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  1. 1. Northwestern Memorial Hospital’s Approach to Process Improvement Presented To WCBF's 8th Annual Lean, Six Sigma and Process Improvement in Healthcare Summit March 18, 2009 By Bob Costello, Director, Process Improvement Northwestern Memorial Hospital
  2. 2. Northwestern Memorial Hospital Chicago, Illinois <ul><li>Second oldest hospital in Chicago (1865) </li></ul><ul><li>Largest hospital in Illinois: 873 licensed beds / 46,182 admissions in 2008 </li></ul><ul><li>Only acute care hospital in Chicago’s central area </li></ul><ul><li>Primary teaching affiliate of Northwestern’s Feinberg School of Medicine </li></ul><ul><li>Average of 17% operating cash flow margin for last 20 years </li></ul><ul><li>AA+ bond rating by Standard and Poor’s and Aa/AA category rating for more than 25 consecutive years </li></ul><ul><li>Approximately $1 billion in revenue </li></ul>Feinberg and Galter Pavilions
  3. 3. NMH Has Been Recognized for Quality and Excellence <ul><li>“ Most Preferred Hospital” for 14 Years </li></ul><ul><li>Leapfrog Group’s “Top Hospitals List”, 2006, 2008 </li></ul><ul><li>UHC Top 10 for Quality and Accountability 2006-2007 </li></ul><ul><li>2005 National Quality Health Care Award </li></ul><ul><li>Achieved Magnet Status, 2006 </li></ul><ul><li>Named to “100 Best Companies for Working Women” for 9 Years </li></ul><ul><li>10 Specialties in U.S. News & World Report of Best Hospitals </li></ul><ul><li>“ Most Wired” for 8 Years </li></ul>
  4. 4. NMH Is Mission Driven with a Strategic Plan that Guides the Organization <ul><li>Mission: </li></ul><ul><ul><li>NMH Is an Academic Medical Center Where the Patient Comes First </li></ul></ul><ul><li>Strategic Plan: </li></ul><ul><ul><li>To Provide the Best Patient Experience from the Patient’s Perspective </li></ul></ul><ul><ul><li>To Recruit, Develop and Retain the Best People who Share the Organization’s Values and Achieve Results </li></ul></ul><ul><ul><li>To Develop the Resources to Achieve Our Mission and Vision through Exceptional Financial Performance </li></ul></ul>
  5. 5. Goal of Process Improvement Program <ul><li>Deliver Measurable Results which Significantly Impact the Strategic Plan </li></ul><ul><li>Best Patient Experience </li></ul><ul><li>Best People </li></ul><ul><li>Exceptional Financial Performance </li></ul>
  6. 6. <ul><li>154 projects completed </li></ul><ul><li>78% reduction in avoidable severe events (since 2004) </li></ul><ul><li>Over 1 million patient interactions impacted </li></ul><ul><li>Over $30 million in net financial benefit </li></ul><ul><li>Over 70% of completed projects achieved statistically significant improvement </li></ul>Impact of Process Improvement Program Since 2002
  7. 7. Core Elements of Process Improvement Program <ul><li>Chartered projects with data driven problem statements, key metrics for success, and timelines </li></ul><ul><li>DMAIC framework for problem solving </li></ul><ul><li>Toolbox featuring a wide array of tools, including Six Sigma, Lean, Rapid Improvement Workshops, and Change Management </li></ul><ul><li>Trained process engineers and change managers on staff </li></ul><ul><li>Project selection process </li></ul><ul><li>Project oversight </li></ul>
  8. 8. <ul><li>Clarifies what is expected of the team </li></ul><ul><li>Keeps the team focused </li></ul><ul><li>Keeps the team aligned with organizational priorities </li></ul><ul><li>Transfers the project from the Project Sponsor to the project team </li></ul>Project Charter The charter establishes the purpose and plan for the process improvement project
  9. 9. Project Charter Template Project Name Overview <ul><li>Linkage to BPE/BP/EFP: “Why is this a strategic project” </li></ul><ul><li>Problem Statement: “What is specifically wrong with how we’re currently doing things?” </li></ul><ul><li>Goal/Benefit: “By next September this will be better by this much” </li></ul><ul><li>Scope: “By next September this process/area will have been affected … this process/area will not” </li></ul><ul><li>System Capabilities/Deliverables: </li></ul><ul><li>“ The problems will be solved and the goals achieved through the delivery of the following functionality” </li></ul><ul><li>Resources Required: “This can only be achieved with xx system, yy people and zz dollars” </li></ul>Key Metric(s) “ Here’s how you’ll know that we’ve made an impact” “ Yes, I can measure this“ “ No, it does not require manual data pulls” Executive Sponsor: Sponsor : Process Owner: Improvement Leader: Milestones “ Here’s how you’ll know I’m on track” Description Date (mo/yr) #1 #2 #3
