Achieving And Sustaining Excellence Transforming The Health Care System
Biography – Jennifer Ralston• Jennifer Ralston is the Health Care Subject Matter Expert for The Quality Groups Master Champion Network. Ralston is a Multifaceted Manager with unique blend of experience in quality, process improvement, process engineering, regulatory, pharmaceutical, quality auditing, software quality, project and program management, change management and lean six sigma.• Ralston has worked with American Red Cross Bio Medical Services Headquarters and Organ Transplant Team, United States Postal Service (USPS), the Naval Yard, Genentech part of the Roche Family, The Project Management Institute (PMI), Merck Pharmaceuticals, The Army, Reston Hospital, The National Security Agency (NSA), American Association of Blood Banks (AABB), Medical College of Virginia, University of Maryland Medical System, Georgetown University Cellular Engineering, Department of State, and iJet Travel Intelligence. She has presented Quality Concepts to places such as the University of Cairo in Egypt, conducting an International Audit of the Vascera, in Cairo, Egypt in 2001. This was a unique opportunity to teach regulatory concepts to a pharmaceutical company overseas. Ralston has also won the American Red Cross Spirit of Excellence Award, which is an award for individuals that achieve major results.• During her time working for American Red Cross, Jennifer was the Director of Process Improvement for Biomedical Services at American Red Cross National Headquarters. She is a certified Master Black Belt, Lean Sensei, and managed the Red Cross’ Lean Six Sigma Program and Computer Simulations. Ralston began her seven (7) year career at Red Cross in 2002, serving as Senior Change Engineer, Change Management, Senior Quality Design Engineer, and Systems Design Engineering. She was also the organization’s first Black Belt and Master Black Belt in the Six Sigma program. In this role, she introduced and implemented Six Sigma and Project Management tools in support of the continuous improvement program and in compliance with FDA regulations, applicable laws, cGMP, CLIA/CMS, as well as AABB, JCAHO and ISO Standards. Ralston is also an auditor for several organizations such as AABB, CAP and ISO. She has also trained with the American Society of Quality as a Certified Quality Auditor and Certified Quality Engineer. Ralston has also worked as a Clinical Technologist, Medical Technologist and Microbiologist when she first started her career in Health Care. 2
Biography – Kathy Price• Kathy Price is the Director, Clinical Effectiveness, Sisters of Charity of Leavenworth Health System (SCLHS), KS, and a Master Lean Sensei responsible for implementing, training, facilitating and leading Lean Six Sigma quality improvement teams and methods for the 11 hospital system and University. She trains, coaches and mentors Lean Thinking Change Leaders and performance improvement teams in the use of quality improvement tools and methods focused on an innovative blend of Lean Six Sigma. First year deployment trained 439 employees and mentored 110 teams to produce $1,299,803 lean savings to exceed target by 133%. Second year deployment trained 256 employees and mentored 150 teams to produce $8,389,778 savings to exceed target by 113%. She trains and mentors local Lean Sensei to become ASQ Six Sigma Black Belt certified. She is responsible for curriculum development, standardization and deployment. She has created curriculum and blended e‐ learning modules. She has designed and created 1 day, 9 day, 20 day and blended e‐learning modules along with just in time (JIT) materials. She is a presenter at national, state and local conventions and meetings. She is published in a peer reviewed journal. She is a leader in Strategy, Vision, and Mission planning. She is successful in Team Building, Negotiating, Consensus Building and Change Management. She is competent in Data Management and Analysis. • As a Six Sigma Black Belt and Master Lean Sensei she has led, facilitated, and/or coached projects involving: Organizational Assessments, including Baldridge Self Assessment, Operational Efficiency Improvements, Patient Care Management, i.e. Stroke Care and Transforming Care at the Bedside (TCAB), Nursing Documentation, Patient Satisfaction Improvements (HCAHPS), Integration of Electronic Medical Records into Workflows, Redesign of Work Areas and Build Outs, Design for Six Sigma for new construction, Improvement of Patient Billing and Revenue Cycle, Throughput and Cycle Time Reductions, 6S for operations and supplies, and Root Cause Analysis. • Prior to SCLHS she was a Sr. Improvement Advisor at the University of Texas MD Anderson Cancer Center in Houston, TX. She previously worked with Quest Diagnostics, SmithKline Beecham Clinical Labs and Richards Laboratories and teaches Biology at the university level. Kathy has been in the Healthcare profession for 30 years. Kathy has a bachelor’s degree in Science from Stephen F. Austin State University, Nacogdoches, Texas; a medical technology certification from St. Paul Hospital, Dallas, Texas; and her master’s in science education from the University of Texas in Dallas. She has ASQ Six Sigma Black Belt, Project Management, Lean, and TeamStepps Master Trainer certifications. Her professional affiliations include the American Society for Quality, the Quality Institute for Healthcare and the Institute of Healthcare Improvement. 3
