implementing a balanced lean six sigma operating system in a healthcare organization
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Implementing a Balanced Lean Six Sigma Operating System in a Healthcare Organization
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
Doug Dulin, Akron Children’s HospitalLean Master, Master Black Belt
A Balanced Lean Six Sigma Operating System
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
Part 1
Speaker: Doug DulinBio: Doug Dulin is the Senior Director for Akron Children's
Hospital Center for Operational Excellence. He is a proven leader with extensive experience transforming manufacturing and healthcare organizations utilizing Lean Six Sigma fundamentals based upon the Toyota Production System. Throughout his career, Doug, has held such positions as Director Lean Six Sigma, Business Unit Manager, Plant Manager, Lean Site Leader and Lean Master. He earned his Lean Six Sigma Master Black Belt Certification from Honeywell International. Earlier in his career, he learned the Toyota Production System from Aoyama Seisakusho, a Tier One Supplier to Toyota Motor Manufacturing.
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
Balanced Lean Six Sigma Operating System
Shigeo Shingo – “Know how alone isn’t enough! You need to Know-why”! All too often, people visit other plants only to copy their tools and methods.”
“Think in terms of categorical principles.”
Tools Systems Principles
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
Balanced Lean Six Sigma Operating System
Goals of this presentation• Introduce to the elements of a Balanced
Lean Six Sigma Operating System• Case Study Review: Learn about Akron
Children’s Hospital Balanced Lean Six Sigma Operating System
Balanced Lean Six Sigma Operating System
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
Elements of a Balanced Lean Six Sigma Operating System
Baseline Event
LEAN SIX SIGMA PRINCIPLES
A3 for Healthcare Transformation
Kaizen for GoodPatient Care
Build your Daily Management
System
Balanced Lean Scorecard
Connecting yourBoard Directors
Baseline Kaizen Events
Internal Lean Sensi Team
Lean Six Sigma Belt Program
Tools Systems Principles
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
Balanced Lean Six Sigma Operating System
Internal Lean Sensi Team> Team of Internal Organization Stakeholders leading the culture and
process transformation using Lean Six Sigma Tools, Systems and Principles
> Development driven through outside learning, internal cycles of learning managing projects and leading enterprise wide improvements
> Internal Lean Team should include a range of experienced employees, Physicians, Nurses and key leaders within the organization
> Use of outside consultants should be used to help begin a program, introduce new advanced lean six sigma tools or off set a head count issue for a short term period
Internal Lean Sensi Team
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
Balanced Lean Six Sigma Operating System
Baseline Kaizen EventsA baseline is a starting point. The baseline process will allow us to gain a defined
understanding of our current state. Without a baseline, we cannot be certain what or where to improve. Baseline deliverables include: An understanding of the current and future states, Identification of the gaps between the two, and A plan to close the gaps.
