To subscribe: http://www.ksmartin.com/subscribe To buy the book: http://bit.ly/TOObk These are slides from a keynote given on 2/23/14 in Orlando, Florida at the Healthcare Systems Process Improvement Conference which was organized by The Society for Health Systems.

1. The Outstanding
Organization
Building the Foundation
for Everyday Excellence
Healthcare Systems Process Improvement Conference
February 23, 2014
© 2014 The Karen Martin Group, Inc.

2. Success with Improvement
2001 – The Economist
Lasting
20%
None
17%
Temporary
63%
2

3. …A Decade Later
2010 – Accenture
69%
58%
33%
Needs re‐evaluation,
restart or complete
makeover
Minimal
financial
impact
Mixed to
disappointing
results
3

4. To Err is Human
Institute of Medicine, 1999
Up to 98,000 deaths
annually due to
medical errors.
Improvement goal:
Reduce by 50%
in 5 Years.

5. Something Is Terribly Wrong…
“Progress has
been slow.”
Journal of the American
Medical Association
Office of the
Inspector General
“33% hospitalized
patients are harmed;
7% result in permanent
injury or death.”
“180,000 Medicare
patients die annually
from medical errors.”
2009
2005 “Annual death toll
from medical
errors is closer to
200,000.”
Dead by Mistake
Heart Newspapers
Special Report
2010
2010
Health Affairs
“No significant
2011
change in rate of
preventable errors.”
New England Journal
of Medicine
2013
“200,000‐400,000
deaths per year
due to preventable
harm in hospitals.”
Journal of
Patient Safety

6. 7 in 10 American workers are
“not engaged” or “actively
disengaged” in their work.
Per Gallup, actively disengaged employees cost the U.S.
$450‐$550 billion a year in lost productivity.
6

7. Employee Engagement – Gallup Findings
2000
26
58
18
2001
16
54
30
2002
17
53
30
2003
17
55
28
2004
17
54
29
2005
15
2006
15
59
26
30
55
2007
20
50
30
2008
20
51
29
2009
18
54
28
2010
19
53
28
2011
19
52
29
2012
18
52
30
0%
ACTIVELY
DISENGAGED
100%
NOT ENGAGED
ENGAGED
7

8. © 2014 The Karen Martin Group, Inc.
8

9. CHAOS
Ineffective
behaviors
© 2014 The Karen Martin Group, Inc.

10. 10

11. © 2014 The Karen Martin Group, Inc.
11

12. Ambiguity complicates,
slows, frustrates…
and is dangerous
© 2014 The Karen Martin Group, Inc.
12

13. 8 Ambiguity Wastes
1.
2.
3.
4.
5.
6.
7.
8.
Organization purpose & vision
Customers & products
Business goals & priorities
Policies
Roles & responsibilities
Work systems & process performance
Problem solving & decision making
Terminology & communication
13

14. Silo‐Centric vs. Value Stream Thinking
Dept A
Dept B
Dept C
Dept D
Support Value Streams
Core Value Streams
Support Value Streams

15. Gaining Clarity: Current State Value Stream Map
Outpatient Imaging

16. Percent Complete & Accurate (%C&A)
Customer
75%
Process
1
80%
Process
2
95%
Process
3
50%
Process
4
90%
Rework = Correcting, Adding, Clarifying
Rolled %C&A = 26%

17. Gaining Alignment: Future State Value Stream Map
Outpatient Imaging

18. Who Owns the
Value Stream?
18

19. How are we performing?
19

20. Visualize Work Queues & Status
20

21. © 2014 The Karen Martin Group, Inc.
21

23. There is no such thing
as multitasking.*
* For cognitive tasks.

24. The Cost of Switch Tasking
Task #1: Focus Reduces Chaos
Task #2: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Round 1 – Alternate between tasks : letter, number, letter, number, etc.
Sentence:
Numbers:
Round 2 – Write the full sentence, followed by the numbers 1‐17.
Sentence:
Numbers:

25. Focus Law #1:
STOP DOING
Focus Law #2:
DO FEWER THINGS
AT ONCE

26. 26

27. The Power of Focus:
Projects Completed in One Year
80
73
70
60
• No additional
resources
• Higher quality
output
• Lower stress
50
40
30
24
20
10
0
Pre‐Focus
Post‐Focus
27

28. What is Your Improvement Strategy?
28

29. Strategy Deployment Key Feature: Catchball
What?
Who?
When?
Executive
Team
What?
Who?
When?
Senior
Mgmt
What?
Who?
When?
Middle
Mgmt
What?
Who?
When?
Frontlines
29

30. Actively Working On
In Queue
Started & Stopped
New Ideas
30

31. Must Do, Can’t Fail
Maybe
Delay
Eliminate
31

32. Creating Organization‐Wide Focus:
The Annual Work Plan
< Company Name >
2013 Priorities
2013 Goals & Objectives
1. Increase sales 5%.
3. Achieve 10% profit.
2. Achieve 50% gross margin.
4. Improve morale (metric TBD).
X = Planned
Priority
5
8
9
17
29
32
33
10
30
31
25
26
15
20
22
Content removed for confidentiality
21
● = Actual
Jan
Feb
3,500 uni ts s ol d by 12/31/2013 through a l l cha nnel s
(a pprox. $700K)
2
11
Goal or Measurable Objective
X
X
X
X
X
X
Devel op & del iver tra i ni ng to top 50 Dea l ers
X
X
X
X
X
X
X
X
Educa tion: 1 s chool di s tri ct s pec'd/underperforming
COM dis tri butor (25) by 12/31 va l ued a t mi n $35K ea ch
10 new dea lers on boa rd (net) ($500K per dea l er thi s
yea r)
5 new di s tri butors bri ngi ng $200K a nnua l rev (& 5
termi na ted)
X
X
X
X
X
Josh R?
X
X
X
X
X
X
X
X
X
X
Howa rd
Mi cha el S
X
X
X
X
X
X
X
X
X
Howa rd
X
X
Mktg Ops
3
HR
Fin
3
3
Bob
2
PE Pario
COM CDs / PD
PD
BMD SWS
Direct AMs Rec Mgmt
3
1
1
3
2
1
3
2
3
3
3
2
3
1
3
3
3
Mi ke B
3
3
2
3
3
2
X
X
X
X
X
X
X
X
X
X
Howa rd
Howa rd
2
3
X
X
X
X
X
X
X
X
X
X
Howa rd
Da na
1
3
3
X
X
X
X
X
X
X
X
X
Howa rd
Ma rk H
2
3
Howa rd
Howa rd
X
X
X
X
X
X
X
X
X
Howa rd
Howa rd
Ji m
Ra nda l l
Ji m
Jos h
X
TBD
X
X
X
TBD
Useful reporti ng a nd metri cs a re es ta bl i shed a nd i n
pl a ce
X
X
TBD
X
X
TBD
X
X
X
X
X
X
X
X
X
1
3
X
X
X
X
X
X
X
X
X
Jos h
Ji m
Sys tem 7.0's i n pl a ce
1
1
X
Sha nnon
1
Ji m
Ra nda l l
1
3
1
X
X
X
Phyl l is
1
Mi cha el M
2
Ma tt D
3
Nea l l
X
1
Da na
Da vi d R
1
1
1
1
1
1
1
1
1
1
1
1
1
3
2
Sus a n
X
3
3
Nea l l
X
3
1
Jos h
X
3
1
Mi cha el M
X
3
1
1
1
1
3
Ji m
TBD
La y out compl ete; equi pment i ns ta l led
2
X
X
30 pa rts s ourced in U.S.; compl eted pl a n for ma na gi ng
Chi na ‐s ourced pa rts
Wa rehous e l a id out; ka nba n revi s ed; Sys pro
i mplemented
Da na
Rex/Tim
X
X
Des ign cha nged to s ol ve dela m i ss ue l ong‐term
Bob
X
20 by yea r‐end
1
14
X
X
10 projects s pec'd by 12/31; $300K rev by 12/31
100% a ccura te pa yrol l ; 100% ma na gement s a ti sfa cti on
a t Apri l mgmt. meeting
Internet ta s k l is t is si mpl i fi ed a nd strea ml i ned for
PDs then pl a n is rol led out to PDs
Des ign Ca l cul a tor i s upda ted success ful l y a nd rol l ed
out
Level of Effort/Involvement Required
IT
Exec Owner
X
Competi tive Ana l ys i s compl ete a nd di stri buted for us e
13
Aug Sep Oct Nov Dec
Tactical
Owner
Bob
Mar Apr May Jun Jul
Revis ed cours e ma teri a l s by 6/30/2013
Plan review dates:
Bob
X
24
12
Created: 01‐14‐13
Revised:
1
2
3
1
1
3
3
3
2
1
X
X
X
Susa n
Sha nnon
3
X
X
X
Susa n
Sha nnon
X
X
Susa n
Da vi d R
3
2
2
3
3
X
X
X
X
X
X
2
3
3
3
3
2
3
3
3
X
3
3
1
2
2
3
32

33. © 2014 The Karen Martin Group, Inc.
33

34. Train/Practice vs. Performance
Perform
99%
Train
90%
100%
90%
80%
70%
60%
50%
40%
Perform
10%
30%
20%
10%
Train
1%
0%
Athletes
Businesses
Jim Loehr & Tony Schwartz, The Power of Full Engagement
34

35. Develop
hypothesis
Refine
Standardize
Stabilize
Conduct
experiment
Measure
results
© 2014 The Karen Martin Group, Inc.
35

36. What problem are you
trying to solve?
Why is it a problem?
36

37. True Continuous Improvement
37

38. © 2014 The Karen Martin Group, Inc.
38

39. Engagement Drivers: The Three C’s
The Outstanding Organization, pp. 155‐158
To vision, annual goals,
immediate supervisor,
peers, customers
Connection
Creativity
Full use of talents,
capacities,
potentialities,
& skills
© 2014 The Karen Martin Group, Inc.
Control
Heavy involvement in
decisions that influence
their work life
39

40. Leaders determine
strategy (what)
Workers determine
tactics (how)
© 2014 The Karen Martin Group, Inc.

41. Cross‐Functional Problem Solving & Improvement:
Connecting, Using Creativity, Gaining Control

42. Doubles
Triples
Single Hits
Add Up!
Home Runs & Grand Slams
42

43. © 2014 The Karen Martin Group, Inc.
43

44. www.ksmartin.com
858.677.6799
Signing books immediately after
talk in exhibit hall
© 2014 The Karen Martin Group, Inc.