improving health care delivery through collaboration with...
TRANSCRIPT
Improving Health Care Delivery Through
Collaboration with Lean Tools April 15, 2015
A. James Bender, MD
Virginia Mason
Don Woodlock, GE Healthcare
Kate Goodrich, MD, Quality Measurement and Health Assessment Group, Centers for Medicare &
Medicaid Services (CMS)
DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.
Conflicts of Interest A. James Bender, MD and Kate Goodrich, MD
Have no real or apparent conflicts of interest to report.
Don Woodlock is an employee of GE Healthcare.
© HIMSS 2015
Lean Tools in the Pursuit of the Perfect Patient Experience A. James Bender, MD Virginia Mason
Learning Objectives Share Virginia Mason’s Lean Journey Towards Defect-Free Care.
Understand basic applications of Lean Methods in Clinical Care.
Who is in the room?
Who is in the room?
Who came to HIMSS to learn about big data?
Sorry to disappoint
I am going to talk about small data and the tool that changed health care.
(hint: it is not an EHR)
The Tool that Changed Health Care
Time…..
• Belongs to our patients
• Helps us to measure demand for our services so we can pace our delivery
• Helps us identify waste
• Is the basis for training—not to a tool to see how fast we can work
• Multiplies into (really) big numbers
Lean is the pursuit of perfection by removing waste from the patient’s experience
Lean is “just in time”
VMPS Teaching
Taiichi Ohno’s
Seven Wastes
Defects Waste related to costs for
inspection of defects in
materials and processes,
customer complaints and
repairs
Processing Unnecessary
processes and
operations
Traditionally accepted
as necessary
Motion •Unnecessary movement
or movement that does
not add value
•Movement that is done
too quickly or slowly
Inventory •Maintaining excessive
amounts of supplies,
materials, or information for
any length of time
•Having more on hand than
what is needed and used
Time •Waiting for
people or services
to be provided
•Time when
processes, people or
equipment are idle
Waste
Transportatio
n Conveying,
transferring, picking up,
setting down, piling up
and otherwise moving
unnecessary items
Overproducti
on Producing what is
unnecessary, when it
is unnecessary, and in
unnecessary amounts
VMPS Teaching
Lean Behaviors—to Eliminate Waste
• Single piece flow….no batching, no inventory
• External set up….
• Correct errors before they become defects
• Targets….reduce lead time, zero defects
• Supported by ‘5S’ – the visual work place
Improving Flow By Reducing Walking
109 steps
pre-Kaizen
37 steps;
66% reduction
in motion
Create Work Space and Communication Channels
VMPS: Document the Current State
VMPS Method: One Piece Flow
Flow Stations
June 28, 2004
June 28, 2004
July 28, 2004
“But we don’t make cars!”
Our production process prepares patients to leave our hospital or office.
The goal is flow. We can’t have flow if there are defects and waste.
What does defect free care look like?
• Diabetes
• Blood clot prevention
• Hospital falls
Diabetes
How can we make sure that our patients with diabetes reliably receive evidence based care?
Preventing blood clots
How can we assure 100% compliance with VTE prevention standards?
Hospital Fall Trend
Applications of Lean in Software Development Don Woodlock, VP/GM Cardiology IT, GE Healthcare
Learning Objectives Describe how Lean is being applied in multiple healthcare industry types.
Demonstrate the success of applying Lean tools and the results that can be achieved.
Discuss how collaboration between industry, regulatory, and the delivery system has transformed the way healthcare is being delivered.
Old Our SW Dev process - Waterfall
Planning and Definition Design & Verification Commercialization Transfer & Validation
What the Industry is Telling Us . . .
64% The number of features rarely or
never used in a SW release
Solution: Design research to
identify & prioritize needs
Successful (on time, on budget, planned features) Challenged Failed
Source: The Standish Group, 1994, 2012
Lean/Agile initiatives
Lean Startup
UX
Lean Scrum
XP SAFe
Two-pizza
teams (5-9)
Product Owner
Scrum Master
Team Members
Scrum
SPRINT
PLANNING
SPRINT
DEMO SPRINT
RETROSPECTIVE
USER
STORIES STORIES,
TESTS,
TASKS
BACKLOG
GROOMING Definition
of
Ready
Definition
of
Done
Agile / Scrum Development Process
System Demo
The System Demo
• A demonstration of the integrated software assets to business owners and other program stakeholders
• Happens after the team sprint demos (may lag by as much as one sprint, maximum!)
At every sprint, the System Team/Product Management demonstrates the solution increment to the stakeholders
4 Month Release trains
Long Waterfall 4-mo Release Trains
Infrequent and late
Functional commitments
Measure variance to plan
Hope it is valuable
Frequent and on-time
Shared commitments
Measure variance to goal
Know it is valuable
Pivot example – historical shade feature
One larger pivot during development was a feature that we added to address the need for review of historical data. Based upon a review of this need with our customers and further exploration, we (collaboration with both customers and engineering) came up with a concept of a historical "shade" (attached) and pivoted the team to build this as the solution vs our original concept of an integrated single scrollable strip. We conducted some market research to help validate the overall value of this module to decision makers and what they would be willing to pay. We were able to truly validate our key assumptions by getting a release quickly to market with a very limited scope and target market.
