rona consulting group brochure 2014

transforming healthcare; pursuing perfection

It is not by accident that you were chosen to be a leader, it is your destiny.– Sensei Chihiro Nakao

The American healthcare system is not performing very well. Quality and safety are poor — and not improving. The cost of quality and cost to payers is too high — and rising.

The statistics are well known. Clearly, our old way of managing healthcare is not working. The only question is:

By what method will we make it better?

Poor quality

Poor safety

High cost of quality

Rising cost to payers

Morale of workers

Limited access

The challenges of healthcare

The future of healthcare

Quality

Safety

Customer satisfaction

Staff satisfaction

Economic performance

The principals of Rona Consulting Group (RCG) have experience in transforming healthcare through their work at leading hospitals and healthcare systems, specifically in their leadership roles at Virginia Mason Medical Center in Seattle and Park Nicollet Health Services in Minneapolis — the first healthcare organizations in the country to fully adopt and implement the Toyota Management System.

Clerk

register

Tech

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TN

triage

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assess

MD

TreatTech

Treat

MD

Assess

Patient

change

Greeter

greet

MD

TreatTech

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Discharge

CT = 3:30

(3 min filling

out form; 30

sec = greet

time)

CT = 7:00 CT = 5:00 CT = 0:00 CT = 1:30 CT = :30 CT = :3:30 CT = 5:35 CT = 9:36 CT = 9:03 CT = 2:00 CT = 0:22 CT = 106:33

LT = 47:35

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Tech

EKG

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RN

I.V.

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CTTech

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Tech

Labs

MD

assess

RN

triage

CT = 6:15 CT = 3:35 CT = 7:00 CT = 5:00 CT = 7:00 CT = 13:00 CT = :10:00 CT = 16:00 CT = 11:00

Clerk

register

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escort

TN

triage

RN

assess

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labTech

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assess

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assess

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greet

MD

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assess

RN

Discharge

CT = 1:20 CT = 4:10 CT = 2:05 CT = 3:04 CT = 2:25 CT = 16.32 CT = 1:25 CT = 8:50 CT = 7:12 CT = 9:30 CT = 2:30 CT = 2:40 CT = 61:43

QT = 132:22

LT = 194:05

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assessRN

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assess

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assess

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Discharge

CT = 2 CT = 7 CT = 5 CT = 2 CT = 2 CT = 1 CT = 10 CT = 30 sec CT = 3 CT = 7 CT = 1 CT = 5 CT = 46

QT = 158

LT = 204

CT = 78:50

QT = 7:00

LT = 85:50

AcuityLevelIV-V

AcuityLevel

III

AcuityLevel

I-II

SMMC E.D. Value Stream Maps (prepared by KPMG and Rona Consulting Group in the week of November 26, 2007)

5 min 0 min 9:06 min 0 min 1 min 0 min 2:40 min 0 min 20:16 min 11:37 min :20 min

4:36 min 1:09 min 6:43 min 3:18 min 25:45 min 5:45 min 21:10 min 7:45 min 8:13 min 28:27 min 18:31 min

2 min 3 min 25 min 30 sec 10 min 50 sec 7 min 2 min 17 min 1:20 min 10 min

0 min 0 min 0 min 0 min 0 min 3 min 2 min 2 min

Greeter

greet

0 min

CT = 6:15 CT = 46

QT = 158

LT = 204Process iconStands for a majorstep in the process.

Wait iconIndicates that the patientis waiting for providers orbeing moved.

“Push” iconIndicates that patient is movedaccording to requirements ofproviders, not the patient

Data boxReports measures foreach step in a process.

Summary data boxSummarizes measures forthe total process.

CT = cycle time (time to perform process)QT = queue time (time patient waits)LT = lead time (sum of CTs and QTs)

LEGEND

By what method will we make it better?

The Toyota Management System (TMS), also known as the Toyota Production System (TPS), allows its adopters to produce…

…twice as much……in half the time……at half the cost……with half the problems……with a fraction of the inventory……with near-zero defects.

TMS applies to healthcare processes in a very straightforward manner. At least 50% of all work in healthcare adds no value to patients. By mapping the flow of the patient and the daily activities (see value stream map below) of clinicians and support staff, we can identify and eliminate waste and increase the capacity to serve — without additional staff or capital investment. All of this leads to improved outcomes:

• Increase nursing time at bedside by 50% and more.• Increase throughput in revenue-generating operations like the OR.• Eliminate delays in the ED.• Eliminate delays in ancillary services and the discharge process.• Eliminate defects in quality and safety.

Value stream mapping

One of the first legs of the journey to lean enterprise involvesvalue stream mapping key processes:

1. Physically walk the value stream from beginning to end (e.g., follow an ED patient from the waiting room to discharge or admission to the hospital).

