Your SlideShare is downloading. ×
0
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Click here to read this Lean Six sigma presentation.ppt
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Click here to read this Lean Six sigma presentation.ppt

455

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
455
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
14
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide
  • As we discover new medical treatments we are dramatically improving our ability to cure diseases and save lives. On the other hand each new and more powerful drug, each new technology has associated with it increased chance for adverse events. Unfortunately Medical errors have been to easily accepted as the collateral damage for progress in healthcare. Before you feel too depressed, on balance there are still more medical miracles than medical mistakes
  • Transcript

    • 1. Engaging the Leadership Triad in Accelerating Change Using Lean Six Sigma Stephen Mayfield, Dr. H.A., MBA, MBB Senior Vice President American Hospital Association [email_address]
    • 2. Several Themes from High Performing Organizations
      • Seeing differently – especially using variation and error as welcome feedback.
      • Engaging two levels of leadership for collaboration which means:
      • embracing system thinking which cultivates process excellence in which the human factors tendencies within the system are attended.
      • Use of tools that facilitate the dialogue between levels of leadership.
      • Establishing the value proposition, or the Business Case for Quality
      • Using Lean / Six Sigma as methods to Reduce Waste and Eliminate Defects
    • 3. It All Starts With:
      • Create awareness for transformative change that focuses on the Patient’s Experience
      • Grow capacity for Robust Performance Improvement
      • Executive Leadership owns Common Cause Variation
    • 4. Aspects of the Situation
      • Humans are fallible
      • Healthcare is a high-risk environment
      • Faulty communication and hierarchal barriers are common root causes of medical error
      • Healthcare providers do not receive adequate training in communication, teamwork, and assertiveness skills
      • Errors can be reduced through a definable set of teamwork concepts and skills
      From Check Six Training
    • 5. Observations from High Performing Organizations
      • Learning to SEE differently – it’s not about more data, it’s how you look at existing information.
      • DeKalb, Illinois
      • DeKalb, Georgia
    • 6. How Did Healthcare Become So Unsafe?
      • Number
      • Of Deaths
              • Years
      Disease Treatment From P. Gluck
    • 7.
      • “ Medicine used to be simple, ineffective and relatively safe.
      • Now it is complex, effective and potentially dangerous.”
      • Cyril Chantler
      • Lancet, 1999
    • 8. Lessons from Other Fields
    • 9.
      • It’s About Leadership
      • Executive Leaders – Administrators, Trustees & Physician Leaders
      • Patient Care Leaders – those close to the delivery of care to the patient
      • Executives have to “own” common cause” variation !
      PI Hospitals in Pursuit of Excellence
    • 10. PI Hospitals in Pursuit of Excellence
      • Core Principles
      • Focus on the Patient’s Experience - Care must be respectful of, and responsive to, individual preferences, needs and values
      • Create a Culture of Reliability - Culture defines the values and behaviors of organizations. Highly reliable cultures are known to be the safest organizations in the world
      • Manage Organizational Variability - Achieve consistency wherever possible in what you do and how you do it
    • 11.
      • Core Principles
      • Remove Inefficiency and Waste - Removing waste, including in the form of unnecessary steps, has a direct, positive impact on clinical and financial performance
      • Eliminate Harm and Defects - Finding and resolving problem points will result in greater efficiency and better health outcomes
      • Reduce Process Variation - Using quality tools and frameworks can increase consistency in processes of care and administration, thus reducing the risk of errors
      PI Hospitals in Pursuit of Excellence
    • 12. More Important than ever: The New Realities
      • Moody’s has a negative outlook for the US not-for-profit hospital sector, as virtually all rated healthcare credits are facing some degree of credit stress due to a combination of impaired access to the capital markets, soaring credit spreads, counterparty downgrades, and a slowdown in the global economy .