  10. 10. Tips for Successful Chartering <ul><li>If it sounds confusing to you, then it is … you’re not done </li></ul><ul><li>Complete the problem statement first </li></ul><ul><li>There is data collection in the Charter … it can take time </li></ul><ul><li>Always answer the “Start - Stop” question </li></ul><ul><li>Ensure your scope reflects your time horizon </li></ul><ul><li>Try to avoid over 12 month projects … ideally target < 6 months </li></ul><ul><li>Outcomes, outcomes, outcomes … whenever possible … studies do not impact our patients, employees or finances </li></ul><ul><li>Estimate where necessary, refine over time … something provides a guide, nothing causes delay’s </li></ul><ul><li>Like issues, like team members, like timeframes = potentially same project </li></ul><ul><li>As a sponsor ask “If I was the improvement leader, would I know what to do?” </li></ul>
  11. 11. Process Improvement Methodology (DMAIC) DMAIC provides an easily managed, systematic process to deliver measurable results To Date: Nearly 700 Managers / Staff trained in DMAIC fundamentals Who are the customers and what is the problem from their perspective? How is the process performing today and how is it measured? What are the most important drivers of poor performance? How do we remove the drivers of poor performance? How do we ensure that we sustain the improved performance? Define Measure Analyze Improve Control
  12. 12. Improvement Teams Proper team establishment increases probability for success Project Sponsor Improvement Leader Process Owner Improvement Team Project Executive Sponsor Clinical / Academic Sponsor (As Required)
  13. 13. The “Toolbox” Six Sigma Change Acceleration Process Lean Rapid Improvement Workshop Leading Change Changing Systems & Structures Current State Transition State Improved State Creating A Shared Need Shaping A Vision Mobilizing Commitment Making Change Last Monitoring Progress
  14. 14. Process Improvement Department <ul><li>Structure: </li></ul><ul><ul><li>Northwestern Memorial Hospital Employees </li></ul></ul><ul><ul><li>Peers to Management </li></ul></ul><ul><ul><li>Lead and Coach projects </li></ul></ul><ul><ul><li>Aligned with Corporate Objectives </li></ul></ul><ul><ul><li>Engaged Through Implementation </li></ul></ul><ul><li>Experience: </li></ul>50+ years experience in operational consulting <ul><li>Industries </li></ul><ul><li>Providers </li></ul><ul><li>Automotive </li></ul><ul><li>Telecommunications </li></ul><ul><li>Banking / Financial Services </li></ul><ul><li>Retail </li></ul><ul><li>Non-Healthcare Clients </li></ul><ul><li>AT&T </li></ul><ul><li>Saturn (GM) </li></ul><ul><li>Bankers Trust </li></ul><ul><li>Sears </li></ul><ul><li>Lucent Technologies </li></ul><ul><li>Healthcare Clients </li></ul><ul><li>Cedars Sinai Medical Center </li></ul><ul><li>University of North Carolina </li></ul><ul><li>Baptist Memorial Health System </li></ul><ul><li>American College of Radiology </li></ul><ul><li>University of Pennsylvania </li></ul>
  15. 15. Process Improvement Training CLASS DESCRIPTIONS DATES Introduction to Process Improvement and DMAIC This class provides individuals with a basic understanding of the DMAIC methodology, lean principles and change management.  Participants will receive a series of basic tools that will equip them to lead and execute improvements within their specific departments. (Time Commitment: 8 hours) 11.28.07 1.30.08 3.25.08 5.20.08 7.22.08 Lean Principles and Tools for DMAIC This class gives individuals the opportunity to gain a deeper understanding of the Lean principles and philosophy.  The class will cover how to identify a Lean opportunity during a DMAIC project and how to translate Lean thinking into action and results (value stream mapping, push vs. pull model, eight wastes, 5s, set-up reduction, kanban). (Time Commitment: 8 hours) 01.08.08 03.05.08 06.03.08   The above two classes will be available on ELM for enrollment during the week of October 8, 2007   DMAIC Project Leader Training This class is designed for individuals assigned to lead a DMAIC improvement project.  This class will provide an in-depth exposure to the tools and methods necessary to successfully lead and achieve results using the DMAIC methodology, lean thinking and change management techniques.  Application of methods along with hands-on exercises will help to ensure rapid learning, knowledge retention, and immediate application.  