Pre-Summit Workshop Objectives: • We will focus on Delivery of Services and Patient Safety can be enhanced by reducing waste and using a data‐driven methodology • Applying next Generation Quality Management Philosophy and Methodology in Health Care • Successful Improvement Projects undertaken in the field • Achieving Quality and Organizational Performance Effectiveness • BONUS: You will learn how to use The Quality Group’s new Lean Six Sigma Blended e‐Learning Series for Healthcare professionals to drive process improvement initiatives throughout their organizations and take your deployment to the next generation. 4
Ground Rules for WorkshopInteractive Discussion is a MustPlease Participate in DiscussionAsk QuestionsOpen Dialogue is WelcomeOthers? 5
American Red Cross Biomedical Services Mission & VisionOur Mission Our VisionAmerican Red Cross To be recognized by the peopleBiomedical Services will fulfill and organizations we serve, asthe needs of the American well as others in our field, as thepeople for the safest, most provider of choice for blood,reliable, most cost-effective plasma and tissue services.blood, plasma, and tissue This will be accomplished byservices through voluntary commitment to quality, safetyDonations. and use of the best medical, scientific, manufacturing and business practices.
Aligning strategy to focus the organization on shared priorities8
Executive Review: M4 Performance Summary (SDP) M4: Achieve market share >50% (Collections) Owner: Greg Ballish Related Initiative Status Summary CAGR = 7.5% Description Timing Status CRM/DRM strategy execution Will close to new CR IDEO donor environment design project TBD Donor recruitment development TBD SDP strike force (also 6σ) TBD Donor assertions Pending best practice assessment System - Daily Collections Goal Achievement (% of total) Increasing Apheresis donor frequency Pending best practice assessment Mon Tue Wed Thu Fri Sat Sun Determining best choice donor pre-count Pending best practice assessment Target 16.1% 14.9% 9.8% 11.5% 16.3% 15.7% 15.7% July 16.3% 15.6% 13.0% 13.7% 16.3% 14.8% 10.3% NOTE: These projects identified “Increase donations” as at least one of 3 August 16.3% 15.4% 13.3% 13.5% 15.9% 15.1% 10.5% their strategic goals M4: Analysis, Opportunities and Issues M4: Forward Looking Actions• SDP sales continue to exceed target: demand and • Six sigma projects aligned to SDP collections are our ability to collect on DOW has been excellent! underway• Still some mismatch of DOW requirement, but • Managing SDP collections for splits and overall volumes are sufficient machine/staff utilization can increase efficiencies 10
ARC Deployment History• Began Six Sigma Deployment August 2005 – Trained 78 BBs – Trained 40 GBs – Trained 350 Champions – Hired 3 MBBs – Self Sustaining• Began Lean Deployment October 2007 – Lean 101 Awareness Training – Hired 2 Lean Engineers at the beginning and supplemented with consultants to gain velocity – Hiring 6 Lean Engineers, 1 Lean Sensei/Program Manager – Self Sustaining in March 2009 11
How we use Lean & Six Sigma Quality Enables Speed Six Sigma Lean Culture + Quality Speed + Low CostGoal Improve performance Outliers on Goal Reduce waste, increase process Customer Critical to Quality requirement speed, and Standard WorkFocus DMAIC with Total Quality Focus Identify non-value added steps and Management tools to eliminate variation cause for delayMethod Management engagement, dedicated Method Kaizen events, Value Stream Maps Champions and Black Belts Speed Enables Quality 12
X2 = Project Selections Idea Definition Prioritization ExecutionGeneration Projects Planned Current Available Projects Resources Potential Projects All Projects Must Pass Through a Strategic Filter.13
X8 = Sustaining Infrastructure Leadership Team Project ProjectChampion Champion Master Black Belt Black Belt Black Belt Yellow Green Belt Green Belt Belts A Sustaining Infrastructure Must Have Senior Management’s Support and Guidance. 14
Y = Successful Deployment X1 = Leadership Commitment X2 = Project Selection X3 = Black Belts Selection X4 = Fully Dedicated Black Belts X5 = Champion Engagement X6 = Master Black Belt Support X7 = Organizational Tools X8 = Sustaining Infrastructure Scale 100 %Y = f ( x 1 , x 2 ,..., x k ) 75% 50% or less 17
Sisters of Charity Mission & Vision Our Mission “We will, in the spirit of theSisters of Charity, reveal God’s healing love by improving the health of individuals and Our Vision communities we serve, SCLHS Mission realized especially those who are through unyielding pursuit of poor or vulnerable.” performance excellence, innovative growth and health care for all
SCLHS Core ValuesSCLHS carries out Jesus healing ministry today through its commitment to the following core values:• Excellence We offer excellent and compassionate care. • Respect We recognize the sacred worth and dignity of each person. • Response to Need The health care we offer is based on community need, with a special concern for the poor. • Stewardship We are mindful that we hold our resources in trust. • Wholeness We value the health of the whole person‐spiritual, psycho‐social, emotional and physical.
