Accelerating The Lean Six Sigma Transformation By Engaging Physicians

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Accelerating The Lean Six Sigma Transformation By Engaging Physicians

  1. 1. Accelerating the Lean Six Sigma Transformation by Engaging PhysiciansWCBF’s 10th Annual Lean Six Sigma and Process Improvement in Healthcare Summit May 10, 2011 Workshop A David V. Chand, MD Anne Musitano, RPh, PharmD, MBOE, BB Akron Children’s Hospital Center for Operations Excellence Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron 1
  2. 2. AgendaOverview of ACHBrainstorming exercise and discussionResident EducationRadiology JourneyBreakPractical exerciseTakeaways Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  3. 3. Overview of AkronChildren’s Hospital Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  4. 4. Akron Children’s Hospital• Largest pediatric healthcare provider in Northeast Ohio.• 2 Freestanding pediatric hospitals & services in 80+ locations across the region• 253 bed• ½ million patients each year• 4,000 + employees• 10,000 admissions• 579,000 outpatient visits• Gold Seal of Approval from the Joint Commission• Magnet Recognition Status from American Nurses Credentialing Center Process improvement through people development™ 4 Copyright Childrens Hospital Medical Center of Akron
  5. 5. Akron Children’s HospitalCenter for Operations Excellence Center for Operations Excellence: • The mission of the Center for Operations Excellence is to develop and use in-house talent to improve the healthcare experience of our patients and families, while improving the working experience of our staff. • Currently staffed by 8 individuals o 1 Senior Director o 5 project leaders o 1 data analyst o 1 office coordinator Process improvement through people development™ 5 Copyright Childrens Hospital Medical Center of Akron
  6. 6. Philosophy of the Center forOperations Excellence Process Improvement Through People Development TM Process improvement through people development™ 6 Copyright Childrens Hospital Medical Center of Akron
  7. 7. Akron Children’s HospitalLean Six Sigma Operating System•A3 Benefit Category Since COE inception (as of February 2011) Patient wait time 42,831•Green Belt reduced (days)•Black Belt Staff non-value added time reduced (hours) 24,056•Blue Belt Appt access times reduced (days) 74,608•Kaizen Financial Impact (direct and indirect) $8,177,222 Process improvement through people development™ 7 Copyright Childrens Hospital Medical Center of Akron
  8. 8. Akron Children’s Hospital’sLean Six Sigma Operating System• A3: 8-week formal training program which teaches front-line staff the basics of Lean, culminating in the completion of a project in the participant’s home department. Process improvement through people development™ 8 Copyright Childrens Hospital Medical Center of Akron
  9. 9. Akron Children’s Hospital’sLean Six Sigma Operating System• Green Belt: Formal training program and project which lasts 6-12 months, following the DMAIC (Define, Measure, Analyze, Improve, Control) format. Process improvement through people development™ 9 Copyright Childrens Hospital Medical Center of Akron
  10. 10. Akron Children’s Hospital’sLean Six Sigma Operating System• Black Belt: 12-month projects involving large value streams which utilize more advanced tool of Lean Six Sigma via OSU. Process improvement through people development™ 10 Copyright Childrens Hospital Medical Center of Akron
  11. 11. Akron Children’s Hospital’sLean Six Sigma Operating System• Blue Belt: Training for managers and departmental leaders focusing on daily management in a Lean enterprise through tools, processes, and systems. Process improvement through people development™ 11 Copyright Childrens Hospital Medical Center of Akron
  12. 12. Akron Children’s Hospital’sLean Six Sigma Operating System• Kaizen: Events lasting 2-5 days which result in rapid implementation of countermeasures. Process improvement through people development™ 12 Copyright Childrens Hospital Medical Center of Akron
