How Leadership Commitment and a Systematic Approach Spread Improvement
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Hosted by KaiNexus, presented by Karen Kiel-Rosser and Ron Smith of Mary Greeley Medical Center. Does your organization struggle with engaging everybody in daily continuous improvement? Is it difficult to figure out how to combine formal improvement events, projects, and "WorkOuts" while engaging all employees to bring forward their ideas? Are you unsure how to spread improvement methodologies across departments? In this webinar, you will learn: How MGMC has combined Lean tools and methodologies with a "managing for daily improvement" approach How leadership and technology enable and support successful improvement methodologies MGMC's vision for leaders getting everybody engaged in improvement How MGMC has systematically (and successfully) spread continuous improvement methodologies across the hospital over the past 12 months Why it's important to engage leaders and to educate them about improvement and the role they need to play Mary Greeley Medical Center (MGMC), a 220 bed acute care facility in Ames, Iowa, has received "Gold" level recognition in the Iowa Recognition for Performance Excellence (IRPE) program, the top honor in the IRPE program (the state level Malcolm Baldrige award).
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How Leadership Commitment and a Systematic Approach Spread Improvement
- 1. Host: Mark Graban VP of Improvement Services mark@kainexus.com @markgraban How Leadership Commitment and a Systematic Approach Spread Improvement Presenter: Karen Kiel-Rosser Vice President / Chief Quality Officer Mary Greeley Medical Center Presenter: Ron Smith Process Improvement Coordinator Mary Greeley Medical Center
- 2. Agenda & Logistics • Presentation (40 minutes) • Q&A (15 minutes) – Use the GoToWebinar Meeting Panel to submit a question at any time • Recording link & notes will be sent via email – Or, see “handouts’” in the GoToWebinar control panel
- 3. Objectives • Describe how to develop leadership to support a culture of managing for daily improvements • Share a systematic approach for documenting and managing improvements
- 4. Mary Greeley Medical Center • Located in Ames, Iowa • 220 bed acute care facility – 1,300 employees – 200 physicians – 500 volunteers – 8,000 admissions per year – 26,000 emergency room visits per year • Governed by city-elected five member Board of Trustees
- 6. How We Enable and Spread Improvements Leadership • Commitment • Communication • Accountability Methodology • Simple • Consistent • Disciplined Technology • KaiNexus
- 7. MGMC Improvement Philosophy Do Work Improve Work
- 8. Leadership Commitment What the Experts are Saying
- 9. MGMC Leadership Commitment (2009) • Vision: Reduce Waste, Eliminate Risk • Objectives: – Common vocabulary (communication) – Develop a supportive system to ensure accountability Build a culture where every day, everyone of our 1,300+ employees are engaged and empowered to make improvements.
- 10. • Proactively plan for the future • To do the right thing, and ONLY the right thing • Those closest to the work need to be involved • Sustainability is everyone’s job • Learning from each other is critical to the success • Eliminate errors, reduce variation The Why Behind the What
- 11. MGMC Board Commitment Education - 2009 Penny Exercise – hands on assembly-line concept; shift pennies from one inspector to the other. Engages several participants in a process to demonstrate flawed workflows. Lessons Learned: • Batch and queue is less efficient than single piece flow • Inspection wastes time • Trust can be empowering and make work easier • You can have increased capacity with less work and the same number of staff Did you know? • The P.O. Box numbers on the backs of insurance cards are sometimes as small as the date on a penny? If you send the claim to the wrong one, the claim may be denied!
