Culture of Lean - The Journey at Massachusetts General Hospital
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Culture of Lean - The Journey at Massachusetts General Hospital Culture of Lean - The Journey at Massachusetts General Hospital Presentation Transcript

  • WCBF 10 th Annual Lean Six Sigma and Process Improvement in Healthcare Summit Culture of Lean The Journey at Massachusetts General Hospital Mary O. Cramer Process Improvement Program Director May 11, 2011
  • Objectives
    • Describe the Masschusetts General Hospital & Physicians’ Organization Process Improvement Deployment Journey
    • Within a Highly Traditional, Firmly Entrenched Culture
    • Discuss the Critical Success Factors
    • Describe the Vision - What’s Next?
    • Establish a Sense of Urgency
    • Build the Guiding Team
    • Create the Right Vision
    • Communicate for Buy-in
    • Empower Action Throughout – Encourage Risk-Taking
    • Plan for and Create Short-term Wins
    • Reinvigorate the Process with New Projects
    • Sustain the Changes
    • Source: Kotter, John P., “Winning at Change” Leader to Leader 10 (Fall 1998)
    Kotter’s Eight Critical Stages of Successful Change Management
  • Why is Change so Hard?
    • Lack of Shared Vision
    • Misaligned Expectations
    • Lack of Urgency
    • Lack of Commitment
    • Culture
    • Culture
    • Culture
    Source: Conner, Darryl R., Managing at the Speed of Change , 1992, 2006
  • What is Culture?
    • What is Culture; Is it Real?
    • One Definition:
    • “ Culture in a work organization is the sum of peoples’
    • deeply ingrained habits related to what they do and
    • how they do it. It’s the way we do things here .”
    • Question:
    • Should an organization’s culture be among the considerations in Process Improvement program design and execution?
    • Source: Mann, David, Creating a Lean Culture , 2005
  • Culture Matters You bet!
  • Massachusetts General Hospital Background
  • MGH Overview
    • Founded in 1811, third oldest general hospital in the US
    • Original and largest teaching hospital of Harvard Medical School
    • Largest hospital based research program in US – annual research budget: $550 million
    • Consistently ranked among top five hospitals in the US News & World Report
    • Founding Member: Partners HealthCare – Integrated Healthcare System
    • Some Operating Statistics:
    • 900 Inpatient Beds
    • 47,000 Inpatient Admissions
    • 1.5 Million Outpatient Visits
    • 83,000 ED Visits
    • 22,000 Employees
    • 4,000 Physicians
  • Humble Beginnings: Ernest Codman’s End Results Guarantee 1915
  • MGH Quality and Safety Program Recent Evolution
    • 2000: Established Board of Trustees Quality Committee . Launched combined MGH & MGPO Clinical Performance Management program
    • 2003 – Hospital Strategic Planning exercise identifies Quality and Safety as one of 5 institutional priorities. Plan developed
    • 2004-2006 – Execution of plan, focusing on culture
      • Electronic incident reporting
      • Safety culture surveys
      • Board presentations focused on the 6 IOM Aims
    • 2005-2006 – Leadership Retreats
      • November 2005 PO Board retreat
      • October and December 2006 Harvard Business School retreats
    • 2006 – Proposal to Accelerate Progress
      • Creation of new leadership position
    • 2007 – Center for Quality and Safety Established
    • 2008 – Process Improvement Program Established
    Historically committed to quality improvement at MGH using traditional tools including quality assessment, incident reporting, etc..
  • What Do We Mean By Quality? IOM 6 Aims
    • Safety - no needless death, injury, pain or suffering for patients or staff
    • Timeliness - waste no one’s time
    • Effectiveness - care and service will be based on best evidence, informed by patient values and preferences
    • Efficiency - remove all unnecessary processes or steps in processes; streamline all activities
    • Equity - all care and service will be fair and equitable – the system will treat all patients equally
    • Patient Centeredness - all care and service will honor individual patients – their values, choices, culture, social context and specific needs
    Source: Institute of Medicine
  • Conceptual Framework Analysis of problem Performance reporting Operations design Executive oversight Organizational strategy Performance Measurement (Signal detection) Short term implementation Executive incentives Practitioner influence and incentives Longer term implementation Research enterprise Regular Operations Improvement Efforts Process Improvement Design Improvement Cycle Operations Cycle MGH/MGPO Culture
  • Vision - the Big Ask Analysis of problem Performance reporting Operations design Executive oversight Organizational strategy Performance Measurement (Signal detection) Short term implementation Executive incentives Practitioner influence and incentives Longer term implementation Research enterprise Regular Operations Improvement Efforts Process Improvement Design Improvement Cycle Operations Cycle MGH/MGPO Culture Doing Your Job Improving Your Job
  • MGH Center for Quality and Safety Organization Chart ~ 2008
    • The MGH Process Improvement
    • Program Deployment Journey
    • Massachusetts General Hospital will lead the nation in
    • health care quality and safety.
