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Managing Change: Developing a LEAN Leadership

CultureMay 25th, 2017

Alicia Hynek, RN, BSN

Rene Salazar, MS, PMP

ABOUT US

CLINICAL CARE DELIVERY SYSTEM + HEALTH INSURANCE PROVIDER

75,000+Members

800+Employees

41 Years

Making a Difference in

Our Community

OUR COMMON VALUES

Innovative

Quality Driven

Patient Centered

Community Involved

Non-Profit Cooperative

WHAT WE OFFER

Access to Hospitals

and

Specialty Partners

Primary Care and

Select Specialty Care

PRIMARY CARE SERVICES

Family Practice

Internal Medicine

Pediatrics

Geriatrics

Laboratory

Radiology

Pharmacy

Urgent Care

SPECIALITY CARE SERVICESBehavioral Health

Chiropractic

Clinical Health Education

Complementary Medicine

Dermatology

Eye Care

Occupational Therapy

Physical Therapy

Podiatry

OBJECTIVES

Integrate and adapt MGMA resources to implement a LEAN leadership culture

Motivate and engage front line staff through LEAN concepts

Maintain momentum to sustain a LEAN leadership culture

INTEGRATINGRESOURCES

LEADERSHIP OUR BODY OF KNOWLEDGE

Senior Leader and Chief Nursing Officer sponsorship, extensive quality and practice management knowledge

Clinical Practice Solutions Manager, RN BSN and Yellow Belt Lean Six Sigma

Business Strategy Analyst, Project Management Professional and Green Belt Lean Six Sigma

Practice Operations Specialist, Certified Medical Practice Executive

RESOURCES

MGMA “Using Lean Principles inMedical Practice” – free webinar withMGMA membership

MGMA LEAN Leadership Modules

MGMA LEAN Leadership Project Toolkit

MGMA Final Exam

ADDITIONAL RESOURCES

GHC Project Management Resources

Institute for Healthcare Improvement – ihi.org

2015 Wisconsin LEAN Government Conference Information –wisquality.org

American Society for Quality – asq.org

UW Health Improvement Network Toolkit – uwhealth.org

Catalysis Formerly ThedaCare Center for Healthcare Value –createvalue.org

Mind Tools – mindtools.com

Lucid Charts – lucidchart.com

Poll Everywhere – polleverywhere.com

The Institute for Health Care Improvement “Triple AIM” and “LEAN” Defined

“Triple Aim”:

Improving the patient experience of care (including quality and satisfaction)

Improving the health of populations

Reducing the per capita cost of health care

“LEAN”:A continuous improvement process that systematically seeks to achieve small, incremental changes improving efficiency, quality, and satisfaction.

MOTIVATE & ENGAGE

SETTING THE STAGE

Have any of your organizations encountered…?

Multiple changing methodologies for process improvement

Change fatigue

Limited resources

Limited budget

Without Using the word “LEAN”, use one word or phrase to describe LEAN

GETTING STARTED Planting the Seeds

Senior Leadership Buy-in

Choose your team (Clinic Managers and Site Chiefs)

Introduce LEAN principlesMGMA Lean Leadership

Modules and WebinarMGMA LEAN Final Exam

Obtain LEAN Concepts and Process Improvement techniques from a wide array of resources

Why start with middle management?

• Support local leadership• Create a strong foundation for improvement• Enhance knowledge for our mentors

CURRICULUM DESIGN

Focusing on the patient

Removing unnecessary steps and waste

Making hard to perform steps easier

LETTING TEAMS LEARN THE PROCESS Maintain Flexibility In Learning

Some projects were not “LEAN”

Important for dyads to learn the concepts and tools to be able to share with their teams

Open approach to start out with “LEAN” creates Buy-In

Designed our process to incorporate flexibility with use of tools

Respected peoples leadership voices and uniqueness of each clinic site

PRACTICE MANAGEMENT TEAM PLANNING

12/17/2015 5/24/2016

1/1/2016

12/17/2015

· MGMA Final Exam· Overview of Lean Project

and Learning Module Pathway

1/14/2016

Project Concept Question Poster in Depts/Clinic Sites

1/28/2016

Bring Top 3

1/25/2016

Voting Dots – Poster Questions

1/29/2016 - 3/10/2016

“PLAN” Phase

3/11/2016 - 4/7/2016

DO” Phase

4/8/2016 - 4/21/2016

"CHECK" Phase

4/22/2016 - 5/5/2016

"ACT" Phase

5/19/2016

CLC Mgr Meeting Dry Run

5/24/2016

Mgr Mtg Project Presentation

Started out with simple timeline

Important not to overwhelm the teams

12/1/2015 6/30/2016

1/1/2016

Ongoing Process

Improvement

6/7/2016

Mgr MtgPresentations

· PDSA Model Explained· 5X5 Template

6/2/2016

CLC Mtg 5X5 Project

Presentation Dry Run

1/28/2016

Defining the Project –· Voting Dots· Affinity Diagram· Project Charter Dcmt· A3 Worksheet· SMART Goal Handout

