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End to-End Patient Flow


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vshown at the Lean Summit 2010 - New Horizons for Lean Thinking on 2/3 November 2010

Published in: Education, Business, Technology
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End to-End Patient Flow

  1. 1. Hotel-Dieu Grace Hospital End to End Patient Flow Nicki Schmidt RN Senior Lean Facilitator
  2. 2. Hotel-Dieu Grace
  3. 3. Virus?Our Journey to Date Oct. 2005-06  ED VSA  Mental Health VSA  Joint Replacements VSA  Clinical Teaching Unit VSA  Central Sterilizing VSA  General Radiology VSA  Lab Pathology VSA  Pharmacy RIE  TPOC  Medical VSA  Surgical VSA  Supply VSA  ICU VSA  D.I. 6S  26 RIEs  1 Transformational Leadership Event  1 2P  Information Services. VSA Oct. 06- May 08 May 08- current
  4. 4. Why End to End?
  5. 5. A New Beginning
  6. 6. A New Beginning
  7. 7. Reality Sets In
  8. 8. Reality Sets In
  9. 9. 2005: The Burning Platform
  10. 10. 2005: Learning to See
  11. 11. Building On Success
  12. 12. Departments and Value Streams
  13. 13. Challenges
  14. 14. Enterprise Approach
  15. 15. End to End: AH HA’s
  16. 16. Who knows the Plan?
  17. 17. Do We All Know?
  18. 18. Discharge a Priority??
  19. 19. Chaos!! Can We Coordinate?
  20. 20. Sustaining?
  21. 21. Challenges “Do not assign responsibility without accepting the responsibility to Mentor” HDGH Core Team
  22. 22. Lead By Example
  23. 23. Inspiring Others
  24. 24. Enabling the Value Creating Work
  25. 25. RESULTS GUIDING PRINCIPLES SUPPORTING PRINCIPLES Measure what matters Align behaviors with performance Identify cause and effect relationships STEWARDSHIP See reality Focus on long term Align systems Align strategy CONTINUOUS PROCESS IMPROVEMENT Stablize process Rely on data Standardize process Insist on direct observation Focus on the Value Stream Keep it simple and visual Identify and eliminate waste Integrate improvement with work CULTURAL ENABLERS Nurture long term relationships Empower and involve everyone Develop people Assure a safe environment Create value for the customer Create constancy of purpose Think Systemically Focus on process Embrace scientific thinking Flow and pull value Assure quality at the source Seek perfection Lead with humility Respect every individual STEWARDSHIP TEAM WORK CONTINUOUS IMPROVEMENT RESPECT COMPASSION SUPPLY MANAGEMENT OPERATIONS PRODUCT & SERVICE DEVELOPMENT CUSTOMER RELATIONS SASH BOARD STRATEGY DEPLOYMENT VALUE ENABLING SYSTEM ENSURING FISCAL RESPONSIBILITY VALUE STREAM MANAGEMENT DAILY MANAGEMENT SYSTEM SAFETY SYSTEM PEOPLE SYSTEMS TALENT RECRUITMENT & MANAGEMENT PERFORMANCE MEASUREMENT SYSTEM SYSTEMSOUR VISION
  26. 26. Building A New Culture Page 2 Hotel-Dieu Grace Culture Wednesday, October 27, 2010 VALUES CompassionRespect StewardshipTeamwork Continuous Improvement Tells the truth Keeps promises Keeps confidences Maintains privacy Maintains confidentiality HONESTY and INTEGRITY Speaks with candor in a respectful manner Encourages truthfulness Is transparent to process and to content Says hello to all they pass Shows up on time to meetings Attentive and focused in meetings Looks to ensure that people aren’t in need of help, lost or in distress Promotes a clean, profes- sional and safe environment Does not spread gossip Asks for clarification if they do not understand Listens to others without interrupting. Repeats what was heard to clarify as necessary when communicator is done. Sensitive to the spiritual and emotional needs of every individual Demonstrates patience SEEK TO UNDERSTAND VOICE OF THE CUSTOMER Asks the patient “Have your needs been met?” Acknowledges requests for help Explains why – especially if needs cannot be met Voice of the Customer is used to identify and develop change Sensitive to the needs of the patient and responds to them Understands the patient is our focal customer Encourages self- determination SYNERGIZE Works together with others to problem solve Thinks ’Win Win” in support of a consensus agreement Recognizes other’s efforts daily Coachs and mentors, never blames Uses the patient as the focus of all teamwork Looks for input from team members that have been silent Being flexible when presented with alternate ideas/timing Owns up to mistakes ACCOUNTABLE Accepts accountability for tasks Accepts accountability for his/her behaviour Meets deadlines and communicates action plans Seeks help when needed Completes work on time Completes work on budget ELIMINATE WASTE Identifies waste in work processes Removes process steps that are unnecessary Collaborates with other departments to ensure smooth transitions in the work Uses just what is needed and doesn’t hoard TRUSTING AND TRUSTED Does what he/she says Doesn’t take what does not belong to them Takes pride in our organization and speaks highly of its people Takes pride in their work and the work of others Does their share of the workload. Does not leave work undone for others to do Values the competence of colleagues Trusts coworkers work and clarifies if a problem is identified HUMILITY Recognizes other people for their role in a success attributed to them Talks about team effort not individual effort Works at their highest capability and not boastful Having an understanding for inadvertent mistakes COURTESY and HOSPITALITY SEEK PERFECTION SEEKS FEEDBACK Asks for feedback Asks questions to gain other’s views Shares information openly with the understanding that others will do the same. Open to the ideas of others USE RESOURCES WISELY Offers suggestions to improve use of resources Open to changing work to improve utilization of resources Responsible for resources utilized Protects the hospital’s assets UTILIZE SCIENTIFIC THINKING ASSURE QUALITY Creates value in work processes Stabilizes processes Shortens the length of time to complete work processes Continually improve the work process Implements PLAN, DO, CHECK, ACT cycles Uses data and direct observation to make changes Follows standard work Make work visual Uses systems thinking Simplifys processes Stops and fix problems Reports all defects, problems and near misses Designs work to eliminate harm and promote safety Speaks slowly and clearly Asks if there are any questions or comments Repeats what they said for clarity SEEK TO BE UNDERSTOOD
  27. 27. So What! # of PATIENTS DISCHARGEDwith ALC DAYSper MONTH 0 10 20 30 40 50 60 70 80 90 APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR # 2010-2011 2009-2010 2008-2009 2007-2008
  28. 28. Results OVERALL OCCUPANCYRATE 75.0 85.0 95.0 1 2 3 4 5 6 7 8 9 10 11 12 13 Percentage 2010-2011 2009-2010 2008-2009 2007-2008 TARGET
  29. 29. Questions ?