1. Lean Thinking in Health Care at UMHS Creating the Michigan Quality System
Jack Billi, M.D.
Michigan Quality System:
med.umich.edu/mqs
Michigan Quality System:
Quality
Safety
Efficiency
Appropriateness
Service 1

2. Lean Thinking in Health Care at UMHS Summary A3 J Billi 10/8/10
Background
SEMI has problems in quality, safety, efficiency, appropriateness, service
Problems harm patients, raise costs, frustrate workers
Economy: short & long term
Current state at UMHS
>20,000 faculty, staff, trainees
>100,000 processes, all have problems
Great workers trying to do a good job
Goals
Ideal Pt Care Experience
Ideal Clinician/Staff Experience
Ideal Research/Trainee Experience
Safest health system in US
Financial stability
Analysis
Workers/mgrs: +/- trained in problem solving; little std work
Problems complex, cross units; work often invisible
Unclear responsibility for problems
Unclear priorities
Time, cost pressures: stress
Strategies
Spread a consistent QI model across UMHS
-Build on our CQI base
-Study lessons from Lean Thinking
20,000 problem solvers
Michigan Quality System
Plan: (UMHS workers help build it) 2

3. The Ideal Patient Care Experience
Our future state vision:
Based on Institute of Medicine Report
“Crossing the Quality Chasm”
Patient Centered Medical Home
Patient and Family Centered Care
Clinical Quality
Safety as a System Property
Service Excellence
Care Coordinated Around the Needs of the Patient
Facilities, Amenities for a Healing Environment 3

4. The Ideal Patient Care Experience
The IOM “Chasm” Report gives us a vision of where to go
Lean Thinking gives us the holistic approach and business system to get there 4

5. The Ideal Patient Care Experience
The IOM “Chasm” Report gives us a vision of where to go
Lean Thinking gives us the holistic approach and business system to get there 5

6. Goal: All 20,000 UM “workers” can:
Do our work every day in a standard way that we created
Not just the way the work evolved!
Be alert to things going wrong
They always do!
Fix the problem now
For this patient or co-worker
Find and fix the root causes of the problem
So it never happens again!
Modified after Spear; Billi 6

7. Three Keys to Problem Solving … and leadership
Go See.
Go to the real place where real work is done
Ask Why.
Seek deep understanding of causes
Show Respect.
Workers solve their own problems
-John Shook, quoting Fujio Cho 7 7

8. Psychiatry Referral Process
Current State Map 8

9. Value Stream Mapping: Learning to See
“Ah ha” moments:
I never knew this is how it worked!
I can’t believe what a mess this process is!
No wonder we’re frustrated!
It’s a miracle a patient ever gets through it! 9

10. applying the scientific method to every part of daily work.
“20,000 Problem Solvers”
Every worker
applying the scientific method
to every part of daily work.
Turn all daily work into an experiment and every worker into an investigator.
-Steven Spear 10

11. Lean Thinking - Like great medical care
Tackle work problems with the rigor and systematic thinking we use for patient problems.
Help every worker become an skilled clinician. 11

12. How can we create (liberate) “20,000 problem solvers”?
Help each worker take initiative to find and fix causes of problems he/she faces daily
This means each of us has two jobs:
Do the work
Improve the work
Managers role:
Support improvement work (time, mentoring)
Align improvements so value flows to the customer
Modified from J Shook 12

13. Some Results from the Michigan Quality System
Patients referred for brain metastases
From 3 visits over 5 days (consult, simulation, treatment)
To 95% of patients have all 3 parts within 24 hours
Getting Lab Results to the Right Physician
From 13% lab requests had no ordering physician,
To Less than 2%
Better Discharge Planning – appointment in hand
Decreased readmissions by 33%; ER visits by 81%
Redesigned Handoffs from Cardiac Surgery to ICU
Standard work resulted in 2 day decrease in LOS
CT scheduling and throughput for inpatients
Like drycleaners: In by 9AM, out by 5 PM for inpatients 13

14. Michigan Collaboratives & Lean Thinking
Many hospitals and physicians!
PGIP Lean Collaborative (BCBSM) redesign care of chronic illness
Collaborative Quality Initiatives (BCBSM) – use process redesign
Michigan Quality Improvement Consortium – prioritizes across MI, uses RCA, PDCA
MHA’s Keystone ED Collaborative
GDAHC’s SaveLivesSaveDollars ED Collaborative: avoidable visits 14

15. Save Lives Save Dollars: Southeast MI’s Collaborative
Convened by GDAHC
Many stakeholders: employers, labor, payers, hospitals, physician organizations, public health, community
Goals: competitive health region through compliance with evidence based guidelines & bending cost curve
Means: common public reporting, coordinated quality improvement
Current Collaborative Initiatives:
ED Collaborative: avoidable visits
Low back pain: reduced imaging and surgery
Diabetes: worksite education
Common public reporting:
RWJ Aligning Forces For Quality (3rd cycle application)
HHS Charter Value Exchange 15

16. Our Challenge
Lean thinking: successful in manufacturing, service, banking, airlines, and increasingly in healthcare.
Isolated results in healthcare have been great but systematic uptake across organizations has been slow.
The Challenge: "What specifically do we recommend that Southeast Michigan groups do to accelerate the use of lean thinking to transform health care to improve quality and control cost?"
Each table volunteers to address 1-2 of the 6 questions

17. Our Deliverable
Action Group 5 recommendations to encourage the use of lean thinking to improve value in Southeast Michigan:
Common Definition of Quality - adopt/revise:
Physicians, PO's, MSMS and MOA:
Hospitals, health systems, and MHA:
Insurers/payers, and MAHP:
Employers:
Coalitions/SLSD: