Mark Graban Mass. Lean Healthcare Group


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Presentation given April 15 2010 to networking meeting group.

Published in: Business

Mark Graban Mass. Lean Healthcare Group

  1. Massachusetts Hospital Lean Network Mark Graban Senior Fellow, Lean Enterprise Institute Author, “Lean Hospitals: Improving Quality, Patient Safety, and Employee Satisfaction”
  2. Topics • Overview of LEI and Healthcare Value Leaders Network • Staff engagement in continuous improvement • Systems and processes for preventing errors • Role of senior leadership in “strategy deployment” 2
  3. About LEI • Lean Enterprise Institute, Inc. (LEI) is a nonprofit education, publishing, conference, and research organization founded by James Womack, Ph.D. in 1997 to promote and advance the principles of lean thinking in every aspect of business and across a wide range of industries. • Through its publications, summits, conferences, workshops, webinars, online forums, and website resources, LEI helps organizations transform themselves into lean enterprises, based on the principles of the Toyota Business System. 3
  4. Our mission is to fundamentally improve healthcare delivery through lean thinking. LEI TCVHC We educate leaders in lean thinking, facilitate networks of practioners, host an annual conference and provide resources at
  5. 1st Network- Members • Group Health Cooperative • Gundersen Lutheran Health System • Hotel-Dieu Grace Hospital • Iowa Health System • Johns Hopkins Medicine • Lawrence & Memorial Hospital • Lehigh Valley Health Network • McLeod Health • Mercy Medical Center • Park Nicollet Health Services • St. Boniface General Hospital • ThedaCare • UCLA Health System • University of Michigan Health System
  6. 2nd Network- Members • Akron Children's Hospital • Alberta Health Services • Beth Israel Deaconess Medical Center • BJC Healthcare • Christie Clinic • Cleveland Clinic • Harvard Vanguard • Kaiser Permanente • Seattle Children's Hospital • St. Joseph Health System
  7. “Equally Important Pillars” of The Toyota Way
  8. Different Types of Kaizen Very few Large problems Mgmt Kaizen Six Few Sigma Medium problems Kaizen Event Many Small problems Daily Kaizen Adapted from: “The Toyota” Way Fieldbook, Liker and Meier
  9. The Problem with Ignoring “Respect for Humanity” Found posted in a hospital lab (during Lean assessment)
  10. Engaging Employees From Locked Box To Visual Idea System
  11. One Idea Card Format FRONT BACK
  12. Idea Board – Microbiology Lab
  13. Documenting & Celebrating Improvements Area: STL Kaizen Wall Date: 5/31/07 of Fame What was the Problem? • What was the problem? For disposal of pipette tips, the only containers we had were “sharps” containers. This Adds extra disposal cost, as the tips are not sharp. The contai ner hole was also Hard to get tips into. What was changed, improved, implemented? Create biohazard bag holders out of urine jugs, cut the tops off. • What was changed, Photo/Diagram: improved, or implemented? Old Style Container New Container • What were the benefits? What were the benefits? Safety? Quality? Time? Waste? Cost? Reduces cost since we aren’t doing unneeded sharps disposal and we aren’t throwing the containers away each time. No safety risk. Easier to get tips into container (less motion and less arm strain, since the Container is lower and easier to get into). Tips can be dumped into a larger Biohazard bin or we can replace the bag. • Who was involved? Who was Involved? Gretchen, Beth, Janie, Franke
  14. Kaizen Wall of Fame – Core Lab
  15. Value of Kaizen in a Hospital? • $4,000 per employee (Toyota) – Just the quantifiable benefit • What about benefits from: – Better Quality – – – Morale Patient Satisfaction Less Waiting Time = $$ ?
  16. Employee Quote “This is the best thing we’ve done in my 20 years. We’re finally fixing things.”
