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Cascading Strategy Through Hoshin Kanri (Strategy Deployment)

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In this webinar you will:

- Learn about the purpose and building blocks of hoshin kanri
- Understand how health care organizations arrive at and use hoshin
- Understand why hoshin is the quintessential PDSA and how experience with small tests of change and A3s create a foundation for hoshin
- Learn about some common rocks in the hoshin road and what can be done about them

Presenters:

Joanna Omi
Principal | Rona Consulting Group, the Lean practice of Moss Adams

Craig Vercruysse
Principal, CEO | Rona Consulting Group, the Lean practice of Moss Adams

Published in: Business
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Cascading Strategy Through Hoshin Kanri (Strategy Deployment)

  1. 1. Cascading Strategy Through Hoshin Kanri Mark Graban VP of Improvement & Innovation Services KaiNexus @MarkGraban Joanna Omi Consulting Director Moss Adams @JoannaOmi Craig Vercruysse Partner Moss Adams @CraigVercruysse
  2. 2. Webinar Logistics • Presentation (45 minutes) • Q&A (10 minutes) – Use the GoToWebinar Meeting Panel to submit a question at any time • Recording link & slides will be sent via email – Also – see the “Handouts” feature and Chat box
  3. 3. Cascading strategy through hoshin kanri KaiNexus Webinar November 14, 2017 Craig Vercruysse and Joanna Omi
  4. 4. Learning Objectives • Learn about the purpose and building blocks of hoshin kanri • Understand how health care organizations arrive at and use hoshin • Understand why hoshin is the quintessential PDCA/PDSA and how experience with small tests of change and A3s create a foundation for hoshin • Learn about some common rocks in the hoshin road and what can be done about them
  5. 5. Hoshin building blocks
  6. 6. 方針管理 hoshin + kanri (direction) (management, control)
  7. 7. What is hoshin kanri? • Also called strategy deployment, policy deployment. • A means of connecting the macro with the micro. (John Shook) • A management process aligning—both vertically and horizontally—an organization’s functions and activities with its strategic objectives. A specific plan—typically annual—is developed with precise goals, actions, timelines, responsibilities, and measures. (Lean Lexicon, LEI) • An organizational learning method and competitive resource development system. (Hoshin kanri for the lean enterprise, Tom Jackson)
  8. 8. What is it NOT? • Traditional strategic planning. • A “thump report.” • Top–down dictate. • Limited to annual (or less frequent) reviews. • Owned solely by executives.
  9. 9. Hoshin kanri Just in time Jidoka leveled production (heijunka) cost reduction through the elimination of muda people materials equipment standard work standard WIP andon & availability takt time production flow production system pull system production 5S Hoshin is the roof of the Toyota management system
  10. 10. (Scan), plan, do, check, act Scan: understand the environment. Plan: • Understand foundational mission, vision, and values. • Identify “True North” dimensions and targets. • Identify “breakthrough” strategic themes or goals. • Identify one-year measures, responsible managers, and sub-teams. • Create visual management. • Play catchball to finalize plans. Do: implement the plan. Check: monthly management meetings to ensure success. Act: develop and implement countermeasures when fall-off occurs. Plan Do Check Act Scan (internal and external) Hoshin Kanri for the Lean Enterprise As we explained above, the hoshin team takes responsibility for the first three experi- ments of the hoshin system. Once in the Plan stage, the hoshin team will help form and hand 4 Teams Hoshin Team Tactical team Operations team plan check doact plan check doact plan check doact plan check doact plan check doact plan check doact plan check doact 7 Experiments 1. Long-term strategy 2. Midterm strategy 3. Annual hoshin 4. Tactics 5. Operations 6. Kaikaku 7. Kaizen Action Team Figure 1-1. The 4 Teams and the 7 Experiments
  11. 11. SCAN: tools and A3i (3) (1) (5) (4) (2) 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10 market focus: global reach market differentiation: healthcare specialization Porter analysis of market for lean healthcare transformation services CD Form 2-2 Hoshin Kanri for the Lean Enterprise © 2006 Thomas L. Jackson Page 1 Product / Market Matrix market product Porter Analysis Product/Market Matrix Innovation Matrix SCAN Tools
  12. 12. PLAN: Step-by-step Establish guiding True North Define outcomes Develop initiatives to achieve outcomes Define incremental measures and targets • Quality. • Safety. • People. • Growth. • Financial stewardship. • (The short list.) • Define and prioritize strategies to achieve defined outcomes. • “What,” not “how.” • (Another short list.) • What of ”the whole” can we achieve this period? • Recognizes required reporting and overall reporting burden. • Answers “how will my work be affected?” and “how does my work contribute?” • Define and quantify success within the True North dimensions. • Language is widely accessible. • Outcome/ lagging measures. Plan
  13. 13. Building the x-matrix: clockwise progression on one page (the 5 lists) • South box: business goals • West box: True North • North box: one-year strategic initiatives or themes • East box: measures and targets • East-east box: resources ™ ™ ™ 9 ™ 8 ™ ™ ™ 7 6 ™ ™ 5 ™ ™ ™ ™ ™ ™ ™ 4 ™ ™ ™ ™ ™ ™ 3 ™ ™ ™ ™ ™ ™ ™ ™ 2 ™ ™ ™ ™ ™ ™ ™ ™ 1 ™ ™ ™ ™ ™ ™ Safety Quality CareExperience Workforce FinancialStewardship Equity #unitswithtimely,accuratefinancialstatements Performanceappraisalcompletion %ofnewemployeeswhoreceivestandardizedorientation %ofexistingemployeestrainedonour3pillars(lean,racialhumility&TIS) Contractdone,scopedefinedwithselectpayers Dowehavethefundinginplace? On-time,on-budgetimplementationofERP Maximizefeeforservicerevenue Timelyaccess DecreaseOOMGuseforMCmembers IncreasenumberofpatientswithaPCC/healthhome Recommendasaplacetowork Recommendasaplacetoreceivecare ReducesquarefootdeficitbyX% ReadershipofFastFacts,Bridge,Director'sReport Surveystaffonsatisfactionwithlevelofinformation xxwebsiteeyeballcount Meetbudgetthresholdforvariouswaivers Meetclinicaloutcomesforvariouswaivers Frequencyofaccesstodatareports Increasethenumberoftier2reports Dir Dir DeputyDir CMO CFO Dir,BehavioralHealth CEO COO ChiefofStaff Dir,AmbulatoryCare Dir,PrimaryCare ChiefQualityDir,AmbulatoryCare CEO Dir,TraumaInformedSys Dir,PopHealth Dir,Transitions BudgetDir,BIULead CIO CommDir BIU,AsscAdmin Dir,MCAH AssocAdmin Dir,AccountableCare Dir,HumanResources FY2016 FY2017 FY2018 FY2019 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 ™ ™ ™ Slow growth rate in net GF $ TBD TBD TBD TBD ™ ™ ™ ™ ™ Quality: 70% of targets 70% 70% 70% 70% ™ ™ ™ Safety: 70% of targets 70% 70% 70% 70% ™ ™ = strong correlation or team leader Care Experience: 70% of targets 70% 70% 70% 70% ™ ™ ™ = ™ Workforce: 70% of targets 70% 70% 70% 70% ™ ™ ™ r = Equity: 70% of targets 70% 70% 70% 70% ™ Optimize internal communication and external outreach Legend important correlation or core team member correlation / contribution weak correlation or rotating team member Implement the master facility plan Create timely, actionable and relevant data to support continuous improvement Operational Integration correlation / contribution accountability Stabilize and optimize finances Develop our people Right care, right place, right time Establish an effective EHR program team members Leverage statewide waivers to transform care strategic initiatives true north outcomes truenorth performance © 2015 rona consulting group MISSION: We provide high quality health care that enables all (patients) to live vibrant, healthy lives. VISION: To be every (patient's) first choice for health care and well-being.
  14. 14. True North: the “what” of strategy deployment Safety Customer experience Quality Growing our people Financial stewardship Equity True North: A balanced scorecard of leading and lagging indicators that plot the course of your organization's movement from one "strategic position” to another.
