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Safety, Quality and Productivity at the Joint Commission

Safety, Quality and Productivity at the Joint Commission






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    Safety, Quality and Productivity at the Joint Commission Safety, Quality and Productivity at the Joint Commission Presentation Transcript

    • Safety, Quality and Productivity at The Joint Commission WCBF Global Summit Orlando 2008Anne Marie Benedicto, Executive Vice President and Chief of Staff, Certified Green Belt © Copyright, The Joint CommissionRick Morrow, Director, Business Excellence, Certified MBB
    • The Joint Commission Founded in 1951, The Joint Commission seeks to continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations. The Joint Commission is the nations oldest © Copyright, The Joint Commission and largest standards-setting and accrediting body in health care. WCBF Global Summit - 2
    • Vision forThe Joint Commission EnterpriseTo lead the transformation ofhealth care into a high-reliabilityindustry, with rates of adverseevents and safety processbreakdowns comparable to air © Copyright, The Joint Commissiontravel safety. WCBF Global Summit - 3
    • Past Success Enables this Next Generation of ImprovementThe Joint Commission and JCR have createdstate of the art measures, programs, productsand services to enhance safety and qualityPositive impact has been enormousWithout this solid foundation, we couldn’teven think of taking these next steps © Copyright, The Joint CommissionStanding still is not an optionJoint Commission = continuous improvement WCBF Global Summit - 4
    • Robust Process Improvement ™The Joint Commission is adopting a systematicmethodology for improving our business processesthat will continuously increase our efficiency and thequality of our products and services.Our aim: Consistent excellence in our workprocesses and consistently exceptional customer © Copyright, The Joint Commissionservice, resulting in recognition by the field of TheJoint Commission as a model practitioner of highlyeffective process improvement. WCBF Global Summit - 5
    • Why Robust Process Improvement™? Even after the unidentified patient noted what knee needed surgery, the surgical team still performed the operation on the wrong side… In what officials are calling a “Tragic medical © Copyright, The Joint Commission error,” error,” a surgical team removed the wrong cancer… kidney from a patient with kidney cancer…. WCBF Global Summit - 6
    • What is RPI?A set of strategies, tools, methods, andtraining programs proven in other sectorsto greatly improve work processes focus on customers and all stakeholders drastically decrease failure rates simplify and increase speed of processesBroadly applicable, not just manufacturing © Copyright, The Joint CommissionJust beginning to be applied in health care,so far usually not in safety and quality WCBF Global Summit - 7
    • How Will The Joint Commission Pursue the Vision?Coordinated, enterprise-wide effort.Two key, interrelated components: 1. Internal RPI initiative Increase our capacity for improvement 2. Continue and enhance current efforts to improve standards, sentinel events, © Copyright, The Joint Commission measures, survey process and other products WCBF Global Summit - 8
    • How Often Does This Happen? Most common sentinel event Since 1995: 651 reviewed Extrapolating these figures……. 6 wrong site surgical procedures in US every day---365 days per year © Copyright, The Joint Commission WCBF Global Summit - 9
    • Benchmark, Apply and Innovate for New Thresholds of Quality © Copyright, The Joint CommissionMore hospitals are borrowing safety protocol from the airlineindustry to prevent surgical errors such as checklists and x- rays as part of its pre-surgical safety. WCBF Global Summit - 10
    • Using RPI at The Joint CommissionWill increase our capacity for improvementMake our work processes more efficient and lessprone to error---reduce reworkDecrease cost pressure for fee increasesImprove customer service and retentionIncrease our capacity to handle volumeIncrease resources for new opportunities © Copyright, The Joint Commission WCBF Global Summit - 11
    • Robust Process ImprovementThese tools and principles are important tous as a way to improve our work processesthroughout The Joint Commission enterpriseRPI is an important new way for health careorganizations to achieve unprecedentedexcellence in safety and quality © Copyright, The Joint CommissionEmpowerment Efficiency ExcellenceIt will be fun! WCBF Global Summit - 12