2. Identify the major processes in the value stream (e.g., assessment, treatment, discharge, or admission).

3. Measure the “cycle time” of each process in the value stream.4. Total the cycle times and the wait times in between to calculate

a “lead time”.5. Identify the percentage of waste in the process (often around 95%). 6. Construct a waste-free future state value stream map.7. Make it happen.

Seven deadly wastes

Overproduction

Waiting

Transport

Overprocessing

Inventory

Motion

Defects

Originally developed at Toyota to document production and supply chain processes, and to identify major improvement opportunities,

value stream mapping has been applied effectively to healthcare.

Standard work

Healthcare operations are seldom performed in the same way twice and patients constantly wait for care. Standard work reduces variation in healthcare procedures and eliminates waiting by creating standard, repetitive procedures that are carefully timed to meet patient requirements. Based upon systematic time studies of provider activities, standard work is perfectly calibrated to your actual capabilities.

3P (production preparation process)

The 3P process applies continuous improvement thinking and Toyota’s A3 evidence-based change system to the simultaneous development of a new healthcare service and the process by which it will be delivered to the patient. Millions of dollars and precious time are saved when this revolutionary approach is applied to launching new services, building new facilities, or when making any major change to your current operations.

Care that flows

Doctors and nurses are frequently interrupted for all sorts of reasons, some as simple as having to walk to central storerooms to retrieve frequently used items. By organizing repetitive work into logical cycles, combining tasks, moving equipment and supplies to where they are needed, and eliminating unnecessary interruptions, healthcare can be delivered in a continuous flow of value-adding operations, greatly improving patient safety and provider satisfaction.

Patient safety and quality

In a lean healthcare organization, any staff member can “stop the line” if an error is found or suspected. Providers are taught to conduct 100% in-line inspection and mistake-proof work with poka yoke. Alerts triggered by providers are sorted on the basis of severity. Some issues demand executives, physicians, and staff to “drop and run” to investigate and fix the problem immediately. Remaining issues are resolved within 24 hours using the PDCA3® process. Result: Safer healthcare that only gets better.

© 2013 rona consulting group.

TRANSFORMATION ROADMAP

PLAN DO CHECK ACT

Executive leadership

Find your sensei. Train and certify the executive team in lean thinking.

Set up and staff the lean promotion office system.

Build and deploy a companywide improvement policy.

Conduct weekly and monthly progress reviews of value stream process improvement metrics and financial results.

Go “beyond budgeting” and focus on the process, not on results.

Conduct a president’s diagnosis using the Transformation Ruler®.

Training & certification

Train and certify a core group of lean healthcare champions in core tools and training modules focused on eliminating waste and creating flow.

! Value stream maps. ! Standard work. ! Quick setup. ! 5S+2®.

! Visual control. ! PDCA3®. ! Safecare Andon®. ! Careflow®.

The number of modules expands to incorporate methods aimed at creating pull scheduling and supporting continuous improvement. By the end of this period, the client is able to train and certify its own experts in all relevant lean tools.

! Kanban. ! Poka-yoke. ! A3P®. ! TPM.

! Hoshin kanri. ! Value stream accounting. ! Transformation Ruler®.

Healthcare operations

Value stream map OR, perioperative, ED, nursing, and ancillary services.

Conduct time studies and build percent-load charts.

Reduce setup times, redesign work flow, implement standard work, and promote adherence with 5S+2®.

! Implement patient safety andon system. ! Introduce PDCA3® problem-solving documentation. ! Implement pull scheduling to link ancillary services

and doctor referrals with healthcare operations.

Improve continuously: ! PDCA3®. ! Poka-yoke. ! Patient safety and quality.

Administration & support

Value stream map administrative operations, including accounting and human resources.

Conduct time studies and build percent-loading charts; introduce lean accounting practices.

Reduce setup times, redesign work flow, implement standard work, and promote adherence with 5S+2®.

Improve continuously: ! PDCA3®. ! Patient safety and

quality. ! Poka-yoke.

New services & facilities

Value stream map new service development process and establish a gated development system with strict design review.

Improve program management: ! A3P® and the QC matrix. ! Target costing. ! Kaizen costing.

Improve continuously: ! PDCA3®. ! Patient safety and quality. ! Poka-yoke.

Value chain transformation

Measure quality, cost, and delivery; give feedback to suppliers.

Reduce number of suppliers based upon performance criteria.

Work with suppliers to eliminate waste, standardize work, and solve problems.

Involve key suppliers upstream in the development of new services and facilities.

What’s the fastest way to spread a new method?

This question was asked and answered during World War II, when America trained 1.7 million new workers for wartime production. The answer was documented in Training Within Industry, which explains how to set and improve standard work, and lays out a systematic approach to training and certifying managers capable of training front-line workers. The same work methods and systematic approach to training are still taught at Toyota and found in all successful implementations of Toyota’s system in the manufacturing and service industries.

A new method of work needs a new method of managing.