  15. 15. Do, Check, Act Establish process & cadence of accountability • Visually managed. • Tiered accountability. • Rolled up from the actual work to managers to executives. • Missed targets provide an opportunity for coaching and require counter- measures. Do – Check – Act Scan… Plan…
  16. 16. CT VA CT VA CT VA CT VA CT VA CT VA CT VA CT VA CT VA CT VA CT VA Hospital)current)state)map) Bed nurse EMERGENCY Charge nurse LT CT WT VA NVA VAR 120 patients per day Two 12-hr. shifts Takt time = 20 minutes patient Close-up: executive sponsor visibility wall Kaizen action bulletin [insert client logo here] © 2012 rona consulting group. Department: Team name: Date: Process owner: Item # Problem Countermeasure Responsibility Date Status Team Name: Date: Department: TAKT Time: Product/Process: Team Leader: Process Owner: Baseline Target Post Kaizen 30 Days Date:_____ 60 Days Date:_____ 90 Days Date:_____ Percent Change Numerator (# defects) Denominator (sample size) Percentage ≥ 3 Remarks: © 2010 rona consulting group 021KW_H-14_post-K_targets_r4.xls Space (sq footage) Target progress report and results sheet Inventory (dollars) Walking Distance (feet) Travel Distance (feet) Lead time (minutes) Quality (% Defects) Setup (minutes per operation) Productivity Gain (mins of operator time) Aggregate/convert to FTEs Other-1: Measures ADD DETAIL OF CALCULATION AND MEASUREMENT OF EVERY METRIC USED Environmental, Health & Safety (5S) Levels 1-5 DUE DATE A3-T TEAM CHARTER Date: Reporting Unit: Theme: © 2009 rona consulting group CHECK AND ACT ANALYSIS ACTION ITEM RESPONSIBILITY PROBLEM STATEMENT PROPOSED ACTION TARGET STATEMENT IMPLEMENTATION PLAN Kaizen action bulletin [insert client logo here] © 2012 rona consulting group. Department: Team name: Date: Process owner: Item # Problem Countermeasure Responsibility Date Status Team Name: Date: Department: TAKT Time: Product/Process: Team Leader: Process Owner: Baseline Target Post Kaizen 30 Days Date:_____ 60 Days Date:_____ 90 Days Date:_____ Percent Change Numerator (# defects) Denominator (sample size) Percentage ≥ 3 Remarks: © 2010 rona consulting group 021KW_H-14_post-K_targets_r4.xls Space (sq footage) Target progress report and results sheet Inventory (dollars) Walking Distance (feet) Travel Distance (feet) Lead time (minutes) Quality (% Defects) Setup (minutes per operation) Productivity Gain (mins of operator time) Aggregate/convert to FTEs Other-1: Measures ADD DETAIL OF CALCULATION AND MEASUREMENT OF EVERY METRIC USED Environmental, Health & Safety (5S) Levels 1-5 Kaizen action bulletin [insert client logo here] © 2012 rona consulting group. Department: Team name: Date: Process owner: Item # Problem Countermeasure Responsibility Date Status Team Name: Date: Department: TAKT Time: Product/Process: Team Leader: Process Owner: Baseline Target Post Kaizen 30 Days Date:_____ 60 Days Date:_____ 90 Days Date:_____ Percent Change Numerator (# defects) Denominator (sample size) Percentage ≥ 3 Remarks: © 2010 rona consulting group 021KW_H-14_post-K_targets_r4.xls Space (sq footage) Target progress report and results sheet Inventory (dollars) Walking Distance (feet) Travel Distance (feet) Lead time (minutes) Quality (% Defects) Setup (minutes per operation) Productivity Gain (mins of operator time) Aggregate/convert to FTEs Other-1: Measures ADD DETAIL OF CALCULATION AND MEASUREMENT OF EVERY METRIC USED Environmental, Health & Safety (5S) Levels 1-5 Kaizen action bulletins Target sheets Run charts Executive sponsor’s current state maps Executive sponsor’s future state maps A3-T Press Ganey results Comment cards Acute&Emergency&Care&Current&State&Map& patient Charge nurse Ambulancepatient HOSPITAL Bed nurse 240 min 100 patients per day Two 12-hr. shifts Takt time = 15 minutes 33% admitted to hospital CT VA CT VA CT VA CT VA CT VA CT VA CT VA CT VA CT VA CT VA CT VA LT CT WT VA NVA VAR Kaizen action bulletin [insert client logo here] © 2012 rona consulting group. Department: Team name: Date: Process owner: Item # Problem Countermeasure Responsibility Date Status Team Name: Date: Department: TAKT Time: Product/Process: Team Leader: Process Owner: Baseline Target Post Kaizen 30 Days Date:_____ 60 Days Date:_____ 90 Days Date:_____ Percent Change Numerator (# defects) Denominator (sample size) Percentage ≥ 3 Remarks: © 2010 rona consulting group 021KW_H-14_post-K_targets_r4.xls Space (sq footage) Target progress report and results sheet Inventory (dollars) Walking Distance (feet) Travel Distance (feet) Lead time (minutes) Quality (% Defects) Setup (minutes per operation) Productivity Gain (mins of operator time) Aggregate/convert to FTEs Other-1: Measures ADD DETAIL OF CALCULATION AND MEASUREMENT OF EVERY METRIC USED Environmental, Health & Safety (5S) Levels 1-5 