the next frontier of lean & innovation in healthcare seminar · 22 april 2019, monday 9.00am to...

22 April 2019, Monday

9.00am to 12.00pm

Kwong Wai Shiu Hospital –

Multi Purpose Hall

The Next Frontier of LEAN &

Innovation in Healthcare

Seminar

Organised by:

WelcomeAddress

Dr Ow Chee Chung, Chief Executive Officer,

Kwong Wai Shiu Hospital

Transforming through

LEAN and Innovation

Organised by:

Challenging the “We have always done this way!” Mindset

Ms Denise Bennett, Executive Director,

Australasian LEAN Healthcare Network

Using LEAN in O’Joy’sCommunity Mental Health Work

Mr Choo Jin Kiat, Executive Director,O’Joy Care Services

Bringing Oceans of Joy to Those We Serve

Using LEAN in O'Joy'scommunity mental

health work

Choo Jin KiatExecutive Director

22 Apr 2019

O’Joy Care Services

Using LEAN to transform O'Joy’s

integration of community mental

health care, social care and community care

programs.

Choo Jin KiatExecutive Director

22 Apr 2019

Step One:

What organization problems are we trying to solve and why?

• Funding

• Program Integration

• Database Centralization

• Younger Clients

LEAN’s Definitions:

• Purpose of the organization: to provide products and/or services that solve customers’ problems/fulfil a need.

• Customer’s Value:

• solve my problem completely,

• don’t waste my time,

• give me exactly what I want,

• delivery value where and when I want it and

• reduce the number of decisions I have to take to solve my problems.

• Value is expressed as Safety, Quality, Delivery and Cost.

O’Joy Care Services : Safety

Issue OCD &

personality or addiction

Eating or

Dementia Anxiety or Depression

Trauma &

Social Others

% 2 3 7 10 10 15 20 98 6

1. Assessment - Biopsychosocial Framework & Multi Discipline Team Approach

O’Joy Care Services : Safety

(BPS) Interventions Biological Psychological Social

% 39 99 56

Biological Health monitoring, Improving functionality and safety & Caregiver Psychoeducation& Training

Psycholog-ical

Reminiscence, Person-centred therapy, Mindfulness, Acceptance and Commitmenttherapy (ACT), Cognitive behavioural therapy (CBT), Dialectical behavioural therapy(DBT), Motivational interviewing (MI), Mentalization-based therapy (MBT), Focusing,Compassion-focused therapy, Emotion-focused therapy(EFT), Solution-focusedtherapy, Metacognitive work, Schema work, Trauma work, Grief work, Couplestherapy, Marital therapy, Family therapy, Psychoeducation, Existential counselling,Internal Family Systems (IFS), Behavioural activation, Affect regulation, Addictioncounselling, Pain management & Risk management (suicide, violence, self neglect)

Social Financial help, Housing, Home Improvement, Employment, Personal hygiene,Interpersonal relationships, Legal, Long-term care plan, Social connection, ElderAbuse/Family Violence, Advocacy work & Collaborative work

2. Intervention Approach – Clinical Case Management (CCM)

O’Joy Care Services : Quality

“The organization places a strong emphasis on quality, for example, through extensive training for staff and volunteers; strict service standards; and carefully considered design of its services.”

Philanthropists Forum 2017 Research Report

“O’Joy is one of few non-profits in Singa-pore providing special-ised mental health counselling for older people. Partners inter-viewed by Just Cause, Asia noted that they stand out for being able to offer home visits, speak dialects and under-stand the cultural issues of older people in the area they work.”

“they place special emphasis on staff and volunteer training; and have carefully thought through processes for ensuring and building quality. This was ack-nowledged by stake-holders (interviewed by Just Cause), e.g. “their counsellors are very well-trained”.”

• Between 2013 to 2016, Ang Mio Ko Family Medical Centre (2 MOU signed)

• Between 2015 to 2017, Unity Family Medical Centre (no MOU needed)

• In 2018, 30 Sep 2018, over 50% of the 322 total referral are from GPs, SingHealth polyclinics.

O’Joy Care Services : Delivery

Fulfilling the Purpose of COMIT - Outreach to GP Partners

O’Joy Care Services : Cost

Significant saving-At 6th year, 90% of original 5 years budget

Financial figures FY12/13 FY13/14 FY14/15 FY15/16 FY16/17 FY17/18 Total

Original Budget ($ ,000) 484 472 513 520 535 NA 2,524

Actual Expenses ($ ,000) 362 331 390 496 492 454 2,525

Actual Client Served (Nos) 113 211 267 240 314 359 1,504

Actual Cost/Client ($) 3,515 1,569 1,461 2,067 1,567 1,265 NA

Step Two:

If safety, quality, delivery and cost are good, why the problems still exist?

• Purpose

O’Joy is to provide services that fulfil clients’ mental health, social and/or community needs.

• Customer’s Value

• Who is our customer?

• public funder

• program user

• both

: secondary

: primary

Step ThreeMan: PLUS “Story telling” summary

What organization problems are we trying to solve and why?

• Funding

• Program Integration

• Database Centralization

• Younger Clients

Material: Clients needs

Method: A3 for every clients

Machine: Cloud Case Management System

Thank You

Panel Discussion:

Transformation through LEAN and Innovation

John Shook

Executive Chairman

LEAN Global Network

Denise Bennett

Executive Director

Australasian LEAN Healthcare Network

Low Yee Chang

Performance Improvement Consultant &

Certified Workplace Learning Specialist

Institute for Adult Learning

Choo Jin Kiat

Executive Director

Dr Ow Chee Chung

Chief Executive Officer

Kwong Wai Shiu Hospital

TEA BREAK

Organised by:

Driving Performance

through Leaderships

and Culture

Organised by:

Strengthening Quality Culture through KPICharts

Ms Patsy Pang, Director of Nursing,

Lions Home for the Elders

LIONS HOME FOR THE ELDERS

BEDOK BISHAN

Introduction

•Lions Home for the Elders actively promotes and employs best practicein providing services and programs for the ageing community .

•Our first community home was founded in 1980 and it housed 18destitute and elderly residents.

•Today , Lions Home operates two fully equipped well designed nursinghome at Bishan and Bedok South with capacity to house a total 384residents .

Services

Recreational Service

Rehabilitation Service

Training and Education

Social work and Advocacy

Clinical Service

Aims of the initiative are:

• To establish a recognition platform to strengthen “Quality Culture” in Lions Home for the Elders.

• To recognize the efforts and achievements of our care staff when rendering resident care.

• To increase attention on solutions, encourage on-going innovations and critical examination of care in the ward level.

Key Performance Indicator (K.P.I.)

Chart in the ward

Process1. Gather all QI champions.

- Create awareness

- Allow them to design the chart.

2. Set a target for each core QI indicator.

3. Create the timeline implementation.

4.Implemantation:

- Data: collected the data from QI champions

- Updating the chart: Assigned QI members in each level.

- Review and Analyzing the data: KPI in the ward on monthly basis.

- Sharing of data at Monthly Clinical Meeting.

What have we done so far?

In March 2018, all wards displayed their KPI chart to showcase the outcome measures of the following core quality indicators:

• Hand hygiene compliance rate

• Pressure Injury rate

• Fall incident

• Customer Feedback – number of complaints

• Advance Care Planning (ACP) / Preferred Plan of Care (PPC)

• Medication Discrepancy

The data entered in the charts were updated promptly by Quality Improvement (QI) team members.

What was the result has been so far?

o Helps improved care staff engagement in resident care, communication within the team and promoting sense of ownership.

o Increased the Hand Hygiene compliance rate.

o Increased number of resident with ACP/PPC.

o Serves as a review and monitoring tool for everyone.

Bishan Key Performance Indicator (K.P.I.)

Chart in the ward

Bedok Key Performance Index

(K.P.I.) Chart in the ward

What are our next step?o @ DND we launched the ‘Recognition

Program for Care Staff in Maintaining Key Performance Indicators’

o Refined our awards criteria.

Lesson we learned:

Initially in customer feedback only the complaints is the indicator. After 3 months of implementation we realised that it would be good to include the compliments.

Continuously fine tuning our selection criteria.

Staff recognition @ DND for maintaining Key Performance Indicators

Implementing Senior Management Walk Around

Mr Kelvin Ng, General Manager,

Pacific Healthcare Nursing Homes

REACH OUTSenior Management Walk Around

Kelvin Ng

22 April 2019

Reach Out - Senior Management Walk Around

Senior

Management

Walk Around

(SMWA)

Management By

Walking Around

(MBWA)

1) Senior management is aware of issues on the ground

2) Closing the inter-department communication gap

3) Improve productivity and efficiency

Aim of SMWA

1) Identify members and forming the team

2) Decide on a regular date and time

3) Identify issues when walking around and decide an action plan with timeline

How has been done

1) Most decision can be made on the spot

2) Improve staff morae

What is the outcome

1) Regular walk around to ensure action has be taken

and to identify new issues

2) Encourage all ground staffs in reporting

issues to strengthen SMWA

Follow up action

KELVIN NGMobile: +65 9754 4082

Email: kelvinng@pachealthholdings.co

Thank you

Panel Discussion:

Driving Performance through Leaderships & Culture

John Shook

Executive Chairman

LEAN Global Network

Patsy Pang

Director of Nursing

Lions Home for the Elders

Kelvin Ng

General Manager

Pacific Healthcare Nursing Homes

Tyler Thorpe

Senior Consultant

Great Place to Work Institute

FT Liu

Specialist Adult Educator

Institute for Adult Learning

Mr Goh Keng Hwee

Skills Future Singapore

Healthcare Skills

Framework

Organised by:

Do take a few minutes to give us your feedback of the Seminar by scanning the QR code below. Slides will be sent to you after we receive your feedback. Thanks.

Lunch / Networking Session

Smart Ward Exhibition

Booths by SIT, SSG and GPTW

At Level 10

(12pm to 2pm)

Organised by:

Skills FrameworkFor You & Your Business

Businesses Are Being Disrupted Today

How can we better

prepare our workers

for the jobs of today

and tomorrow?

*The Straits Times (10 Jan 2018 and 31 May 2017) and News Release, 2017 SME Development (SMED) Survey, DP Information Group (DP Info), part of the Experian Group

^The Boston Consulting Group, From Capability to Profitability, Realizing the Value of People Management, July 2012

Supporting Business Growth

Key SME business growth strategies

include:*

• Improving customer service

• Increasing marketing and

promotion

• Enhancing current range of

products and services offered

• Expanding internationally

• Raising productivity

• Expanding domestically

• Developing brand

• Strengthening e-commerce/

online platforms

• Strong Human Resource and developing employees’

competencies are essential to drive such business

strategies and growth

• Companies that are strong in key HR capabilities, such as

recruitment, performance management and talent management,

amongst others, can have up to 3.5 times in revenue growth and

2.1 times in average profit margin^

• Consulted with and developed for employers, the Skills

Frameworks provide a robust and up-to-date reference to

strengthen such key HR capabilities

Skills Framework (SFw) is an Integral Part of the

Industry Transformation Map (ITM)

ovatio

rnatio

Industry Transformation MapA skills and innovation-driven economy

Jobs & Skills

Manpower

profile

Skills

adequacy &

relevance

Career &

progression

pathways

Skills utilisation,

HR practices,

Job redesign &

Workplace

conditions

Skills Framework(s)

SSG’s development of 33 SFWs, Targeting 2/3 Of Workforce

Manufacturing Services

Aerospace Accountancy Landscape

Air Transport Design Media

Biopharmaceuticals Manufacturing Early Childhood Care & Education Public Transport

Energy & Chemicals Environmental Services Retail

Energy & Power Finance Security

Electronics Food Services Social Service

Engineering Services Healthcare Tourism

Food Manufacturing Hotel & Accommodation Services Training & Adult Education

Logistics Human Resource Wholesale Trade

Marine & Offshore Infocomm Technology Workplace Safety & Health and

Occupational Hygiene

Precision Engineering Intellectual Property

Sea Transport

Note: * Completed SFws.5

That help in talent attraction, performance and career management, learning and development …

Each Skills Framework (SFw) Contains Useful Information

Skills and Competencies

Training

Programmes

Technical

Skills &

Competencies

Generic

Skills &

Competencies

Sector

Information

Career

Map/Pathways

Occupations

RolesJob

RolesJob Roles

Critical Work Functions; and

Key Tasks2

Some of our 33 Skills Frameworks……

http://www.skillsfuture.sg/skills-framework

Usefulness of SFw For Key Stakeholders

Individuals

• Education &

career planning

• Training for skills

upgrading and

deepening

• Opportunities for

career

progression or

conversion

• Talent Attraction

• Performance

management

• Career

management

• Learning and

development

Enterprises

• Training

programme

development

• Curriculum

development

and review

• Education and

career guidance

• Policy formulation

• Skills and

manpower

interventions

• Professionalisation

of workforce

Education &

Training ProvidersGovt, Unions,

and Others

SFw for Healthcare – An Overview

6 Tracks:

1. Nursing

2. Occupational Therapy

3. Speech Therapy

4. Physiotherapy

5. Operations (Patient Service Associates)

6. Pharmacy Support

70 Job Roles

111 Technical Skills and

Competencies

18 Generic Skills and

Competencies

93 Critical Work

Functions

932 Key Tasks

SFw for Healthcare – An Overview

• Up-to-date information on the sector such as projected growth, opportunities, job prospects, key

statistics as well as emerging trends.

• Desired personal attributes and highlights emerging skills required

Sector Information

Career Map/Pathways

Job Roles

Job Role Description

provides information on

job scope, work context,

attributes and skill

requirement for every job

Critical Work Functions

comprises a list of key

Skills and Competencies

Skills Frameworks: What’s In It For Enterprises

Talent Attraction

• Conduct workforce planning

• Refine job descriptions for hiring

• Determine selection criteria

• Set interview questions and assessment

Ready Reference, Customisable, At No Cost

SFw enables Enterprises to …. Through enhancing HR strategies and

processes….

2. Build A Performing Culture

4. Develop And Grow Talent

Performance Management

• Refine job roles and performance standards

• Determine criteria to evaluate performance

• Design performance appraisal document

Career Management

• Design organisational chart and career pathways

• Develop career progression plan

Learning And Development

• Identify skills requirements/ gaps

• Identify training courses

• Design training plan

1. Attract The Right Talent

3. Retain Existing Talent

Talent Attraction….

Conduct Workforce Planning

Write Job Description

Determine Selection Criteria

Set interview questions

and assessment

Conduct workforce planningConduct

Workforce Planning

Set Interview Questions And

Assessment

Allied Health Director

Principal Speech Therapist

Principal Physiotherapist

Chief Nurse

Staff Nurse

Assessment

Note: The complete list of Skills And Competencies will be found in the SFw for Landscape booklet.

Example: Occupational Therapist

An Occupational Therapist is responsible for providing client care, performing therapy execution and client education

activities to an assigned group of clients. S/He performs continuing education and research to achieve quality client

care. S/He is also conscientious in providing therapy recommendations based on evaluation of the client’s condition.

S/He may work in various settings such as but not limited to public and private institutions, acute and community

hospitals, rehabilitation centres, voluntary welfare organisations, schools, long-term care facilities and clients’ homes

and work environments. S/He may also work as part of collaborative, interdisciplinary teams which may include

teachers, doctors, audiologists, psychologists, social workers, physiotherapists and speech therapists.

S/He should have initiative and be sensitive to the needs of her/his clients. S/He should possess communication and problem-solving skills.

18Note: The complete list of Skills And Competencies will be found in the SFw for Landscape booklet.

Assessment

Candidates for Landscape Supervisor

Change

Management

Client

Assessment

Occupational

Therapy

Communication Leadership Total Comments

Name 1

Name 2

Name 3

Determine a selection criteria based

on skills and competencies to

shortlist potential candidates for

interviews.

Example: Occupational Therapist

Technical Skills & Competencies Generic Skills & Competencies

The technical and generic skills and

competencies can be used to craft

competency-based interview

questions too!

Skills and Competencies Interview Question(s)

Teamwork (GSC)

Facilitate work team activities,

provide assistance and support

needed by team members and

promote ownership and

commitment among team

members to improve team

performance.

1. Describe a specific incident in your

work experience that you had to

step up and support your team

mates in order to improve your

team’s success.

