1. AAMC’s Lean Journey Presented by Mary Margaret Jackson, CPHQ Chief Quality and Risk Officer

2. The Situation: Where We Are The future of Abbeville Area Medical Center as an independent community health system is threatened. Neither the status quo nor incremental changes in quality, cost, and the patient experience will be sufficient. AAMC's survival requires a shared disciplined approach to innovative improvement that will transform the way we do business. The success of the transformation will ultimately depend on the participation of all team members, volunteers, and physicians.

3. The Goal: Where We Need to Be AAMC will improve the value of our patient and family experience through higher quality, lower cost, and improved safety. We will eliminate waste from processes. We will instill a culture of continuous improvement. Whenever possible, we will double the good and half the bad. We will focus on what is important!

4. Why are we implementing Lean? For several years, we have focused on improving our quality, finances, and the patient/family experience. To date, we have made only incremental changes in these measures. That is not acceptable. AAMC needs to make swift, breakthrough improvements to ensure its survival as an independent community health system.

5. What will Lean do for AAMC? Lean is not another “program” or a short-term cost reduction plan. It is a ground-breaking initiative that utilizes Lean thinking to eliminate waste from processes and instill a culture of continuous improvement. It is a break-through change intended to transform the way we care for patients and their families. In short, it is the way we will operate and do business.

6. Who Will be Involved in Lean? EVERYONE!!! All team members, physicians, and volunteers will be involved. Our success depends on everyone’s participation. We are even branching out to the community for involvement. CPHQ 1. Quality Leadership and Structure B. Leadership 3. Engage Stakeholders

7. The Duke Endowment, in partnership with the South Carolina Hospital Association (SCHA) and the North Carolina Hospital Association (NCHA), awarded AAMC an innovative, opportunity to establish the Carolinas Rural Hospital Lean Culture Transformation Collaborative. In year one, the grant funding was awarded to 4 hospitals in SC to improve operational, quality and financial performance, patient care, customer service and health outcomes of small, rural hospitals in South Carolina and North Carolina by implementing a lean operating system and culture. AAMC has been paired with Newberry hospital to work through the Lean process for the past three years. CPHQ 1. Quality Leadership and Structure B. Structure 3. Assist in selecting and using performance improvement approaches (e.g., PDCA, Six Sigma, Lean thinking) Grant Funding

8. How will Lean work? Based on our goals, we will select departments or units on which to focus. For each of these focus departments, we will put together teams of about 4 to 6 team members, one-third of whom will be from the focus department, one- third will be from areas that interact with the focus department, and one-third will be those not involved with the department but who can provide a fresh perspective on the situation. Over a three-day + period, the team will partake in a Value Stream Analysis which will result in Rapid Improvement Events, RIEs, Projects, and Just Do Its.

9. How Many Teams Will We Have? During the third year on our Lean journey, we anticipated working in four Value Streams and conducting several Rapid Improvement Events in each, involving at least 41% of our full time and part time work force.

10. I If Lean Eliminates Waste, Will it lead to Layoffs? NO! Lean includes a redeployment policy, meaning that jobs will not be eliminated as part of a Lean project. In addition, we created a Lean Department, which created career developing opportunities. Lean will create opportunities. Those who serve on teams will have a chance to develop new skills. We have developed manager/leadership skills. CPHQ B. Implementation and Evaluation Establish teams and roles

11. Certifications Green/Bronze Certification: Mary Margaret Jackson, Cindy Hill, Sharon Norryce, Charlotte Campbell (September 2013) Carl Monson (November 2013) Latressa Kennedy & Sherry Hall (March 2014) Erin Stillinger & Sarah Rudder (Feb 2015) Alberta Watt & Ernest Shock (July 2015)

12. Certifications Silver Certification Mary Margaret Jackson & Carl Monson (July 2014) Erin Stillinger & Charlotte Campbell (Oct 2014) CPHQ 3. Performance Measurement and Process Improvement C. Education and Training 2. Provide training on performance/quality improvement, program development, and evaluation concepts.

13. TPOC Transformational Plan of Care for AAMC was first developed October 4, 2012. Reviewed quarterly, just completed our 9 th review on August 5, 2015

14. How h ave the Focus Departments Been Chosen? Senior Leadership assessed every department in the hospital to identify the units in which rapid improvement would have the biggest impact throughout AAMC. The decision process included evaluating all opportunities for improvement. The four focus departments chosen are ED, Revenue Cycle (RVC), Health Related Home Care (HRHC) and Physician’s Practice. CPHQ 1. Quality Leadership and Structure A. Leadership 1. Support organizational commitment to quality

15. Mission Control Board is where we discuss the TPOC For the first two years AAMC executive leadership met at the Mission Control Board every week, recently we have gone to every 2 weeks. The meeting lasts for about 30 minutes and we have agendas that cover all of our topics CPHQ 1. Quality Leadership and Structure A. Leadership 1. Support organizational commitment to quality

16. Value Streams A VSA is 3 day event where a team of people who work in an area undertake a value stream mapping exercise as a way to see those activities that are either valued by the patient or are simply necessary to get through the internal processes that exist.

17. RIE’s RIE (Rapid Improvement Event): A 4.5 day process utilizing a team based methodology to apply the lean tools for seeing waste and making immediate improvement. Used for Implementing Change.

18. Where do we go from here? Added Value Stream in Inpatient

19. Evaluate & Implement Swing Bed Charlotte Campbell Develop ED Business Plan Erin Stillinger Improve HRHC Admits and Recerts Tempie Gilmer Implement 340b Program for Outpatients Cynthia Glover Develop Comprehensive Plan To Increase Market Share – Tele-Health and Behavior Health Gregg Holtzclaw Physician Quality Reporting System D r. Chris Oxendine

21. Questions??