Hospital!Emergency! Flow manager! Patient! O"X"O"X""" 120 patients per day Two 12-hr. shifts Takt time = 20 minutes CT VA CT VA LT CT WT VA NVA VAR Close-up: process owner visibility wall Department Evaluation criteria By/Initials: 1 3 By/Initials: Section 2 4 By/Initials: By/Initials: *Each box must contain the following - Score (circled), Date,Validator's Initials Standard WorkValidation Checklist - (Enter Department Name) Unable to do operation Can do with assistance/need review Can do operation independently Can do operation well/Instruct Staff member Competency date date date date date date date day eve noc day eve noc day eve noc day eve noc day eve noc day eve noc day eve noc Remove items from desk/shelves that don't belong and discard all waste Store personal items in locked locations Eliminate all safety hazards Ensure reference materials are in proper labeled locations and are neat Supplies stocked in proper locations Wipe counters and desk with sanicloth Wipe telephones and computes with sanicloth 1) 2) 3) 4) zone 1:rooms 1,2 and MD charting area 5-minute 5S S1S2S3 department:Pod A Each zone owner must complete and initial. See Zone Assignment Sheet for your assignment. A monthly audit will be conducted by an external audit team and will include ensuring the days are all covered and completed as signed. INSTRUCTIONS The 5S checklist for zone 1 (desk area) will be conducted every shift every day and signed off on by the zone owner. The zone owner is responsible for ensuring that each item is completed and appropriate action taken. Zone owners should crosscheck each task with the Job Cycle Chart to determine the required frequency (daily, weekly, etc.) of the task. If a task is not to be performed on a given day, the zone owner should mark through the initial box with an X. Kaizen action bulletin [insert client logo here] © 2012 rona consulting group. Department: Team name: Date: Process owner: Item # Problem Countermeasure Responsibility Date Status Team Name: Date: Department: TAKT Time: Product/Process: Team Leader: Process Owner: Baseline Target Post Kaizen 30 Days Date:_____ 60 Days Date:_____ 90 Days Date:_____ Percent Change Numerator (# defects) Denominator (sample size) Percentage ≥ 3 Remarks: © 2010 rona consulting group 021KW_H-14_post-K_targets_r4.xls Space (sq footage) Target progress report and results sheet Inventory (dollars) Walking Distance (feet) Travel Distance (feet) Lead time (minutes) Quality (% Defects) Setup (minutes per operation) Productivity Gain (mins of operator time) Aggregate/convert to FTEs Other-1: Measures ADD DETAIL OF CALCULATION AND MEASUREMENT OF EVERY METRIC USED Environmental, Health & Safety (5S) Levels 1-5 Kaizen action bulletin [insert client logo here] © 2012 rona consulting group. Department: Team name: Date: Process owner: Item # Problem Countermeasure Responsibility Date Status Team Name: Date: Department: TAKT Time: Product/Process: Team Leader: Process Owner: Baseline Target Post Kaizen 30 Days Date:_____ 60 Days Date:_____ 90 Days Date:_____ Percent Change Numerator (# defects) Denominator (sample size) Percentage ≥ 3 Remarks: © 2010 rona consulting group 021KW_H-14_post-K_targets_r4.xls Space (sq footage) Target progress report and results sheet Inventory (dollars) Walking Distance (feet) Travel Distance (feet) Lead time (minutes) Quality (% Defects) Setup (minutes per operation) Productivity Gain (mins of operator time) Aggregate/convert to FTEs Other-1: Measures ADD DETAIL OF CALCULATION AND MEASUREMENT OF EVERY METRIC USED Environmental, Health & Safety (5S) Levels 1-5 Kaizen action bulletin [insert client logo here] © 2012 rona consulting group. Department: Team name: Date: Process owner: Item # Problem Countermeasure Responsibility Date Status Team Name: Date: Department: TAKT Time: Product/Process: Team Leader: Process Owner: Baseline Target Post Kaizen 30 Days Date:_____ 60 Days Date:_____ 90 Days Date:_____ Percent Change Numerator (# defects) Denominator (sample size) Percentage ≥ 3 Remarks: © 2010 rona consulting group 021KW_H-14_post-K_targets_r4.xls Space (sq footage) Target progress report and results sheet Inventory (dollars) Walking Distance (feet) Travel Distance (feet) Lead time (minutes) Quality (% Defects) Setup (minutes per operation) Productivity Gain (mins of operator time) Aggregate/convert to FTEs Other-1: Measures ADD DETAIL OF CALCULATION AND MEASUREMENT OF EVERY METRIC USED Environmental, Health & Safety (5S) Levels 1-5 Kaizen action bulletins Target sheets Run charts Process owner’s current state maps Process owner’s future state maps 5-minute 5S checksheets Standard work validation checklist Comment cards Acute&Emergency&Care&Current&State&Map& patient Charge nurse Ambulancepatient HOSPITAL Bed nurse 