Implementing A Balanced Lean Six Sigma Operating System In A Healthcare Organization

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  • 1. Implementing a Balanced Lean SixSigma Operating System in aHealthcare Organization Doug Dulin, Akron Children’s Hospital Lean Master, Master Black Belt Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  • 2. A Balanced Lean Six Sigma Operating System Part 1 Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  • 3. Balanced Lean Six SigmaOperating System Speaker: Doug Dulin Bio: Doug Dulin is the Senior Director for Akron Childrens Hospital Center for Operational Excellence. He is a proven leader with extensive experience transforming manufacturing and healthcare organizations utilizing Lean Six Sigma fundamentals based upon the Toyota Production System. Throughout his career, Doug, has held such positions as Director Lean Six Sigma, Business Unit Manager, Plant Manager, Lean Site Leader and Lean Master. He earned his Lean Six Sigma Master Black Belt Certification from Honeywell International. Earlier in his career, he learned the Toyota Production System from Aoyama Seisakusho, a Tier One Supplier to Toyota Motor Manufacturing. Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  • 4. Balanced Lean Six SigmaOperating System Shigeo Shingo – “Know how alone isn’t enough! You need to Know- why”! All too often, people visit other plants only to copy their tools and methods.” “Think in terms of categorical principles.” Tools Systems Principles Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  • 5. Balanced Lean Six SigmaOperating System Goals of this presentation • Introduce to the elements of a Balanced Lean Six Sigma Operating System • Case Study Review: Learn about Akron Children’s Hospital Balanced Lean Six Sigma Operating System Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  • 6. Balanced Lean Six SigmaOperating System Elements of a Balanced Lean Six Sigma Operating System Internal Lean Lean Six Sigma Sensi Team Belt Program Baseline Baseline Balanced Lean Connecting your Event Kaizen Events Scorecard Board Directors A3 for Healthcare Kaizen for Good Build your Daily Transformation Patient Care Management System LEAN SIX SIGMA PRINCIPLES Tools Systems Principles Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  • 7. Balanced Lean Six SigmaOperating System Internal Lean Sensi Team > Team of Internal Organization Stakeholders leading the culture and process transformation using Lean Six Sigma Tools, Systems and Principles > Development driven through outside learning, internal cycles of learning managing projects and leading enterprise wide improvements > Internal Lean Team should include a range of experienced employees, Physicians, Nurses and key leaders within the organization > Use of outside consultants should be used to help begin a program, introduce new advanced lean six sigma tools or off set a head count issue for a short term period Internal Lean Sensi Team Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  • 8. Balanced Lean Six SigmaOperating System Baseline Kaizen Events A baseline is a starting point. The baseline process will allow us to gain a defined understanding of our current state. Without a baseline, we cannot be certain what or where to improve. Baseline deliverables include: An understanding of the current and future states, Identification of the gaps between the two, and A plan to close the gaps. Organization Development Operations OD Baseline understands: Operations Baseline understands: •Human Capital Current State •Current State of all Operations •Creates the Future State and links it with •Creates the Future State and links it with Strategy Strategy •Determines and Creates Go Forward Action •Determines and Creates Go Forward Action Plan Plan Baseline Kaizen Events Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  • 9. Balanced Lean Six SigmaOperating System A3 for Healthcare Transformation http://leanforhaiti.org/ “Essence of Lean” Methodology • Staff driven – 8 week course • Bottom up – General Lean Tools • Enabling process – 2 hours per class • Numerous but small projects – 2 hour “homework” – 15-30 students – Offered twice per week – Complete one project using A3 story telling visual board – Graduation ceremony with executive leadership A3 for Healthcare Team Transformation Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  • 10. Balanced Lean Six SigmaOperating System Lean Six Sigma Belt Program Description Flash Sterilization Rate by LSS Project Phase (P Chart) > Projects link with program or [Excl Procedures Outside ORs; Oct 2007-present; Target < 3%] enterprise strategic plan 0.25 Baseline Pre-Implementation/ Implementation Control > Data driven projects 0.20 UCL=0.1967 > Advanced training in Lean Six UCL=0.1895 Sigma Tools 0.15 _ P=0.1307 > Advanced training in project _ P=0.1132 management 0.10 UCL=0.0906 > Advanced training in soft skills 0.05 LCL=0.0648 _ P=0.0483 > Projects range from 6 to 9 months LCL=0.0368 0.00 LCL=0.0061 > Advancement program includes 1 8 15 22 29 36 43 50 57 64 71 Green, Black and Master Black Belt Tests performed with unequal sample sizes > Development tools for future leaders Lean Six Sigma and Physicians Belt Program Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  • 11. Balanced Lean Six SigmaOperating System Kaizen for Good Change for Patient Care Description • Drive Business strategic plan quickly using lean six sigma tools • Significant and rapid change (rapid improvement week) • Short term intensive concentrated effort by front line stakeholders, physicians and nurses Kaizen for Good • Enterprise should support 20 Patient Care to 30 per year Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  • 12. Balanced Lean Six SigmaOperating System Tier 3 VPs Building a Daily Directors Management Supporting Functions System Tier 2 Directors Managers Supporting Functions Tier 1 Area Manager Area Stakeholders Each metric should be applicable to team … Build your Daily Winning or Losing at a Glance Management Metrics … ↑ Visibility … Dig @ source of issue System …Countermeasures! Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  • 13. Balanced Lean Six SigmaOperating System Connecting your Board of Directors to your Lean Operating System Executive Team Corporate StrategyManagement Deployment Team Front Line Daily Leaders Management Connecting your Stakeholders Board Directors Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  • 14. Balanced Lean Six SigmaOperating System Balanced Lean Operating Scorecard Overview Benefit Category Result > Enterprise wide metrics linked directly to strategy of organization Patient wait time 42,831 > Metrics could include $s direct and reduced (days) indirect savings Staff non-value added 24,056 > Patient centered metrics included in time reduced (hours) scorecard Appt access times 74,608 > Simple tracking of metrics possible reduced (days) > More advanced lean six sigma metric tracking available on the Financial Impact (direct $9,177,222 market to improve process through and indirect) the journey Balanced Lean Scorecard Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  • 15. Balanced Lean Six SigmaOperating System What makes a successful Balanced Lean Six Sigma Operating System Project Program EnterpriseStrong support from Champions and The people and managers do the work Support of top executives includingPhysician Leaders physiciansFull Engagement of team by going to Support of top executives by going to Vocal and Visible Support from wholethe Gemba the Gemba and asking questions leadership team by going to the GembaVisibility & Communication Support of physicians No-Lay off policy for Lean initiativesUse data that supports reality Use data that supports reality Use data that supports realityMust have project follow-up and re- Begin to use balance tools, processes Use balanced tools, processes andadjustment and systems within a value stream systemsContinuous Improvement is foundation Learn from other areas and companies Dedicated, trained resources – with most of the team being internal candidatesTeam Engagement is Key Continuous Improvement is foundation Continuous Improvement is foundation Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  • 16. Akron Children’s HospitalBalanced Lean Six Sigma Operating System Case Study Part 2Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  • 17. Blue Belt Program A3 Program DEFINE CONTROL ACH Lean MEASURE Operating System IMPROVE ANALYZE Lean Six SigmaKaizen Events Belt Program Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  • 18. About Akron Children’sHospital • Day Nursery in 1890 to independent stand-alone teaching hospital • Largest pediatric health care system in northeast Ohio • 253 bed hospital – Main campus • 32 bed hospital – Youngtown • offering services at 80+ locations across the region. • 579,000 outpatient visits each year • 10,000 admissions Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  • 19. About Akron Children’sHospital• 4,000 + employees• Gold Seal of Approval from the Joint Commission• Magnet