Presented by Karen Kiel Rosser, MHA, CLSSGB Vice President of Quality Mary Greeley Medical Center Ron Smith, MPA, CLSSGB Process Improvement Coordinator Mary Greeley Medical Center Hosted by Mark Graban and KaiNexus In this webinar, you will learn: How MGMC combines various methodologies to improve A high-level view of MGMC’s improvement journey Ways in which MGMC engages leaders in Lean Tips for increasing the sustainability of improvement work Lessons learned through a Lean transformation

1. Host: Mark Graban
Senior Advisor
mark@kainexus.com
@markgraban
Engaging Leaders and the Baldrige
Framework to Advance Excellence
A Look into the Extraordinary Work at Mary Greeley Medical Center
Karen Kiel Rosser, MHA, CLSSGB
Vice President of Quality
Mary Greeley Medical Center
kielrosser@mgmc.com
Ron Smith, MPA, CLSSGB
Process Improvement Coordinator
Mary Greeley Medical Center
smith@mgmc.com

2. Agenda & Logistics
• Presentation (40-45 minutes)
• Q&A (10-15 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
1. Identify engagement strategies for
leadership buy-in of lean culture
2. Strategies to involve those closest
to the work
3. Enhancing sustainability through
project management and
documentation

4. Mary Greeley Medical Center
• Located in Ames, Iowa
• 220 bed acute care hospital
– 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

5. Mission
To advance health through specialized care and personal
touch.
Vision
To be the best.
Values
People Oriented
Respectful
Innovative
Dedicated
Effective

7. Objective 1
Identify engagement strategies for leadership
buy-in of lean culture

8. Keys to Success at
Mary Greeley Medical Center
• Senior Leader engagement and discipline.
• Baldrige as a Framework for Excellence.
• The Baldrige process becomes part of the
work we do everyday.
• Support for a learning environment.

9. Baldrige Framework for Excellence

10. Years of Examiner Experience
6
11
19
31
42
51
60
65
2010 2011 2012 2013 2014 2015 2016 2017

11. Systems Approach to
High Reliability

12. HR Work Systems Map

13. Our Work Continues
• Create a sense of urgency
• Continue to design our work until we can’t get
it wrong
• High Reliability is an ongoing process – never
complete, never perfect
• Engaging the workforce = respect for the work

14. • Proactively plan for the future
1.1c(2) create a focus on action)
• To do the right thing, and ONLY the right thing
(1.1c(2) identify needed actions)
• Those closest to the work need to help design
and re-design their work
(5.1a(4) workforce accomplishment; 6.1a(3) design your work)
• Learning from each other is critical to success
(4.2b knowledge management; best practices; organizational learning)
Why Lean?

15. 6 Traits of a Lean Leader:
1. Makes lean part of the strategy
2. Accepts continuous improvement and
rejects the status quo.
3. Customer is at the beginning and end of all
improvement.
4. Looks to simplify . . .with an eye for waste.
5. Involves those closest to the work.
6. Respect for the people and their work.

16. Leadership Commitment
What the Experts are Saying

17. 100 Day Workout – 2014
Identify an improvement project in your area
– Can be completed in 100 days
– Use our software platform, KaiNexus, to manage
project

18. Ground Rules
1. All leaders must participate
2. Idea must be within your scope
– Make sure you understand the problem
– Make sure you understand barriers (if any)
3. Idea must:
– Improve revenue**
– Save cost**
– **without negatively impacting quality/safety/service
4. Idea must be completed in 100 days

19. 100 Day Workout Timeline - 2014
Jan. 2014 Feb. 2014 March 2014 April 2014 May 2014
100 day work
out projects due
Senior leaders review
and approve all projects
Meet with KaiNexus to
establish final 100 day plan
First 30 day follow up with
KaiNexus; select projects
reported to leaders
2nd follow up with
KaiNexus; Check-
in/Questions from Leaders
Final 100 Day Workout
report out celebration
Project results
validated w/ Finance

20. 100 Day Workout Common Themes
• Cost Savings
– Contract Renewals/Re-Negotiations
– Inventory Management/Reduction
– Savings on Medications/Supplies
• Revenue Generation
– Sell unused equipment
– Review charges for accuracy
– Increase volumes

21. 100 Day Workout 2014
Final Results
• 54 opportunities for improvement completed
• $722,661 financial impact – hard savings
– $691,527 cost savings
– $49,084 revenue generation
• 5,308 labor hours saved per year
– $116,101 in soft savings