      • Moody’s Investors Service
      • Dec. 2008
    • 13. The New Realities = Margin Non payment adverse events Medicare pressures Non payment readmissions Waste & Inefficiency “ 20% to 50% of all health care efforts are attributable to waste and inefficiency.” Rework, work arounds, defects, errors, unnecessary harm, delays, misuse, overuse, underuse. - COSTS REVENUES
    • 14. A Physician CEO Sees Differently
    • 15. Seeing Differently 1847
      • See
      Dr. Ignaz Semmelweiz General Hospital of Vienna First Ward Second Ward Patients Deaths Percent 4,010 459 11.4 Patients Deaths Percent 3,754 105 2.7
    • 16. Outward Visible Signals of Culture
    • 17. Outward Visible Signals of Culture
    • 18. Jump From 1847 to 2009
      • Number One National Patient Safety Goal of the Joint Commission for reducing Healthcare Associated Infection:
    • 19. Seeing Differently 1986 Challenger Disaster resulted from decisions made in 1972 Individual competence in a poorly designed system
    • 20. Seeing Differently 2003
      • Successful transplant surgery (twice)
      • No verification system for “matching blood type”
      Jesica Santillan Individual competence in a poorly designed system
    • 21. Optimizing the System – Context and Content
      • Premise:
      • All patient care is a system, every system has processes and every process has waste and variability.
      • Corollary:
      • Separating all the processes and optimizing each one and then combining them DOES NOT optimize system performance
    • 22. Four Major Components of Care Delivery
    • 23. Systems of Care and Simple Metrics At the Operational Level Information -> Clinical Decisions -> Care Processes -> Patient Flow Clinical Information System Financial System Patient Patient Patient Patient Cp 1 + Cp 2 + Cp 3 …. Cp 1 + Cp 2 + Cp 3 …. Cp 1 + Cp 2 + Cp 3 …. Evidenced Based Medicine Clinical Best Practices Outcome Indicators (LOS, Mortality, Infection, Readmits) Patient Flow Process Measures (Waste, SMR, Cycle Time Variances, etc.) Charges CD CD CD
    • 24. On a Cruise who has the most impact on your safety?
    • 25. What is Human Factors Science?
      • “… ..Concerned primarily with the performance of one or more persons in a task-oriented environment interacting with equipment, other people, or both.”
      • National Academy of Sciences
    • 26. The Study of factors that contribute to errors including:
      • Human Vulnerabilities related to memory
      • Situational or environmental aspects
      • Cognitive Lapses
    • 27.
      • Perception and Communication
      • An Example
    • 28. Perception and Communication How Many Squares Do You Count? Silently count, and write down your total Image One
    • 29. Say the Color of the word
    • 30. Say the Color of the word
    • 31. Mistake Proofing
    • 32.
      • Perception and Communication
      • An Example of How Technologies Impact System Performance
    • 33.
      • In Short – Performance is affected by Human Tendencies related to cognitive processing attributes and limitations and the effects of system variability and interactions, ESPECIALLY those associated with decisions and communication.
    • 34. PI Hospitals in Pursuit of Excellence
      • Core Principles
      • Focus on the Patient’s Experience - Care must be respectful of, and responsive to, individual preferences, needs and values
      • If it starts with the Patient’s Experience, what does the system deliver?
    • 35. Consumerism Book:
    • 36. New Book I’m Working On:
      • “ If a Hospital Ran Your McDonald’s”
    • 37. Are we getting the message?
      • “ American industry has become very accustomed to running their businesses by watching each other. In fact many of them are still focusing on the competition, only this time it is Japan. In a few years it will be Korea, then China, then some other country. If you just try to meet the competition, you will not survive in this new economic age. You must try to meet the customer, not just the competition.
      • And it is you who must change , not the competition.”
      • -- William Scherkenbach, 1986 , excerpted from a presentation to General Motors
    • 38. Engage Leaders
      • Systemness
      • Culture
      • Structure
      • Strategy
      • Process Field
      • Process Excellence
      • Competencies
      • Team
      • Training
      • Process Improvement
      Healthcare Excellence Requires Collaborative Leadership System Thinking that Supports Process Excellence Context Leaders (executive, trustee, physician leaders) Content Leaders (clinical and non-clinical)
    • 39. Leadership Creates the Framework for a System that Supports Process Excellence Culture Strategy Structure Process Process Excellence
    • 40. Performance Improvement is a function of standardizing the methods, stabilizing the performance, reducing variation until the next innovation moves performance to a new level
    • 41. Iceberg of Ignorance: What % of the Organization’s Problems are known to…. 4 % 9 % 74 % 100% Top Management Middle Managers Supervisors Front-line Employees Problems hidden from management Adopted from Sydney Toshida
    • 42. Five Important Questions for Trustees:
      • What are we trying to accomplish with respect to our performance?