Organization Development OperationsOD Baseline understands:•Human Capital Current State•Creates the Future State and links it with Strategy•Determines and Creates Go Forward Action Plan
Operations Baseline understands:•Current State of all Operations•Creates the Future State and links it with Strategy•Determines and Creates Go Forward Action Plan
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
Balanced Lean Six Sigma Operating System
Baseline Kaizen Events
A3 for Healthcare Transformation
A3 for Healthcare Transformation
“Essence of Lean”• Staff driven• Bottom up• Enabling process• Numerous but small projects
Methodology– 8 week course– General Lean Tools– 2 hours per class– 2 hour “homework”– 15-30 students– Offered twice per week– Complete one project using A3 story
telling visual board– Graduation ceremonywith executive leadershipTeam
http://leanforhaiti.org/
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
Balanced Lean Six Sigma Operating System
Lean Six Sigma Belt Program
Lean Six Sigma Belt Program
71645750433629221581
0.25
0.20
0.15
0.10
0.05
0.00
_P=0.1307
_P=0.1132
_P=0.0483
UCL=0.1967UCL=0.1895
UCL=0.0906
LCL=0.0648
LCL=0.0368
LCL=0.0061
Pre-Implementation/ Implementation ControlControlBaseline
Flash Sterilization Rate by LSS Project Phase (P Chart)[Excl Procedures Outside ORs; Oct 2007-present; Target < 3%]
Tests performed with unequal sample sizes
Description> Projects link with program or
enterprise strategic plan> Data driven projects> Advanced training in Lean Six
Sigma Tools> Advanced training in project
management> Advanced training in soft skills> Projects range from 6 to 9 months> Advancement program includes
Green, Black and Master Black Belt> Development tools for future leaders
and Physicians
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
Balanced Lean Six Sigma Operating System
Kaizen for Good Change for Patient Care
Kaizen for GoodPatient Care
Description• Drive Business strategic plan
quickly using lean six sigma tools
• Significant and rapid change (rapid improvement week)
• Short term intensive concentrated effort by frontline stakeholders, physicians and nurses
• Enterprise should support 20 to 30 per yearProcess improvement through people development™
Copyright Children's Hospital Medical Center of Akron
Balanced Lean Six Sigma Operating System
Building a Daily Management
System
Build your Daily Management
System
Tier 3VPsDirectorsSupporting Functions
Tier 2DirectorsManagersSupporting Functions
Tier 1Area ManagerArea Stakeholders
Each metric should be applicable to team … Winning or Losing at a Glance
Metrics … ↑ Visibility … Dig @ source of issue …Countermeasures!
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
Balanced Lean Six Sigma Operating System
Connecting your Board of Directors to your Lean Operating System
Daily Management
CorporateStrategy
Deployment
ExecutiveTeam
ManagementTeam
Front LineLeaders
StakeholdersConnecting yourBoard Directors
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
Balanced Lean Six Sigma Operating System
Balanced Lean Operating Scorecard
Balanced Lean Scorecard
Benefit Category Result
Patient wait time reduced (days)
42,831
Staff non-value added time reduced (hours)
24,056
Appt access times reduced (days)
74,608
Financial Impact (directand indirect)
$9,177,222
Overview> Enterprise wide metrics linked
directly to strategy of organization> Metrics could include $s direct and
indirect savings> Patient centered metrics included in
scorecard> Simple tracking of metrics possible> More advanced lean six sigma
metric tracking available on the market to improve process through the journey
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
Balanced Lean Six Sigma Operating System
What makes a successful Balanced Lean Six Sigma Operating System
Project Program EnterpriseStrong support from Champions and Physician Leaders
The people and managers do the work Support of top executives includingphysicians
Full Engagement of team by going to the Gemba
Support of top executives by going to the Gemba and asking questions
Vocal and Visible Support from whole leadership team by going to the Gemba
Visibility & Communication Support of physicians No-Lay off policy for Lean initiatives
Use data that supports reality Use data that supports reality Use data that supports reality
Must have project follow-up and re-adjustment
Begin to use balance tools, processes and systems within a value stream
Use balanced tools, processes and systems
Continuous Improvement is foundation Learn from other areas and companies Dedicated, trained resources – with most of the team being internal candidates
Team Engagement is Key Continuous Improvement is foundation Continuous Improvement is foundation
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
Balanced Lean Six Sigma Operating System
Akron Children’s Hospital Balanced Lean Six Sigma
Operating System
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
Case StudyPart 2
Blue Belt Program A3 Program
Kaizen EventsLean Six Sigma
Belt Program
ACH Lean Operating
System
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
DEFINE
MEASURE
ANALYZEIMPROVE
CONTROL
• Day Nursery in 1890 to independent stand-alone teaching hospital
• Largest pediatric health care system in northeast Ohio
• 253 bed hospital – Main campus• 32 bed hospital – Youngtown• offering services at 80+
locations across the region. • 579,000 outpatient visits each year
• 10,000 admissions
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
About Akron Children’sHospital
• 4,000 + employees• Gold Seal of Approval from the Joint
Commission • Magnet Recognition Status from American Nurses Credentialing Center• Stable Leadership
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
William H. Considine President & Chief Executive Officer
About Akron Children’sHospital
COO Led• Wanted to better the patient
experience (decreasing patient wait times, access times)
• Looked for a sustainable way for a hospital to improve operations
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
Mark Watson
About Akron Children’s Lean SixSigma Journey
Center for Operations Excellence:The mission of the Center for Operations Excellence is to
develop and use in-house talent to improve the healthcare experience of our patients and families, while improving the working experience of our staff.