    • Four Critical Success Factors for Breakthroughs with RPI1. Leadership commitment and action2. The right work3. The right people4. The infrastructure © Copyright, The Joint Commission WCBF Global Summit - 13
    • The Joint Commission’s Total Value Stream for Robust Process ImprovementConceive Develop Procure Provide Maintain Prevent Receive © Copyright, The Joint Commission WCBF Global Summit - 14
    • Robust Process Improvement Using Lean Six Sigma DMAIC DMAIC Define Measure Analyze Improve Control Phase Stabilize, reduce Identify all Eliminate variation Standardize, Specify steps and waste and and defects level flow RPI what inputs in the variation at and create sustain andPrinciples customers value the root flow letting continuously value stream cause the improve customer pull © Copyright, The Joint Commission What are the What are the What are the How do we opportunities for What is our possible wastes and root maintain the improvement current solutions andQuestions we causes for gaps gains we have that will achieve performance how do we answer or problems in achieved and the strategy and level? implement the performance? standardize? goals? best solution? Is the organization prepared for change? WCBF Global Summit - 15
    • Path to Robust Continuous Improvement Level Incrementally Standardize Create Flow Stabilize Level Incrementally Standardize Create Flow Stabilize Level Incrementally Standardize © Copyright, The Joint Commission Create Flow StabilizeRPI creates and sustains stable capable processes WCBF Global Summit - 16
    • Results-Driven Versus Activity-Centered Robust Process Improvement ApproachesActivity-Centered Programs Results-Driven ProgramsA1. Every manager is involved in an action 1. “Get a team together to solve this issue” fa lla2. “Don’t look for results this year – it is a long term process.” 2. “We should strive to eliminate half of the cost disadvantage in 3 cy3. Staff experts and consultants train everyone first because months” 3. RPI experts help managers otherwise it will be a Tower of achieve results and discover Babel customer-centric metrics4. First year training, 2nd year 4. “Let’s get started trying to increase © Copyright, The Joint Commission diagnose, third year consultant sales and if it does, scroll and survey customers…. replicate in other areas.” The RPI Way Adapted from Successful Change Programs Begin with Results, Schaffer, Thomson, HBR J-F 1992 WCBF Global Summit - 17
    • Learning TJCs Robust ProcessImprovement Methodology We want the best Belts in the World Best = Achieving breakthrough results TJCs Belts are trained by doing – not just learning Using proven, powerful and productive tools Trained, mentored and coached by TJCs experienced Black Belts and MBB’s © Copyright, The Joint Commission With relevant examples repetitively WCBF Global Summit - 18
    • The Joint Commission RPI Roadmap © Copyright, The Joint Commission WCBF Global Summit - 19
    • Renaissance Blvd and the Avenues, Butterfield and 22nd Renaissance Blvd is always where we start. Renaissance Blvd gets us a quick consistent start and towards our destination consistently and with the fewest diversions. Belts and teams will start on Renaissance Blvd and take the Avenues based on the project’s needs. The Belts and teams will end on Renaissance Blvd arriving successfully and as quickly as possible Renaissance Blvd has the core tools needed in any project and the common tools regardless of project. © Copyright, The Joint Commission Avenues represent specific tools driven by project/metric type WCBF Global Summit - 20
    • Mentoring in Problem Solving is Easy with The Joint Commissions Lean Six Sigma Roadmap Guide the Belt starting with the module on The Joint Commissions Lean Six Sigma Roadmap Key Points:1. All problems are best solved using our roadmap2. Start on Renaissance Blvd. and ensure all tools are completed well3. The Mentor and Belt assure Tollgates are performed with the Champion and Sponsor4. Tollgates are simply the validation that the questions are answered sufficiently with the tools prior to the Tollgates5. The Tollgate marker on the Roadmap lists the key deliverables © Copyright, The Joint Commission6. The Mentor should have been directing the Belt at least weekly through the Roadmap7. Not all tools on the Blue and Yellow Avenues are necessary WCBF Global Summit - 21