      • What level of quality and safety are we pursuing?
      • How do we measure it?
      • How is our performance changing?
      • Is what we’re doing making a difference?
    • 43. Trustees have a Right and a Responsibility to ask:
      • How do we know if care in our hospital is –
      • S afe?
      • T imely?
      • E fficient?
      • E ffective?
      • E quitable?
      • P atient-Centered
      • ( The Six Institute of Medicine Aims: STEEP )
    • 44. Five Important Questions for Physicians:
      • How do we know if our care processes are reliable ?
      • How do we embrace and promote evidence-based practices ?
      • Are we eliminating preventable harm ?
      • Am I managing the care of my patients and their flow through the system , or have I assigned that to others?
      • Are we actively engaged in peer review learning?
    • 45. Seven Important Questions for Executive Leaders:
      • Are we developing Systems of Care ?
      • Are we providing efficient processes ?
      • What indicators of quality and safety are we bringing to our Board and Physicians?
      • How are we engaging our Physicians ?
      • What are our Costs of Poor Quality ?
      • How is the CFO involved?
      • How are we continually reducing variation ?
    • 46.
      • Has the organization clearly established what is important?
      • Has the organization determined expected performance levels for:
        • (a) Clinical outcomes
        • (b) Operational performance
        • (c) Safety
        • (d) Satisfaction?
      • Has the organization developed a Balanced Measurement System?
      • Has the existing performance been assessed?
      Hierarchy of Activities for High Performers: Engage the Triad
    • 47.
      • Has the Business Case for Quality been established clearly?
      • Are departments/functional areas aligned with the organization ’ s performance expectations?
      • Are priorities for process improvement identified?
      • Are appropriate tools and methods used to bring about successful change and improved performance?
      Hierarchy of Activities for High Performers
    • 48. Outpatient Surgery
    • 49. Process Oriented – Results Driven
      • “ The Toyota mind develops brilliant processes in which average employees may excel.” (Taiichi Ohno)
    • 50. Process Oriented – Results Driven
      • “ The Toyota mind develops brilliant processes in which average employees may excel.” (Taiichi Ohno)
      • Healthcare Analogue -
      • “ Healthcare systems have discontinuous processes in which brilliant staff struggle to produce average results.”
    • 51. Six Sigma Example: High Level Phlebotomy Flow MQC
    • 52. Detailed Phlebotomy Flow MQC
    • 53. Over 40 specific defects identified in 5 classes:
      • Label defects (unlabeled, misplaced, wrong patient labels, misaligned, etc.)
      • Patient ID band defects ( improper matching, no label, wrong label, etc.)
      • Unsuccessful draw (not first stick, second phlebotomist required)
      • Unacceptable specimen/recollect (wrong tube, clotted, hemolyzed, insufficient quantity, contaminated, overfilled, etc.)
      • Order entry defects (time, test, patient)
    • 54. Surrounded by Defects !
    • 55. The System will get you if you Choose Sub-Optimal Solutions !
    • 56. Cost of Poor Quality and Defects
      • For Error that can lead to harm - What is the:
        • Possibility?
        • Availability?
        • Probability?
        • Liability?
        • Opportunity Cost?
    • 57.  
    • 58.
      • It’s About Leadership
      • Executive Leaders – Administrators, Trustees & Physician Leaders
      • Patient Care Leaders – those close to the delivery of care to the patient
      PI Hospitals in Pursuit of Excellence
    • 59. Leaders must ask:
      • How do we know if care in our hospital is –
      • S afe?
      • T imely?
      • E fficient?
      • E ffective?
      • E quitable?
      • P atient-Centered
      • ( The Six Institute of Medicine Aims: STEEP )
    • 60. Several Themes from High Performing Organizations
      • Seeing differently – especially using variation and error as welcome feedback.
      • Engaging two levels of leadership for collaboration:
      • embracing system thinking which cultivates process excellence in which the human factors tendencies within the system are attended.
      • Use of tools that facilitate the dialogue between levels of leadership.
      • Establishing the value proposition, or the Business Case for Quality
      • Becoming a Learning Organization

    ×