240 min 100 patients per day Two 12-hr. shifts Takt time = 15 minutes 33% admitted to hospital CT VA CT VA CT VA CT VA CT VA CT VA CT VA CT VA CT VA CT VA CT VA LT CT WT VA NVA VAR Emergency! Flow manager! Patient! O"X"O"X""" 100 patients per day Two 12-hr. shifts Takt time = 20 minutes CT VA LT CT WT VA NVA VAR Hospital! Kaizen action bulletin [insert client logo here] © 2012 rona consulting group. Department: Team name: Date: Process owner: Item # Problem Countermeasure Responsibility Date Status Team Name: Date: Department: TAKT Time: Product/Process: Team Leader: Process Owner: Baseline Target Post Kaizen 30 Days Date:_____ 60 Days Date:_____ 90 Days Date:_____ Percent Change Numerator (# defects) Denominator (sample size) Percentage ≥ 3 Remarks: © 2010 rona consulting group 021KW_H-14_post-K_targets_r4.xls Space (sq footage) Target progress report and results sheet Inventory (dollars) Walking Distance (feet) Travel Distance (feet) Lead time (minutes) Quality (% Defects) Setup (minutes per operation) Productivity Gain (mins of operator time) Aggregate/convert to FTEs Other-1: Measures ADD DETAIL OF CALCULATION AND MEASUREMENT OF EVERY METRIC USED Environmental, Health & Safety (5S) Levels 1-5 DUE DATE A3-T TEAM CHARTER Date: Reporting Unit: Theme: © 2009 rona consulting group CHECK AND ACT ANALYSIS ACTION ITEM RESPONSIBILITY PROBLEM STATEMENT PROPOSED ACTION TARGET STATEMENT IMPLEMENTATION PLAN A3-T Press Ganey results Close-up: daily production board January 2014 31Sunday 1Monday 2Tuesday 3Wednesday 4Thursday 5Friday 6Saturday 7Sunday Patient A Patient B plan! actual! arrival! decision! discharge forecast! discharge delay!change in plan! plan! actual! rehab rehab rehabrehab rehab labs labs 7.1 $Value$Stream$Implementa1on$Loops$ Hospital! Emergency! Flow manager! Patient! O$X$O$X$$$ Clinical cell! Flow manager! O$X$O$X$$$ Emergent(Care( Primary(Care( Inpa0ent(Care( Annual strategy Deployment process Organization chart Hospital Primary care Ancillaries & specialties Supply chain A3-T A3-SR A3-T A3-SR A3-T A3-SR A3-T A3-SR A3-T A3-SR A3-T A3-SR A3-T A3-SR A3-T A3-SR A3-T A3-SR A3-T A3-SR A3-T A3-SR A3-T A3-SR A3-T A3-SR A3-T A3-SR A3-T A3-SR A3-T A3-SR mission vision Value stream map lean management cycle plan do check act Define a problem or challenge and design an experiment to address it Conduct the experiment under controlled conditions Validate the experiment Institutionalize lean thinking Experimental design w the A3-X Chartering successful teams through policy deployment Transforming the organization through training Checking progress in real time Build the book of knowledge scan Fashion business strategy as an experimental design by analyzing the business as a complex system, identifying truly critical factors and their interaction effects. Standardized work provides controlled conditions for execution of the experiment. Otherwise promote adherence through intensive training in productivity and quality methods before initiating continuous improvement. Empower your workforce of scientists to check results and make adjustments in real time. Manage exceptions through your business operating system. Make new knowledge part of standard work through PDCA embedded in daily operations. Coach and mentor to develop leaders at every level. valuestreammanager Hoshin team Engage the entire workforce in conducting the experiment by formally chartering departments and teams at every level in the organization. All teams Tactical teams Operational teams Develop leaders who can teach  apprenticeship  kaizen blitz  train-the-trainer  quasi-apprenticeship  six-sigma middlemanagers Define the elements of strategic intent  mission & vision  long-term strategy Scan environment with 7 smart tools 1 A3-i 2 value stream P&L 3 market/ technology matrix 4 value stream map 5 value stream P&L 6 Porter matrix 7 The president’s diagnosis Build a mid-term strategy and the annual hoshin 1 Identify 3-5 year breakthrough opportunities 2 Forecast financial results 3 Determine measures of process improvement 4 Study interdependencies 5 Identify 6-12 month tactics 6 Use the A3-T to establish annual targets for process and results 7 Use the A3-X to study interdependencies 8 Play catchball, rounds 1, & 5 Play catchball rounds 1, 2, & 5 1 Prepare for the meeting 2 Introduce the hoshin 3 Discuss the plan 4 Charter tactical teams with the A3-T 5 Study the plan 6 Complete and confirm the tactical plans Play catchball rounds 2, 3, & 4 1 Prepare for the meeting 2 Introduce the tactical project plan 3 Discuss the operations plan 4 Charter operations teams with the A3-T 5 Study the plan 6 Complete and confirm the operations plan 1 Finalize project plans 2 Apply PDCA methods 3 Eliminate waste/reduce variability 4 Manage internal and external customer connections visually and unambiguously 5 Use traditional project management tools. Note: Teams at all levels participate in leadership development, but responsibility lies with the value stream manager. Becoming lean cannot be delegated. 