(changing to excellence) improving the patient experience oct 10, 2014 waste not, want not...
TRANSCRIPT
(Changing to Excellence)
Improving the Patient Experience
Oct 10, 2014
Waste Not, Want NotConducting a Lean
Assessment
2014 Annual Healthcare
Symposium: Lean Strategies in
Transforming Patient Care
Challenges facing Healthcare
Basic concepts and philosophy of Lean
Waste in Healthcare
Case Studies
Managing Change
Today’s Talking Points
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It is not necessary to change. Survival is not mandatory.
- W. Edwards Deming
Challenges Facing Healthcare
Shortage of healthcare professionals
Financial challenges
Declining volumes
Changing needs
Changing health care systems
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Physician wait times up, expected to keep increasing
A growing physician shortage, payment decreases and adoption of electronic health records may be to blame as
patients wait longer for care in doctors’ offices.
Affordable Care Act (Obamacare)
What is Lean?
Based on…
What is Lean?
The Deming Cycle - PDCA
Implement themethods
Do
If goals were achieved adoptthe new methods permanently.If not, determine root cause of failure and return to ‘Plan’
Adjust
Examine the results
Check
Determine goals to be achievedand the methods to reach them
Plan
Based on…
What is Lean?
The Deming Cycle - PDSA
Implement themethods
Do
If goals were achieved adoptthe new methods permanently.If not, determine root cause of failure and return to ‘Plan’
Adjust
Examine the results
Study
Determine goals to be achievedand the methods to reach them
Plan
1. Define value from the customer’s perspective and express value in terms of a specific product
2. Map all of the steps…value added & non-value added…that bring a product of service to the customer
3. The continuous movement of products, services and information from end to end through the process
4. Nothing is done by the upstream process until the downstream customer signals the need
5. The complete elimination of waste so all activities create value for the customer
LeanThinking
Womack & Jones
What is Lean?
Shifting from Traditional to Lean Healthcare
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Improving the quality of patient care
Eliminating non-value added waste
Reduce non-value added cost
Improving the Patient Experience
Environment transformation
What is Lean Thinking?
“Lean is not a program; it is not a set of quality improvement tools; it is not a quick fix; it is not a responsibility that can be delegated.”
“Rather, Lean is a cultural transformation that changes how an organization works . . . It requires new habits, new skills and often a new attitude throughout the organization.”
Dr. John Toussaint, CEO, ThedaCare Center for Healthcare Value Leonard Berry, Professor, Texas A&M
A New Way of Thinking
Get Creative
New Knowledge
Question Everything
Look Beyond Traditional Metrics
What is over-valued and under-valued at your organization?
Waste in Healthcare
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20-30% of health spending is "waste"
with no benefit to patients, because of
overtreatment, failure to coordinate care, administrative
complexity and fraud
Waste in Healthcare
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Once waste has been identified and
removed, and standardization has
been introduced you will begin to see change in your
workplace!
Value and
Waste
Value and Waste
Essential Steps
Change Product or Service
Done Right the First Time
Customer/Business wants and is willing to pay for them
Value-Added Work Non Value-Added Work Value-Enabling Work
Non-Essential Steps
Not done correctly first time
Customer/business doesn’t want them or is unwilling to pay for them
Non-Essential Steps
Allow the Value- Added tasks to be done better and faster
Mandatory from aregulatory standpoint
A Practical Lean Managers Goal is to:Eliminate the Non-Value-Added activitiesMinimize the Value-Enabling WorkMaximize the Value-Added Work
Waste in Healthcare
Eliminating waste will accomplish the following:
Improve patient care and safety
Improve productivity and process efficiency
Improve quality (reduce the opportunity for errors or
mistakes)
Reduce cost to the facility
Reduce wait (queue) time between processes
Make the facility more competitive
Encourage teamwork and staff involvement
Waste in Healthcare
To fully grasp the power of Lean you first need to be able to understand and identify waste.
Waste is a symptom and Lean tools and concepts are used to find and eliminate its root cause(s).
Waste in Healthcare
There are eight major wastes in healthcare
Never mistake activity for achievement.
- John Wooden18
Waste in HealthcareWASTE-An activity that is unneeded, unwanted or involves excess effort
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Repeating Why Five Times
“…the Toyota production system (i.e., Lean) has been built on the practice and evolution of this scientific approach”
Taiichi Ohno – Toyota Production System, Page 17
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Problem: Delays in performing x-rays.
