This document summarizes Hotel-Dieu Grace Hospital's journey with lean process improvement from 2005 to the present. It outlines various value stream analyses and rapid improvement events conducted across departments. It discusses the motivation to take an enterprise-wide approach to end-to-end patient flow and challenges faced. Guiding principles for continuous process improvement, cultural enablers, and results including reduced ALC days and improved occupancy rates are presented.

1. Hotel-Dieu Grace Hospital
End to End Patient Flow
Nicki Schmidt RN
Senior Lean Facilitator
nschmidt@hdgh.org

2. Hotel-Dieu Grace

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. Why End to End?

5. A New Beginning

6. A New Beginning

7. Reality Sets In

8. Reality Sets In

9. 2005: The Burning Platform

10. 2005: Learning to See

11. Building On Success

12. Departments and Value Streams

13. Challenges

14. Enterprise Approach

15. End to End: AH HA’s

16. Who knows the Plan?

17. Do We All Know?

18. Discharge a Priority??

19. Chaos!! Can We Coordinate?

20. Sustaining?

21. Challenges
“Do not assign
responsibility without
accepting the
responsibility to Mentor”
HDGH Core Team

22. Lead By Example

23. Inspiring Others

24. Enabling the Value Creating Work

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. 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. 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. 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. Questions
?