The next generation of Lean Six Sigma Innovation in Healthcare

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The next generation of Lean Six Sigma Innovation in Healthcare

  1. 1. WCBF Lean, Six Sigma & Process Improvement in Healthcare Summit The next generation of Lean Six Sigma Innovation (LSSI) In Healthcare by Bob KingThe Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 1
  2. 2. Survival is not mandatory! - W. Edwards Deming 1984 Innovation New ideas Common ObjectiveSix Best Practices LeanSigmaError & Speed variation reduction The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 2
  3. 3. LSSI Culture• Shifts focus to customer, not service provider or organization structure• Uses common methodology for process improvement and decision making• Uses common metrics• Ensures decisions are data driven• Aligns projects with strategy and business objectives• Focuses on waste, variation, and defect reduction• Increases effectiveness of investments• Improves ability to meet expectations of customers The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC Overview - 3
  4. 4. Factors Supporting Project Success• Regular management reviews• Team knowledge of process• Adequate measurement system• Constant environment• Bias for urgent action• Measurable goals• 90-day maximum execution timeframe The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC Overview - 4
  5. 5. Objectives of this talk• Help participants develop a roadmap of improvement for their organization – Clarify strategy and get alignment of all levels of staff and physicians. – Enrich lean six sigma with innovation – Pick the projects and tools that will best help you achieve your strategy. – Use time management to free up time for improvement efforts The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 5
  6. 6. Simplify and map strategy – Southwest example Increase profitabilityThe Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 6
  7. 7. Simplify and map strategy – Southwest example Increase profitabilityFewer Moreplanes passengersThe Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 7
  8. 8. Simplify and map strategy – Southwest example Increase profitability Fewer More planes passengers Lowest cost On time flightsFast turn around The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 8
  9. 9. Simplify and Map Strategy - Hospital Profitably Improve Health of the Community The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 9
  10. 10. Simplify and Map Strategy – Hospital Profitably Improve Health of the CommunityPatient Satisfaction GoodPayer Satisfaction Outcomes Economical The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 10
  11. 11. Simplify and Map Strategy – Hospital Profitably Improve Health of the CommunityPatient Satisfaction GoodPayer Satisfaction Outcomes EconomicalTransparency Patient Reduce Patients Waste in Safety Get Better Processes The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 11
  12. 12. Barriers• Joint Commission• Medicare – CMS• Strategy Plan written by outside consultant The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 12
  13. 13. Enriching Lean Six Sigma with Innovation• Improve the improve step of DMAIC• Need to choose process and tools by experience of your team.• Need to choose process by type of change – If some other part of organization has done it, then the 7MP tools will work – To do something that you haven’t done, but another organization has, use 7 Creativity tools – To do something that no one else has done before, use Advanced Innovation TRIZ. The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 13
  14. 14. Pick strategic projects and tools• The more your projects are tied to strategy the better the chance of success.• Pick the elements of six sigma, lean and innovation that will help you succeed in your improvement effort. The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 14
  15. 15. Example 1: Reducing Falls• Reducing falls during the hospital stay.• Reducing falls when the person returns home after being in the hospital to treat a previous fall. The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 15
  16. 16. Prevalence of Falls• Data shows fall related injuries in older adults are the largest number of trauma admissions at the hospital.• Falls are also the leading cause of injury EMS runs.• Falls are the leading cause of injury visits in the emergency department.• Falls are the leading cause of injury death in those over 65. The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 16
  17. 17. Selecting tools for falls teams• Six Sigma applications. – Kinds of falls, causes of falls• Lean applications. – Processes of care, lag time from coding a person as a fall risk to taking action• Innovation applications. – Identify ways of preventing falls, preventing harm – Ways to educate families, discharge instructions. The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 17
  18. 18. Example 2: Improve IT Capital Asset Tracking• Number of items purchased vs. number of items tagged.• Relevance?• Six Sigma: # of variances from process• Lean: What are unnecessary steps and delays in the process? Mistake-proofing.• Innovation: Analogies of dependable processes. The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 18
  19. 19. Example 3: Reduce time to transfer Paper Medical Record to EMR – Issues of quality of information that is being transferred. Easier to access wrong information – Understanding the differences between ED reports and in-patient reports. – How long to process an inch of rehab, an inch of cardio, to see if there are efficiencies that can be gained there as well. The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 19
  20. 20. Electronic Medical Records• Six Sigma: What is the quality of the original records, quality of transmission? Who are the customers of the records? What do they want?• Lean: What are the steps in developing the records, what are the steps in transcribing the records? Where are the delays?• How can innovation help find the best ideas for these questions? The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 20
