Building Of A Value Stream

Presented by:

 

Kelly Miller, Senior Director Improvement Institute
Mamta Reddy, MD, Medical Director, Continuous Improvement
Rockland Kuhlman, Performance Improvement Consultant, Children’s Mercy Kansas City, Missouri

In October 2015 the ambulatory value stream kicked off, which set into motion the transformation of services impacting 500,000 visits annually, across seven locations in a bi-state region.  Learning and innovation from the four-year journey led the way for a value stream development road map. 

Key learnings included:

• Evaluation of value stream readiness and need for a support infrastructure
• Crucial roles within the value stream, including a triad leadership team (nurse/provider/business professional)
• Timeline for achieving value stream milestones
• Determining best practices among 6 model lines and methods for spread to 30 additional speciality clinics
• Continuous evaluation and adjustments to the daily management system and approach to problem solving
• Vital elements of sustainment

Results: NRC (patient experience) survey percent for “Overall Rating” showed dramatic increase from DecFY2016, 73.5% to DecFY2019, 83.2%.  Number of clinics with 3rd available within 10 days increased 41% in 2015 to 62% in 2018.  Ambulatory gross revenue increased 12.57% from FY2016 to FY2018.

At the end of this session, attendees should be able to

• Recognize the benefits of value stream thinking.
• Consider the value stream selection criteria and infrastructure requirements.
• Relate the roles and responsibilities within the value stream and benefits of a value stream manager to your organization.
• Describe key elements in gaining buy-in from clinicians

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Connecting Financial Stewardship And Process Improvement

Presented by: 

 

 

Jeannine Grinnell, SVP Chief Financial Officer

Learn why Valley Medical Center – Washington’s oldest and largest Public Hospital District – made the decision to leverage process improvement as their fundamental approach in achieving their mission: caring for their community like family – and why they thought the CFO would be the most compelling and best sponsor.  The organization understands that clear financial stewardship underpinning process improvement is a necessity in achieving their vision of becoming a highly reliable organization by 2025.

At the end of this session, attendees should be able to:

• Connect financial stewardship & process improvement
• Describe why CFO as a primary sponsor can support innovation
• Describe how traits of an effective CFO line up with Improvement

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Digital Daily Management

Presented by:

 

 

 

Lucy Xenophon MD, Chief Transformation Officer
Brian Radbill MD, Chief Medical Officer

In direct response to a flawed information framework of “too much, too late, and too fragmented,” Mount Sinai Morningside (MSM), an urban community hospital in New York City, set out to investigate the hypothesis that a radical change in the way we access and utilize information can increase flow and prevent safety events before they occur.

An underlying premise of the MSM daily management strategy is that staff at all levels of the organization are expected to both do the work and improve the work. We did not have real-time information to understand current state and to support improvement. That gap led to the creation of the James Jones Daily Management and Incident Command center (DMC). The vision for the Command Center is to make select actionable information available in real-time, display it transparently to multidisciplinary stakeholders, and have that information be easily accessible for both daily operations and disasters.

In this session, participants will learn how we used Lean to design the DMC, how we use the DMC to support and improve daily operations, and how we are partnering with data scientists to experiment with predicative analytics for daily management.

At the end of this session, attendees should be able to

• Articulate how and why to integrate an information framework into daily management
• Describe the process by which a multidisciplinary team can use a real-time information framework to foster transparency and break down siloes of care
• Use case studies to demonstrate how digital information supports improved performance in patient safety and flow in real-time

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How An Award-Winning Culture Is The Foundation For Employee Engagement

Presented by:

 

 

Gambrelli Layco, Lean Analyst
Rachel Klemens, Director, Culture and Engagement

With hospital turnover rates at 18% and continuing to rise annually, and facing an ever tightening labor market, implementing a positive onboarding experience is no longer an option, but rather a necessity for healthcare organizations that hope to attract and retain top talent and to provide exemplary patient care.  Effective onboarding serves two functions: (a) to provide a new employee with the knowledge and tools to perform their job functions well in the near term; and (b) to foster employee engagement and improve retention in the long term.  While many organizations are making strides in delivering the former, multiple challenges arise in implementing the latter, particularly when there is not a company culture needed to support it.  Learn how CHG Healthcare’s culture, systems and tools play a central role in its continued success, exhibiting sustained growth while maintaining its reputation as one of the “100 Best Companies to Work For” by Fortune magazine each of the past ten years.     

At the end of this session, attendees should be able to:

• Identify key elements of an effective onboarding process
• Recognize the culture necessary to support it
• Develop a list of ideas to implement in their organization

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Lean Game Night - Simulations As First PDCA Tests

Presented by: 

Kaitrin Bassett, Senior Kaizen, Quality, and Safety Consultant
Elisa Bledsoe, Kaizen Specialist

Learn through play! By utilizing the same set up as familiar board games, we can quickly get results, create spaces where it is safe to fail, or even learn in spaces that do not yet exist, all to better design how to bring value to the patient. Salem Health will share their own story on how they have increased velocity of PDCA cycles without negatively impacting patients through the implementation of table tops and other game-like scenarios. These scenarios include: the rebalance of tasks across roles in the ED, redesign of ED flow to maximize patient throughput, Pharmacy space remodel, prediction of the flow of traffic when building a new tower, and emergency preparedness for computer system failure within the lab. Armed with data and some game pieces, attendees will learn how to set up their own simulations, and practice with the scenarios from Salem Health described above.