2. What challenges did you face and

how did you overcome them?

Assessment

Skills Frameworks: What’s In It For Enterprises

Talent Attraction

• Conduct workforce planning

• Refine job descriptions for hiring

• Determine selection criteria

• Set interview questions and assessment

Ready Reference, Customisable, At No Cost

SFw enables Enterprises to …. Through enhancing HR strategies and

processes….

2. Build A Performing Culture

4. Develop And Grow Talent

Performance Management

• Refine job roles and performance standards

• Determine criteria to evaluate performance

• Design performance appraisal document

Career Management

• Design organisational chart and career pathways

• Develop career progression plan

Learning And Development

• Identify skills requirements/ gaps

• Identify training courses

• Design training plan

1. Attract The Right Talent

3. Retain Existing Talent

Self Help

Interview Checklist Job Advertisement

OJT Blueprint Performance Appraisal

What are the Next Steps ?

Download editable SFwstemplates for HRM and HRD processes

http://www.skillsfuture.sg/skills-framework

Download Skills Framework For Healthcare

Download:

• SFw Booklet

• Career Map

• Skills Maps

• Training Programmes Listing

For your reference and adaptation

http://www.skillsfuture.sg/skills-framework/hc

What Are Some Next Steps For Your Enterprise?

Self HelpWorkshops

& ClinicsConsultancy & Other Support

Downloadable resources on SFwsprofessional documents

1-day SFwWorkshops to help enterprises be learn about SFw

SFw Clinics as a further support to apply SFw @ work

Consultancyservices

HR Technology solutions

especially designed for Business Owners & HR practitioners

Attend the 1-Day Skills Framework Workshops COMPLIMENTARY

Key Takeways:

1. Appreciate the intent and purposes of SFw

2. Appreciate the components of SFw (e.g. career pathways, skills)

3. Understand how the SFw can be applied to enhance HRM & HRD

practices (e.g. talent attraction, performance management, career

management, learning and development)

4. Relate how the skills can support business outcomes

https://tinyurl.com/SkillsFrameworkWorkshop

To further discuss how Skills Framework (SFw) can benefit your

enterprise

Barry Chou

Principal Manager, SSG

Barry_CHOU@ssg.gov.sg

Contact us:

Betty Yeo

Senior Specialist, SSG

Betty_yeo@ssg.gov.sg

Enterprisesfor

Summary Of SkillsFuture Initiatives For Your Business

A 2-day programme to develop digital confidence in your employees.

Acquire skillsets in eight emerging areas:

A 1.5hr fully funded workshop tailored to your organisation to empower self-directed learning amongst your employees.

• Entrepreneurship• Finance• Tech Enabled Services• Urban Solutions

Hire fresh graduates from ITEs and Polytechnics with relevant skills and aptitude to meet your company’s needs.

Access to training information anytime

Honours exemplary employers who champion employee’s skills development and build a culture of lifelong learning in their workplace

6 Enhanced Training Support for SMEsClaim Absentee Payroll and enjoy higher course fee subsidy when you sponsor your employees for certifiable courses.

• Advanced Manufacturing • Cyber Security• Data Analytics• Digital Media

For further enquiries on these SSG initiatives, you may contact Enterprise_engage@ssg.gov.sg

More To Come….

To Support You & Your Business

Thank You

CHALLENGING THE “WE HAVE ALWAYS DONE IT THIS WAY”

MINDSETDenise Bennett, RN, MBALean Thinking & Practice CoachLean Enterprise Australia Australasian Lean Healthcare NetworkLean Global NetworkSingapore Institute of Technology

Flinders Medical Centre South Australia

Lean Transformation of Organisations and Leaders

• In the early years, probably more time is spent convincing leaders, clinicians and staff that they should do this than actually doing anything!

• No time• No need• Just another

program• We’re different – it

won’t work here• Not research• We already exceed

benchmark or meet targets

• Them but not me• I say yes but I don’t

do yes• Next new bright

shiny thing

How to get organisations (leaders and staff) to do this!