  13. 13. Brainstorming Exercise When you think of engaging physicians in a Lean Six Sigma transformation, what potential barriers to success have you encountered in your organization? Please list them and be prepared to share with the audience Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  14. 14. Green Belt Project:Resident Rounding Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  15. 15. Goals• Review a green belt project from start to finish and understand how to involve physicians• Realize the importance of engaging physicians-in- training to cultivate a lifelong attitude of continuous improvement• Identify the key success factors necessary for successful engagement of physicians in Lean Six Sigma projects Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  16. 16. DEFINEProcess improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  17. 17. Center for Operations Excellence Project CharterProblem Statement: Goal Description:Residents are currently limited to working a maximum of 80 Reduce the non-value-add time per patient (including necessaryhours per week, and this limit will likely be reduced to 55-60 non-value-add time) present in the pre-rounding and roundinghours in the next 2-3 years. In order to provide excellent patient process from 66% to 50% (25% reduction) in 9 months.care and drive educational value, the entire resident roundsprocess, which comprises roughly 50% of the day, must beimproved in terms of efficiency so as to maximize value-addtime during their work day.Project Y: Key Metrics: Scope:Non-value add (NVA) time •Survey results pre- and post- In Scope: 7:00 AM-12 Noon on weekdays for the Green Team(including necessary NVA): intervention (resident, Hospitalist service only. Only those activities related to the pre-includes time not spent with attending, nurses, and rounding and rounding processpatient/family which does not families)contribute directly to • time per patientdiagnosis/treatment/dischargeTeam Members: Stakeholders: Benefits:•Champions: M. Ramundo, Residents Reduced time spent roundingMD, and N. Christopher, MD Attending physicians Opportunity for attendings to do bedside teaching and role model•MBB: Laura Winner, Johns Nurses Improved nursing morale/satisfactionHopkins Patients and Families Improved patient/family satisfaction•Green Belt: David Chand Medical students Better communication•Process Owner: DavidChand and Chief Residents Potential reduction in length of stay•Team comprised of residents, Potential earlier times of discharge 17attendings, nurses, and parent
  18. 18. MEASUREProcess improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  19. 19. Feedback appears to focus on making communicationefficient and visible, as well as an emphasis ondeveloping a clear management plan Attendings Nurses “There should be “We need to “I didn’t even “We need better fewer handoffs” focus on know resident communication diagnosis and rounds existed” and legible management” notes” “Smaller teams “More bedside “Attendings and “There should be would allow for contact with residents should a scheduled time better teaching patients” round with the for rounds” and efficiency” nurse” Residents Parents “Need to follow a “Order entry “More “Physicians schedule—too during rounds” communication seemed very much time from docs on rushed” waiting around” plan of care” “Involve interns “More bedside in forming plans contact with and focus on patients” management” 19 Source: DRG Attending, pediatric resident, nursing, and patient family surveys administered Fall 2008
  20. 20. Sample observation data
  21. 21. The current Value Stream Map (VSM) for each resident iscomprised of three major steps composed ofseveral sub-processes* Currently, there is no predetermined sequence of events. There is wide variation in the order in which these sub-processes are performed. 21** 5 rounding sessions covering 88 total patients, including 23 primary patients covered by the observed residentsSource: Resident rounds observation data, Fall 2008
  22. 22. The majority of time is spent in formal educational activities, note writing, and formal sit-down rounds Average time spent during each step Time (hours:minutes); N=5* 1:00 0:45 0:30 0:15 0:00 22* 5 rounding sessions covering 88 total patients, including 23 primary patients covered by the observed residentsSource: Resident rounds observation data, Fall 2008