Currently staffed by 8 individualso 1 Senior Directoro 5 Deployment Directorso 1 data analysto 1 office coordinator
21Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
ACH Center for OperationsExcellence Group
Process Improvement Through People Development TM
22Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
ACH COE Philosophy
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DMAIC Methodology (Define, Measure, Analyze, Improve, Control)•Kaizen Events
• Rapid Process Improvement Week- anywhere from 2 to 5 day events • Strategically driven by Executives• Belts = project leaders; team of 5 – 10 from dept & from dept’s customers
•Green Belt and Black Belt Projects• 6 - 9 month projects • Strategically driven by Executives – VPs, C suite, etc. • Project leaders are COE staff, or trained belts• Team of 5–10 from the department
•A3 Projects• 8 week long projects, usually within the boundaries of the participants’ home dept• Driven by the line staff doing the work, and supported by their manager
•Blue Belt• Manager training to include Gemba Walks, implement daily metrics boards and daily
huddles, coaching for staff, etc.
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
ACH Lean Six Sigma OperatingSystem
• A3: 8-week formal training program which teaches front-line staff the basics of Lean, culminating in the completion of a project in the participant’s home department
24Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
ACH Lean Six Sigma OperatingSystem – A3
25
Akron Children’s Hospital A3 Project Overview
A3 Projects•Burn Center
•Reduction in the number of inaccurate burn dressing cards
•Pediatric Psychology•Reduce missed number of MACSIS forms for Medicaid clients
•Laboratory•Reduce the QNS rate for patients 3 months and older by 40% for sweat tests
•Nursing•The amount of unused linen in empty rooms on the 7th floor will be decreased from up to 31 pieces to 0 pieces
•Food Services•Reduce non Nursing non value added time and variation in fortified breast milk preparation.
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
A3 Example from a Project
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
• Lean Six Sigma Belt Program: Formal training program and project which lasts 6-12 months, following the DMAIC (Define, Measure, Analyze, Improve, Control) format
27Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
ACH Lean Six Sigma OperatingSystem – LSS Green Belt Program
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Green Belt Projects•Flash Sterilization
•Problem statement•The Sterile Processing Department cannot currently meet case demand for surgical instruments without a weekly 13.1% flash sterilization rate
•SMART Goal•Reduce weekly flash sterilization rate in the OR to ≤ 3%
•Results•Reduced weekly flash sterilization rate from 13.1% to 2%
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
ACH Lean Six Sigma OperatingSystem – LSS Green Belt Program
71645750433629221581
0.25
0.20
0.15
0.10
0.05
0.00
_P=0.1307
_P=0.1132
_P=0.0483
U CL=0.1967U CL=0 .1895
U CL=0.0906
LCL=0.0648
LCL=0.0368
LCL=0.0061
P re-Imp lemen tatio n / Imp lemen tatio n C o n tro lC o n tro lBaselin e
Flash S terilization Rate by LS S Project Phase (P Chart)[Excl Procedures Outside ORs; Oct 2007-present; Target < 3%]
Tests p erfo rmed w ith uneq ual samp le sizes
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
ACH Lean Six Sigma OperatingSystem – LSS Green Belt Program
• Black Belt: 12-month projects involving large value streams which utilize more advanced tool of Lean Six Sigma via OSU
30Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
ACH Lean Six Sigma OperatingSystem – LSS Black Belt Program
Center for Operations ExcellenceProject CharterLocust Pediatrics 3PBackground/Problem Statement:Locust Pediatrics Care Group is going through the following changes throughout 2010: 1. Potential for more patients to the daily schedule: The clinic has become the primary
medical home for patients in the care of Summit Children’s Services Board (CSB), eventually adding on a projected 400 visits per month t(20 visits/day) to its schedule.
