1. WHA Improvement Forum For December    “Removing Waste and Improving Efficiencies”   Tom Kaster Courtesy Reminders: Please place your phones on MUTE unless you are speaking (or use *6 on your keypad) Please do not take calls and place the phone on HOLD during the presentation. 1

2. 2 Today’s Agenda  The Value Equation  What is Improving Efficiencies?  What is Removing Waste?  Gaining Staff Engagement in Waste Reduction and Efficiency Improvement

3. The Value Equation 3 Increase Quality = Increase Value Decrease Cost = Increase Value Increase Quality and Decrease Cost = Accelerated Increase in Value

4. Improving Efficiencies Which School of Thought? 4

5. Efficiency Improvement Fewer FTE’s 5 Excess or Wasted Inventory Inefficient care Over / Underuse HACs Poor Communication FTE Savings Wasted Energy Poor Scheduling Poor Service Non- valued Activities Unnecessary Delays FTE Savings through Attrition

6. Back to Deming: 14 Points for Management #8: Drive out fear, so that everyone may work effectively for the company. Improvements in efficiencies and waste cannot be made when people are afraid that the project is a veiled excuse to cut FTE’s. If the culture is of fear, your project will do more harm than good. 6

7. Back to Deming: 14 Points for Management #9: Break down barriers between departments. Large improvements in efficiencies and waste reduction cannot be made at the micro level. You need knowledge from members of the whole process to improve the system. Without a systems team approach, you could improve in one area but cause more harm than saved in another. 7

8. The 8 Wastes 8 Waiting Over- processing DefectsMotionTransportation Over- production InventoryConfusion Removing Non-Value Activities

9. Example WasteExampleDirection Waiting Waiting for medical records Waiting for medical staff Waiting for test results Patients waiting for medical staff "Right now" scheduling Fewer meetings; work done in small focus groups Matching capabilities to demand for services, supplies 9 WasteExampleDirection Over-Processing Clarifying orders Redundant information gathering/charting Missing medications Multiple blood draws for different tests Clear interpretation of regulations System (electronic or paper)of information traveling with patient that eliminates redundancy

10. Example WasteExampleDirection Defects Medication errors Rework Variation in outcomes Incorrect charges/billing Surgical errors Incorrect diagnosis Harm caused System redesigns that support workers in doing their good work by clear specification of activities of work, clear expectations of outcomes and safe environment for problem solving in the course of work Clear definition/ understanding of what is "defect free" Single, clearly understood method of addressing "defect free" right now 10

11. Example 11 WasteExampleDirection Motion Looking for information Looking for materials and people Materials, tools located far from the work IT systems that match the demand of work Reliable communication systems Fluid materials availability that meet the current demand Consistent scheduling that meets the demand

12. Example WasteExampleDirection Transportation Delivery of medication from central pharmacy Staff travel to a remote storage room to retrieve supplies Delivery of surgical pack to OR Unnecessary / untimely delivery of meals Conduct 5-S workplace organization to standardize location of supplies near the point of work Examine staff location as related to commonly used supply storage locations 12

13. Example 13 WasteExampleDirection Over-Production Duplicate charting Multiple forms with same information Unneeded Copies of reports sent automatically Unnecessary labs ordered Multiple / duplicate labs ordered Clear interpretation of regulations System (electronic or paper)of information traveling with patient that eliminates redundancy Bring departments together to map processes and find solutions

14. Example WasteExampleDirection Inventory Overstocked medications on units Overstocked supplies on units and in warehouses Duplicate supplies based only on preference Inadequate inventory management process Build up of outdated inventory Supply exactly what is needed; no more, no less Keep supply availability current Understand personal preferences and orchestrate "like" items use 14

15. Example 15 WasteExampleDirection Confusion Same activities being performed in different ways by different people Unclear MD orders Unclear route for medicine administration Unclear system for indicating charges for billing Patients not understanding discharge instructions Poor shift change hand off Lack of daily patient goals All activities of work clearly specified Clear signals that trigger activities of work uniformly

16. Better use of existing resources Less patient waiting time Less time waiting for orders Savings from using less inventory / energy Improved customer service Improved communication Decreased OT or Less Agency Service Costs Improved employee satisfaction 16 Efficiency Improvement More Value Added Work

17. Project Ideas 17

18. Where to Start Develop a portfolio of improvement projects Align them with the primary and secondary drivers Set an aim of cost savings for each project Develop a cross-functional team which focuses on each project which includes frontline staff Research potential solutions PDSA PDSA PDSA 18

19. Takeaways If you develop a culture that defines efficiency improvement as cutting FTE’s you are going to fail in your improvement projects / initiatives Your staff is you best resource for improvement Understand that waste comes in multiple forms Develop your improvement portfolio Always strive to increase value added activities and decrease non-value activities 19

20. In Closing 20 “It is better to protect investment by working continually toward improvement of processes and of product and service that will bring the customer back again.”

21. Resources Institute for health improvement– Increasing Efficiency and Enhancing Value in Health Care Institute of Medicine: Overuse, Underuse and Misuse of Medical Care 21

22. Thank You! Questions Please complete 3 question survey when closing webinar window. 22