Recognition Status from American NursesCredentialing Center• Stable Leadership William H. Considine President & Chief Executive Officer Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  • 20. About Akron Children’s Lean SixSigma Journey COO Led • Wanted to better the patient experience (decreasing patient wait times, accessMark Watson times) • Looked for a sustainable way for a hospital to improve operations Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  • 21. ACH Center for OperationsExcellence Group 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 Deployment Directors o 1 data analyst o 1 office coordinator Process improvement through people development™ 21 Copyright Childrens Hospital Medical Center of Akron
  • 22. ACH COE Philosophy Process Improvement Through People Development TM Process improvement through people development™ 22 Copyright Childrens Hospital Medical Center of Akron
  • 23. ACH Lean Six Sigma OperatingSystemDMAIC Methodology (Define, Measure, Analyze, Improve, Control)•Kaizen Events • Rapid Process Improvement Week- anywhere from 2 to 5 day events • Strategically driven by Executives • Belts = project leaders; team of 5 – 10 from dept & from dept’s customers•Green Belt and Black Belt Projects • 6 - 9 month projects • Strategically driven by Executives – VPs, C suite, etc. • Project leaders are COE staff, or trained belts • Team of 5–10 from the department•A3 Projects • 8 week long projects, usually within the boundaries of the participants’ home dept • Driven by the line staff doing the work, and supported by their manager•Blue Belt • Manager training to include Gemba Walks, implement daily metrics boards and daily huddles, coaching for staff, etc. Process improvement through people development™ 23 Copyright Childrens Hospital Medical Center of Akron
  • 24. ACH Lean Six Sigma OperatingSystem – A3• 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™ 24 Copyright Childrens Hospital Medical Center of Akron
  • 25. Akron Children’s HospitalA3 Project Overview A3 Projects •Burn Center •Reduction in the number of inaccurate burn dressing cards •Pediatric Psychology •Reduce missed number of MACSIS forms for Medicaid clients •Laboratory •Reduce the QNS rate for patients 3 months and older by 40% for sweat tests •Nursing •The amount of unused linen in empty rooms on the 7th floor will be decreased from up to 31 pieces to 0 pieces •Food Services •Reduce non Nursing non value added time and variation in fortified breast milk preparation. Process improvement through people development™ 25 Copyright Childrens Hospital Medical Center of Akron
  • 26. A3 Example from a ProjectProcess improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  • 27. ACH Lean Six Sigma OperatingSystem – LSS Green Belt Program• Lean Six Sigma Belt Program: Formal training program and project which lasts 6-12 months, following the DMAIC (Define, Measure, Analyze, Improve, Control) format Process improvement through people development™ 27 Copyright Childrens Hospital Medical Center of Akron
  • 28. ACH Lean Six Sigma OperatingSystem – LSS Green Belt Program Green Belt Projects •Flash Sterilization •Problem statement •The Sterile Processing Department cannot currently meet case demand for surgical instruments without a weekly 13.1% flash sterilization rate •SMART Goal •Reduce weekly flash sterilization rate in the OR to ≤ 3% •Results •Reduced weekly flash sterilization rate from 13.1% to 2% Process improvement through people development™ 28 Copyright Childrens Hospital Medical Center of Akron
  • 29. ACH Lean Six Sigma OperatingSystem – LSS Green Belt Program F la s h S te r iliz a tion R a te by L S S P r oje ct P ha s e (P C ha r t) [Excl Proce dure s O utside O R s; O ct 2007-pre se nt; T a rge t < 3% ] B aselin e P r e- Im p lem en tatio n / Im p lem en tatio n C o n tr o l 0.25 0.20 U CL= 0 .1 9 6 7 U CL= 0 .1 8 9 5 0.15 _ P = 0 .1 3 0 7 _ P = 0 .1 1 3 2 0.10 U CL= 0 .0 9 0 6 LCL= 0 .0 6 4 8 _ P = 0 .0 4 8 3 0.05 LCL= 0 .0 3 6 8 0.00 LCL= 0 .0 0 6 1 1 8 15 22 29 36 43 50 57 64 71 T ests p er fo r med w ith u n eq u al sam p le sizes Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  • 30. ACH Lean Six Sigma OperatingSystem – LSS Black Belt Program• 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™ 30 Copyright Childrens Hospital Medical Center of Akron