GE
Confidential
Results
2013 Connect orders – 60% above expectations
To date… 2 customer-found bugs reported in 4+ years of use (60+ installs)
Quarterly releases to market
Every release on-schedule since 2010
GE Confidential
Jeff Immelt, GE Chairman and CEO
• Visiting with entrepreneurs has helped me focus on complexity, accountability and purpose. I have found two books—The Lean Startup and The Startup Playbook—to be particularly useful.
• Entrepreneurs simplify everything. They are purpose-driven. They focus on customers, people and solving problems. They do fewer things, but with bigger impact. They use judgment, they move fast, and they are accountable.
The Lean Startup Model
Build series of tests
to validate
assumptions
3| MVPs
Identify and track
leading indicators
… validate
learnings
4| Learning Metrics
Define customer
problem … long
term vision to solve
1| Problem Statement
5| Pivot or Persevere
Adjust strategy
based on validated
learnings
Identify
assumptions that
need to be true to
achieve vision
2| Leap of Faith
Assumptions
What the Industry is Telling Us . . .
64% The number of features rarely or
never used in a SW release
Solution: Design research to
identify & prioritize needs
Successful (on time, on budget, planned features) Challenged Failed
Source: The Standish Group, 1994, 2012
Questions
Don Woodlock
VP/GM Cardiology IT
GE Healthcare
Email: [email protected]
Twitter: @don_woodlock
Imagination at work
Lean at HHS Kate Goodrich, MD MHS Director, Quality Measurement and Health Assessment Group Centers for Medicare & Medicaid Services (CMS)
Initial Start of Lean in HHS
• Joint Centers for Medicare & Medicaid Services (CMS) and
Office of the National Coordinator for Health IT (ONC)
Entrepreneur Fellowship
• Focused on Electronic Clinical Quality Measure (eCQM)
Development which is slow and of variable quality
• Initial scope of the eCQM Lean work
o Contracting process
o All phases of front line measure development
o Pre-rulemaking and Rule-making
• Measures Under Consideration list clearance reviews
reduced from 23 to 1 and delivered on time for the first time
• Measure Authoring Tool integrated with Value Set Authority
Center
• One Implementation Guide for all electronic measures in
CMS programs
• Moved electronic reporting of eCQMs to Calendar Year to
align Eligible Hospitals (EH) and Eligible Professionals (EP)
• Piloting measure update evaluation using a multi-stakeholder
change review process
• Initial Pilot of National Test Collaborative in progress
• Electronic Clinical Quality Improvement Resource Center
released
o http://www.healthit.gov/ecqi-resource-center/
• Increased quality, transparency, collaboration, defect
reduction
eCQM Results
• Yearly Time Savings of ~ 5,360 hours/year from meeting reductions
• 95% Reduction in Post Implementation Change Requests (156
Change Requests to 8)
• Yearly Time Savings of ~ 3,395 hours/year from the reduction of
change requests (RCR’s)
• Eliminated the printing of 95,000 pages/year
• Rework Reduction with early stakeholder engagement/early Quality
Assurance
• Increased User Experience due to more feedback and quicker
response to feedback
• Contractors working at the highest level of their certification and high
job satisfaction
• 38% Reduction of overtime contractor hours from last year
• Increased Collaboration and Transparency between QIMHAG, ISG,
and Contractors
• PQRS seen as best in class the Premier line of business for
reporting
• Total savings= $650,007
Physician Quality Reporting System Business Requirements Kaizen Results
Lean Culture Change
© HIMSS 2015
Lean is culture of continuous quality improvement made through small, incremental changes to achieve an ideal state.
Manager Commitment – Employee
Empowerment
Priority – Part of Daily Work
Aligned to Strategic Objectives –
Employee Reviews
Leap of Faith
&
“Being Excited for the Horrors”
5-10% Improvement
30-40% Improvement
Sustaining the Culture
• Practice
– Leaders and staff use the tools
– Coach staff to be problem solvers
• Prioritize
– Apply to most urgent business needs
– Integrate into daily management
Promote
– Recognition
– Share results
Contact Information
• Kate Goodrich, MD MHS
• Mindy Hangsleben
• Elijah Ditter
Visit CMS at Booth #6039
© HIMSS 2015
TITLE SESSION TIME & LOCATION
MONDAY, APRIL 13
CMS EHR Incentive Programs Overview 10 10:00 a.m. – 11:00 a.m.
Room S100C
CMS Meaningful Use Stage 3 Requirements 40 1:00 p.m. – 2:00 p.m.
Room S100C
TUESDAY, APRIL 14
Keynote Address by Patrick Conway, MD:
The Intersection of Quality and Innovation at
CMS
67 10:00 a.m. – 11:00 a.m.
Room W196C
CMS Quality Strategy 86 1:00 p.m. – 2:00 p.m.
Room S100C
CMS Quality Reporting Update 116 4:00 p.m. – 5:00 p.m.
Room S100C
WEDNESDAY, APRIL 15
CMS Future Directions in Quality
Measurement 131
8:30 a.m. – 9:30 a.m.
Room S100C
CMS Meaningful Use Stage 3 and ONC 2015
Edition Certification Criteria Changes: The
Discussion Continues
160 11:30 a.m. – 12:30 p.m.
Room S100A
Improving Health Care Delivery through
Collaboration with Lean Tools 176
1:00 p.m. – 2:00 p.m.
Room S102D
CMS Educational Sessions at HIMSS15
Visit CMS at Booth #6039