  21. 21. Pharmacy Project• Wide variation on special formulations• One patient expected a 30 minute wait and left after 75 minutes resulting in a $3,000 loss to the hospital. The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 21
  22. 22. Rx Entry ACC Delivery ElapsedPatient Medication Time Time Time 1 Remicade 1407 1429 22 2 Remicade 1142 1450 308 3 Venofer 1102 1110 8 4 Xolair 1003 1045 42 5 Remicade 1329 1350 21 6 Venofer 1409 1420 11 7 Remicade 1304 1328 24 8 Orencia 1123 1135 12 9 Remicade 1425 1445 20 10 Orencia 824 855 31 11 Remicade 1328 1345 17 12 Xolair 1156 1337 181 13 Venofer 1058 1117 59 The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 22
  23. 23. Affinity Chart of ideas Pharmacy staff Dispersing workload Consistent delivery Early/real time Maintain consistent Coordinate pharmacyassignment to better by scheduling times and locations notification that the accurate medication inventory, workflow and handle ACC patients according to increase patient has arrived orders to improve compounding with ACC workload to their medications awareness of when 13 efficiency of orders 10 5 medications are pharmacist order 9 available entry 11 13•Have all medications •Have a scheduling •If meds are sitting in •Have patient continue •Get all orders in •Have a hood in ACC somade during the system viewable by the delivery bin, then to call ahead pharmacy prior to day pharmacy can compound on theovernight shift ACC and pharmacy deliver to patient room •Better communication of visit floor.•Have a full time •Compound Xolair if •Keep ACC orders fast between shift change •Enter all meds at 7am •Have premixed items (lovenox)barcode and packaging more than two patients tracked. Don’t wait for •Dedicated RN in ACC and deliver all at once available in pyxistech that is IV room are coming there is less next IV to be made for communication with •No bar scanner issues •Less expensive genericstrained and floats in IV a chance of waste before delivery pharmacy (is it med or IV) available to be made prior toroom during busy ACC •Posted calendar of •ACC patient pick up •Getting the patient from •Enter all orders prior to patient arrivaltimes schedule in the IV room their own meds from registration in a timely patient arrival. Then •Make sure pharmacy has enough• Have a dedicated tech •Have dedicated days the pharmacy fashion keep labels ready to go inventoryto coordinate heavy for designated drugs •Move ACC and •Have registration call •Change Remicade •Have pharmacy pre mix medsACC load days to days •Juggle scheduling if pharmacy closer the pharmacy throughout the house. like daptomycin and Xolair andwith extra pharmacy possible- early morning together •Electronic check in that Med or IV no choice. study how much med is actuallytech coverage Xolair, etc. •Continue with notifies ACC and Then there will be no wasted•Have a tech assigned to bringing up premade pharmacy of patient barcoding problem •Have a dedicated ACC orderACC meds/orders meds in the morning arrival •ACC protocol with the section in the IV room•Consider ACC meds a •Have the RN come to •RN/pharmacy to meds usually used in •Have all ACC orders delivered toSTAT in the IV room- the pharmacy to pick up shadow each other’s ACC (build in HMM) RPh for checking oncepull another tech if meds when pharmacy is department to have a compoundedneeded short runners better understanding of workflow The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 23
  24. 24. ID for drivers Pharmacy staff assignment to better handle ACC workload 5 in 0 out Dispersing workload by Maintain scheduling patients consistent/accurate med according to their orders to improve medications efficiency of RPh entry 1 in 4 out 1 in 4 outConsistent delivery timesand locations to increase Early/real time notification awareness of when that the patient hasmedications are available arrived 4 in 1 out 2 in 3 out Coordinate pharmacy inventory, workflow and compounding with ACC orders 2 in 3 out Green = Process Drivers The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC Nov. 12, 2008 24
  25. 25. Heuristic Redefinition for focus Ease of implementation Expected impact on the Likelihood of reaching Good/High = 3 the goal Average/Medium = 2 Total goal Poor/Low = 1Problem Statement“How can we ensure that…”We maintain consistent/accurate medication orders to improve efficiency ofRPh order entry 3 2 3 8We dispersing workload by scheduling patients according to their medications 1 1 3 5We coordinate pharmacy inventory, workflow and compounding with ACCorders 3 2 3 8 The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 25
  26. 26. Scatter Plot of idle time vs Total wait time For patients that DID NOT call ahead 50 40Idle time 30 20 10 25 30 35 40 45 50 55 Tot wait time The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 26
  27. 27. Using Innovation to Correct the Problem of delay time• Level 1 – Use the 7 Management and Planning tools to get ideas from people working in the system and from similar problems that has been addressed in the hospital• Level 2 – Use the 7 creativity tools to adopt other solutions to lag time in other hospitals and other industries. The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 27
  28. 28. Using Innovation to Correct the Problem of delay time, cont.• Advanced Innovation TRIZ – Use advance methods to create new ways of eliminating pharmacy that have never been tried or used before. Find the ideal solution.• Note: Team members need to become proficient at levels 1 and 2 before they should attempt level 3 of innovation tools. The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 28
  29. 29. How innovation will help your organization• Lean Six Sigma has one key weak point coming up with the best idea of how to improve.• Healthcare organizations who learn and use basic creativity and innovation tools will improve every aspect of their improvement effort.• Better process improvement• Better planning• Better products and services The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 29