1 Manage visually  Provider process control boards  Visual project boards 2. Conduct smart review meetings  Daily 5-minute meeting  Daily review  Weekly review  Monthly/quarterly with the A3-SR  Annual review with the A3-SSR 3 Conduct president’s diagnosis  Self diagnose  Prepare for visits  Site visits  Analyze and score development  Recognize achievement 1 Document learning with the A3 system 2 Share lessons learned on line 3 Repeat the hoshin cycle supervisors& teamleaders Inclusion in planning phase optional; not recommended for companies just starting to implement hoshin kanri Team members Included in implementation but not in the planning Play catchball rounds 2, 3, & 4 1 Prepare for the meeting 2 Introduce the operations plans 3 Discuss the plan 4 Charter action teams 5 Study the plan 6 Complete and confirm action plans © 2008 rona consulting group A3-i Competitive information report Theme: Date: Reporting unit: A3 document system © 2008 Rona Consulting Group Page 1 OBSERVATION ANALYSIS IMPLICATIONS FOR THE BUSINESS f c p g year 1 year 2 year 3 year 4 year 5  =  =  = = © 2008 rona consulting group Legend important correlation or core team member correlation correlation / contribution customer weak correlation or rotating team member weak correlation or rotating team member strong correlation or team leader proces growth team members A3-X correlation correlation / contribution accountability tactics financial results strategicthemes processimprovements f c p g year 1 year 2 year 3 year 4 year 5  =  =  = = © 2008 rona consulting group Legend important correlation or core team member correlation correlation / contribution customer weak correlation or rotating team member weak correlation or rotating team member strong correlation or team leader proces growth team members A3-X correlation correlation / contribution accountability tactics financial results strategicthemes processimprovements f c p g year 1 year 2 year 3 year 4 year 5  =  =  = = © 2008 rona consulting group Legend important correlation or core team member correlation correlation / contribution customer weak correlation or rotating team member weak correlation or rotating team member strong correlation or team leader proces growth team members A3-X correlation correlation / contribution accountability tactics financial results strategicthemes processimprovements f c p g year 1 year 2 year 3 year 4 year 5  =  =  = = © 2008 rona consulting group Legend important correlation or core team member correlation correlation / contribution customer weak correlation or rotating team member weak correlation or rotating team member strong correlation or team leader proces growth team members A3-X correlation correlation / contribution accountability tactics financial results strategicthemes processimprovements f c p g year 1 year 2 year 3 year 4 year 5  =  =  = = © 2008 rona consulting group Legend important correlation or core team member correlation correlation / contribution customer weak correlation or rotating team member weak correlation or rotating team member strong correlation or team leader proces growth team members A3-X correlation correlation / contribution accountability tactics financial results strategicthemes processimprovements Daily improvement in 3D Process owner 3D wall Executive sponsor 3D wall Strategy deployment in 3D Tiered visibility walls cascade priorities and measures
  17. 17. Practiced, consistent and tiered visual management JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN YTD Actual Total Bellevue $0 Metropolitan $263,131 $216,565 $189,502 $288,303 $68,574 $80,613 $60,820 $25,000 $1,192,508 Coler Carter $330,062 $35,534 $562,835 $77,300 $146,920 $7,662 $107,208 ($47,352) $31,695 $27,767 $1,279,631 Gouverneur $65,844 $59,892 $99,720 $75,144 $45,720 $75,144 $47,244 $17,472 $65,844 $285,646 $837,670 Lincoln $1,219,620 $1,294,818 $3,364,974 $5,879,412 Harlem $3,031,427 $3,031,427 Ren/Mor/Bel Jacobi $624,482 $886,466 $722,283 $1,292,446 $194,633 $471,816 $82,246 $495,596 $1,144,213 $5,914,181 NCB $0 Queens $551,876 $1,965,274 $1,276,906 $3,794,056 Elmhurst $2,922,634 $1,418,234 $3,161,562 $7,502,430 KCHC $1,648,933 $750,630 $896,159 $1,321,575 ($496,376) $1,148,628 $970,470 ($62,906) $259,637 $948,367 $7,385,117 Woodhull $533,500 $231,635 $204,859 $815,040 $35,454 $226,021 $340,233 $125,215 $253,177 $319,452 $3,084,586 Cumberland East NY DSSM Coney Island $574,000 $302,000 $370,168 $1,246,168 Sea View Home Health Central Office $160,000,000 $200,000 $5,300,000 $40,900,000 $12,100,000 $218,500,000 Other Actual Total $3,465,952 $2,180,722 $7,943,488 $3,869,808 ($5,075) $6,688,210 $161,608,221 $1,030,025 $18,284,603 $42,481,232 $12,100,000 $259,647,186 Target Total $25,000,000 $25,000,000 $25,000,000 $25,000,000 $25,000,000 $25,000,000 $25,000,000 $25,000,000 $25,000,000 $25,000,000 $25,000,000 $25,000,000 $300,000,000 Monthly Difference ($21,534,048) ($22,819,278) ($17,056,512) ($21,130,192) ($25,005,075) $18,311,790 $136,608,221 ($23,969,975) ($6,715,397) $17,481,232 $12,900,000 ($40,352,824) Revenue target management
