just do it! the kaizen approach to health care performance ... · kaizen at beaumont •not a...

April 14, 2018

Dorothy Bernard, RN, MSADirector, Specialty Programs

Sam Flanders, M.D.Chief Quality Officer

Just Do It!The Kaizen Approach to Health Care

Performance Improvement

Beaumont HospitalRoyal Oak, Michigan

UPDATE SLIDE

• 1,100 beds• 58,555 admissions• 130,733 ER visits• 51,248 surgeries• 6,872 births• >450 residents/fellows

• Magnet designated• 9 U.S. News & World Report

national rankings• Part of Beaumont Health,

Michigan’s largest health system

Beaumont’s Reality in 2008

• New hospitals in primary service area

• 2008 economic collapse

Resulted in …

• Record operating loss

• Significant drop in cash on hand

• Bond rating downgrade

• Position reductions

• Freeze on pay raises

Prior Approach to Improvement

• Projects prioritized by committee

• Participants trained in classroom setting - specific

tools and techniques

• Events led by trained PI experts

• Extensive data analysis prior to implementation

• Projects extended over several months

• “Best Practices” spread to everyone

• Projects prioritized by committee

• Participants trained in classroom setting - specific


• Events led by trained PI experts

• Extensive data analysis prior to implementation

• Projects extended over several months

• “Best Practices” spread to everyone

NEW Approach to Improvement

• Projects defined by area, based on business need

• Learn by doing – no reliance on classroom-based


• Front-line staff and managers make the change

• Data used to prioritize; no extensive data analysis

• Changes made in the moment, based on

observation

• There is no “best” practice, only better

Established “Rules for Change”

If someone has an idea that is….

• Low risk to safety and quality

• Low cost

• Easy to implement

• Easy to reverse

They MUST be allowed to try it!

“Good change”

“the process of deliberate,

continual improvements”

Kaizen

Which way can’t a sailboat sail directly?

Current Condition

Target Condition • Often can’t go directly

from current to target

condition

• Does Kaizen idea get us

closer?

– YES … try it

• “1,000 small Kaizen are

better than one Kaizen

worth 1,000”

Reaching Our Destination with Kaizen

Patient

Flow

Human

Efficiency

Quality

Safety

Financial

Strength

Experience

Patient

Centered

Actions

1. Culture of Safety

2. Risk Adj. Mortality

1. Overall Score (HCAHPS)

2. Responsiveness

1. Contrib. Margin ($$) / Case

2. Expense / Discharge

Kaizen Focus Impact Targets Outcome Metrics

Quality Improvement Philosophy(Rapid Change, Broad Engagement)

Low Cost Low RiskEasy to Install

Easy to Restore

Rapid Change

How Did We Get Started?

Example: 5 North

• 80-bed Medical/Surgical Unit

• New manager; eager to try something new

• Poor staff engagement, safety culture, patient satisfaction scores

• Target condition - increasing time nurses can spend with patients

Initial time spent with patients = 23%

First Hours of Observation

• Team member follows a nurse

– What prevents them from spending more time with

patients?

• Findings (via OBSERVATION)