Beyond 2011 Under Health Reform Market Regulation and The Prelude Expansion Restructuring 2010-2013 2014-2017 2018-2020+ Chase the Manage the Consolidate Incentives – Change Your Position Get Ready• Lean Initiatives/MAP • Medicare • Systems of Care• Physician Alignment Breakeven Targets • Prepare for Medicare 3.0?• ACO & Medical Home • Clinical Integration • Agile & Adaptable to• Performance • New Service Line Change Excellence Plan Models • Able to Manage Risk • Operating• EHR & Meaningful Use Company Model 20
Cost Reduction Efforts: Health Care vs. Other Industries Where Health Care Go to Reduce Cost Inputs to Core Core Processes Outputs Processes • Evaluating • Quality Results • Supplies • Diagnosing • Safety Results • Staff • Treating • Costs • Equipment • Communicating Where Other Industries’ Go to Reduce Cost Source: Reinertsen JL, Bisognano M, Pugh MD. Seven Leadership Leverage Points for Organization-Level Improvement in Health Care (Second Edition). IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2008. (Available on www.IHI.org)
A New focus on Kano? • Move away from mindset that “lower cost implies poor quality”Reduce costs significantly • Get to the “dark green while maintaining or dollars” improving quality - Go beyond notional or potential savings to taking real money out of budgets • Set a cost reduction target (1-3%)? - . . . A new approach!
Lean is focused on the elimination of all non value-adding activities and waste from the organization’s processes. Map andWaste includes understand• Scrap value stream• Rework• Inspection Goals: • Increase productivity• Inventory Customer- • Eliminate waste Make value• Queuing time defined value • Maximize resource stream flow• Transporting materials utilization or products• Redundant motion Continuous process• Anything for which a improvement final customer would not want to pay
Lean Deployment ArchitectureCulture Transformation Project Based • Self‐sustained model • Consultant‐led• Longer deployment time • Shorter deployment • Improvement is a daily time event for everyone • Hobbies• Accountability • Little accountability• Structured education • Selected education• Way of life • Flavor of the month attitude
Lean Accountabilities & Disciplines• Waste reduction 2% per year using 2008 cost figures• Focus on Directors and Managers• System Office certification is good for one calendar year• Certification requires yearly renewal• Must provide evidence of Lean Thinking proficiency every year for continuing certification• Sensei will be certified by American Society for Quality (ASQ) Black Belt, Lean Six Sigma
SIX SIGMA Six Sigma concentrates on variation reduction by using statistical methods to lower process defect rates to less than 3.4 defects per million opportunities.Six Sigma Methodologies:• DMAIC - define, measure, analyze, improve, and control• DMADV - define, measure, analyze, design, and verify
Cascading Effect of Performance Excellence Big Dots Drivers Projects (Pillars, BSC…) (Core Theory of (Ops Plan) Strategy)What are your key Down deep, what What set of projectsstrategic aims? How really has to be will move thegood must we be, by changed, or put in Drivers far enough,when? What are the place, in order to fast enough, tosystem-level achieve each of achieve your aims?measures of those these goals? What How will we know ifaims? are you tracking to the projects are know whether these being executed? drivers are changing?