  23. 23. However, only 17% of time spent can be classified as value-add Average time spent by value Percentage of total time by value contribution contribution Time (hours:minutes); N=5* Percent; N=5* •While only 17% of time is value-add, most manufacturing industries recognize that only 10% of their activities are value-add •Opportunity still exists to drive this percentage higher 23* 5 rounding sessions covering 88 total patients, including 23 primary patients covered by the observed residentsSource: Resident rounds observation data, Fall 2008
  24. 24. Current state capability:Non-value-add time per patientP r ocess C apability of achieving non-value added time within 1 5 minutes pr ior to Impr ove ( O ct 2 0 0 8 - Dec 2 0 0 8 ) Calculations Based on Loglogistic Distribution Model LB USL P rocess Data O v erall C apability LB 0 Pp * Target * PPL * USL 0.01042 PPU -0.01 S ample M ean 0.0140399 P pk -0.01 S ample N 23 E xp. O v erall P erformance Location -4.44952 S cale 0.43071 P P M < LB * P P M > U S L 566075.96 O bserv ed P erformance P P M Total 566075.96 P P M < LB 0.00 P P M > U S L 565217.39 P P M Total 565217.39 0.000 0.015 0.030 0.045 0.060 0.075 Process improvement through people development™ 24 Copyright Childrens Hospital Medical Center of Akron
  25. 25. Spaghetti Diagram: Current State Process improvement through people development™ 25 Copyright Childrens Hospital Medical Center of Akron
  26. 26. ANALYZEProcess improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  27. 27. Most of the waste can be classified as either inventory or overprocessing Average time spent by type of waste Percentage of total time by type of waste Time (hours:minutes); N=5* Percent; N=5* 1:30 1:15 1:00 0:45 0:30 0:15 0:00 •40% of the waste is described as inventory, in which patient information is available but is not acted upon—in other words, it is “stored” to be used later •32% of the waste is classified as overprocessing, in which unneeded steps are taken to complete a task 27* 5 rounding sessions covering 88 total patients, including 23 primary patients covered by the observed residentsSource: Resident rounds observation data, Fall 2008
  28. 28. Cause & Effect (Fishbone)Diagram Measurements Material Personnel Charts Patients/Families Work hours Order sheets Residents Discharge times Attending physicians Nurses Students Ancillary services Average rounding time Signout process per patient of Education schedule 31 minutes Patient assignment Fax machines Presentation format by age Orders XWeb Seasonal effects Note writing Paging system Pre-rounding ClinAcc Physical layout Formal rounds RECS Environment Methods Machines Areas of focus 28
  29. 29. IMPROVEProcess improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  30. 30. Center for Operations ExcellenceEase Impact Chart “Family High impact Centered Including Integrating Care” on all nurses in education patients rounds Collaborative into rounds exam and note Orders written during rounds Use of takt time SWI for presentations Low impact Easy to implement Difficult to implement Process improvement through people development™ 30 Copyright Childrens Hospital Medical Center of Akron
  31. 31. Takt time calculator Process improvement through people development™ 31 Copyright Childrens Hospital Medical Center of Akron
  32. 32. Time directly with patients and families now comprises the majority of residents’ time Average time spent during each step, post-intervention Time (minutes); N=5* 0:45 0:30 0:15 0:00 n e n n al n ng t g io ou tiv io io io t in on ki at ct ct ct tra gn ai al rs uc ra ra lle W is Si W Pe te te Ed Co in In In / m re ta an S3 Ad Ca Da i M ic ed ys er Ph nt Ce ily m Fa* 5 rounding sessions covering 86 total patients, including family-centered care for 8 primary patients covered by the observed residentsSource: Resident rounds observation data, Spring/Summer 2009
  33. 33. 55% of time spent can now be classified as value-add Average time spent by value Percentage of total time by value contribution, post-intervention contribution, post-intervention Time (minutes); N=5* Percent; N=5* 19% 26% NNVA VA NVA 55% The proportion of value-add time has been more than tripled by reducing redundant work and increasing time directly spent with patients and their families 33* 5 rounding sessions covering 86 total patients, including family-centered care for 8 primary patients covered by the observed residentsSource: Resident rounds observation data, Spring/Summer 2009
  34. 34. Pilot phase capability: Non-value-add time per patientP r o c e s s C a p a b ilit y o f a c h ie v in g n o n - v a lu e a d d e d t im e in R o u n d in g w it h in 1 5 m in u t e s in P o s t -I m p r o v e ( J u n e 2 0 0 9 ) C a lcula tions Ba se d on Loglogis tic Distribution M ode l LB USL P ro ce ss D a ta O v e ra ll C a p a b ility LB 0 Pp * T a rg e t * PPL * USL 0 .0 1 0 4 2 PPU 0 .5 1 S a m p le M e a n 0 .0 0 4 6 8 7 5 P pk 0 .5 1 S a m p le N 8 E xp . O v e ra ll P e rfo rm a n ce Lo ca tio n -5 .4 0 5 0 4 S ca le 0 .1 9 2 5 7 4 P P M < LB * P P M > U S L 1 2 5 2 7 .3 7 O b se rv e d P e rfo rm a n ce P P M T o ta l 1 2 5 2 7 .3 7 P P M < LB 0 .0 0 P P M > U S L 0 .0 0 P P M T o ta l 0 .0 0 0 .0 0 0 0 .0 0 2 0 .0 0 4 0 .0 0 6 0 .0 0 8 0 .0 1 0 Process improvement through people development™ 34 Copyright Childrens Hospital Medical Center of Akron
  35. 35. Center for Operations ExcellencePilot Phase VSM * Lean Family-Centered Care includes talking to the family, examining the patient, and discussing the plan of care with the attending, intern, and nurse present. During the “Administrative” step, notes and orders are written ** Cycle times for Clinical Care refer to the average total time spent in each activity, although they may occur during two distinct time periods during morning rounds Signout Lean Family-Centered Care* Morning Report Clinical Care Lecture Option Option CT 1 Min Activity CT (Min)* CT 30 Min Activity CT (Min)* CT 45 Min (%) (%) Batch 10-21 Pts Family-Centered Care 10 100 Option 60 % Data collection 11 100 Option 60 % Option 100 % Administrative 3 100 Family interaction 6 90 Total 24 Min Walking 2 100 Physical exam 5 100 Batch 1 Pts Nursing interaction 1 20 Discussion during rounds Physician interaction 9 50 may force the resident to Process is Orders 10 50 complete further repeated for Notes activities in the Note writing 15 100 each patient clinical care Batch 1-4 Pts arena Value-Add Notes 32 Min 10 Min 28 Min 20 Min 2 Min 30 Min 10 Min 40 Min 30 Min 45 Min Non-Value-Add and Necessary Non-Value Add 7:00 A.M. 8:00 A.M. 9:00 A.M. 10:00 A.M. 11:00 A.M. Examples of Waste: Examples of Waste: Examples of Waste: Illegible notes Walking Patient hand-offs Waiting for available computers Notes and order writing Searching for charts Process improvement through people development™ 35 Copyright Childrens Hospital Medical Center of Akron
  36. 36. Spaghetti Diagram: Pilot Phase Process improvement through people development™ 36 Copyright Childrens Hospital Medical Center of Akron
  37. 37. Center for Operations ExcellenceProject Results Measure Before Goal After % change Average rounding 31 minutes 23.5 minutes 15 52% reduction time per patient* minutes Average value-add 10.9 minutes ≥ 10.9 minutes 8.3 24% reduction* time* minutes Average non-value- 20.2 15.1 6.8 66% reduction add time* minutes minutes minutes *The reduction in value-add time is likely due to several factors: • Improved speed of talking to families and conducting physical exams with experience • Using the traditional method, residents often returned to patients’ rooms more than once to clarify information, convey plans, and answer questions which were eliminated using Lean Family Centered Care 37 •Only includes time spent on a specific patient (i.e., does not include formal education time, personal time, etc.) Source: Resident rounds observation data, Spring/Summer 2009
  38. 38. The newer model facilitates teachingand mentoring by attendingphysiciansHospitalist survey*, pre-intervention, N=5 and post-intervention, N=2**The rounding process provides me with adequate time to reachmy personal teaching goals.After morning rounds, residents have a firm understanding of theplan of care for their patients.The current pre-rounding process allows me to use my timeeffectively.***The rounding process allows me to use my time effectively. PostThe information conveyed by the residents during formal roundshelps me in developing my plan of care for each patient. PreI have the opportunity to coach residents and provide timelyfeedback with regards to their physical examination.I have the opportunity to coach residents and provide timelyfeedback with regards to their assessments and plans.The process provides residents with adequate time to completepatient care duties prior to attending noon conferences.The current role of 3rd year medical students in rounds promotesefficiency. 0 1 2 3 4 5* 1, Strongly Disagree; 2, Disagree; 3, Neutral or no opinion; 4, Agree; 5, Strongly agree** None of the differences in responses seen pre- and post-intervention were statistically significant 38*** There is no pre-rounding process in the Lean Family-Centered Care modelSource: DRG Attending survey administered Fall 2008 and Spring/Summer 2009