    • Key Decisions, RPI Tools, Key Inputs and Key Outputs & Deliverables help us progress along the RoadmapKey Answer these questions to improve theDecisions Quality of your project work and choose the right Avenue and best toolRPI Tools This is a good tool to use in answering the Key DecisionsKey Inputs Necessary for using the tool © Copyright, The Joint CommissionKey Outputs What one should expect after use of the tool WCBF Global Summit - 22
    • Our Primary Metric is cycle time – a ProductivityMetric. We choose the Avenue for Productivityand start at the Key Decision once again…… © Copyright, The Joint Commission WCBF Global Summit - 23
    • Choose the tools that add value on the Avenues and always return to Renaissance Blvd and to Your Final Destination = © Copyright, The Joint Commission Success!Congratulations! WCBF Global Summit - 24
    • A Solution for Quality Issues with Housekeeping and Flow Problems © Copyright, The Joint Commission WCBF Global Summit - 25
    • The First RPI Green Belt Projects Our Mission Patient Safety and Healthcare Quality Patient Safety and Healthcare Quality Customer Quality and Financial Financial Customer Quality and Key Drivers Satisfaction Productivity Performance Performance Satisfaction Productivity Inconsistency Long cycle times and Cycle time in the Revenue below Schedule Inconsistency Long cycle times and Cycle time in the Revenue below Schedule perceived in surveys variability in standards development of target in new changes inperceived in surveys variability in standards development of target in new changes in roll-out standards products survey process roll-out standards products survey process © Copyright, The Joint Commission WCBF Global Summit - 26
    • Robust Process ImprovementLearning and Roles Pyramid Master Mentor, Trainer and Coach of Black Leadership and Belts Belts lts Black Belts Be Leaders dedicated n rs d to strategic projects, an ct nso experts in TJCs ele po io LSS, CAP & tS S Mentor/Trainers ec and Pr ns Green Belts PI pio oj Leaders of vital projects. tR m Skilled in TJCs or ha Lean Six Sigma pp C Methodology and Change Acceleration Process & Work-out Su © Copyright, The Joint Commission Robust Process Improvement Belts and Teams Skilled in PPS and empowered to continuously improve processes. Tools include: histograms, pareto, SPC, “5 Why’s”, C&E diagram, checksheets, 5S, standard work, flow, pull, VSM WCBF Global Summit - 27
    • Practical Problem Solving - Foundation Tools Continuous Flow Process Pull from Customers Pareto Chart Pareto Chart of Day 800 100 700 80 600 500 Percent 60 Count 400 300 40 200 20 100 0 0 Day Mon Tue Wed Other Count 431 231 100 15 Percent 55.5 29.7 12.9 1.9 Cum % 55.5 85.2 98.1 100.0 Histogram 5 Why’s Value Stream Mapping Fist to Five Consensus Histogram of Sales Normal Mean 125.8 4 StDev 3.621 N 12 3 Frequency 2 1 0 120 124 128 132 136 SalesCause and Effect Diagram Control Charts Scatter Diagram Stratification I C ha r t of S a le s 140 Scatterplot of Sales vs Advertising Cause and Effect Diagram U CL=137.84 136 135 Environment Personnel 134 Individual Value 130 132 GAA P _ Inexperience X =125.7 5 125 130 S-O x Sales School 120 128 Statutory Poor Quality 115 126 LCL=113.66 © Copyright, The Joint Commission Manual entries 1 2 3 4 5 6 7 8 9 10 11 12 124 Not integrated Ob s e r v a tion No Poka-Y oke 122 Too many No quality training 120 Sy stem Methods Statistical Process Control 32 33 34 Advertising 35 36 37 Brainstorming Check Sheet Systems Manual Entry Up time Compliance WCBF Global Summit - 28
    • Thanks to: The RPI Team Teena Wilson, Connie Neven ,Caron Wong, Dawn Allbee, John Cullinan, Diane Kohler-Rausch And Bill Bullerman, Patty Chappell, Kathy Wood, Tracy Robinson, Sharon © Copyright, The Joint Commission Sheehan, Andy Trippi, Brian Nosek, Bill Kent The Joint Commissions Print Services WCBF Global Summit - 29
    • Summary Our Vision is: To lead the transformation of health care into a high-reliability industry, with rates of adverse events and safety process breakdowns comparable to air travel safety. RPI is: A set of strategies, tools, methods, and training programs proven in other sectors to greatly improve work processes focus on customers and all stakeholders drastically decrease failure rates simplify and increase speed of processes Leadership for Robust Process Improvement’s Four Critical Success Factors:1. Leadership commitment and action © Copyright, The Joint Commission2. Right work3. Right people4. Right Infrastructure RPI creates and sustains stable capable processes for continuous improvement WCBF Global Summit - 30