    • Process Improvement is one important component of the plan to accomplish this goal and will become part of the way business is done at the MGH and MGPO.
    Vision
  • Fasten Your Seatbelt!
  • Process Improvement Framework Service Quality & Safety Efficiency PROCESS IMPROVEMENT Program Director: Mary Cramer
  • Time Success Tools - Training - Modeling Systems & Structures - Org. Structure - Business Strategy Culture & Behavior
    • - Engagement
    • Continuous Improvement
    • Sustain
    Key Program Elements Where We Started Source: GE Healthcare
  • Mobilizing Commitment
      • Why bother?
      • Need sufficient support and involvement from key stakeholders
      • Must win-over critical mass
      • Tactics:
      • Identify and analyze sources of support and resistance
        • Early Adopters
        • Late Adopters
        • Resistors
        • Develop Strategies for:
        • Encouraging Support
        • Overcoming Resistance
  • Initial Model
    • At the Outset:
    • Building upon rich project management experience throughout Massachusetts General Hospital, developed full time Process Improvement Project Facilitators with competency to lead Process Improvement projects through training and application.
    • Curriculum:
      • Lean Tools and Concepts
      • Change Acceleration Process ©
      • Work-Out ©
      • Project Design, Project Execution and Follow-up
    • Process Improvement Champions Group comprised of Senior Leadership served as a Steering Committee charged with general program oversight including prioritizing projects, championing and supporting project teams as needed, overseeing project outcomes and assuring that adequate and appropriate resources are allocated.
    • Process Improvement Working Group comprised of directors of operational areas providing project management support charged with assuring effective design and implementation of the MGH/MGPO Process Improvement Program including: project selection criteria, project design, project management oversight, training plans, results warehousing, communication, and recognition activities
    Program Governance
  • Comprehensive Training Curriculum
    • Change Management
      • shaping a vision, mobilizing commitment, designing, implementing and sustaining change
    • Value Stream Mapping
      • end to end process diagram including process steps, interdependencies, information flow etc.
    • Lean Tools & Techniques
    • Project Workshop Design and Execution
      • one day & four day formats
    • 40+ individuals selected from across the MGH and MGPO
    At the Outset: Identified the Best and the Brightest GE Healthcare engaged as Process Improvement skills transfer partner. Research Radiation Oncology Professional Billing Office Practice Improvement Police and Security Perioperative Services Patient Care Services MGPO Infusion Center Human Resources Finance Emergency Department Center for Quality & Safety Cardiac Services Administration Admitting
  • Other Leadership Training
    • MGH/MGPO Leadership:
    • Process Improvement Champions,
    • Process Improvement Work Group,
    • Senior Leaders,
    • GEC/Clinical Chiefs,
    • Patient Care Assessment Chairs, Others
    • Process Improvement for Leaders
    • Engagement Overview & Process Improvement Program Roadmap
  • Other Ongoing Training
    • MGH Leadership Academy
    • Process Improvement Primer
    • Process Improvement Practicum
    • Patient Care Services Leadership Development
    • Optimizing Core Processes
    • Physician Leadership Development
    • Process Improvement Capstone Course
    • Practice Improvement Course
    • Process Improvement Practicum
    • Clinical Process Improvement Program
    • Process Improvement Course
  • Learning Objectives
    • Process Improvement Overview
    • Project Selection
    • Project Scoping
    • Create and Facilitate a Team
    • Manage the Change Process
    • Conduct Root Cause Analyses
    • Pilot Improvements
    • Measure Outcomes
    • Fully Implement and Sustain Improvements
    ~250 Employees ~ 35 Discrete Depts ~ > 50 Projects
  • Initially Proof of Concept  Awareness Project Workshop Project Workshop Project Workshop Project Workshop Project Workshop Point Projects … driving project specific results & awareness Dept Process Dept Process Project Workshop Dept Process Dept Process Project Workshop Project Workshop