  39. 39. Residents felt the new modelpromoted efficiency, quality patientcare, and educationPediatric resident survey*, pre-intervention, N=37 and post-intervention, N=11I find the current signout to be useful when I am on-call.I am efficiently able to obtain patient data from the current on-line system.I find that writing a daily progress note is an educational experience.I receive adequate coaching and feedback from attendings.The formal rounding process promotes quality patient care.I am satisfied with the teaching/education I receive during rounds. PostI am satisfied with the way morning rounds are conducted. PreMy time is used efficiently during pre-rounds**.My time is used efficiently during rounds.After morning rounds, I feel that I have a firm understanding of the planof care for my patients.I am satisfied with the amount of time I interact directly with patients andtheir families.I am given the appropriate amount of autonomy to manage my primarypatients.The rounding process allows me to achieve my personal goals (e.g.,patient care, teaching, etc.) 0 1 2 3 4 5* 1, Strongly Disagree; 2, Disagree; 3, Neutral or no opinion; 4, Agree; 5, Strongly agree** There is no pre-rounding process in the Lean Family-Centered Care model 39Source: Pediatric resident survey administered Fall 2008 and Spring/Summer 2009
  40. 40. Nurses significantly favored thenewer model and felt that they weremore involved in the plan of careNursing survey*, pre-intervention, N=48 and post-intervention, N=6Following resident morning rounds, I am aware of the planof care for each of my patients.Physician orders are presented to me in a way that allows meto act upon them in a timely fashion.I believe that my patients’ parents or guardians understandthe daily plan of care. Post PreThe resident rounding process occurs in an efficientmanner.I am able to gain a clear understanding of the patient’s planof care from the primary team’s notes in the chart.The resident rounding process allows me to plan my workday appropriately. 0 1 2 3 4 5* 1, Strongly Disagree; 2, Disagree; 3, Neutral or no opinion; 4, Agree; 5, Strongly agree 40Source: Nursing survey administered Fall 2008 and Spring/Summer 2009
  41. 41. The survey did not detect significantchanges in families’ attitudestowards the processPatient family survey*, pre-intervention, N=33 and post-intervention, N=15I know that I can participate in morning rounds with my child’s healthcare providers.I would be interested in participating in morning rounds with my child’shealth care providers.I know approximately what time my physicians will be in to see my childand me.I am satisfied with the amount of time that physicians spend with mychild and me each day.Following morning rounds, I understand the plan of care for my child. PostMy child’s physicians take enough time to answer my questions eachday. PreI understand the role of each of the health care providers involved in mychild’s care.I understand what needs to occur before my child can be dischargedfrom the hospital.I am satisfied with the quality of physician care provided.I am satisfied with the coordination of care provided.I feel my input is valuable to the team when I can participate in rounds. 0 1 2 3 4 5* 1, Strongly Disagree; 2, Disagree; 3, Neutral or no opinion; 4, Agree; 5, Strongly agree 41Source: Patient family survey administered Fall 2008 and Spring/Summer 2009
  42. 42. Center for Operations ExcellenceFuture State VSM—Vision for the Future The Future State Notes Lean Family-Centered Care Signout Education Activity CT (Min)* Option (%) CT 1 Min CT TBD Min Family-Centered Care 10 100 Batch 10-50 Pts Administrative 3 100 Option 100 % Option 100 % Walking 2 100 Process occurs in parallel with Total 60 Min Batch 1 Pts 2-4 attending physicians Process is based on total repeated for patient volume each patient Continuous Standardized work instructions one-piece flow Patients distributed to interns Smaller “sub- based on volume, complexity, and teams” location Education Takt time calculator used to plan Lean Family-Centered Care integrated into rounding process process SWI for Activity CT (Min)* Option (%) presentations Family-Centered Care 10 100 Administrative 3 100 Walking 2 100 Batch 1 Pts 7:00 A.M. 8:00 A.M. 9:00 A.M. 10:00 A.M. 11:00 A.M. 12:00 P.M. Process improvement through people development™ 42 Copyright Childrens Hospital Medical Center of Akron
