1. Minnesota Enterprise Lean

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

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

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

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

6. 7 Wastes  Overproduction  Waiting  Transportation  Processing  Inventory  Motion  Defects

7. 5s  Method for organizing work space –Sort –Shine –Set in order –Standardize –Sustain

8. Before 5S

9. After 5S

10. 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

11. 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

12. 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

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

14. 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

15. Swim Lane Map

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

17. 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

18. 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

19. 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.

20. Current state Dried Blood Spot Process CurrentFuture QtyTimeQtyTime Tasks6112.75 hrs Waits2151 days Handoffs36 Decisions11 File/stores26 Total time52.5 days

21. Early hearing detection and intervention process CurrentFuture QtyTimeQtyTime Tasks8514.5 hrs Waits2256.5 days Handoffs35 Decisions12 File/stores32 Total time58.3 days

22. 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

23. 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

24. Future State Dried Blood Screening Process CurrentFuture QtyTimeQtyTime Tasks6112.75 hrs255.60 hrs Waits2151 days723 days Handoffs3615 Decisions112 File/stores268 Total time52.5 days23.65 days

25. 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

26. Future state hearing detection/intervention CurrentFuture QtyTimeQtyTime Tasks8514.5 hrs438.60 hrs Waits2256.5 days1021.5 days Handoffs3523 Decisions126 File/stores3211 Total time58.3 days22.7 days

27. 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

28. 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

29. 30 - 60 day Action Plan ActionwhowhenComplete Provide LTFU access to Update Registry Chris3-12-09X Training in LIMS for LTFUAmy3-19-09X Assure LTFU staff have access to LIMS Barb3-22-09X Update and/or create audio-related forms Kirsten3-23-09X Create LTFU Access databaseMaggi e 5-6-09X – Aug 09 Create standards for data itemsAllison3-31-09X Determine if GCs can track in RegistryAmy3-26-09X

30. 30 - 60 day Action Plan, Continued Actionwhowhencomplete Create Work Space rooms for blood spot transfers/hearing QA /H & V Amy3-13-09X – hearing not possible Write a SOP for the HPRs for Blood Spot Julie3-23-09X Update SOP for the HPRs for Hearing Chris3-23-09X Write script for HPRs to find PCPAmy3-12-09X Finish SOP for LTFU hearingNicole Yaoli 3-24-09X Standardize availability/location of procedures Chris/Bar b 5-1-09X Case conference/set up schedule for future Amy3-13-09X -ongoing Implement new processChris/Bar b 5-18-09X - ongoing

31. 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

32. For more information… http://www.lean.state.mn.us/ Kim McCoy Office of Public Health Practice Minnesota Dept of Health Kim.mccoy@state.mn.us 651-201-3877

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

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

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

36. The Event - November 2-6, 2009 36 Agenda Overview of Kaizen Flow charting Brainstorming Identifying a new process Results Assigning homework Gaining buy-in from leadership

37. Flowcharting 37

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

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

40. New Process 40

41. 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

42. 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.

43. 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 !

44. 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!

45. Questions 45

46. Information 46 Service Contracting Process http://www.idph.state.ia.us/mphi/quality_improvement.asp Contact Information: Erin Barkema Iowa Department of Public Health ebarkema@idph.state.ia.us (515) 242-5524