  • Process Improvement Projects - Results
  • Process Improvement Projects - Results
  • Process Improvement Projects - Results
  • Process Improvement Projects - Results
    • Observa tions :
    • We all have a lot of information to share, we just don’t share it
    • We’ve been hearing about these problems for years; we’ve needed a common way of problem solving
    • When we’re all together, we can build on each other’s ideas
    • Previously we’ve attacked this by working in our silos; now we’ve put our heads together to solve the problems
    • We’re all part of the solution
    • Regardless of role and level, everyone’s voice counts
    Process Improvement Projects - Results
  • Now What? Let’s Ride the Wave
    • Moving Forward
  • Using Strategic Planning as the Context
    • Overall Direction and Goals of an Organization
    • Developed as Informed by Effective Strategic Planning
    • One Common approach:
    • Establish Mission/Vision/Values
    • Conduct Environmental Scan
    • Complete Internal Assessment – Perhaps SWOT Analysis
    • Establish Goals
    • Develop Strategies, Objectives, Responsibilities & Timelines
  • What’s Next for the Process Improvement Program?
    • T he Process Improvement program is now at the next leve l
    • Key Attributes:
    • Program Focus; Alignment with Strategic Priorities
    • Robust Senior Level Oversight Body
    • Active Senior Level Sponsorship
    Key: Alignment with Organization’s Strategic Priorities
  • One Compelling Priority: The Patient Protection and Affordable Care Act
  • And Most Importantly, the IOM 6 Aims:
    • Safety - no needless death, injury, pain or suffering for patients or staff
    • Timeliness - waste no one’s time
    • Effectiveness - care and service will be based on best evidence, informed by patient values and preferences
    • Efficiency - remove all unnecessary processes or steps in processes; streamline all activities
    • Equity - all care and service will be fair and equitable – the system will treat all patients equally
    • Patient Centeredness - all care and service will honor individual patients – their values, choices, culture, social context and specific needs
    Source: Institute of Medicine
  • Current Process Improvement Focus Areas Strategic Initiatives  End–to-End Focus Care Redesign Examples End-to-End Process Emphasis Driving Improvements Deeply Within Select Areas of Focus #1 # 2 #3 #4 #5 #6 #7 #8 Patient Affordability #1 # 2 #3 #4 #5 #6 #7 #8
  • Process Improvement Program Timeline – The Work Continues 2008 2009 2010 2011 Planning Wave I Recruitment & Training Coached Projects Wave II Training Coached Projects Centralized Staff Deployment Program Development, Training & Ad Hoc Project Support
  • Success Tools - Training - Modeling Systems & Structures - Org. Structure - Business Strategy Culture & Behavior
    • - Full Engagement
    • Sustained Outcomes
    • Continuous Improvement
    Process Improvement Program Trajectory Where We’re Headed Where We Started 2008 2009 2010 2011+ Where We Are Source: GE Healthcare
  • Critical Success Factors
    • Within the Context of Strategic Planning Activities
    • and
    • Consistent with the Culture of the Enterprise:
    • Actively Engaged Executive Sponsorship
    • Compelling, Well Understood Organizational Priorities – Aligned with Organization’s Strategic Vision
    • Highly trained, Capable Process Improvement Practitioners
    • Fully Engaged Workforce
  • Lessons Learned
      • First, Critically Assess the Organizational Culture.
      • Next, Leveraging the Infrastructure Already in Place:
      • Build a Program Which Will Resonate Within that Culture and
      • Which is Designed to Enable the Organization to Advance Strategic Priorities
  • “ It must be considered that there is nothing more difficult to carry out, nor more dangerous to conduct, nor more doubtful in its success, than an attempt to introduce innovations.  For the leader in the introduction of changes will have for his enemies all those who are well off under the existing order of things, and only lukewarm supporters in those who might be better off under the new.” Niccolo Machiavelli 1469 – 1527 “ The Prince and The Discourses” 1513, Ch. 6 It’s not Surprising -
    • Thank You
    • Questions?