  43. 43. CONTROLProcess improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  44. 44. Pilot Phase Control chart:Non-value-add time per patient I Chart of Non-value added time by Stage (with Stability) Pre-Improv e (O ct 2008 - Dec 2008) Post-Improv e (June 2009) 00:50:00NonValueAdded Time (hh:mm:ss) 00:40:00 00:30:00 00:20:00 UCL=00:13:58 00:10:00 _ X=00:06:45 2 2 00:00:00 1 4 7 10 13 16 19 22 25 28 31 Patient Observation Process improvement through people development™ 44 Copyright Childrens Hospital Medical Center of Akron
  45. 45. Center for Operations ExcellenceControl Plan Frequency of Measure Target monitoring Responsibility Threshold Reaction plan Use of takt 100% of Weekly Senior residents 80% of time Education time time calculator Time per 15 minutes Monthly David Chand 20 minutes •Real-time coaching patient observation •Review of SWI •Monitoring is currently a challenge as it relies on direct observation and manual data collection •In the future, we will randomly audit the process monthly by asking a third-year medical student on the team to track the time spent per patient during the process Process improvement through people development™ 45 Copyright Childrens Hospital Medical Center of Akron
  46. 46. Key Success FactorsFrom this project, we learned the importance of the following:• Utilization of the Voice of the Customer (VOC)• Picking a project that addresses a significant “pain point” for physicians—identifying the “burning platform” for them• Emphasis on the similarities between DMAIC and the Scientific Method• Importance of data/observation: “going to the gemba”• Selection of a multidisciplinary project team• Recognize the opportunity to involve physicians-in-training to instill a commitment to continuous improvement Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  47. 47. Center for Operations Excellence Radiology’s Journey to Providing Exceptional Radiology Services Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron 47
  48. 48. Goals• Review the journey of Radiology from 2008 until present, focusing on the increasing involvement of physicians.• Identify the key success factors necessary for successful engagement of physicians in Kaizen projects and Daily Management Systems (ACH Blue Belt Program) Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  49. 49. The Lean Journey of theDepartment of Radiology A3 projects 1/09 – Present• 13 projects to date- Inventory, layout, patient wait time, imaging quality Green Belt Project 2/9/09 - 6/22/09• Stabilized schedule and built capacity to allow for IP & OP’s Shelly’s A3 Project 7/22/09 – 10/12/09• Figured out how to best populate and manage the schedule by working withthe schedulers MRI Kaizen 8/20/09 – 8/21/09 & Continued follow-up• Radiologists, technologists, managers, and the ARC team worked together todevelop system to pull patients forward to load the daily schedule and improveaccess times of patients needing an MRI. Blue Belt Program 9/10/10 – 4/30/11- Daily Management System Process improvement through people development™ 49 Copyright Childrens Hospital Medical Center of Akron
  50. 50. Radiology- 13 staff members A3 trained!Joanne: ImprovingX-ray verificationstep Nichole: Improving the patient care supply areas Process improvement through people development™ 50 Copyright Childrens Hospital Medical Center of Akron
  51. 51. Radiology Involvement in 2 Kaizens!• Kaizen: Events lasting 2-5 days which result in rapid implementation of countermeasuresDr. Rubin, Dr. Eghbal, Jason, Marie, Sedation Services, Radiology, & others:Carol, Terry, Shelly, Julie, Tina, Improving the utilization of SedationKim: Reducing MRI patient access Services through balancing & coordinatingtimes to outpatient appts by the schedule between departmentsincreasing weekly exams performed Process improvement through people development™ 51 Copyright Childrens Hospital Medical Center of Akron