  17. Data From Children’s Medical Center Dallas Before Lean 12 Months After Starting 3. I have the opportunity to do what I do 3.11 3.92 best every day. 8. I feel free to make suggestions for 2.84 3.48 improvement. 10. I feel secure in my job. 2.32 3.42 13. Stress at work is manageable. 2.43 3.23 17. I am satisfied with the lab as a place to 2.51 3.43 work. 18. I would recommend my work area as a 2.38 3.46 good place to work to others. Grand Average 2.96 3.69
  18. TPS Leadership • “You respect people, you listen to them, you work together. You don’t blame them. Maybe the process was not set up well, so it was easy to make a mistake.” – Gary Convis, President TMMK (Toyota Motor Manufacturing Kentucky)
  19. Many Errors are Preventable • Nosocomial Infections – a.k.a. “Hospital-Acquired Infections” (HAI) – 5 to 10% of hospitalizations • 10% of these are serious bloodstream infections • 87,000 to 350,000 die annually – “Can be prevented through improved hygiene and proper line insertion standards” (1) • Allegheny: reduced bloodstream infections by 68% through standard methods and supplies • (1): U.S. Centers for Disease Control
  20. Make Errors Less Likely to Occur (Source: ThedaCare)
  21. The Quaid Case – Heparin/Hep-Lock Hospital CMO: “This was a preventable error, involving a failure to follow our standard policies and procedures, and there is no excuse for that to occur at Cedars-Sinai.” Was this the first time the policies and procedures were not followed?
  22. The Quaid Case – Heparin/Hep- Lock New Design Old Design
  23. Outpatient MRI Scenario
  24. Case Example • Virginia Mason Medical Center (2004) – Mary McClinton died after cleaning solution was injected (not dye) – Identical looking clear syringes together on tray • “Mistakes will happen,” he said, sadly. “We are exceptionally human.” – Knew about same color syringes 2 YEARS before fatal error occurred • Had switched from brown cleaning solution to clear – Radiology tech MENTIONED the problem to a supervisor 2 MONTHS before the fatality • Why does this happen? How can we prevent this?
  25. Hoshin Kanri • Hoshin = “compass” – Pointing the direction • Kanri = “management” or “control” • Hoshin Kanri – A process for embedding strategy and aligning an organization toward common goals • Developed by Yoji Akao (non-Toyota) • Using PDCA cycles to: – Create goals – Choose measurement points – Link daily activities to high level goals
  26. Top Down and Bottom Up Source: Lean Hospitals, Graban
  27. Purpose: What’s True North? Quality Decrease Defects and Waiting Time by 50% each year Customer Business Engagement Increase Productivity No. of Suggestions 10% each year Implemented
  28. “True North” Metrics & A3s Source: ThedaCare
  29. ThedaCare Mother A3s VS’s Metrics Value Stream Review Area Safety People Shared Growth Productivity • Eventually shift to “Continuous Daily Improvement” 30
  30. “Breakthrough A3” - Safety • Expect 50% improvement in these breakthrough A3s 31
  31. Safety A3 - Detail 32
  32. Standardized Metrics Board Delivery • Weekly review of metrics by Senior Leadership Team 33
  33. Align Measures @ Each Level Patient & Improve Employee Safety Emergency Inpatient Outpatient Dept Med/Surg Telemetry Clinics Surgery Patient Falls Clinic A Clinic B Sprains & Strains Physician A Physician B
  34. Remember This: The problem is the process (or lack thereof)… not the people
  35. ThedaCare “Door to Balloon” Time 100 90 80 70 91 60 Minutes 50 65 40 30 52 20 10 37 0 2005 2006 2007 2008
  36. ThedaCare Code STEMI • Starting Point 2002 – “Did not have a clear, standardized response to heart attacks.” • Studied each process step in detail – Convinced cardiologists to let ER MD call heart attack • Reluctant, but only two false positives in two years • Posted standardized work in each room – Clear process steps and toll-gates
  37. ThedaCare Coronary Bypass Improvement 12 1
  38. For More Information or Follow Up: • Email: – • Lean Enterprise Institute: – • Healthcare Value Leaders: – • Blog: – • Twitter: – – –