– Missing equipment / supplies

– Interruptions

– Missing medications

– Transporters arrived unannounced

• Patients not ready

– Many others

Pill Cutter Example

Observation

• Nurse needed to split pill; med room missing pill cutter

Problem

• Nurse had to walk to other med room to get pill cutter

Kaizen

• Anchor pill cutter to wall in med room

Result

• Pill cutter always available

Turn Teams

Observation

• Bed-bound patients not consistently turned q2 hours

Problem

• Increased risk of pressure ulcers

Kaizen

• Created turn team; use turn clocks as visual cue

Result

• Consistent turning of patients

23%

45%

49%

53%55%

59%

65% 65%63%

65%63%

0%

10%

20%

30%

40%

50%

60%

70%

Nurses time at bedside

Nurses time at bedside

5 North Results – Time at Bedside

0

0.5

1

1.5

2

2.5

3

3.5

1Q11 2Q11 3Q11 4Q11 1Q12 2Q12 3Q12 4Q12

5 North Unit-Acquired Pressure Ulcers

5N

5 North Results – Pressure Ulcers

Units Display Kaizen Improvements

5 North

Pharmacy

Transportation

Other Nursing Units

Dietary

Environmental

Emergency Center

Heart & Vascular

Radiology

TMS Access Center

Supply Chain

Surgery

PT/OT CPD

Troy

Accreditation

Physicians

Clinical Decision Support

Care Management

MQPM

Finance

Oncology Services

How Beaumont Connected

Missin

g m

ed

s

Access to supplies

Un

ex

pe

cted

Pt

Mo

ve

me

nt

Typical Beaumont Kaizen “Event”

• Twice monthly

– Each team works for 2 days

• 4-8 teams working in different areas

– e.g., ER, nursing units, Radiology, Pharmacy

– Each with team leader

• Multidisciplinary

• Experienced coaches round on teams

• Brief kickoff in AM

• Report out in PM with senior leaders

Sweating The “Small Stuff”

• Kaizens typically target small problems that interfere with human efficiency or patient flow

– Unable to print to some printers

– Supplies in patient rooms - instead of walking to supply closets

– Equipment not available where needed

• Hundreds (maybe more) of these exist

– Staff typically works around these problems

Hospital-wide Results

3/19/2018 22

ER “Door to Doc” Discharged Adult Patients

BETTER

Severity-Adjusted Mortality (O/E ratio)

Beaumont, Royal Oak vs Vizient AMCs

Severity-Adjusted Mortality (O/E

ratio)(Beaumont, Royal Oak vs Vizient/UHC AMCs)



Beaumont, RO Vizient AMCs

Direct Cost Index Decline

Length of Stay Decline





1. Transition of care notes

2. Complex Care Committee

3. Plan of Care created

4. Care Huddles

ICU Length of Stay12 months pre and post Early Mobility Implementation

(monthly average)

• Total LOS savings: 0.79 days

• Total $ savings: $1,023,240

Mortality Index 2017(observed/expected)




ratio)(Beaumont, Royal Oak vs Vizient/UHC AMCs)RO

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76 79 82 85 88 91 94 97 100103106

Vizient Academic Medical Centers Mortality Index

January 2017 - December 2017

Beaumont, Royal Oak had the 6th lowest overall mortality index

among Vizient academic medical centers in 2017.

Direct Cost Per Case Index – 2017(observed/expected)





RO

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

1.80

1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76 79 82 85 88 91 94 97 100103

Vizient Academic Medical Centers Direct Cost per Case Index

January 2017 - December 2017

Beaumont, Royal Oak had the 33rd lowest overall direct cost per case index

among Vizient academic medical centers in 2017.

Ignore This Advice

Things Aren’t Always What They Seem

Sweat The Small Stuff

Kaizen at Beaumont

• Not a “program” – it’s how we approach achieving business results

• Not a quick fix – it’s a long-term commitment• Events used to accomplish work, but aim is

PEOPLE DEVELOPMENT

• “Kaizen Spirit” is the goal• Improvement happens every day, everywhere• As part of day-to-day work

Getting Started

• It’s about PEOPLE DEVELOPMENT and CULTURE of continuous improvement

• Define clear set of objectives that everyone is working towards

• Simple decision rules for empowering staff (“4 rules”)

• Weekly progress checks

• Coach people outside of their comfort zone

• Top executive leadership support

Reflection Points

• This is a journey to change our culture

– Not a set of tools/techniques

• Kaizen process created an avenue to identify the

leadership capabilities of our leaders and staff

– They “bubbled up” in the organization

• Has changed our approach to problem solving

– “Let’s go look at” versus having meetings and discussing

in a conference room

Questions & Discussion

just do it! the kaizen approach to health care performance ... · kaizen at beaumont •not a...

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