  52. 52. Sustainability of MRI Kaizen! Process improvement through people development™ 52 Copyright Childrens Hospital Medical Center of Akron
  53. 53. Key Success Factors forKaizen From this project, we learned the importance of the following: • Focusing on the system- look at the entire value stream • Defining the physician role in projects- remove barriers, ask questions, look at & verify the data • Providing brief and consistent updates of the project status • Having solid and plentiful data (e.g. utilization rates) • Presenting the successes to peers, the Hospital Board, and PI groups Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  54. 54. Blue Belt Training:Radiology DepartmentThe Elements of the Daily Management System: People, Tools, and Systems1. People‐ Coaching & Idea Board2.  Tools‐ Daily Metric Boards, Daily Huddles, Value Stream Mapping,  DOWNTIME waste, 5S, Idea Board3.  System‐ Leader Standard Work, Problem Solving, Gemba Walking Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  55. 55. IDEA BOARDSTHROUGHOUT RADIOLOGY Process improvement through people development™ 55 Copyright Childrens Hospital Medical Center of Akron
  56. 56. Tools- Value Stream Mapping,Fishbone, Visual Management Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  57. 57. METRIC BOARDS- Visibility!Quality, Growth, Research, Brand Process improvement through people development™ 57 Copyright Childrens Hospital Medical Center of Akron
  58. 58. Daily Huddles Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  59. 59. Go to the Gemba and See!Ask questions to Learn! Process improvement through people development™ 59 Copyright Childrens Hospital Medical Center of Akron
  60. 60. Takeaways from ACH • Focus on the benefits from quality perspective • Data • Pick a project that addresses a significant “pain point” for physicians • Identify the “burning platform” for them • Demonstrate the wins • Utilization of the Voice of the Customer (VOC)- put parents on teams! • Interdisciplinary teams to solve problems Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  61. 61. Physician Skill-set Needed forCurrent Conditions of Healthcare • Leadership skills- transparency, coaching, visibility, and team oriented approach to meet operational and quality goals • Creating a vision for the respective department (s) that aligns everyone towards the same goal • Focus on the patient – daily if possible • Patience to trial countermeasures Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  62. 62. About the Presenters• David Chand is a pediatric hospitalist and Lean Six Sigma Project Leader at Akron Children’s Hospital. Prior to joining the staff at Akron Children’s Hospital in 2008, David worked for two years as a business management consultant for McKinsey & Company, focusing on growth strategy and operations for healthcare providers in the U.S. and Canada. He earned his B.S. and M.S.E. in Biomedical Engineering from The Johns Hopkins University and then his M.D. through the Health Sciences and Technology program at Harvard Medical School and The Massachusetts Institute of Technology. David completed his residency and chief residency in pediatrics at Rainbow Babies & Children’s Hospital in Cleveland, Ohio. In 2009, he earned his Green Belt in Lean Six Sigma through the Center for Innovation in Quality Patient Care at The Johns Hopkins University. David is currently working on his Master of Business Operational Excellence degree through the Fisher School of Business at The Ohio State University.• Anne Musitano is a Lean Six Sigma Project Leader and staff pharmacist at Akron Children’s Hospital. Anne joined Akron Children’s in 2001 as a staff pharmacist in the Outpatient Pharmacy, after graduating from The Ohio State University with a bachelor’s degree in Pharmacy. In 2004, she then became the supervisor of the pharmacy and returned to Ohio State to earn her PharmD. In October 2008, Anne helped build the program which has now become the Center for Operations Excellence at Akron Children’s Hospital. She completed her Master of Business Operational Excellence degree program through the Fisher School of Business at the Ohio State University in 2010. Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron

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