Advance Training Program (ATP)• Advance Training Program for Performance Excellence• Focus on Leadership ‐ Vice Presidents and Above• 10 days SCLHS Affiliate Program• 20 days Intermountain Healthcare• Both includes completion of a project• Basic PI sciences and 1 day Lean Champion Training
Lean Thinking Change/Project Leader• 9 days training• Require 2 projects – learning and certification project in the magnitude of $25K waste elimination• DMAI2C Methodology• Commitment to continue deployment of lean at their facility
Lean Foundation Training• 6 hours training• Basics of Lean • “Airplane exercise”• Commitment to recognize waste
Lean Sensei Training• 1 week/per month for 6 months (25 days), with one month off in December• ASQ Body of Knowledge (BOK) for Six Sigma Black Belt Certification & SME BOK for Lean Sensei• “People side”• Coaching and Teaching• PT/FT Local Sensei
Mini Courses - Lunch n Learns• Tool Reviews • Observation Skills – VSM • Data Management Skills – Spaghetti Diagrams • Case Studies – Visual Controls • Mentoring / Coaching – 6S Skills• Facilitation Skills• Committees vs. Lean Teams
Advance Courses• Minitab – working with data• TeamSTEPPS – Master Trainer Training• Statistics for Performance Analysts• Facility Design and Simulations
Framework: Leadership for Improvement Setting Direction: Mission, Vision and StrategyPUSH Making the future attractive PULL Changing the old Will Ideas Execution Establish the Foundation Source: IHI
Framework: Leadership for Improvement 1. Set Direction: Mission, Vision and StrategyPUSH PULL Make the future attractive Make the status quo uncomfortable 3. Build Will 4. Generate Ideas 5. Execute Change • Plan for Improvement • Read and Scan Widely, Learn from • Use Model for Improvement for • Set Aims/Allocate Resources other Industries & Disciplines Design and Redesign • Measure System Performance • Benchmark to Find Ideas • Review and Guide Key Initiatives • Provide Encouragement • Listen to Customers • Spread Ideas • Make Financial Linkages • Invest in Research & Development • Communicate results • Learn Subject Matter • Manage Knowledge • Sustain improved levels of • Work on the Larger System • Understand Organization as a performance System 2. Establish the Foundation • Reframe Operating Values • Personal Preparation • Build Relationships • Build Improvement Capability • Choose and Align the Senior Team • Develop Future Leaders Source: IHI
Project Selection Process Financial Potential Strategic Expectations Nonfinancial Organizational Goals and Goals Benefits Politics ProjectsProblems SelectedOpportunities to MoveMandates to the Initiation Stage Current Organization Resource Project Project Risk Preferences Constraints Risk Portfolio Mix
KAIZEN EVENTS• 1 ‐ 3 day Rapid Improvement Events• ED Throughput• Patient Flow• Pharmacy Group• Physician Group
Challenges• “It’s not Lean to fill out all the paperwork”• “Lean is about getting rid of my job”• “What I can improve does not save $25K”• “I don’t have time to be on a Lean team”• “We’re already ‘lean’, we don’t have enough people”• “We can’t do Lean while ____ is going on”• Knowledge Management software
Results As of 2009 ………………• Achieved > 1.0% (target ~ $11M) waste reduction through deployment of LEAN project teams – Preliminary Dark Green $ 9.8M – Preliminary Light Green $ 5.7M – 400 projects in Improve or Control Phases – 140 Directors are certified by the System Office as Lean Thinking Team Leaders – 16 Lean Six Sigma Sensei will graduate in March 2010• Redesigned multiple work flows to enhance efficiency at care sites and in system office• Improved patient flow in many care sites
Innovation• “Innovate and design” have naturally been separated from “improvement work”• But, design is interwoven with existing products and processes• Improvement often means revisiting fundamental design
Barriers to Innovative Thinking These barriers restrict our left brain • Physiological (analytical) and right brain (creative) – Perceptual to – Emotional – Cultural – Properly collect the information – Environmental necessary – Choose and calculate which information is important – Communicate those ideas to our consciousness for an innovative solution
Value Innovation• Focus on making the competition irrelevant by creating Costs a leap in value for buyers and your company, thereby Value Innovation opening up new and uncontested market space Buyer Value
Value + Innovation • Value without innovation – Focuses on value creation at an incremental scale – May improve value, but is not sufficient to make you stand out in the marketplace • Innovation without value – Tends to be technology‐driven – Frequently shoots beyond what customers are ready to accept and pay forKim, W. C., and Mauborgne, R. (2005) Blue ocean strategy. Boston: Harvard Business Review Press.