- 12. Lean Training for Leaders September, 2010 Yellow Belt Training • The Toyota Way & The Rules In Use • 6S • Visual Management • Value Stream Mapping • A3 Thinking & Problem Solving • Understanding the Current Condition • Leading Change
- 13. Engaged Leaders through a group 6S Project Before After
- 14. Training Philosophy • See one • Do one • Teach one
- 15. Leadership Challenge • 6S project in your department • Key learnings – and celebration of success – Best practice for various KanBan systems – Lean ‘champions’ – Lean walk
- 16. GI Visual Inventory System Minimum reorder quantity included in plastic bag; when bag must be accessed, it’s time to reorder! FIFO System (First In, First Out) Consume from the left, replenish on the right
- 17. GI Visual Inventory System Kanban card Card pulled and delivered to Reorder Mailbox
- 18. Cardiopulmonary Visual Inventory System Kanban card When first bottle behind bungee cord is accessed, card is pulled for reorder When first bottle in plastic tub is accessed, card is pulled for reorder
- 19. Form Follows Function • Standard Work – Created Standard Work Steering Committee • Systematically identify and select projects • Organize work • Create standard work documentation process
- 20. Organize our Work Standard Work Standard Work is the known best method (safest, highest quality or most efficient) to perform a task, broken down into elements which are sequenced, organized and repeatedly followed. Standard Work is dependent upon those closest to the work helping to design and continuously improve their work processes.
- 21. Identify Key Work Processes Standard Work Steering Committee identifies key work processes at Mary Greeley 49+ Work Processes!
- 23. Safe, Clean & Quiet Environment Nutrition Education & Communication Medication Non-Invasive Intervention Reasses Sterile Processing Facilities Clean Rooms Laundry Materials Unrestricted DietRestricted Diet Operative & Invasive Procedures In Patient Out Patient ED Intervention (Treatment & Therapy) Bedside (In Patient Only) OR Cath Lab GI Pain Clinic Wound Clinic Birthways Radiology Radiation Therapy Cardio Treatments Rehab & Wellness Therapy Esp. Out Patient
- 25. Top Ten Work Processes 1. Operating Room 2. Emergency Room 3. Lab 4. Medication 5. Continuum of Care 6. Home Health 7. Registration 8. Pre-Authorization/Pre-Admitting 9. Bed Placement Schedule 10. Discharge
- 26. Multiple Methods of Improvement Events (RIE, VSM) Projects Managing for Daily Improvement (MDI)
- 28. Time Performance 20112010 2012 2013 2014 2015 2016 2017 •6S (dozens) •Rapid Improvement Events (13) •Value Stream Mapping (5) •A3 Problem Solving (hundreds) SW Steering Committee
- 29. Time Performance 20112010 2012 2013 2014 2015 2016 2017 •6S (dozens) •Rapid Improvement Events (13) •Value Stream Mapping (5) •A3 Problem Solving (hundreds) SW Steering Committee
- 31. 100 Day Workout Identify an improvement project in your area • Can be completed in 100 days • Results in cost savings or revenue generation • Use KaiNexus to manage project
- 32. Do Work Improve Work
- 33. 100 Day Workout Kick-Off - 2014 January 24 100 day work out projects due February 6 Senior leaders review and approve all projects February 3 Meet with KaiNexus to establish final 100 day plan February 25 First 30 day follow up with Suz and teams; select projects report to management team March 25 2nd follow up with Suz May 2 Final 100 Day Workout – Report out
- 34. 100 Day WorkOut Final Results • 54 opportunities for improvement completed • $722,661 financial impact – hard savings – $675,475 1st year savings – $47,186 1st year revenue generation • 5,209 labor hours saved per year – $116,101 in soft savings
- 35. Time Performance 20112010 2012 2013 2014 2015 2016 2017 •6S (dozens) •Rapid Improvement Events (13) •Value Stream Mapping (5) •A3 Problem Solving (hundreds) SW Steering Committee 100 Day Work Out
- 36. Managing for Daily Improvements January 2015 – Employee Kick-off
- 37. To encourage and harvest staff generated ideas on how to improve the organization and the care it provides. The Bright Ideas Program aims to improve clinical outcomes, increase efficiency, provide for greater employee involvement and increase retention. Purpose
- 38. Do Work Improve Work