  30. 30. How innovation will help your healthcare organization cont.• Use AFD – Advance Failure Determination – Most organizations use a whack a mole approach to patient safety – jumping from one outbreak or mistake to another. – Human factors methodology uses airline safety which is based on building redundant systems. It is an important contribution. – AFD maps all the possible ways of harming a patient and uses innovation to prevent them at the most economic cost. – Healthcare costs will prove human factors alone too expensive; it will need to be supplemented with AFD to get to the next level at lower costs. The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 30
  31. 31. Other Advanced Approaches• In addition to these ideas there are other processes to improve the health system. – Transformation: This refers to alignment of people in the organization around a goal. In pharmacy different individuals and departments are responsible for different steps. One of the transformation tools is appreciative inquiry which looks at times when the process worked really well and focuses on making that happen more often. The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 31
  32. 32. How Transformation will help your healthcare organization• Healthcare is based on silos. Transformation helps build alignment of each groups’ priorities into one unified approach• The change that will be required in healthcare will be significant. There is already an epidemic of physician frustration and resignations. The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 32
  33. 33. Other Advanced Approaches Getting to the Essential• 100X Healthcare Improvement – Reduce deaths due to errors by 95% – Reduce healthcare costs below Medicare reimbursements. – Increase chronic illness self-care from 25% to 95%. The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 33
  34. 34. Jouslin-King Hierarchy Getting to the Essentials1 Customer focus Transformation Unique org. & capability Breakthrough Continuous Total Management2 improvement participation Creativity & Innovation Societal networking Idea generation 7 Creativity Tools Idea selection TRIZ, QFDCQM (Shiba) Triangle Idea Implementation implementation steps Lean Six DMAIC Sigma Emphasis of company GOAL/QPC (King) Wheel DMADV plan Eliminate waste & unnecessary Increased DOE steps Increased reliability TQM: Total Quality Customer driven Management Daily 7 QC Tools Master plan Management 7 MP Tools Roadmap for Hoshin Planning improvement QFD, CFM SPC: Statistical Process Control Control Charts Shiba Deming Seven step Design of Four Profound process experiments Revolutions knowledge 1.Getting to the Essentials: Preserving the company while preserving the planet. Recognizing the spirituality in each person. Facing global issues. 2.Transformation: Alignment of individual and company visions. The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 34
  35. 35. What levels mean• Level 0 - Chasing regulations/standards• Level 1 - SPC, fixing special causes, get rid of noise then fix system problems• Level 2 - TQM, get all employees involved• Level 3 - Lean Six Sigma V=f(x)• Level 4 – Creativity and innovation for all• Level 5 – Aligning employee passions with hospital passions The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 35
  36. 36. Level 6 Getting to the essential• 100X improvement in Healthcare and public health quality• Making the US the world’s healthiest nation• Eliminate unnecessary deaths• Reduce hospital costs below Medicare reimbursements• Increase Chronic Illness self care to 98+ % The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 36
  37. 37. Author may be contacted at• Bob King, GOAL/QPC 12 Manor Parkway, Salem, NH 03079• E-mail: bobking@goalqpc.com• Cell phone: 603.275.0555• For additional slides containing information on how LSSI can help health care organizations respond to the upcoming new health systems, please go to www.goalqpc.com/healthreform. The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 37
  38. 38. Appendix – Additional slides for discussion The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 38
  39. 39. Where Six Sigma came from• HP 1983 commits to 10X quality improvement• Motorola 1985 commits to 10X better that HP or 100x improvement in quality.• Calls it 6 sigma• Six Sigma is a 100X improvement• We need a 100X improvement in healthcare and public health quality The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 39
  40. 40. Where we are today• US ranked 29th as a nation on health care results• US pays double what the nearest country pays• Takes average of 17 years to implement best practice.• 300K to 500K die in US each year due to errors.• Healthcare 15 years behind industry in Quality.• Perfectly organized for health needs of 1950s.• Chronic illness 50-75% of patient needs today. The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 40
  41. 41. So where is healthcare and public health today?• Many hospitals are at level zero with a growing number at levels two to three and a few leaders at levels 4-5.• Public health is mostly at level zero.• RWJ has funded a project to help 15 states to go from level zero to level 1.• So there is lots of room to grow. The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 41
  42. 42. Healthcare and Innovation• Healthcare even further behind on creativity and innovation• Some experiments over the last three years• Mayo Clinic and Massachusetts General Hospital reporting creativity centers teaching brainstorming three years ago.• Memorial hospital in South Bend, Indiana is at level three for last three years, benchmarking nations most innovative companies. The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 42
  43. 43. Where quality technology is going• We are at level four on the quality hierarchy in some leading hospitals today.• Innovation has hit the tipping point in 2007 (have you ideated your ideating yet? – IBM television ad) and will be the next major phase in healthcare. It will be a major force in solving the patient safety and cost crisis.• Transformation, the next phase, will help with the human dimension, coaching and alignment. The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 43