The expectation is for the student to lead future projects and serve as a DMAIC resource for their department. (Time Commitment: 14 sessions at 4-8hrs/session  total of 64 hrs between November and April) Candidate Prerequisites        Executive Sponsor and Sponsor identified, an interview with the Process Improvement team, project charter with problem statement established or willingness to be assigned a project, bandwidth to combine learning time with project execution. Candidate Criteria      Problem solver, ability to communicate effectively, strong presentation skills and 25% of their time dedicated to project workload.   Training will begin in November and will continue into April.   CLASS DESCRIPTIONS DATES Introduction to Process Improvement and DMAIC This class provides individuals with a basic understanding of the DMAIC methodology, lean principles and change management.  Participants will receive a series of basic tools that will equip them to lead and execute improvements within their specific departments. (Time Commitment: 8 hours) 11.28.07 1.30.08 3.25.08 5.20.08 7.22.08 Lean Principles and Tools for DMAIC This class gives individuals the opportunity to gain a deeper understanding of the Lean principles and philosophy.  The class will cover how to identify a Lean opportunity during a DMAIC project and how to translate Lean thinking into action and results (value stream mapping, push vs. pull model, eight wastes, 5s, set-up reduction, kanban). (Time Commitment: 8 hours) 01.08.08 03.05.08 06.03.08   The above two classes will be available on ELM for enrollment during the week of October 8, 2007   DMAIC Project Leader Training This class is designed for individuals assigned to lead a DMAIC improvement project.  This class will provide an in-depth exposure to the tools and methods necessary to successfully lead and achieve results using the DMAIC methodology, lean thinking and change management techniques.  Application of methods along with hands-on exercises will help to ensure rapid learning, knowledge retention, and immediate application.  The expectation is for the student to lead future projects and serve as a DMAIC resource for their department. (Time Commitment: 14 sessions at 4-8hrs/session  total of 64 hrs between November and April) Candidate Prerequisites        Executive Sponsor and Sponsor identified, an interview with the Process Improvement team, project charter with problem statement established or willingness to be assigned a project, bandwidth to combine learning time with project execution. Candidate Criteria      Problem solver, ability to communicate effectively, strong presentation skills and 25% of their time dedicated to project workload.   Training will begin in November and will continue into April.   Introduction to Process Improvement and DMAIC   This class provides individuals with a basic understanding of the DMAIC methodology, lean principles and change management.  Participants will learn basic tools that will help them to lead and execute improvements within their specific teams. (Time Commitment: 8 hours) 9.23.08 11.18.08 1.20.09 3.17.09 5.19.09 7.21.09 Lean Principles and Tools for DMAIC   This class gives individuals the opportunity to gain a deeper understanding of Lean principles and philosophy.  The class will cover the key principles of Lean thinking and how to identify a Lean opportunity during a DMAIC project and how to translate Lean thinking into action (value stream mapping, push vs. pull model, eight wastes, 5S, set-up reduction, kanban). (Time Commitment: 8 hours) 10.28.08 12.16.08 2.17.09 4.21.09 6.16.09 8.18.09 Excel for DMAIC   This class will teach participants to efficiently understand and analyze data using Microsoft Excel within the context of the DMAIC process improvement methodology. Topics include manipulating raw data using formulas and pivot tables, custom graphing strategies, and tactics to best tell the analytical story. (Time Commitment: 4 Hours) 10.21.08 12.9.08 2.12.09 4.14.09 6.9.09 8.11.09 DMAIC Improvement Leader Training   This class is designed for individuals assigned to lead a DMAIC improvement project and will provide an in-depth exposure to the tools and methods necessary to successfully lead and achieve results using the DMAIC methodology, lean thinking and change management techniques.  Application of methods along with hands-on exercises will help to ensure rapid learning, knowledge retention, and immediate application.  The expectation is for the student to lead future projects and serve as a local DMAIC resource for their department. (Time Commitment: planned 14 sessions at 4-8hrs/session; a total of 64 hrs between Oct08 and Mar09) Training will begin in Oct08 and will continue into Mar09.