- 41. Daily Improvements • To date we have received 1,146 OIs submitted from 458 unique managers/staff members • 769 of these OIs have been completed; with 507 (66.2%) resulting in a change • Impact – $148,792 recurring cost savings – 9,375 hours saved ($209,642 soft savings) – 75% (381) resulted in some component of staff satisfaction – 45% (219) resulted in some component of quality improvement
- 42. Time Performance 20112010 2012 2013 2014 2015 2016 2017 •6S (dozens) •Rapid Improvement Events (13) •Value Stream Mapping (5) •A3 Problem Solving (hundreds) SW Steering Committee 100 Day Work Out Managing for Daily Improvements
- 43. Multiple Methods of Improvement Events (RIE, VSM) Projects Managing for Daily Improvement (MDI)
- 44. Lessons Learned • Leader’s challenge • Let the process work • Allow time for habits to change • Set clear expectations (Standard Work is mandatory) • Persistence w/audits and improvements • Ties to the big picture • Patient Satisfaction, Employee Satisfaction
- 45. HOW DO WE ENABLE AND SPREAD IMPROVEMENT IN AN ORGANIZATION? Leadership •Commitment •Communication •Accountability Methodology •Simple •Consistent •Disciplined Technology •KaiNexus
- 46. Capture Capture Share Implement Measure 1-2% Implementation 75% Implementation AVG KaiNexus Customers Methodology Is A Key Difference
- 47. Multiple Methods of Improvement Rapid Improvement Events Projects Managing for Daily Improvement (MDI)
- 48. “Daily Improvements Kickoff” Agenda – Mark Graban • 3 Days – December 2014 • Two Departments • 3-Hour Introduction Class on Day 1 (All Management) – Department 1: 3A (Surgical) – Department 2: Materials Management Notes: • Internal P.I. people will/can be with Mark the entire time • Executive sponsor(s) are welcome to participate or shadow any time • Much of the timing is flexible based on people’s schedules
- 49. Daily Improvements Rollout Strategy • Coach Leaders to Coach and Develop Staff – Leadership vs. Management – Trust and Empower vs. Control • 2-3 Departments at a Time • 2 ½ Weeks per Group – 4 Meetings
- 50. HOW DO WE ENGAGE PEOPLE TO PARTICIPATE, NOT JUST THROW OUT IDEAS? • Coach Leaders to Coach Employees – 1 on 1 with each employee (rounding) – Introduction to Software (Log in and Submit OIs) – Understanding that ideas will become their projects – Ideas should be process related and aimed at making their work better Capture Implement Measure Share
- 51. HOW DO WE ENGAGE PEOPLE TO PARTICIPATE, NOT JUST THROW OUT IDEAS? • Lessons Learned – Keeping staff focused on what they can control • 3’ Radius • There is no “somebody” that works here – Capture OIs first then Log in – Ask the right questions Capture Implement Measure Share
- 52. HOW DO WE ENGAGE AND DEVELOP STAFF IN IMPROVEMENT EFFORTS? • Coaching Leaders to Coach Employees – Standardized Assignment Process • Thanks for the Idea • Provide Direction/Investigate • Offer Assistance/Questions – What is the Problem? – Root cause? Ask why? – Small Tests of Change – Plan, Do, Check, Act Capture Implement Measure Share
- 53. HOW DO WE ENGAGE AND DEVELOP STAFF IN IMPROVEMENT EFFORTS? • Lessons Learned – Managers willingness • to allow staff to try things • to allow staff to fail (learning/development) • resist the tendency to solve problems – Employee expectations that manager will solve their problems – Don’t forget the “check” in PDCA Capture Implement Measure Share
- 54. HOW DO WE DOCUMENT AND MEASURE IMPROVEMENT EFFORTS? • Resolution Process – Change vs. No Change – Categorized OIs • Strategic Initiative • Department • Honor Roll – Measured Impact of OI • Staff and Patient Safety • Staff and Patient Satisfaction • Cost and Time Savings • Revenue Generation Capture Implement Measure Share
- 55. HOW DO WE DOCUMENT AND MEASURE IMPROVEMENT EFFORTS? • Lessons Learned – Time Savings vs. Cost Savings – Seek Partial Improvements vs No Change – PDCA is an iterative model… when we “check” a change, we might learn it is not an improvement. This is a learning opportunity, not a “failure.” Learn from what you tried and then try something different. Capture Implement Measure Share
- 56. HOW DO WE SHARE IMPROVEMENT EFFORTS AND LEARN FROM OTHERS? • Software Utilization – Transparency – Broadcast/Publish OIs • Department Huddles – Reward and Recognize • First Friday Report Out Capture Implement Measure Share
