mark graban ilc / mgmc event 2016
TRANSCRIPT
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PlanDoStudyAdjust
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Startfromneed.
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Whatproblemarewetryingtosolve?
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What’saManagementSystem?• Whatareleadersexpectedtodo?• HowareleadersexpectedTOBE?
– Isthereclearalignment?Aretheregaps?– Or"justgetresults"???
• Howisthistaught,modeled,andreinforced?– Whathappenswhentherearegaps?
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WhyaLeanManagementSystem?
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StrategyDeploymentinHealthcare(Scott & White)
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WhatisStrategyDeployment?• Aka"Hoshin Kanri"
– Hoshin ="compass"– Kanri ="management" or"control"
• "Aprocessforembeddingstrategyandaligninganorganizationtowardcommongoals"
• DevelopedbyDr.YojiAkao– (YokogawaHewlett-Packard)
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StrategyDeployment=PDSA
• UsingPDSAcyclesto:– Creategoals– Choosemeasurementpoints– Linkdailyactivitiestohighlevelgoals
– Driveresults&learning
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FromGoalDeploymentto"CatchBall"
Source:LeanHospitals,Graban
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TheRoleofLeaders• Definepurposeclearly• Identifythebiggestobstacles• Createanatmosphereconducivetoinitiativeandcreativity
• Reducehassle• Leadbyexample!Modelbehaviors.Teach
Source(1-4):Andy&MeandtheHospital(Dennis)
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"TrueNorth"• Broadgoalsanddirection
– "Briefexpressionofdirection,purpose,commitment,andvalues"
– "Whatweshould do,notwhatwecando"– Speakstotheheart
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"TrueNorth" Statements• "Nowait,noharm."• "Eliminateallunnecessarydeathorillness."• "Measurablybettervalue."• "Toprovidehigh-qualityhealthcaretoall,regardlessof
theirabilitytopay."• "____willcareforpatientsthewaywewantmembersof
ourownfamiliestobetreated,whileadvancinghumanity'sabilitytoalleviatehumansufferingcausedbydisease.Wewillprovidetherightcareintherightenvironmentandattherighttime,eliminatingwasteandmaximizingvalue."
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StrategyDeploymentasaSeriesofHypotheses
Hypothesis#1:
Ifwefocusourimprovementeffortsandcloseperformancegapsinthesefour(orfive)areas,wewillthereforeperformwellasanorganization,thisyearandoverthelong-term.
http://www.leanblog.org/SD1
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"TrueNorth" FocusAreas
Source:ThedaCare
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SAFETY&QUALITY PEOPLE PATIENT
SERVICE FINANCIAL
TRUENORTHWALL
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BuildingConsensus
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LessonsLearned• Don’tcopyothers’TrueNorth• Gothroughtheprocessofgainingconsensusaroundwhattheseshouldbe
• TrueNorthmustresonatewithyourpeople• "Thebeststrategydeploymentsystemintheworlddoesn’tmakeupforthewrongstrategy." (Toussaint)
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StrategyDeploymentasaSeriesofHypotheses
Hypothesis#2:
Ifwecanimproveandcloseourperformancegapsinthesekeyperformanceindicators,wewillsatisfyourneedforimprovementinourkeyfocusareas,andthereforewewillbesuccessfulasanorganization,overall.
http://www.leanblog.org/SD1
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"TrueNorth" Metrics
Source:ThedaCare
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SystemLevelMetrics
Source: Thinking Lean at ThedaCare (DVD)
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AnnualPDSACycles
• Goals&Metrics– Howdidweperform?– Whydidwehavethatperformance?– Werethosetherightgoals?– Arethesestilltherightgoals?