2. Additional new staff: 1 RN, 1 CNP, 1 MA, and new 2 PSR’s have joined the staff to help care for the additional patient volume.
3. Additional space: The clinic has gained much of Suite 380’s 3,500 square feet of space and operations are changing which might lengthen the visit times.
4. EPIC (electronic medical records) implementation in the last half of 2010. Extra movement , searching, and rework is interfering with the staff’s ability to care for the children
in the daily schedule and the additional kids cared for behind the scenes.
Goal Description:
•Run a 2-day 3P exercise that will create the plans for the best utilization of space, resources, & staff in the Locust Pediatrics Suite 380 space.
Scope:• Maintain and even improve quality of care at all points of time during a visit•Only the new space (previously Rheumatology; Suite 380) during the 3P event will be considered.•Exceptions might be duplication or centralization of a potential med area, supply area, and lab area that may lead the team to look at Suite 390.• Long term plans would include potentially duplicating the gains realized from Suite 380 to Suite 390.
Benefits:• Optimize the Suite 380 space (previously Rheumatology) in terms of patient flow, staff flow, and information flow. • Help to shorten the patient door to door visit in Locust Pediatrics Note: As of April 2010, the current average visit length for sick visits (door to door) for patients in the Locust Pediatrics Group is still 70 minutes (approximately the same as 2009). • Help establish a model for the Department of Pediatrics to allow departments to understand how an ideal clinic should look and flow, especially when bringing on new providers.
Project Y: Key Metrics:• See Metrics (no project Y necessary)
• A completed renovation plan for Suite 380 space. As promised by Mark Watson and Lin Gentile, all renovations will be completed by June 30th.
Team Members: Stakeholders:Executive Sponsor: Mark Watson, COOChampions: Cindy Dormo, Dr. Norm ChristopherProcess Owner: Dr. Cooper WhiteTeam Members: Cindy Kovacich, Lee Orin, RN, Holly Ross, CNP, Missy Sommers, RN, Jessica Anders, Erica Walters, Angie McCreery, Russ MaroniProject Leaders: Anne Musitano, RPh, PharmD, Kris Grayem, RN, CNPExpert Advisors: Sherrie David, RN, Tim Tomayko, Cliff Greive COE staff: Sherry Valentine, RN, Mike Antochow
Patients and families Locust Pediatrics staffCSB Department of Pediatrics
CURRENT STATE VALUE STREAM MAP – AFTER VSM WORKSHOP – 2/15/10
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
TOTAL TIME IN CLINIC FOR SICK VISITS FOR 2010
86 83 8081
75 7365
0
10
20
30
40
50
60
70
80
90
100
January February March April June July July
Total Time in the Locust Clinic for Sick Appointments
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
Akron Children’s Hospital’s Lean Six Sigma Operating System
• Black Belt: 12-month projects involving large value streams which utilize more advanced tool of Lean Six Sigma via OSU
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
34
Locust Black Belt Project – Through a series of Kaizens and A3-based projects, the Locust team identified and implemented a number of improvements that reduced patient in-clinic time from 70 minutes (2009) to 43 minutes (2011).
Project Specific Example: Creation of Mobile Triage Cart designed by Locust Black Belt Team
XStep 1 – Reduce Triage Room Step 2 – Actual Drawing Step 3 – Actual Triage Cart
• Blue Belt: Training for managers and departmental leaders focusing on daily management in a Lean enterprise through tools, processes, and systems
35Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
ACH Lean Six Sigma OperatingSystem – LSS Blue Belt Program
METRIC BOARDS
36Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
Staff and Management Engagement- A3 projects
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A3 Project: Shelly Orr
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
Akron Children’s Hospital’s Lean Six Sigma Operating System
• Blue Belt: Training for managers and departmental leaders focusing on daily management in a Lean enterprise through tools, processes, and systems
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
38
Below: Example of Kids Metric Board tracking 4 key area metrics linked to ACH pillars of Quality, Research, Brand and Growth
AREA DAILY TEAM HUDDLES
39Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
STAKEHOLDER IDEA BOARDS
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
• Kaizen: Events lasting 2-5 days which result in rapid implementation of countermeasures
41Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
ACH Lean Six Sigma OperatingSystem – Kaizen
Center for Operations ExcellenceProject CharterMRI KaizenProblem Statement:There is currently capacity for additional patients to be scanned on MRI #1 and MRI #2.