  • 31. Center for Operations ExcellenceProject CharterLocust Pediatrics 3PBackground/Problem Statement: Goal Description:Locust Pediatrics Care Group is going through the following changes throughout 2010:1. Potential for more patients to the daily schedule: The clinic has become the primary medical home for patients in the care of Summit Children’s Services Board (CSB), eventually •Run a 2-day 3P exercise that will adding on a projected 400 visits per month t(20 visits/day) to its schedule.2. Additional new staff: 1 RN, 1 CNP, 1 MA, and new 2 PSR’s have joined the staff to help create the plans for the best care for the additional patient volume.3. Additional space: The clinic has gained much of Suite 380’s 3,500 square feet of space and operations are changing which might lengthen the visit times. utilization of space, resources, & staff4. EPIC (electronic medical records) implementation in the last half of 2010.Extra movement , searching, and rework is interfering with the staff’s ability to care for the children in the Locust Pediatrics Suite 380 in the daily schedule and the additional kids cared for behind the scenes. space.Project Y: Key Metrics: Scope:• See Metrics (no project Y • A completed renovation plan for • Maintain and even improve quality of care at all points of time during a visitnecessary) Suite 380 space. As promised by •Only the new space (previously Rheumatology; Suite 380) during the 3P Mark Watson and Lin Gentile, all event will be considered. renovations will be completed by •Exceptions might be duplication or centralization of a potential med area, June 30th. supply area, and lab area that may lead the team to look at Suite 390. • Long term plans would include potentially duplicating the gains realized from Suite 380 to Suite 390.Team Members: Stakeholders: Benefits:Executive Sponsor: Mark Watson, COO Patients and families • Optimize the Suite 380 space (previously Rheumatology) in terms ofChampions: Cindy Dormo, Dr. Norm Locust Pediatrics staffChristopher patient flow, staff flow, and information flow.Process Owner: Dr. Cooper White CSB • Help to shorten the patient door to door visit in Locust PediatricsTeam Members: Cindy Kovacich, Lee Orin, Department of Pediatrics Note: As of April 2010, the current average visit length for sick visitsRN, Holly Ross, CNP, Missy Sommers, RN,Jessica Anders, Erica Walters, Angie (door to door) for patients in the Locust Pediatrics Group is still 70McCreery, Russ Maroni minutes (approximately the same as 2009).Project Leaders: Anne Musitano, RPh, • Help establish a model for the Department of Pediatrics to allowPharmD, Kris Grayem, RN, CNPExpert Advisors: Sherrie David, RN, Tim departments to understand how an ideal clinic should look and flow,Tomayko, Cliff Greive especially when bringing on new providers.COE staff: Sherry Valentine, RN, MikeAntochow
  • 32. CURRENT STATE VALUE STREAM MAP – AFTERVSM WORKSHOP – 2/15/10 Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  • 33. TOTAL TIME IN CLINIC FORSICK VISITS FOR 2010 Total Time in the Locust Clinic for Sick Appointments 100 90 80 81 86 83 75 80 73 70 65 60 50 40 30 20 10 0 January February March April June July July Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  • 34. 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 Project Specific Example: Creation of Mobile Triage Cart designed by Locust Black Belt Team Step 1 – Reduce Triage Room Step 2 – Actual Drawing Step 3 – Actual Triage Cart X Locust Black Belt Project – Through a series of Kaizens and A3-based projects, the Locust team identified and implemented a number of improvements that reduced patient in-clinic time from 70 minutes (2009) to 43 minutes (2011). Process improvement through people development™ 34 Copyright Childrens Hospital Medical Center of Akron
  • 35. ACH Lean Six Sigma OperatingSystem – LSS Blue Belt Program• 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™ 35 Copyright Childrens Hospital Medical Center of Akron
  • 36. METRIC BOARDS Process improvement through people development™ 36 Copyright Childrens Hospital Medical Center of Akron
  • 37. Staff and ManagementEngagement- A3 projects A3 Project: Shelly Orr Process improvement through people development™ 37 Copyright Childrens Hospital Medical Center of Akron
  • 38. Akron Children’s Hospital’sLean Six Sigma Operating SystemBelow: Example of Kids Metric Board tracking 4 key area metrics linked to ACH pillars of Quality, Research, Brand and Growth • 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™ 38 Copyright Childrens Hospital Medical Center of Akron
  • 39. AREA DAILY TEAM HUDDLES Process improvement through people development™ 39 Copyright Childrens Hospital Medical Center of Akron