Red vs. Blue Ocean StrategyRed Ocean Strategy Blue Ocean Strategy• Compete in existing market space • Create uncontested market space• Beat the competition • Make the competition irrelevant• Exploit existing demand • Create and capture new demand• Make the value‐cost trade‐off • Break the value‐cost trade‐off• Align the whole system of a firm’s • Align the whole system of a firm’s activities with its strategic choice activities in pursuit of of differentiation or low cost differentiation and low cost Kim, W. C., and Mauborgne, R. (2005) Blue ocean strategy. Boston: Harvard Business Review Press.
Blue Ocean Analytical Tools: Four Actions Framework Reduce: Which factors should be reduced well below the industry’s standard? Eliminate: New Create:Which of the factors that Which factors should be the industry takes for Value created that the industry granted should be Curve has never offered? eliminated? Raise: Which factors should be raised well above the industry’s standard Kim, W. C., and Mauborgne, R. (2005) Blue ocean strategy. Boston: Harvard Business Review Press.
Exercise:Eliminate-Reduce-Raise-Create Grid Eliminate Raise Reduce Create Value
What we both found was…• TQG’s Blended e‐Learning model helped us to leverage our MBB resources better and to save money in the long run as we were training up our resources and ramping up our Lean Six Sigma Deployments…. 52
The Quality Group (TQG) has been developing and deploying technology‐based solutions to address Lean Six Sigma / Process Improvement (LSS/PI) training challenges, since 1992. 1) Our e-Learning makes ‘Quality Principles’ come alive for everyday people.2) Our portal platform powers effective implementation of blended e-Learning.3) Our processes enable e-Learning solutions that fit your needs, not vice versa.
Why a complete blended e-Learning solution for healthcare quality?• LSS/PI is needed throughout the healthcare industry• LSS/PI experts are spread thin and need to scale their impact • Healthcare organizations need a less disruptive way to teach LSS/PI • LSS/PI training costs must be high quality and low cost
Healthcare Course Content:Phase Module Phase ModuleIntro • Six Sigma Introduction Measure • Types of Control Charts • Introduction to Lean Six Sigma • Introduction to Process for Healthcare Capability and Process Capability • Lean Six Sigma Fusion Assessments • Project Charter • Confidence IntervalsDefine • Voice of the Customer • Normal Curve • Managing the Project - Analyze • Cause & Effect Diagrams Teamwork • Scatter Diagrams • Pareto Analysis • Failure Mode & Effects Analysis • SIPOC • Future State Value Stream • Introduction to Process Mapping Mapping • Hypothesis Testing • Eight Wastes Improve • Maximizing ROIMeasure • Current State Value Stream • Kaizen Event Mapping • 5S/6S • What is Statistics? • Visual Management • Organization of Data • Standard Work • Measures of Central Tendency • Error Proofing • Measures of Dispersion • Changeover Reduction • Descriptive Statistics: Self- • Total Productive Maintenance Assessment • Workplace Design & Layout • Calculating Process-Based • Flow & Pull Systems Costs • Validating the Measurement Control • Sustaining ROI System • Extending ROI
Blended e-Learning• Experienced in 2010• Develop all face to face learning modules into blended e‐learning
What if you don’t use the Blended e-Learning?• Schedule 9 days of classroom instruction• Costs – Employee Time/Instructor Time – Meeting location – Lunch/snacks• Mixed classes/Adult education – Different learning styles – Lecture/activities/group work 74
With Blended e-Learning• 24/7 online learning access. Prior to class, participants learn the core concepts and tools, then ‘search’ and ‘review’ them later, on the job. . • Consistent training delivery. If you teach everyone the same, your course roadmaps have more integrity and your organization alignment increases. • More effective use of classroom time. With participants on the same level, class sessions focus on discussion, hands on exercises and project work. • Higher retention & better mentoring. Retention increases when users control their pace, ability to review etc. Good e‐Learning is flexible for users. Learning more outside class, sets up better mentoring in class.• Reduces Costs Lean Thinking 75
Road Map to Performance Excellence• Roadmap of implementing Lean thinking as an innovative blend Improvement methods included: Lean, Six Sigma, TOC, PDSA & Queuing Theory.• Successes and challenges in our Lean Thinking journey to change culture• Tools to improve patient safety and outcomes, reduce waste, enhance efficiency and increase overall effectiveness.
“ Look forward to the good that is yet to be. ” - Mother Xavier Ross 77