22. Two Fundamental Principles
1. Respect for the work
2. Learning by doing

23. Objective 2
Strategies to involve those closest to the work

24. Our Improvement Philosophy
Events
(RIE, VSM)
Projects
Managing for Daily Improvement
(MDI)

25. 2010
• Pittsburgh Regional Health –
Lean 101 (Yellow Belt
Training)
• Operation Warehouse – 6S
(learning by doing)
2011 - 2012
• Standard Work Steering
Committee
• Project identification/selection
• First Rapid Improvement Event
(RIE) Pump Management
• KaiNexus project management
software
2013
• Process Mapping tools
• 6S (dozens)
• Rapid Improvement Events (13)
• Value Stream Mapping Events (5)
• A3’s (hundreds)
Lean Transformation

26. 2014
• 100 Day Workout
• $650k savings (learning by
doing)
• RIE/VSM/A3s
• Systems thinking
• IRPE Gold
2015
• Managing for Daily Improvements
via KaiNexus
• RIE/VSM/A3s
• 1st Baldrige application submission
2016-present
• Improvement & Innovation
Council
• 100 Day Workout 2.0
• $450k savings
• RIE/VSM/A3s
• 2nd Baldrige application
submission
Lean Transformation

27. Our culture takes a significant shift!
Managing for Daily Improvements
Projects
Rapid
Improvement Events

28. Multiple Methods of Improvement
Managing for Daily Improvements
Projects
Rapid Improvement
Events
CULTURE

29. Three Stages of a Daily Improvement
Program
1. First Stage:
Supervisors must make every effort to help employees bring forward
improvement ideas, no matter how small. Initial focus is on improving one’s own
job and area.
2. Second stage:
Organization starts to provide more education for staff on problem-solving skills,
so people can provide better quality suggestions.
3. Third stage:
Only in this stage should managers be concerned about the financial payback or
ROI of improvements, once employees are interested and educated about Kaizen.
Imai, Masaaki, KAIZEN: The Key to Japan’s Competitive Success (New York: McGraw-Hill, 1986), 113

30. How Do People Feel About Change?
“People don’t
resist change,
they resist
being changed.”
– Peter Scholtes
(1938-2009)

31. Improvement Principles
Empower the
worker to
enact change
Adapted from: Jacobson, Gregory H. MD, Nicole Streiff McCoin MD, Richard Lescallette, Stephan Russ MD, MPH, and Corey M. Slovis MD, “Kaizen: A
Method of Process Improvement in the Emergency Department,” Academic Emergency Medicine, Volume 16, Issue 12, pages 1341-1349, December 2009.

32. Improvement Principles
Continually
improve, with
no idea being
too small
Adapted from: Jacobson, Gregory H. MD, Nicole Streiff McCoin MD, Richard Lescallette, Stephan Russ MD, MPH, and Corey M. Slovis MD, “Kaizen: A
Method of Process Improvement in the Emergency Department,” Academic Emergency Medicine, Volume 16, Issue 12, pages 1341-1349, December 2009.

33. Improvement Principles
All ideas are
addressed and
responded to in
some way
Adapted from: Jacobson, Gregory H. MD, Nicole Streiff McCoin MD, Richard Lescallette, Stephan Russ MD, MPH, and Corey M. Slovis MD, “Kaizen: A
Method of Process Improvement in the Emergency Department,” Academic Emergency Medicine, Volume 16, Issue 12, pages 1341-1349, December 2009.

34. Improvement Principles
A major source of
quality defects is
problems in the
process
Adapted from: Jacobson, Gregory H. MD, Nicole Streiff McCoin MD, Richard Lescallette, Stephan Russ MD, MPH, and Corey M. Slovis MD, “Kaizen: A
Method of Process Improvement in the Emergency Department,” Academic Emergency Medicine, Volume 16, Issue 12, pages 1341-1349, December 2009.

35. Asking Every Day
• Are there any problems
interfering with your
work?
• With patient care?
• Have you had any ideas
for improvement
lately?
• Do you have what you
need to do your job?