Goal Description:
Increase the number of weekly exams (Monday through Friday) performed on MRI #1 and MRI #2 from 86 to 112 by August 24th, 2009. The assumption is that demand is there to meet the goal of 112 exams per week.
Scope:Main campus only; MRI #1 and MRI #2.
Benefits:
• Reduce the backlog of patients requiring MRI services. • Reduce the patient access times for MRI services.• Potential annualized net revenue gained: $1.7M (from increasing the total number of weekly exams Monday through Friday between MRI #1 and MRI #2 from 86 to 112.)
Project Y: Key Metrics:Patient access times for non-contrast, contrast, and sedated MRIs.
# of exams performed per day on MRI #1 and MRI #2 on Monday through Friday
Team Members: Stakeholders:•Kaizen Team Members- Dr. Mike Ruibin, Dr. Azam Eghbal, Carol Arteno, Jason Duncan, Terry Tarray, Shelly Orr, Marie Biasella, Julie Madden, Kim Gresham, Tina Keith•Champions: Lin Gentile, Chis B. •COE Team- Anne Musitano, Mike Antochow, Sherry Valentine, Trauda Gilbert, Dr. David Chand, Chris Weisbrod•On Call Team- Michelle Taylor, Karen Horning, Betsy Cetnarowski
Patients, physicians, and radiology staff of Akron Children’s Hospital
Visibility & Communication and Focus on the Goal
• Keep staff involved with project information• Don’t take your eye off the ball
43Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
DATA- LOOK AT THE REALITY!
44Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
Strong Support from the Top
45
CEO: Bill Considine
VP: Lin Gentile
COO: Mark Watson
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
Areas of Opportunity
46Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
Go to the Gemba and See!
47Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
MRI Schedule- Constantly Evolving in Response to Actual Patient Demand
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
Sustainability of MRI Kaizen!
49Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
•A3•Green Belt•Black Belt•Blue Belt•Kaizen
50
Benefit Category Since COE inception early 2009
Patient wait time reduced (days)
42,831
Staff non-value added time reduced (hours)
24,056
Appt access times reduced (days)
74,608
Financial Impact (directand indirect)
$9,177,222
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
ACH Lean Six Sigma OperatingSystem – Program Results
• Lean is more than tools or project work• Lean is 90% engagement of people/10% tool knowledge• Hard to deploy with other full time job commitments• A Lean program needs to focus considerable effort on
engagement of the middle management early on in deployment
51Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
ACH Lean Six Sigma OperatingSystem – Lessons Learned
52
Keys to Success•C-level support of the Lean Six Sigma initiative•Dedicated full time staff•Front line engagement•Middle management engagement•VP level engagement•Experienced Lean Six Sigma consulting firm for first 2 years
.
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
ACH Lean Six Sigma OperatingSystem – Keys to Success
LEAN IS A JOURNEY…
ToolsPoint Projects, A3 program, Kaizens(2008-onward)
PrinciplesGreen Belt Program, Blue Belt Program, Black Belts, more Kaizens(2010-onward)
SystemsFurther Development of Tools & PrinciplesStrategy Deployment(2010- onward)
Akron Children’s
Lean Operating
System
53
ACH Lean Six Sigma Operating System
True North
Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
Questions?
Contact information: Doug Dulin
Akron Children’s Hospitalddulin@chmca.org330-543-5245 (w)330-697-1682 (c)
54Process improvement through people development™Copyright Children's Hospital Medical Center of Akron
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