1.Why are the x-rays delayed?Because the exam takes longer than scheduled
2.Why does the exam take longer?Because the rad tech is busy with other things
3.Why is the rad tech busy? Because they have to answer the phone4.Why do they have to answer the phone?
Because there’s a phone that rings in the area5. Why does the phone ring in the area?
Because it hasn’t been programmed to ring at the clerk’s station…
5 Whys
5 Whys
See if you can drill down to the root cause of the problem – go beyond the symptom
Avoid the easy answers – “because we don’t have enough staff” or “because the computer system is bad”
Collect data on the identified root cause – is it really a problem?
If you can't describe what you are doing as a process, you don't know what you're doing.
- W. Edward Deming
Consisted of two on-site visits by our team
Over thirty (30) hours of observation
Used Lean tools to identify and gather information
Background of Assessments
Case Study Review
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All we are doing is looking at the timeline. From the moment the patient gives us a complaint to the point of care. And we are reducing that timeline by removing non value-added wastes.Adapted from Taiichi Ohno’s book “Toyota Production System”
Case Study A - Observations
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Signage need to be updated. Rural Health Clinic or a Family Practice?
Case Study A - Observations
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This is a Band-Aid not a
solution to a problem in the
process.
Case Study A - Observations
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A quick inspection of all exam rooms showed that supplies varied depending
on the room.
Hidden supplies can lead to over ordering.
Case Study A - Observations
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Cluttered cabinets lead to time wasted looking for
materials.
Unorganized. Materials/supplies randomly placed on the shelf.
Case Study B - Observations
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Case Study B - Observations
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Case Study B - Observations
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Impact Dollar ImpactImplementing Lean will increase:1.Staff Satisfaction2.Clinical quality3.Clinic productivity – without adding staff4.Patient experience
a. Access/Flowb. Patient Satisfaction
As visits increase the Cost Per Visit will decrease allowing for more patients to be seen with a minimal rise in costs. $ 27.71 Decrease in cost per visit The clinic would see approximately 480 more Medicare patients at the reduced cost per visit rate $ 12,000Emergency Room supply expense decrease for level 1 visits $ 5,000We estimate the Clinic would have 440 additional Medicaid visits $ 32,000Volume increases for all other insurances/self-pay $ 48,000
Estimated cost of additional RHC visits $ (9,000) Total Impact - Cost/Reimbursement $ 88,000
Potential Impact - Case Study A
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Potential Impact - Case Study B
Impact Dollar ImpactImplementing Lean will increase:1.Staff Satisfaction2.Clinical quality3.Clinic productivity – without adding staff4.Patient experience
a. Access/Flowb. Patient Satisfaction
As visits increase the Cost Per Visit will decrease allowing for more patients to be seen with a minimal rise in costs.
$ 13.66 Decrease in cost per visit
The clinic would see approximately 236 or 590 more Medicare patients at the reduced cost per visit rate $2,000 $3,000We estimate the Clinic would have 577 or 1,443 additional Medicaid visits $65,000 $163,000Volume increases for all other insurances/self-pay $91,000 $229,000
5S of the exam and supply rooms $10,000 $10,000
Estimated cost of additional RHC visits $(10,000) $(10,000) Total Impact - Cost/Reimbursement $ 158,000 $390,000
Why Initiatives Fail
Complacency
Failure to create a sufficiently powerful guiding coalition
Under-estimating the power of the vision
Under-communicating the vision by a factor of 10 (or 100 or 1,000)
Why Initiatives Fail
Permit obstacles to block the new vision
Fail to create short-term wins
Declare victory “too” soon
Neglect to anchor changes firmly in the corporate culture
Why Initiatives Succeed
Simplicity
Active and visible executive sponsorship
Structured approach
Why Initiatives Succeed
Frequent and open communications around need for change
Dedicated resources for change management
Total Employee Involvement
“We don’t have enough time or resources to do it right the first time……we only have enough time and resources to do it over again, again, and again when we’ve done it wrong the first time.”
Why Lean?
A New of Way of Thinking
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Leaders need to think and manage differently!
Questions
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Resources
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Coming Soon Winter 2014
Questions
Todd SperlManaging Partner
Lean Fox Solutions, LLC248.798.7984
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“If your actions inspire others to dream more, learn more, do more and become more, you are a leader”
John Quincy Adams