1. *6 Mute your Line *7 Un-mute your line Please do not put your phone on hold. 1-800-504-8071, code 8422006

2. Kaizen Model for Continuous Improvement July 23, 2010 1-800-504-8071, code 8422006

3. Minnesota Enterprise Lean

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

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

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

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

8. 7 Wastes  Overproduction  Waiting  Transportation  Processing  Inventory  Motion  Defects

9. 5s  Method for organizing work space –Sort –Shine –Set in order –Standardize –Sustain

10. Before 5S

11. After 5S

12. 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

13. 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

14. 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

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

16. 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

17. Swim Lane Map

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

19. 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

20. 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

21. 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.

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

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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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

34. Service Contracting Kaizen Event Erin Barkema Iowa Department of Public Health Presented July 23, 2010 34 Quality Improvement in Iowa

35. Why a Kaizen event? 35 Customer concerns about the service contracting process Grant application process Issuance of contracts Reimbursement of expenses

36. Pre-event activities 36 Identified a facilitator Identified participants Developed a charter Scope Objectives Goals Gathered data

37. The Event - November 2-6, 2009 37 Agenda Overview of Kaizen Flow charting Brainstorming Identifying a new process Results Assigning homework Gaining buy-in from leadership

38. Flowcharting 38

39. Brainstorming 39 7 ideas for improvement 7 different ways to implement main idea

40. Brainstorming 40 Small groups Discuss options Identify solutions Prioritize solutions IIII IIIV IMPACTIMPACT DIFFICULTY

41. New Process 41

42. Homework 42 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

43. Buy-in 43 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.

44. Post-event activities 44 HOMEWORK, HOMEWORK, HOMEWORK!!! Follow-up meetings 30 day* 60 day* 90 day* 120 day 150 day 6 month* Communication C ELEBRATION !

45. Accomplishments & Lessons Learned 45 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!

46. Questions 46

47. Information 47 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

48. Reflections and Questions

49. Announcements from NNPHI

50. Site Visits and Final Learning Congresses – Schedule is posted on MLC page of website – Please let us know the dates of final sessions/learning congresses 2010 Open Forum September 15-17 th Washington, DC – Please register/reserve your room. Spots still available for the workshops on Sept. 14 th ! – More information regarding presentations/display space is coming soon. Thank you for your patience!

51. Storyboard Call (June 18 th ) – Foiled by technology! – Slides are on MLC page and notes will be available soon. Stories from the MLC – http://www.nnphi.org/mlcstories http://www.nnphi.org/mlcstories

52. More information www.nnphi.org/mlc