects Idea themes generated by Administrative Staff Physician Leadership Retreat ideas included in review Themes refined and scoped for team development Projects Patient Flow - Discharge Process Follow-Up Appointments Supply Chain Physician Handoff Physician Call Schedules

Lean Daily Management Learning the Concept North Mississippi Medical Center Baylor Zale Lipshy Advocate, Chicago University of Utah Baltimore Medical Center Virginia Mason Goal Turn our staff into accountable, focused problem solvers every shift Visual transparency of patient outcomes at the point of care in real time Use a standard, low tech method of data collection Administrative staff rounding at boards for analysis and issue resolution Begin 4 th Quarter 2015

Summary UMC Journey Selecting the Methodology Lead Forward Training Waste Walk 2014 Projects 2015 Projects Lean Daily Management Questions?