At the end of this session, attendees should be able to:

• Identify opportunities for using simulation (and when not to)
• Understand how to use data to create a system for testing
• Verbalize how to turn games into actionable tests

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Lean Facilitation - It's Not A Magic Show

Presented by:

Judy Yankey, Lean Project Manager
Mary Brickels, Lean Project Lead I

Merriam-Webster states that magic is an extraordinary power or influence seemingly from a supernatural source.  The work of a lean facilitator is sometimes viewed as a “magic show” – especially as the facilitator develops the ability to ask thought provoking questions that respectfully ask the leaders and their teams to delve deeper into their subject matter.  This learning session will break down a few of the most important elements of lean facilitation and uncover what is needed for a successful facilitator and coach experience.  Some highlights include: discussing the importance of developing a clear, concise event/initiative charter and eliminating scope creep, discussion and practice around the importance of clear communication, and how to successfully use humble inquiry to ask those crucial questions that might be “the elephant in the room”.  Finally, the session will discuss how to coach to the roles and responsibilities before, during and after an event and why this step should never be omitted. Promoting ownership of those in leadership versus having the ownership lie with the facilitator is key to the success of all lean ventures.  

At the end of this session, attendees should be able to

• Explain the importance of charters and scope definition to the success of facilitation
• Differentiate between Humble Inquiry and other types of questions (and the pros and cons of each style of questioning)
• Describe the importance of the facilitator role in the Lean process
• Know the difference between being a facilitator and a participant

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Reducing Provider Burnout Through Patient-Centered Care

Presented by:

 

 

Mandy Bakner, Lean Promotion Specialist
Eileen Hissong, CRNP

This presentation will walk the audience through a journey about a CRNP who had her resignation letter written, preparing to leave due to frustrations with the amount of indirect work she had accumulated as a practitioner.   The indirect tasks resulting from the implementation of an EMR had become too much to handle and she was burnt out.   Recognizing this, she contacted the Lean Promotion office to see if they could help as a last effort.   After many hours of observation, data analysis and PDSA cycles, she is still with the organization and leading improved workflow initiatives for all outpatient practices.   In the beginning, she was spending 10-12 hours a week at home working on documentation and has successfully reduced that to 3-4 hours by focusing on the patient experience.  With the introduction of patient self-rooming, waterfall scheduling, and in room checkout, she admitted to taking a vacation without her computer for the first time in 7 years and has improved access for her patients by seeing an additional 32 patients each month.  This presentation will describe how Wellspan Family Medicine in Waynesboro is changing healthcare delivery through continuous improvement and patient-centered care.

At the end of this session, attendees should be able to:

• Identify ways to streamline patient flow in primary care.
• Discover ways to reduce provider burnout.
• Understand cycles of continuous improvement.

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Resident-Driven DMS At A Safety Net Hospital

Presented by:

 

Jens Krombach, Medical Perioperative Director

Zuckerberg San Francisco General Hospital examined their process improvement activities from 2016 to 2018. Their lean Daily Management System (DMS) includes a 15-minute team huddle (“UroLean”) of service residents, faculty, clinic and operating room (OR) nursing staff, and anesthesia liaisons. Their DMS also includes a 5-minute preoperative huddle. Besides team-building, UroLean surfaces logistics, safety or equipment improvement ideas, and ensures progress and completion of initiated projects.

RESULTS: Over a 2-year period Zuckerberg developed and completed 67 projects. Projects impacted the outpatient setting (57%), followed by the OR (22%), the Urology service (12%) and inpatient setting (9%). We completed projects in the following domains: safety (26%), quality (22%), care experience (21%), workforce care and development (13%), equity (11%), and financial stewardship (7%). UroLean significantly reduced new patient clinic access time (119 to 21 days), and Bacillus Calmette-Guérin (BCG) in clinic treatment time (180 to 105 min). The average urology on-time surgery start was better than the overall surgery start mean (71% v 61%).

CONCLUSIONS: UroLean successfully applied DMS in a service specific yet holistic approach. UroLean improved resident engagement in quality and safety endeavors and served as a DMS model throughout perioperative and clinic areas.

At the end of this session, attendees should be able to:

• understand the complexity of DMS in the OR
• understand how integration of MD and trainees in DMS can be successful
• understand the benefits of a holistic specialty DMS approach

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The Power of Model Cells In Healthcare

Presented by:

 

 

 

Aaron Hunt, Director, Performance Improvement
Alyssa Lancaster, Nurse Manager

Washington Health System launched their first model cell or “Innovation Unit” in the fall of 2016.  The goal was to create a patient care unit where the patient family experience is completely redesigned and standardized through incremental improvement.  This unit would be a demonstration and learning one that uses the Washington Performance System (grounded in the principles of Lean/Toyota Production System (TPS)) to generate ideas to adopt, adapt, or abandon. Innovation is encouraged to increase the quality and safety of care provided to patients while eliminating waste and decreasing costs.   There is continuous rapid cycle improvement and continuous learning while patients and their families are partners in the care process and problems are being solved in real time.  The unit management actively participates in providing real time feedback, coaching, and holding team members accountable for their standard work. The unit goals are aligned with WHS goals, mission, vision, and values, and the best practices from the model cell are spread throughout WHS through pull.  Applying visual management to patient care activities, identifying and eliminating missed and excessive care, and achieving top decile patient satisfaction scores are some of the results that have been  realized.

In the fall of 2019, Washington Health launched an Innovation Practice focused on reducing provider overburden and increasing patient access.

At the end of this session, attendees should be able to:

• Understand why piloting in a small area speeds overall change
• Understand some cultural considerations for building a model area
• Connect Lean improvement methods to improved Employee Engagement.

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