Staff safety firstZero defects second

Lead with Safety and Quality

PQMS: Packard Quality Management System

Lead with Quality and build on what already exists

MISSIONTo provide Quality, Comprehensive and Convenient healthcare services to the needy in Singapore

VISIONTo be a Leading Community Healthcare Hub in Singapore

Identify a problem

Understand the current state and try to identify root cause or causes

Monitor and measure outcomes

Try something – implement countermeasures

Continue to improve

Lean Thinking and practice looks at qualitythrough different lens

Defects result in defective parts

and scrap

This results in ‘failure demand’Work that needs to be done again

Every time we need to do work again it is wasted

productivity

The further the defect gets in the

production line the higher the impact

The product takes longer to deliver (time to

service)

Improved quality = reduced cost

Quality by adding extra people,

extra steps

Questions for you to consider• How do you currently focus on quality and what currently

exists that you could build on?

Toyota didn’t develop TPS in their finance department

Work on something important to increase relevance & involvement• Access to care is important PLUS

– include something that will improve the quality of care for the patient in front of clinicians

– Something that will make life easier for staff• Use Lean Thinking to break down big problems into

bitesize, achievable pieces

exists that you could build on? • What are the important problems to be worked on? What

are your current strategies for solving these problems?

“I have something I would like to spread to you.”

Don’t do this!

https://blog.ordoro.com/2015/02/24/pull-pull-marketing/

Pull not Push

Adoption not

Spread

It’s lonely on your

Find your first

follower

https://blog.ordoro.com/2015/02/24/pull-pull-marketing/

Pull not Push

Adoption not

Spread

Go where the ‘early adopters’ take you. Lean Thinking and Practice applies everywhere. Every story of improvement will be worth it!

They understand and connect to most

processes, particularly

communication

They spend their lives trying to get other groups of

professionals to do things

They are usually the one who has a birds eye view of the patient

journey (s)

Their role is patient advocate – their

profession is built on connecting with patients

and families

Its not difficult to convince them to reduce waste in

their work

They often provide local and

front line line leadership

Nurses make great leaders of

Lean Thinking

and Practice

Spaghetti diagram

are your current strategies for solving these problems?• Where are your early adopters? How could you unleash

their influence on the organisation?

Make ‘things’ visibleWhere is the

patient journey up to?

Where is the work up to?

Make ‘things’ visibleWhere is the

patient journey up to?

Where is the work up to?

Photos courtesy of Flinders Medical Centre, SA

their influence on the organisation?• Can you see where the patient journey and the work are up

“we have always don’t it like this”“I have always done it like this”

to?• Do you have WADILTs that are an opportunity for engaging

Maybe you don’t need a Lean Transformation• Maybe you are good and you want to be great• Maybe you are average and you want to be good• Maybe you are great and you want to be outstanding • Maybe your service delivery is inconsistent and you want to be

consistent• Maybe you have demands you cant meet• Maybe you have a lot of waste in the system and you want to have

less waste in the system• Maybe you have unsatisfied patients and families and you want them

to be satisfied• Maybe you have some unstable departments you would like to

stabilise• Maybe you want to be better tomorrow than you want to be today• Maybe you have to be better tomorrow than you want to be today

to?• Do you have WADILTs that are an opportunity for engaging

staff• Be clear and consistent about the why – transformation is

not a why

LEAN THINKING AND PRACTICEA business / organisational strategy for everything!• Do you want a safer organisation for patients and staff?• Do you want to deliver higher quality service (care) without

errors or defects?• Do you want your customers (patients) to get their services

(care) without waiting?• Do you want to reduce the cost of your service (care)?• Do you want your staff to be more engaged and morale to

be higher?• Do you want your customers (patients) to be more

satisfied?• Do you want to develop your staff and leaders at the same

Are you prepared to learn, work

hard and get involved?

Getting started with Lean Thinking & Practice1. An internal leader with some influence who ‘believes’ and

would like to lead a lean experiment2. An acknowledgement of what already exists and building

on that wherever possible3. A local area or a horizontal value stream (ideally both) as

an area to experiment4. Someone to teach (inspire, build relationships) and show

the next step 5. Some time to do the improvement6. A plan for sharing the improvement that is done7. A plan for fun!

Spot the WHADILT

the next frontier of lean & innovation in healthcare seminar · 22 april 2019, monday 9.00am to...

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