1/14/2016

Project Concept –· Timeline and Talking Points· Brainstorming Poster · Instructions for Clinic Sites

2/4/2016

CLC Meeting – · TOP 3 Discussion· Project Selection

12/17/2015

LEAN Project Overview –· MGMA Final Exam· Learning Module Pathway

1/29/2016 - 3/24/2016

"PLAN" Phase1/29/16 to 2/18/16 --· Brainstorm· Select Project2/18/16 to 3/10/16 --· Draft A3 Project Charter Worksheet

a) Define Problem Statementb) Define Team and Stakeholdersc) Identify SMART Goalsd) Define Project Scopee) Define Organizational Impactf) Define Resources,

g) Draft Brief Project Plan) · Root Cause Analysis (5 Whys) 3/10/2016to 3/24/16 -- · Develop Project Plan

(Identify “Change in Process” to Test)· Identify Current and Future State· Define Measure of Success

4/14/2016 - 4/28/2016

“STUDY” Phase· Create shared understanding · Identify “New state”

4/28/2016 - 5/12/2016

“ACT” Phase· Need to Repeat Cycle?· Set goals for Ideal State· Continue to measure and improve

3/24/2016 - 4/14/2016

"DO" Phase· Carry-out steps in Action Plan for Test of Change· Adjust Plan as needed· Gather data on test of change (Measurement)· Identify Risks to Project

5/12/2016 - 5/30/2016

Manager Mtg Presentation Preparation

5/19/2016

Closing A Project· Create a Sustainability Plan· Lessons Learned

PRACTICE MANAGEMENT TEAM PLANNING –Creating the Timeline

GHC-SCW Clinic Staff Brainstorming Process

PROJECT SELECTION Affinity Diagrams and Voting Dots

CREATING VALUE FOR OUR MEMBERS Eliminating Waste

WASTE = Non-Value Added Activities

PROJECT CHARTER A3 WORKSHEET Combined the MGMA Project A3 Worksheet from the MGMA toolkit with our Project Charter GHC-SCW Document

ROOT CAUSE ANALYSIS5 WHYS

PROCESS MAPPING

Teaching and Tools of the

Trade

FacilitatorPost-It NotesMarkersTeam Ideas

EXAMPLE OF PROCESS MAPPING

REDEFINE and REFOCUS

PROJECT PLAN An organic and dynamic tool used throughout process

MANAGING RISK FAILURE MODES and EFFECTS ANALYSIS(FMEA)

STUDY and ACT PHASES Principles of Forming, Storming, Norming, and Performing –

Understanding the stages of team formation allows teams to recognize, develop strategies and quickly become a high-performing team www.mindtools.org

IHI PDSA Worksheet www.ihi.org and MGMA PDCA Worksheet (MGMA Lean Leadership Project Toolkit)

5X5 PRESENTATIONS

Highlighted growth and success of the project teams

MAINTAINING MOMENTUM

CREATING BUY-IN

Investment in middle management growth

Engagement of frontline staff

Engagement of Senior Leaders

Securing 2017 Budget

PROJECT COMPLETION

• Presentation at Managers’ Meeting

•Celebrate Accomplishments

• Lean Principles used new improvement projects

• Successful projects moving into phase two projects

SUCCESSES – URGENT CARE

SUCCESSES – DEFOREST CLINIC

THE VALUE OF DATA

“Without data, you’re just another person with an opinion.”

W. Edwards Deming

BARRIERS AND CHALLENGES

• Inconsistent Senior Leadership sign-off

•Not all projects were Lean projects

•Selected a fixed set of tools

•Building trust through failure

LESSONS LEARNED

Staff engagement at all levels

Regular check-ins create accountability

Peer group offered space for sharing

Process improvement is not busy work

Measurement is keySponsorship sign-off is critical

to successSimple solutions are usually

the answer

Without Using the word ‘Lean’, use one word of phrase to describe Lean

It’s so simple. I could have done that!

GOING FORWARD

Making it Stick –Creating a New Culture

Continued Senior Leadership Buy-in

Curriculum Development

Fostering Leaders at All Levels

Maintaining a Budget

No Assumptions

Creating Spread

Communication

TimeEncouragement

Engagement

Value Cost

CULTURE CHANGE AND SUSTAINABILITY

QUESTIONS

Alicia Hynekahynek@ghcscw.com

Rene Salazarrsalazar@ghcscw.com