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ACMC LDI March 7, 2013 DFox 1

Integrating LEAN and Baldrige

Pattie Skriba – VP, Business ExcellenceVikram Patel – Director, Operations Improvement

About Advocate Good Samaritan Hospital

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Vision: Provide an exceptional patient experience marked bysuperior health outcomes and service.

2004 G2G 1.0 – Clinical and service excellence

2006 G2G 2.0 – Process honoring culture (Baldrige)

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Moving from Good to Great (G2G) Transformation


Milestones Achieved Along the Way

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2009, 2011, 2012, 2013

2008, 2009, 2010, 2011, 2012, 2013

#1 in Illinois & #4 in the USAfor Overall Hospital Care 2010100 Great Hospitals

2012, 2013

2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013

2011 The Reason for Action

UNFUNDED RETIREMENT & HEALTH CARE COSTS

Taking Action on the DataTo provide an exceptional patient experience marked by

superior health outcomes, service, and value.


Vision: Provide an exceptional patient experience marked bysuperior health outcomes, service, and value.

2004 G2G 1.0 – Clinical and serviceexcellence

2006 G2G 2.0 – Process honoringculture (Baldrige)

2011 G2G 3.0 – Value (LEANEnterprise)

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Moving from Good to Great (G2G)

Integrated Approaches

Strategic &Operational

Goals

Aligned Approaches

Strategic &Organizational

Goals

Integration

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“Effective integration goes beyond alignment and is achievedwhen the individual components of a performance

management system operate as a fully interconnected unit”-- Baldrige Glossary

Reacting to Problems


Goals

Early Systematic Approaches


Goals

What Baldrige and LEAN Have in CommonThe Value, Process, People, Continuous Improvement Connection

LEAN• Minimizing waste• Improve PROCESSES• Create VALUE• Respect for PEOPLE

Baldrige• Create VALUE (1.1, 6.1, 6.2)• EngageWORKFORCE inimprovement (5.2)

• Improve work PROCESSES (6.1)• Ensure effective OPERATIONS (6.2)


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Results

Maturing ofApproaches

Systematic ApproachesSelf defined;LEAN;Evidencebased; etc

Baldrige Criteria238+ required approaches

Level, Trend, Comparison

Non-PrescriptiveAdaptable –What It Takes to Be World-Class

Select / De-Select Approaches that Address Criteria

ADLI

The Framework for Integration

Integrating LEAN and Baldrige:Addressing Individual Criteria Items

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Example 1:

P.2c What are the KEY elements of yourperformance improvement system…?

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Our Performance Improvement System: LEAN Methodology

Identify the Problem What’s the problem?1

Set the Aim What are we trying to accomplish?2

Select the Change What changes could we make to improve?3

Select the Measure How will we know we’ve improved?

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5 Test the change

GSAM’s Performance Improvement Approach v 1.0

Box 1:Problem Statement

Box 4Root Cause Analysis

Box 7: CompletionPlan

Box 2:Current State Box 5: Solutions Box 8: Confirmed

State

Box 3:Ideal State

Box 6:Rapid Experiments

Box 9:Insights

GSAM’s Performance Improvement Approach:PDSA – A3 v 2.0

PLAN

PLAN

PLAN

PLAN

PLAN

DO

DO

STUDY

ACT

GSAM’s PI System: Deployment

Transformation&Inno

vatio

n

Rapid Improvement EventsMonthlyWeek longParticipants: frontlineA3 methodologyFriday report outs

GSAM’s PI System: Deployment

Transformation&Inno

vatio

n

DailyIm

provement

Lean LeadershipDevelopment

Learn, Do, Coach, Mentor24 month deployment


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5.2 How do you develop the workforce toachieve high performance?

How do you engage the workforce inimprovement and innovation?

Baldrige Criteria

PI Approach: Breadth and Depth of Deployment

Prior to 2011 2012 2015Target Condition

NumberTrained 100 All 160 leaders and

150 associatesAll 160 leaders and 750associates

Number Doing 33 160 leaders and 150associates

160 leaders and 1000associates

Number ofImprovements 500 per year >1000 32,000 (2 improvements

per associate per month)

Number ofTransformations(Innovation)

Random One value stream per18 months

One value stream per 18months

Integration: PI Approach – A3-PDSA

Create and modify action plans – 2.2Improve organizational performance 4.1Improve health care services – 6.1Improve work processes – 6.1ADLI

P.2c Performance Improvement SystemA3 PDSA


Lean Approach = the ‘L’ in ADLIThe Improvement Engine

• Approach – Is your approach systematic andrepeatable?

• Deploy – Is your approach used by everyone andin every place it should be?

• Learning Have there beenimprovements to the approach?

• Integration – Is the approach integrated withother organizational priorities and processes?

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Examples: Using A3 PDSA as PI Approach

6.2a How do you control the overall costsof your operations?

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Example 2:


Box 1:ProblemStatement

Box 2:Current State

Good Samaritan: Supply ManagementExcess on-hand supply inventories

$10,459 on this cart alone

$5000 storage closets

Have too much, or not enough“Stuff” everywhereExpired suppliesOrdering in silosMultiple ordering processes‘Non-stock’ ordering – expensive!