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SAFETY&QUALITY
PEOPLE PATIENTSERVICE
FINANCIAL
TRUENORTHWALL
STRATEGYA3
STRATEGYA3
STRATEGYA3
a.k.a."MOTHER"
A3
MEASURE1
MEASURE2
MEASURE3
MEASURE1
MEASURE2
MEASURE1
MEASURE2
MEASURE1
MEASURE2
MEASURE4
MEASURE3
MEASURE3
MEASURE4
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TheA3ManagementDiscipline
Heading
PlanDo
Study Adjust
Footnotes
17"
11"
A3(PDSA)StoryBoard
CyclesoflearningandcontinuousprocessimprovementDevelopingpeopleandimprovingprocesses
Plan(Hypothesis)
Do(Try)
Study(Reflect)
Adjust(Act/Adjust/Abandon)
GrasptheSituation
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Strategy A3
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InitialStrategyA3Work
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"BreakthroughA3" - Safety
• Expect 20 to 50% improvement in these breakthrough A3s
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TrueNorthCanEvolve
11/1/12 Rev: 10
Safety• System Patient Safety Bundle• D.A.R.T
People• Engagement Index• Health Assessment Score
Customer"Lori"
• Customer Loyalty Score
© 2011 ThedaCare
Financial Stewardship• Operating Margin• Productivity
Quality• Preventable Mortality• 30 Day Readmission
&
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ImproveSafety
Inpatient
Med/Surg Telemetry
Outpatient
Clinics
ClinicA
PhysicianA PhysicianB
ClinicB
Surgery
EmergencyDept
Patient&Employee
Sprains&Strains
PatientFalls
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TieredMetrics(3Levels)
Source:GroupHealthCooperative
Office
Clinic
PrimaryCareGroup(26clinics)
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DailyManagementBoards
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LessonsLearned• KPI=KEY PerformanceIndicator
– Trackingmoremetricsisn’talwaysbetter
• Don’tcopy:gainconsensusonthemetrics• Focusonmetricsthatarebestindicatorsofprogress&gap
closure• Isitwortharguingtoomuchoverexactgoals?• Getalignment,noteverybodymeasuringtheexactsamething
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StrategyDeploymentasaSeriesofHypotheses
Hypothesis#3:
IfweactuallyexecuteandcompletethesetopXinitiatives,projects,events,andA3s,thenwewillmakethegreateststridestowardclosingthekeyperformancegaps(fromHypothesis#2)andthereforewe’llbemoresuccessfulinourstrategy.
http://www.leanblog.org/SD2
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PrioritizationisaMust• Whatarethe"mustdo,can’tfail"initiativesforourorganization?
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AGeneralization…• Mostorganizationshavetoomany:
– "Highpriority" or– "Toppriority" initiatives/projects
• Doesanyinitiativegetrejectedorpostponed?
• Howmanyofourtoppriorityprojectsaregettingcompleted??Photo: Dr. John Toussaint
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"Deselecting"• Don’t implement every idea at once (Focus)• Deselect if it doesn’t meet immediate value stream project criteria
Source:ThedaCare
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Project A3
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BABYA3#1
BABYA3#2
BABYA3#3
BABYA3#4
BABYA3#5
BABYA3s
BABYA3#7
BABYA3#8
BABYA3#9
BABYA3#10
BABYA3#12
BABYA3#13
BABYA3#14
BABYA3#15
BABYA3#17
BABYA3#18
BABYA3#19
a.k.a"TACTICALA3"
#20
BABYA3#6
BABYA3#11
BABYA3#16
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NursingUnitBoard
Source: Thinking Lean at ThedaCare (DVD)
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Six Sigma
Projects
LargeKaizen
MediumKaizen
SmallKaizen
LeanEvents
Circle size is meant to roughly represent relative size of effort; Blue = tracked top initiatives ("Baby A3s")
Com
plex
ity
Daily Kaizen
Women & Children’s
3P
ElectronicMedicalRecord
ImplementationNew
Bed Tower
3 Types of Kaizen
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LessonsLearned
• Don’ttakeontoomuch
• Gainingconsensusonthistakesalotoftime,too
• Maybeerronthesideof"toofew" keyinitiatives?
• Stopjumpingtosolutions!
• Don’tlet"alignment"stifleKaizen
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StrategyDeploymentasaSeriesofHypotheses
Hypothesis#4:
WeactuallyhavetheorganizationalcapacitytocompletetheseXtopprioritiesinayearoragiventimeframe(andwiththerightquality).
http://www.leanblog.org/SD2
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PDSAReviewCycles
• UsingPDSAcyclesto:– Checkprogresson:
• Activity• Results• Lessonslearned
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TraditionalApproachGot Results
Didn’t Get Results
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LeanApproach
Didn’t follow process Did follow process
Got Results
Didn’t Get Results
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Mid-YearReview• Lean/S.D./A3/PDSAApproach:
– If"Red" (notmeetingtarget),ask:• Didwedowhatwesaidwe’ddo,butdidn’tgetresults?
– Doweunderstandwhy?– Whatdidwelearn?
• DidweNOTdowhatwesaidwe’ddo?– Doweunderstandwhy?– Whatdidwelearn?
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Mid-YearReview• Lean/S.D./A3/PDSAApproach:
– If"Green" (meetingtarget),ask:• Didwedowhatwesaidwe’ddo,andgotresults?
– Whatdidwelearn?
• DidweNOTdowhatwesaidwe’ddo,butstillgotresults?
– Doweunderstandwhy?– Whatdidwelearn?
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LessonsLearned• Don’tbeconfusedbyasingledatapointversusasustainedtrendinresults
• Don’twaituntiltheendoftheyeartosay,"Oops…"• PDSA– Studycapacityandprogress
– Adjustasneeded
• Ifthere’sanew"toppriority" initiative,whatareyougoingtodeselect?
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Our4Hypotheses1. Wehavetheright
TrueNorth&categories2. We’vechosenthe
rightmetrics&gaps3. We’vechosenthe
rightinitiatives4. Wehavetherightcapacity
toexecutethem