  18. 18. System-level deployment tree Divisions (not all engaged in hoshin) Division x-matrix/strategic plan Division A3s Hospital/subdivision x-matrices Hospital/subdivision A3s Strategy (executive) wall
  19. 19. Daily improvement Hoshin at the front line
  20. 20. Use of hoshin in healthcare 2 vignettes
  21. 21. A story – integrating the adoption of lean into the x-matrix • DMS (Daily Management System) is currently active in 76 areas in 12 different facilities • DMS will be launched at a total of 77 areas by end of June 2015. Countermeasure: ü As of April, a corporate-wide review of plan against actual revealed a significant slowing of new launches. Sites are using this unanticipated lull to strengthen and stabilize existing DMS work, as well as ensure alignment of DMS to value stream objectives. However, it represents a significant reduction in the original plan, which would have led to 118 of 244 planned areas launched by the end of FY15. Note: • DMS has been launched in 33 HK focused values streams. 41 54 54 54 54 71 71 71 80 90 110 118 44 47 52 53 54 59 63 67 72 75 76 0 20 40 60 80 100 120 140 JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN Target Daily management system engagement As of May 31, 2015
  22. 22. Increase the Event Sustainment Rate (% kaizens sustaining improvements for > 90 days) As of May 31, 2015 • Consistent monitoring of sustainment rates and ongoing on-site meetings with facility staff to review both process of calculating sustainment rate as well as improving rate are being completed each month. • Metropolitan did not have events during the reporting period and therefore could not report sustainment rate. Lincoln did not report their sustainment rate in time for inclusion in this report. Countermeasures: ü Facilities are reviewing the scope and goals of new RIEs to ensure that the events can be closed in a timely fashion and the goals are achievable. ü Facilities are working to complete pre-event preparation including having all needed data available. The lack of adequate preparation was identified as a major cause for not achieving goals in required time frames. ü Quality vs quantity of RIEs has been stressed by the Enterprise Breakthrough Office. ü Successful sustainment strategies developed at some facilities are now being shared with all facilities. ü Visual management (control boards) are being installed at facilities (or electronically) to better track event sustainment. Notes: • Event sustainment rate is defined as: Over a rolling 12 month period, the percent of Rapid Improvement Events (of all completed RIEs) for which improvements have been sustained for more than a 90 day period. • Goal is 60% in FY15; 72% in FY 16 and 85% in FY 17. • As RIEs are both the major sources of improvements and are very resource intensive, this is the unit selected for measure. South Manhattan Generation Plus Queens North Central Brooklyn South Brooklyn North Central Brooklyn 53 53 53 54 55 55 56 56 57 58 59 60 48 48 46 45 54 53 46 51 51 53 56 30 40 50 60 70 JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN Target Actual G O A L 53 44 86 75 78 50 50 60 67 45 56 38 0 20 40 60 80 100
  23. 23. Hoshin applied a large, strategic project
  24. 24. Acute stabilization KPI performance – 90 days post live # Status Group Trend Pillar Metric Name Reportin g Period Baseline Threshold Full Performance Previous Value Current Value Report Date 1 Physician Clinical Quality Inpatient CPOE Utilization Rate 24 Hours 78% 78% 80% 88% 90% 01/20/2014 2 Physician Clinical Quality Inpatient Medication Reconciliation Compliance Weekly 35% 35% 50% 69% 89%1 1/14-20/2014 3 Clinical Clinical Quality Pharmacy Bar Coding Medication Administration Compliance Weekly N/A % 85% 93% 89% 89%2 1/6-12/2014 4 Clinical Clinical Quality Medication Turn Around Time Order to Rx Verification Weekly 9 Minutes 15 9 8.3 7.892 1/6-12/2014 5 Physician Clinical Quality Problem List Weekly N/A % 40% 80% 53% 95%3 1/12-18/2014 6 Clinical Clinical Quality Core Measures Composite Monthly 98% 90% 97% N/A 97% 11/30/2013 7 Financial Finance Outstanding A/R Days For Uncoded DNB Accounts Month to Date 5.11 Days 5.11 3.74 4.40 3.73 01/20/2014 8 Financial Finance Average Daily Revenue Month to Date $10.033M $10.033M $10.39 $10.14M $10.13M 01/20/2014 9 Financial Finance Days In Candidate For Bill Month to Date 10.2 Days 10.2 8.4 14.9 13.2 01/20/2014 10 Financial Service Excellence Patient Registration Weekly Average Time Weekly ED Non-ED Minutes 10:52 7:27 9:50 5:48 8:55 5:40 8:46 5:28 1/12-18/2014