36. KaiNexus Advantage
Capture Capture
Share Implement
Measure
1-2% Implementation 80% Implementation
Across KaiNexus Customers

37. HOW DO WE ENABLE AND SPREAD
IMPROVEMENT IN AN ORGANIZATION?
Leadership
• Commitment
• Communication
• Accountability
Methodology
• Simple
• Consistent
• Disciplined
Technology
• KaiNexus

38. Capture
Leadership
• Engagement & Encouragement
Methodology
• Rounding, Huddles, Meetings
Technology
• User Submits OI (Private)
• Leader Notification
• Leader Review & Assignment
OI LIFECYCLE
Capture
Implement
Measure
Share

39. Implement
Leadership
• Coaching & Guidance
Methodology
• Personal Check-Ins & Meetings
Technology
• Collaboration
• Communication
• Task Management
• User Implements (Resolves) OI
OI LIFECYCLE
Capture
Implement
Measure
Share

40. Measure
Leadership
• Reinforcement
Methodology
• Categorization Consistency
Technology
• Leader Notified – OI Resolved
• Review & Complete OI
• Categorize OI
• Measure Impact of OI
OI LIFECYCLE
Capture
Implement
Measure
Share

41. Share
Leadership
• Demonstrate Value
Methodology
• Review Opportunity
Technology
• Share & Spread Improvements
• Schedule Future Review
OI LIFECYCLE
Capture
Implement
Measure
Share

42. Facilities Management
Staff and Employee satisfaction

43. Facilities Management
Staff and Employee satisfaction

44. Medical Unit - 4C

45. Medical Unit - 4C
Staff satisfaction/Time savings!!!

46. Objective 3
Enhancing sustainability through project
management and documentation

47. Our Improvement Philosophy
Managing for Daily Improvements
Projects
Rapid Improvement
Events

48. Workout Concept
• Simple, straight forward method for solving
organizational problems – quickly
• Teams of employees and managers coming
together to address issues they identify
• Team recommendations are presented to
senior managers and receive approval to
proceed
•
Authors: Ulrich, Dave, Kerr, Steve, Ashkenas, Ron
“The GE Work-Out : How to Implement GE's Revolutionary Method for Busting Bureaucracy &
Attacking Organizational Problems – fast!” April 15, 2002

49. Workout Concept
• Project owners are assigned to carry out
recommendations and follow through to get
results
• Efforts are documented in fully transparent
methods to ensure sharing and learning
Authors: Ulrich, Dave, Kerr, Steve, Ashkenas, Ron
“The GE Work-Out : How to Implement GE's Revolutionary Method for Busting Bureaucracy &
Attacking Organizational Problems – fast!” April 15, 2002

50. 100 Day Workout(s) at MGMC

51. 100 Day Workout - 2016
• Similar Timeline (February - June 2016)
• Same Ground Rules
• Implemented Story Board Template
• Created competition with categories
– Most Collaborative Effort
– Most Significant Impact on Bottom Line
– Lowest Hanging Fruit

52. “I’m not sure I can find an idea.”
• Rapid Improvement Event ideas?
• Look at brainstorming ideas we came up with
in 2014
• Look at current Daily Improvement ideas
submitted by staff
• Do any fall within the criteria:
– Margin Improvement
– Cost Reduction

54. Friendly Competition
(Voted on by all leaders)
Lowest Hanging Fruit
Most Collaborative Effort
Greatest Margin Impact

55. All Staff Quarterly Updates

56. 100 Day Workout 2017 Summary
• 61 total projects
• 5 completed with no change
• 8 extended beyond 100 Days
• 48 completed with a change

58. Getting Better at Getting Better

59. Getting Better at Getting Better

60. Time
Performance
20112010 2012 2013 2014 2015 2016 2017
•Rapid
Improvement
Events (25)
•Value Stream
Mapping (10)
•A3 Problem
Solving (100+)SW Steering
Committee
Managing for Daily
Improvements (1000+)
100 Day
Workout - 2014
100 Day
Workout - 2016
6S (dozens)
Pittsburgh
Regional Health
Training

62. Time
Performance
2010 2015 2020 2025
Getting Better at
Getting Better

63. Lessons Learned
throughout the Journey
• Make Baldrige about how you do business. . .everyday.
• Senior leader engagement is vital.
• Be willing to accept feedback and focus on incremental
improvement.
• Focus on beneficial results rather than on winning.
• Never lose sight that your organization is improving,
even if you haven’t achieved your ultimate goal.
• Don’t cram for the test (site visit), let your employees
live it.
• Build your internal expertise to support the work you
do every day.

64. Other Resources
KaiNexus.com/webinars
blog.KaiNexus.com

65. Our Next Presentation Webinar
• “Pets and Vets: Applying Lean
in Unexpected Places”
– Emanuel (Chip) Ponsford, III, DVM
• May 7, 2018
at 1 pm ET
• Kainexus.com/webinars

66. 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