University of Utah Health Value Improvement Leaders: Methodology
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At the University of Utah, we use a general value improvement methodology based on Lean and Six Sigma with the following phases: Project Definition, Baseline Analysis, Investigation, Design, Implement, Monitor. Problem-solving runs into challenges when an immediate solution is implemented as a reaction to the problem. Following a proven, structured, and balanced improvement methodology forces reflection on a problem.
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University of Utah Health Value Improvement Leaders: Methodology
- 1. Methodology
- 2. Methodologies: Lean / Six Sigma / PDSA Create Flow Improve Quality* Eliminate Waste Lean 6s D M A I C PDSA PLAN DO ACT STUDY
- 3. Lean: The Toyota Production System Decoded Each of these can be achieved alone or in conjunction with the other two. *poor quality is a form of waste. Create Flow Improve Quality Eliminate Waste “It’s not the big that eat the small. It’s the fast that eats the slow.” – Jennings and Haughton
- 4. • Map your Value Streams • Identify Value vs. Waste • Value is defined by our patient Lean Value Principles Value = Quality + Service Cost
- 5. Healthcare Quality Cost Curve As HC Quality Increases Costs Decrease Cost Quality A B • Spending too much on healthcare doesn’t just waste money. It lowers quality. • GOOD NEWS: When we focus on quality, costs come down. Optimal Value US Healthcare Today Focus on Value
- 6. Value Stream: Every activity required to deliver your product or service, from very first to very last. DIRT $$ FIRST CONTACT $$
- 7. Value Stream: Applying Lean to healthcare value streams means making it easier for patients and their information to move between our silos.
- 8. Patients come to us for two reasons: 1. Information about their health 2. Care provision Identify Value & Eliminate Waste Manufacturing Value-Added: An activity which changes the form, fit, or function of the product. Everything else is non-value added (NVA). Healthcare Value-Added: An activity that builds on a patient's information or is directly involved in care provision. Everything else is non-value added (NVA). “Okay, but where is all this waste? I don’t see it.”
- 9. Non Value Added: The 7 Wastes NVA ≠ “UNNECESSARY” A taxonomy for seeing NVA 1.Defects / Mistakes 2.Waiting 3.Over-processing 4.Over-production 5.Transportation 6.Inventory 7.Motion -Taiichi Ohno “Eliminating waste is easy. Seeing waste is hard.”
- 10. How much waste is in our system?
- 11. Old Adage Lean Adage Create Flow Improve Quality Eliminate wasteBefore Lean: • You can have it fast. • You can have it high quality. • You can have it low cost. Pick 2. Lean says, “Pick 3.”
- 12. • Map your Value Streams • Identify Value vs. Waste • Value is defined by our patient • Eliminate delays • Create Standard Work • Design Error-Proof Systems • Use pull to avoid over-production • Design Out the Complexity you can… • Use Visual Controls to manage the remaining complexity • Track process performance Lean Principles
- 14. Taguchi Shewhart Deming Juran Ishikawa Six Sigma in Nothing New
- 15. • Variation is the Enemy • The answers are in your data • Listen to the Voice of the Process • For consistent output, control your inputs • Listen to the Voice of the Customer • Your problems are in your processes, NOT your people Six Sigma Principles
- 16. Mean Process Improvement with Six Sigma Step 1: Control Step 2: Shift Before TargetLower Spec Upper Spec Target,Lower Spec Upper Spec TargetMeanLower Spec Upper Spec Mean
- 17. Six Sigma follows a methodology called DMAIC (“duh-MAY-ick”). Define • Define the project with a chartering document. • Map the process in low-detail, maybe with SIPOC. • Gather VOC (Voice Of the Customer) data. Measure • Quantitatively describe the current situation. • Identify the appropriate process metrics and establish a baseline. You will compare these against post-implementation metrics. • Map the process in greater detail. Analyze • Determine the root causes with a variety of methods. • Most of your statistical analysis happens here. • Tie the root causes to the problems you are solving. Improve • Design improvements • Model improvements • Pilot improvements • Estimate post-implementation process metrics Control • Design control systems to ensure gains are sustained. • Establish metrics collection systems. • Design elements that reduce the cognitive load while ensuring the new process is followed: visual cues, electronic cues, etc. • Transfer ownership back to original process owner.
- 18. DMAIC is sometimes shown as a cycle, sometimes as a linear project progression. Improve Control Define Measure Analyze Six Sigma Project Plan (aka “best intentions”) Define Measure Analyze Improve Control X weeks What actually happens. Defi Meas Analy Imp Control Define Measure Analysis Re-Define Improve X + 50% weeks
- 19. Plan-Do-Study-Act When a change is deemed worthy of implementing: • The team turns toward spreading and adapting the change to all appropriate places in the organization. • Continued monitoring. • The scientific method applied to process improvement • What are we trying to improve? • What are the baseline measures? • What are the goals? • Who are the right people to evaluate the improvement? PLAN DO ACT STUDY
- 20. •Orderly •Controlled •Time-consuming •Expensive • Rapid implementation, multiple iteration • In this sense, you are experimenting, but… • If you shortchange the methodology, you’re NOT engaged in continuous quality improvement; you’re chasing hunches. • Throw things against the wall to see what sticks • Go with your gut • Rely on common sense (a myth) PDSA: Clinical Research Shotgun Approach P D A S
- 21. • Needs to be tolerance for not getting it perfect on the first try • This is how innovation works • But remember that “change fatigue” is a threat. • This image does not mean constant tinkering. Potential Issues with PDSA PLAN DO ACT STUDY PLAN DO ACT STUDY PLAN DO ACT STUDY PLAN DO ACT STUDY
- 22. Value improvement methodology at UUHC 1. Project Definition 2. Baseline Analysis 3. Investigation 4. Improvement Design 5. Improvement Implementation 6. Monitoring Lean 6s PDSA
- 23. Project Life Cycles Project Progress ResourcesRequired& BusinessDisruption Project Def. Baseline Analysis Investigation Improvement Design Improvement Implementation Monitoring Define Measure Analyze Improve Control 6s PDSA MonitoringPLAN DO STUDY ACT
- 24. • A process of incremental resource allocation. • At the end of every phase progress is reviewed. • A stop/redirect/continue business decision is made. Project Gating: Incremental Project Approval ResourcesRequired& BusinessDisruption Project Def. Baseline Analysis Investigation Improvement Design Improvement Implementation Monitoring
- 25. Bottom Line Benefit EffortandComplexity Project Selection: Align with strategic priorities and go for the green.