  44. 44. Healthiest nation plans• Infant mortality• Life expectancy• Obesity The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 44
  45. 45. So what does all this mean for your hospital? Would you like to:• cut your employee healthcare costs by 25%,• free up beds currently occupied by low margin patients to create space for high margin patients,• reduce the need for capital expenditures to get more beds?• The following example will tell you how. The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 45
  46. 46. Controllable Health Care Costs • Lack of Chronic illness self-care causes over 50% of total health care costs • Cost shifting from Medicare, Medicaid, uninsured is almost 25% of healthcare premiums. The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 46
  47. 47. Successful chronic illness self care programs• Hannaford Bros. supermarket stores• City of Asheville, North Carolina• Increased self care participation levels from 25% to 80% +• Reduced total cost of treatment by 50% The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 47
  48. 48. Areas for research by the world’s top quality and innovation experts1. Getting public health organizations to the cutting edge of quality, innovation and transformation.2. Getting JACCHO on the cutting edge of quality, innovation and transformation.3. Help CMS better support a continuous improvement model and reduce unnecessary paper work and too frequent procedure changes with lack of lead time.4. Helping public health organizations implement lean and other quality improvement, innovation, and transformation methods. Provide the training for this. The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 48
  49. 49. Areas for research by the world’s top quality and innovation experts5. Redesign national health report cards so they reflect the best of performance management and improvement technology.• For further information on the preceding themes see: www.Thehealthiestnation.com The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 49
  50. 50. Getting hospital costs in line with Medicare reimbursements• The new CEO of Dartmouth Hitchcock Medical Center in Hanover, NH had the foresight to coin this challenge.• It is akin to the peak of the Quality Hierarchy “Getting to the essential”.• Current proposals for Medicare cuts would put 10% of America’s hospitals out of business.• Current gap between costs of service and Medicare reimbursements is considerable and is cost shifted to those who are paying, contributing to runaway healthcare costs. The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 50
  51. 51. The hospital quality and cost national demonstration project• Twenty years ago, Don Berwick brought in industrial quality experts to see if industrial quality would work in healthcare. It does and that is why you are here.• However, todays methods are not adequate to solve tomorrow’s problems. That is why we need a new demonstration project to bring the most advanced quality and innovation tools to a dozen hospitals.• There are still openings for your hospital to participate in the first round. The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 51
  52. 52. Who is involved?• An advisory panel of the top quality and innovation people in the world has agreed to donate their time to this effort.• Local consultants around the country will use the top quality and innovation tools as outlined in this talk. The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 52
  53. 53. Making U.S. patient safety the best in the world• This will be part of the national demonstration project and will begin with 12 hospitals.• Participants will learn the first 5 levels of innovation on the innovation hierarchy.• Focus will be on the AFD tool to map all possible ways to harm patients and eliminate these situations effectively and efficiently using the appropriate innovation tools. The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 53
  54. 54. Ten tasks for the new U.S. President to improve healthcare1. Commit to making the U.S the healthiest nation and put the resources behind it.2. Develop a plan to transform the healthcare system into a health system.3. Fix the national report cards based on where we need to improve to be number one.4. Help CMS better support a continuous improvement model and reduce unnecessary paper work.5. Save money by insuring everyone: a job for the states. The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 54
  55. 55. Ten tasks for the next U.S. President to improve healthcare, cont.6. Help redesign the healthcare system so it better meets the need of the chronically ill.7. Get public health organizations to the cutting edge of quality and innovation.8. Put resources and energy behind reversing the obesity epidemic.9. Expand the federal effort to do research on alternative medicines and make findings widely available.10. Take control of the FDA away from the pharmaceutical companies. The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 55
  56. 56. References for further study• The Six Sigma Memory Jogger™ II• The Black Belt Memory Jogger™• The Lean Enterprise Memory Jogger™• AFD Manual• Coaching in the Workplace pocket guide• The Transformation Desktop Guide• The Transformation Fieldbook• The Transformation Case Study Book The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 56
  57. 57. Author may be contacted at• Bob King, GOAL/QPC 12 Manor Parkway, Salem, NH 03079• E-mail: bobking@goalqpc.com• Cell phone: 603.275.0555• For additional slides containing information on how LSSI can help health care organizations respond to the upcoming new health systems, please go to www.goalqpc.com/healthreform. The Next Generation of LSSI in Healthcare © 2010 GOAL/QPC 57

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