  • 40. STAKEHOLDER IDEA BOARDS Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  • 41. ACH Lean Six Sigma OperatingSystem – Kaizen• Kaizen: Events lasting 2-5 days which result in rapid implementation of countermeasures Process improvement through people development™ 41 Copyright Childrens Hospital Medical Center of Akron
  • 42. Center for Operations ExcellenceProject CharterMRI KaizenProblem Statement: Goal Description:There is currently capacity for additional patients to be Increase the number of weekly exams (Monday throughscanned on MRI #1 and MRI #2. Friday) performed on MRI #1 and MRI #2 from 86 to 112 by August 24th, 2009. The assumption is that demand is there to meet the goal of 112 exams per week.Project Y: Key Metrics: Scope:Patient access times for # of exams performed per Main campus only; MRI #1 and MRI #2.non-contrast, contrast, day on MRI #1 and MRIand sedated MRIs. #2 on Monday through FridayTeam Members: Stakeholders: Benefits:•Kaizen Team Members- Dr. Mike Patients, physicians, andRuibin, Dr. Azam Eghbal, Carol • Reduce the backlog of patients requiring MRIArteno, Jason Duncan, Terry Tarray, radiology staff of Akron services.Shelly Orr, Marie Biasella, Julie Children’s Hospital • Reduce the patient access times for MRI services.Madden, Kim Gresham, Tina Keith•Champions: Lin Gentile, Chis B. • Potential annualized net revenue gained: $1.7M (from•COE Team- Anne Musitano, Mike increasing the total number of weekly exams MondayAntochow, Sherry Valentine, TraudaGilbert, Dr. David Chand, Chris through Friday between MRI #1 and MRI #2 from 86 toWeisbrod 112.)•On Call Team- Michelle Taylor,Karen Horning, Betsy Cetnarowski
  • 43. Visibility & Communicationand Focus on the Goal • Keep staff involved with project information • Don’t take your eye off the ball Process improvement through people development™ 43 Copyright Childrens Hospital Medical Center of Akron
  • 44. DATA- LOOK AT THE REALITY! Process improvement through people development™ 44 Copyright Childrens Hospital Medical Center of Akron
  • 45. Strong Support from the Top CEO: Bill Considine COO: Mark Watson VP: Lin Gentile Process improvement through people development™ 45 Copyright Childrens Hospital Medical Center of Akron
  • 46. Areas of Opportunity Process improvement through people development™ 46 Copyright Childrens Hospital Medical Center of Akron
  • 47. Go to the Gemba and See! Process improvement through people development™ 47 Copyright Childrens Hospital Medical Center of Akron
  • 48. MRI Schedule- Constantly Evolving inResponse to Actual Patient Demand Process improvement through people development™ Copyright Childrens Hospital Medical Center of Akron
  • 49. Sustainability of MRI Kaizen! Process improvement through people development™ 49 Copyright Childrens Hospital Medical Center of Akron
  • 50. ACH Lean Six Sigma OperatingSystem – Program Results•A3 Benefit Category Since COE inception early 2009 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) $9,177,222 Process improvement through people development™ 50 Copyright Childrens Hospital Medical Center of Akron
  • 51. ACH Lean Six Sigma OperatingSystem – Lessons Learned • Lean is more than tools or project work • Lean is 90% engagement of people/10% tool knowledge • Hard to deploy with other full time job commitments • A Lean program needs to focus considerable effort on engagement of the middle management early on in deployment Process improvement through people development™ 51 Copyright Childrens Hospital Medical Center of Akron
  • 52. ACH Lean Six Sigma OperatingSystem – Keys to Success Keys to Success •C-level support of the Lean Six Sigma initiative •Dedicated full time staff •Front line engagement •Middle management engagement •VP level engagement •Experienced Lean Six Sigma consulting firm for first 2 years . Process improvement through people development™ 52 Copyright Childrens Hospital Medical Center of Akron
  • 53. LEAN IS A JOURNEY… True North ACH Lean Six Sigma Operating System Akron Children’s Lean Operating System Systems Further Principles Development of Green Belt Tools & Tools Program, Blue Principles Point Projects,Belt Program, Strategy A3 program, Black Belts, Deployment Kaizens more Kaizens (2010- onward) (2008-onward) (2010- onward) Process improvement through people development™ 53 Copyright Childrens Hospital Medical Center of Akron
  • 54. Questions? Contact information: Doug Dulin Akron Children’s Hospital ddulin@chmca.org 330-543-5245 (w) 330-697-1682 (c)Process improvement through people development™ 54 Copyright Childrens Hospital Medical Center of Akron