  25. 25. # Status Group Trend Pillar Metric Name Reporting Period Baseline Threshold Full Performance Previous Value Current Value Report Date 11 Clinical Service Excellence Press Ganey Patient Satisfaction Scores HCAPHS Drill Down Measures Communication With Nurses Communication with Doctors Communication about Meds Discharge Instructions Overall Satisfaction/ Responses Amb Surg ED OP Monthly 72.5 78.9 59.8 83.1 71.61 75.84 58.23 81.41 72.5 78.9 59.8 83.1 68.1 76.6 54.5 82.7 181 responses 82.1 85.2 64.6 84.0 68 responses Reported data received through 1/20 aggregated per Discharge Dates 11/1-30 Previous 12/1-31 Current 91.3 85.9 85.3 89.75 84.05 84.55 91.3 85.9 85.3 93.0 /24 84.0/182 88.1/ 440 88.4/ 22 82.8/125 88.7/ 233 12 Clinical Targeted Growth Emergency Department Average Length of Stay Daily 187 Minutes 200 177 208 168 1/20/2014 13 Clinical Targeted Growth Admission Time from Emergency Department to Inpatient Unit Weekly N/A Minutes Weekly Average TBD 137 148 Report in Validation4 14 Clinical Targeted Growth In-Patient Average Length of Stay Month To Date 4.51 OCT 2013 4.83 YTD 2013 Days 5.12 4.59 5.27 5.11 01/20/2014 15 Clinical Targeted Growth BTMG Interfaces Operational per Charter To Date N/A UP UP UP UP As of 1/20/2014, SLAs have been met Acute stabilization KPI performance – 90 days post live
  26. 26. Big Strategy, small tests of change
  27. 27. Multiple vehicles for developing people • Deploying hoshin kanri through catchball. • Coaching managers, genuine and humble inquiry. • Problem solving at multiple levels of the organization.
  28. 28. Developing an organization’s problem solving capabilities • Cascading strategies respects the expertise of the people closest to the work and ensures relevance. • Coaching engages people in a two-way dialogue. • Enabling problem solving develops critical thinking, acknowledges value. What? How?
  29. 29. Coaching using humble inquiry behaviors It’s not a checklist, it’s a set of behaviors Genuine curiosity Interest in what the other has to say Listening vs. telling Edgar Schein Humble Inquiry:The gentle art of asking instead of telling (2013)
  30. 30. A story: connecting strategy to front line improvement in Perioperative Services
  31. 31. A story: connecting strategy to front line improvement in Perioperative Services
  32. 32. Organization level hoshin Sterile Processing Service line hoshin Level 0 Reduce harm events A story: connecting strategy to front line improvement in Perioperative Services Level 1 Eliminate post- op infections Level 2 Daily defects in flash sterilizing process
  33. 33. Inevitable rocks in the hoshin road
  34. 34. Common rocks… and lessons learned • Weak organizational “strategy muscle” • Starting too high up the organizational tree • Underlying project management discipline • Imprecise measurements • Failure to deploy • Individualism • Developing strategy takes time • Start where there is pull • Define, and expect adherence to, deliverables and dates • Clarity and specificity matter • Enable and empower all levels of the organization • Hoshin requires a well-functioning TEAM with measures only achievable across silos Rocks Lessons Learned
  35. 35. We’ve joined the Health Care Consulting Practice at Moss Adams effective September 1, 2017. This combination is built on a shared culture that cares about our people and our clients— and helping them succeed.
  36. 36. Announcements (Then Q&A)
  37. 37. Our Next Webinars • Register at www.KaiNexus.com/webinars • November 29 – "Healthcare Collaboration" – Dr. John Toussaint and Paul Pejsa, Catalysis • December 7 – "4 Components of an Employee-Led Lean Initiative" – Simon Murray and Benny Ausmus, Big Change Agency
  38. 38. Other Resources www.KaiNexus.com/webinars Blog.KaiNexus.com
  39. 39. KaiNexus Podcasts • www.KaiNexus.com/podcasts • Subscribe via: – iTunes – Google Play – Stitcher
  40. 40. Q&A • Web: – www.kainexus.com – blog.kainexus.com – www.ronaconsulting.com • Webinars on Demand: – www.kainexus.com/webinars • Social Media: – www.twitter.com/kainexus – www.linkedin.com/company/kainexus – www.facebook.com/kainexus Mark Graban VP of Improvement & Innovation Services Mark@KaiNexus.com @MarkGraban Joanna Omi Consulting Director Moss Adams @JoannaOmi Jo.Omi@mossadams.com Craig Vercruysse Partner Moss Adams @CraigVercruysse Craig.Vercruysse@mossadams.com

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