  16. 16. Project Selection Process <ul><li>Completion of NMH goals </li></ul><ul><li>Linkage with Annual Quality Planning Process </li></ul>Compile Project Requests Launch New DMAIC Projects Confirm Alignment with Organizational Priorities <ul><li>PI internal review </li></ul><ul><li>Cross-Departmental Advisory Group review </li></ul><ul><li>BPE Committee review </li></ul><ul><li>Identify resources to lead prioritized projects </li></ul><ul><ul><li>PI Leaders </li></ul></ul><ul><ul><li>Departmental staff </li></ul></ul><ul><li>Communicate status to Sponsors </li></ul>PI project selection is aligned with the annual NMH & Quality goal setting processes Refreshed Quarterly
  17. 17. Project Request Process <ul><li>Common process for all proposed PI projects </li></ul><ul><li>Builds upon the Annual Quality Planning process </li></ul><ul><li>Consistent level of detail facilitates effective project prioritization </li></ul>
  18. 18. Project Oversight <ul><li>Improvement Council </li></ul><ul><li>Bi-monthly sessions for all PI projects </li></ul><ul><li>Chaired by Senior VP Quality & Planning </li></ul><ul><li>30+ projects per session </li></ul><ul><li>Front line staff present, senior leaders attend </li></ul><ul><ul><li>Complete a standard template </li></ul></ul><ul><ul><li>50% presentation – 50% Q&A </li></ul></ul>Provides improved communication, prioritization and accountability
  19. 19. Improvement Council “Four Blocker” <ul><li>The DMAIC phase you are in </li></ul><ul><li>The problem, described using key measures </li></ul><ul><li>What the analysis tells us about the drivers of error (starting in Analyze phase) </li></ul><ul><li>Planned and/or implemented improvements and linkage to key drivers of error (starting in Improve phase) </li></ul><ul><li>The key outcome metric, expected improvement, and when we should see the outcome measure move </li></ul>“ The script”
  20. 20. Key Organizational Focus Areas in FY08 Achieve Top Decile performance on 80% of publicly reported quality measures Achieve $35 Million in cost improvement and Increase net revenue by $6 Million through revenue cycle enhancements Operationalize New Prentice Women’s Hospital, Increase bed capacity, and Improve patient throughput Achieve 95% - 100% compliance with 80% of targeted safe care practices Evidence-based Care Always Practices Operating Excellence Improving Access for our Patients
  21. 21. Process Improvement Project Portfolio Reflects Key Focus Areas <ul><li>Door to Balloon Time Improvement </li></ul><ul><li>Heart Failure: Compliance with Discharge Instructions </li></ul><ul><li>Pneumonia Core Measures </li></ul><ul><li>Surgical Care Improvement Project: Colorectal Normothermia </li></ul><ul><li>Surgical Care Improvement Project : Core Measures </li></ul><ul><li>Clean Hands Improvement </li></ul><ul><li>Compliance with Pitocin Protocol </li></ul><ul><li>Falls Prevention and Patient Safety </li></ul><ul><li>Management of Major Obstetrical Hemorrhage </li></ul><ul><li>Pressure Ulcers Phase II: Developing New Always Practices to Reduce Prevalence </li></ul><ul><li>Item Availability </li></ul><ul><li>Pharmacy Distribution Automation </li></ul><ul><li>Reducing the Use of Safety Aides </li></ul><ul><li>Revenue Cycle Enhancement </li></ul><ul><li>Surgery Scheduling Workflow </li></ul><ul><li>Care of the Critically Ill Oncology Patient </li></ul><ul><li>Decentralized Design: Role of the Unit Secretary in Interdepartmental Communication </li></ul><ul><li>Dining On Call </li></ul><ul><li>Emergency Department Length of Stay </li></ul><ul><li>Optimizing Observation Care </li></ul>Evidence-based Care Always Practices Operating Excellence Improving Access for our Patients
  22. 22. Key Results Enabled by Process Improvement Achieved Top Decile performance on 84% of publicly reported quality measures Achieved $35 Million in cost improvement and Increased net revenue by $8.3 Million through revenue cycle enhancement projects Added 72 inpatient beds as a result of NPWH opening & Feinberg re-stack enabling a 12% increase in admissions, and Achieved throughput improvements Achieved 95% - 100% compliance with 90% of targeted safe care practices Evidence-based Care Always Practices Operating Excellence Improving Access for our Patients
  23. 23. Lessons Learned <ul><li>The right questions drive culture: </li></ul><ul><ul><li>What is the problem you are trying to solve? </li></ul></ul><ul><ul><li>Where is the graph which shows this is a problem? </li></ul></ul><ul><li>Select the right projects </li></ul><ul><li>Put the right people on the bus for every project </li></ul><ul><li>The value of a consistent framework </li></ul><ul><li>Provide strong improvement tools & experienced improvement leaders and coaches </li></ul><ul><li>Process improvement supports strategy…it’s not “the strategy” </li></ul><ul><li>Ensure clear accountability for sustaining results </li></ul><ul><li>Measure, Measure, Measure…Report, Report, Report </li></ul>

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