Hoshin kanri or policy deployment is a Japanese management system perfectly adapted to the management of a decentralized decision-making process. Hoshin allows management to align the organization around critical improvement targets that link the development of current capabilities to future performance and customer satisfaction.

Rona Consulting Group’s approach to hoshin kanri is based upon Tom Jackson’s book, Hoshin Kanri for the Lean Enterprise (Productivity Press), winner of the prestigious Shingo Prize. In this book, Jackson explains how to integrate hoshin with PDCA thinking and Toyota’s famous A3 system for visual knowledge management. This powerful combination is the basis for Rona Consulting Group’s PDCA3® process, which informs both standard work and improvement activity in all areas.

PDCA3® (evidence-based change)

The RCG Management System is an evidence-based learning system that utilizes the scientific method for gathering data and promising hypotheses about how to improve healthcare quality, cost, and access. This organizational learning system is based on the Deming Cycle of PDCA (plan do check act) and utilizes Tom Jackson’s prize-winning A3 visual documentation system (at right). Coupled with the A3, the Deming Cycle becomes PDCA3®, a powerful knowledge-management system.

Kaizen promotion office (KPO)

Transformation requires infrastructure. The best way to manage change is to set up a system of KPOs staffed by full-time lean healthcare managers responsible for:

• Focused improvements aligned with strategic organizational goals.• Explicit measurable targets.• PDCA3® process and documentation.• Accountability for implementation. • Enhanced leadership structure.• Enhanced shop-floor support.

A3-T

Proposed team charter Theme:

Date: Reporting Unit: A3 document system © 2007 rona consulting group Page 1

PROBLEM STATEMENT

TARGET STATEMENT

ANALYSIS

PROPOSED ACTION

IMPLEMENTATION PLAN

Action Responsibility Date

CHECK AND ACT (verification and follow up)

A3-i Competitive information report Theme:

Date: Reporting unit:

A3 document system © 2008 Rona Consulting Group Page 1

OBSERVATION

ANALYSIS

IMPLICATIONS FOR THE BUSINESS

A3-SR

Status report Theme:

Date: Reporting unit: A3 document system © 2008 Rona Consulting Group Page 1

BACKGROUND

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Action Responsibility Due Complete

IMPACT

UNRESOLVED ISSUES

Revenue $0

Development costs $0

Material costs $0 =

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Value stream profit $0 =

A3-Xcorrelation correlation / contribution

weak correlation or rotating team member

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important correlation or core team member

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Executive education

The responsibility for lean transformation cannot be delegated. Therefore, all executives complete a ten-day course of study in the principles, concepts, and methods of the Toyota Management System. In addition, each executive is expected to complete and maintain certification to run five-day kaizen workshops and teach others on the shop floor.

Industrial study missions

Let Rona Consulting Group take your leaders on a tour of Toyota or another leading practitioner of the Toyota Management System to see for yourself how it works. Participants tour an operation using the Toyota Production System and then debrief with RCG consultants.

Lean operations workshop leader certification

To support the initital phases of lean transformation, every lean healthcare manager must complete a certification process to learn how to conduct improvement workshops and master the following methods:

• Value stream mapping.• 5S and visual control.• Standard work.• Running a kaizen workshop.• Servant leadership.• Running a kaizen

promotion office (KPO).• Continuous flow.• Mistake-proofing.• Quick setup.• Kanban.• Lean management.

Advancedlean programs

To support the completion of lean transformation, lean healthcare managers receive a second round of training and certification in more advanced methods:

• Hoshin kanri and the A3 system.

• PDCA3® (evidence-based change).

• 3P (production preparation process).

• Patient safety and quality.• Leader standard work.• Coaching.

RCG master class

The RCG master class is a year-long intensive course that serves as a formal succession planning and training program for physicians and future executive leaders of the organization.

Who we are

Bringing together backgrounds in healthcare and manufacturing, our team connects to create the lean systems that are changing healthcare. We are former healthcare executives, administrators, and clinicians. In addition to a background in healthcare, our team also has expertise in developing and advising on large-scale transformation programs for Fortune 100 companies.

We have designed and led groundbreaking applications of lean management to operations in the ER, OR, lab, inpatient flow, and in clinics of major medical centers. Through training and coaching, we are greatly improving patient safety and reducing lead times and associated costs. Our team has an in-depth understanding of authentic kaizen methodology and philosophy. Many of us are students of John Black and Chihiro Nakao of Shingijutsu, Japan. Our clients include integrated healthcare systems, hospitals and clinics, medical suppliers, and governmental organizations.

Please visit our website for our team biographies at ronaconsulting.com.

Services provided by Rona Consulting Group

• CEO and board-level coaching for organizational transformation.• Executive-level coaching for planning and transformation.• Management education, training, and certification.• Value stream mapping and rapid improvement workshops.• Organizational assessment and due diligence.• Healthcare purchasing strategy.• Industrial study missions.

What we do

rona consulting group brochure 2014

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