Box 3:Target State

Good Samaritan: Supply Management• Reduce inventory & supply costs• Pull system replenishment• Eliminate ‘non stock’ ordering• Get RNs out of the stocking business!

If we: Then:

Convert Omnicells to a 2 BIN system• Less on hand inventory• Less trips and counting supplies• RNs won’t stock! More patient care time

Convert non stocks to stock items • Leverage supplies across GSAM ($ savings)• Departments out of the materials business

Box 5:Solution

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2 Bin System ImplementedCritical CareCV HartPACUDialysisEmergency Department

Progressive Care UnitTelemetry UnitsMed/Surg UnitsSame day surgery

39% CostSavings


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Box 8:Confirmed

State

Metric Initial Target Confirmed

Supply cost savings due to 2 Bin 0 30% 39.86%

2012-2013

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6.1 How do you design, manage, and improve your health care services to deliver value?

How does your day-to-day operation of work processes ensure that they meet key process requirements?

Example 3:

4.1 How do you improve organizational performance by using data and information at all levels and at all parts of your organization?

Box 1:ProblemStatement

Box 2:Current State

Box 3:Target State

2013 Target & Stretch Goals1 > 1.162 1.16

Target 3 1.044 0.98

Stretch 5 0.92

2011 Baseline 1.442012 Baseline 1.16

Good Samaritan: Vent Index

Too many patients unnecessarily on ventilators causing distress to

patients, complications, deaths and avoidable costs


Box 4:Root CauseAnalysis

Box 5:Solutions

Good Samaritan: Vent Index

Key Root Causes Key Solutions

•Documentationincomplete – not surewhen patient is ready tobe extubated

• RN / MD education• Report 2x daily to ensurecompleteness coaching

•No standard work for RNand respiratory for trialprocess

• Created and documentedrole specific standard workwith timeframes

• Respiratory changed starttime (1 hour earlier)

• Physician with airwayskills not available whenneeded

• MD collaboration to ensurein house coverage forextubation

•No process to ensurestandard work is followed

• Visual management toidentify ‘defects’

Why are we not at target state?

Daily VisualManagement:

Identifies ProcessDefects and Allowsfor ImmediateCorrection

Hospital Goal

Monthly Performance

Daily Performance

Root Causes of ‘Defects’

Actions to Improve

Hospital Goal


Monthly Performance

Daily Visual Management:Identifies Process Defectsand Allows for Immediate

Correction

Daily Performance

Root Causes of ‘Defects’


Actions to Improve

Box 8:Confirmed

State

1.29

1.19

1.06

1.02

1.20

0.96

0.87 0.83

0.93

1.34

1.20

1.13

1.07

1.03

0.98

0.92

1.00

0.96

0.75

0.85

0.95

1.05

1.15

1.25

1.35

1.45

4 QTR2011

1 QTR2012

2 QTR2012

3 QTR2012

4 QTR2012

1 QTR2013

2 QTR2013

3 QTR2013

4 QTR2013

VENTRA

TIO(OBS

ERVE

D/EX

PECT

ED)

Advocate Good Samaritan HospitalVent Day Ratio

4 QTR 2011 4 QTR 2013

GSAM

SYSTEM

Current Performance:Top Decile

GOOD

Visual Management to Sustain

Mar 3-8

Mar 3-8

Mar 9-15

Mar 9-15

MonVENT

MonVENT


Integrating LEAN into OrganizationalProcesses: HowWe Lead

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UnderstandStakeholder Requirements

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Accountability for Results

PatientCommunitySuppliersPartners

PhysiciansVolunteersAssociatesFamilies

MissionValuesPhilosophy

IntegrityPassionCaring

Perform toPlan

Learn, Improve& Innovate

Set DirectionEstablish Goals

Organize, Plan & Align

Visual ManagementStandard Work

Goal Cascading

Annual Goal Setting Process

A3-PDSA

Integration of the Lean Management & Tools: Leadership System

Develop, Reward & Recognize

Observe & Coach

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Mark, ManagerCritical Care Unit

2014 Quest ParticipantsBaltimore, MD

ATTN: Those Interested in an Innovative Approach in Healthcare


FINAL EXAMPLE

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Caring for the Addiction Patient

1.2c Societal well-being

1.1a Vision and values 1.1a

4.1 Improving organizational performance 4.1

6.1 Improving health care services & work processes

3.2a Identify service offerings

P.1b Role of partners in innovation

6.1 Designing healthcare services and processes to meet requirements

3.1 Listen to, interact with patients to obtain actionable information

Truly Caring for the Addiction PatientUsed “A 3 thinking” with staff,physicians, and a patient to uncoverroot causes of current stateDedicated unit and willing staffMedical Director to ensure patients’safety and best protocolConsistent approach adopted – focuson the disease process and educatedpatients and families that addiction is a‘disease of relapse’‘Stigma’ removedInnovative partnership with AAReduced 30 day readmission rate by30%Decreased cost of care for this patientpopulation by $2M between 2011 and2013

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