- 57. HOW DO WE SHARE IMPROVEMENT EFFORTS AND LEARN FROM OTHERS? • Lessons Learned – Easily forgotten/overlooked – Creates new idea generation – Creates additional improvement cycles – Promotes spread – Models culture and behaviors Capture Implement Measure Share
- 58. Some Final Thoughts..... WHERE ARE WE HEADED NOW? • Gravitate toward early adopters (pull vs. push) • Provide ongoing review and coaching for leaders • Make time for improvement – Leaders schedule time to review OIs/provide direction – Leaders schedule time for staff to work on OIs • Drive accountability through key performance measures – % of Staff Logged In – % of Staff Submitted an OI – % of OIs Completed with a Change
- 60. Next Webinar • “Go Slow to Go Fast: Using Practical Problem Solving to Spread Kaizen” – Jon Miller of Gemba Academy • January 12, 2016 at 2 pm ET
- 61. Contact Info Q&A • Web: – www.kainexus.com – blog.kainexus.com • Past Webinars: – www.kainexus.com/webinars • Social media: – www.twitter.com/kainexus – www.linkedin.com/company/kainexus – www.facebook.com/kainexus Mark Graban @MarkGraban mark@KaiNexus.com Karen Kiel-Rosser kielrosser@mgmc.com 515-239-6757 Ron Smith smith@mgmc.com 515-239-2415
Editor's Notes
- Our Strategic Initiatives are centered around the patient and give direction to the organization
- Angela
- Lynn
- There are three levels of improvement: Rapid improvement events are focused, 1-5 day improvement activities involving maybe 5-10 employees that are dedicated to the event. They are used to train folks on tools or to apply tools to complex problems. Projects are similar to what you’re accustomed to today. They typically may take several days or weeks to complete. They often involve a team that work on the project while supporting their typical duties. Daily Improvements are the small things that each of us can do each day to eliminate waste in our work. They could involve things like moving a tool so that it is stored at the point of use or designing a guard for a machine so that chips don’t fly everywhere. Initially, a lot of improvements will come from the top of the pyramid, but over time we want more improvement coming from everyone coming up with better ideas.
- Started using KaiNexus for project management support in 2013
- Karen closes
- Karen closes
- I’m a firm believer in continuous improvement – including improving your improvements!
- Karen closes
- We’re now at the point of taking this to our employees – right to the staff level to engage them in managing for daily improvements.
- Karen closes
- There are three levels of improvement: Rapid improvement events are focused, 1-5 day improvement activities involving maybe 5-10 employees that are dedicated to the event. They are used to train folks on tools or to apply tools to complex problems. Projects are similar to what you’re accustomed to today. They typically may take several days or weeks to complete. They often involve a team that work on the project while supporting their typical duties. Daily Improvements are the small things that each of us can do each day to eliminate waste in our work. They could involve things like moving a tool so that it is stored at the point of use or designing a guard for a machine so that chips don’t fly everywhere. Initially, a lot of improvements will come from the top of the pyramid, but over time we want more improvement coming from everyone coming up with better ideas.
- Karen
- Some of the best KaiNexus customers implement over 90% of opportunities generated.
- There are three levels of improvement: Rapid improvement events are focused, 1-5 day improvement activities involving maybe 5-10 employees that are dedicated to the event. They are used to train folks on tools or to apply tools to complex problems. Projects are similar to what you’re accustomed to today. They typically may take several days or weeks to complete. They often involve a team that work on the project while supporting their typical duties. Daily Improvements are the small things that each of us can do each day to eliminate waste in our work. They could involve things like moving a tool so that it is stored at the point of use or designing a guard for a machine so that chips don’t fly everywhere. Initially, a lot of improvements will come from the top of the pyramid, but over time we want more improvement coming from everyone coming up with better ideas.