kaizen event presentation · kaizen event – definition a two- to five-day focused improvement...
TRANSCRIPT
Company
LOGO
Kaizen EventsKaizen Events: : Achieving Rapid Improvement in Achieving Rapid Improvement in
Healthcare SettingsHealthcare SettingsSociety for Health Systems
Orlando, FL
February 21, 2008
Building a Lean Enterprise
© 2008 Karen Martin & Associates 3
KAIZEN
Kai Zen
Break apart
To change
Study
Make better
EVENTEVENTRapid ImprovementRapid Improvement
© 2008 Karen Martin & Associates 4
Who? Accountability Tool
Leadership “What has to happen” Value Stream Mapping / A3
Workforce “How it will happen” Kaizen Events
Improvement RolesS
tra
teg
icT
ac
tic
al
Middle Management
© 2008 Karen Martin & Associates 5
Value Stream Defined
Value Stream: All of the activities, required to satisfy a customer need from request to receipt.
Value Stream
Process ProcessProcess
Customer
Request
“Order”
Customer
Receipt
“Delivery”
Customer
© 2008 Karen Martin & Associates 6
Typical Healthcare Value Stream
Need
Determined
Appointment
or
Admission
Scheduled
Patient
Arrival /
Admission
Evaluation
&
Testing
Diagnosis
&
Treatment
Patient
Discharged
Claim
Submitted
Payment
Received
Patient
Follow-up
Start
End
“Pre-Production”
“Production”
“Post-Production”
© 2008 Karen Martin & Associates 7
Individual vs. System Performance
Isolated pockets of excellence =
sub-optimization risk
Systems focus =
0ptimal value stream performance
Transcribe Report
(MDI)
Lead Time = 5 mins.
% C&A = 75 %
Customer Demand:
15 patients per Day
(Takt Time = 32 minutes)
8 hours per day
Check-in
Patient(Admitting)
Cycle Time = 2 mins.
% C&A = 90 %
5
Send
Reports(Imaging)
Cycle T ime = 3 mins.
% C&A = 90 %
6
Current State Value Stream MapOutpatient Imaging Services
Schedule
Appointment
Cycle T ime = 11 mins.Lead Time = 12 mins.
% C&A = 98 %
6
Pre-register
Patient
Cycle T ime = 30 mins.Lead Time = 990 mins.
% C&A = 100 %
5
CT=Cycle Time
LT=Lead Time
%C&A=% Complete & Accurate
0.0833 hrs.
2 mins.
0.0833 hrs.
1 mins.
1.33 hrs.
28 mins.
4.13 hrs.
15 mins.
6.08 hrs.
5 mins.
16 hrs.
1 mins.
1.83 hrs.
1 mins.
2 hrs.
3 mins.
LT = 32.5 hrs.
CT = 56 mins.
CT/LT Ratio = 2.87%
Lead T ime = 990 mins.
Prep Patient, Conduct
Exam, Transmit
Images (Tech)
Cycle T ime = 28 mins.
% C&A = 90 %
2
Check-in
Patient(Imaging)
Cycle T ime = 1 mins.
% C&A = 98 %
3
Read/Dictate
Exam(Radiologist)
Cycle Time = 15 mins.
% C&A = 95 %
2
Review / Sign
Report
(Radiologist)
Cycle Time = 1 mins.
% C&A = 95 %
2
Reports(Imaging)
Cycle Time = 1 mins.
% C&A = 99 %
2365 mins. 960 mins. 110 mins. 120 mins.80 mins.
E Pay
Excel
ADS
Symposium
Internet
Waiting Room
Management
System
Fax Order
Solutions
PACS
5 mins.
Lead Time = 10 days
Meditech
234
5 6 78 9
1011 12
Auto Fax 50%
Us Mail 25%
MD Mailbox 25%
Rework Loop
via Fax 25% of
the time
Rolled First Pass
yield = 30%
Patient
1
Value Stream Champion: Paul Scanner
Created July 19, 2005
Refer Patient
(Physician)
% C&A = 65 %
Lead Time = 12 mins. 2
5 mins.248 mins.
© 2008 Karen Martin & Associates 9
Key Metrics: Time
�Process time (PT)
� The time it takes to actually perform the work, if one is able to work on it uninterrupted
� Includes “think” time if process is analytical in nature
� aka “touch time,” work time, cycle time
�Lead time (LT)
� The elapsed time from the time work is made available until it’s completed and passed on to the next person or department in the chain
� aka throughput time, turnaround time, elapsed time
© 2008 Karen Martin & Associates 10
Value Stream Lead Time vs. Process Time
Lead Time
Order (Request)
Delivery (Receipt)
Process Time
LT = PT + Delays
© 2008 Karen Martin & Associates 11
Process Block Lead Time vs. Process Time
Work Received
Work passed to next
step
Process Time
LT = PT + Delays
The time it takes
to do the work
Lead Time
© 2008 Karen Martin & Associates 12
Key Metrics: Quality
�%Complete and Accurate (%C&A)
� % time downstream customer can perform task without having to “CAC”:
�Correct information or material that was supplied
�Add information that should have been supplied
�Clarify information that should have been clear
© 2008 Karen Martin & Associates 13
Summary Metrics (continued)
�Activity Ratio (AR)
� The percentage of time work is being done to the product passing through the process
� AR = PT/LT × 100
� 100 – AR = Idle time
�Rolled First Pass Yield (RFPY)
� %C&A × %C&A × %C&A × …
� Out of 100 occurrences, what percentage of the time does the product pass through the entire process error-free?
Refer Patient
(Physician)
% C&A = 85 %
Patient
Send
Reports
(Imaging)
Cycle T ime = 3 mins.
% C&A = 90 %
6
Future State Value Stream MapOutpatient Imaging Services
Schedule appt
Pre-register
Cycle T ime = 11 mins.
Lead T ime = 45 mins.
% C&A = 98 %
6
CT=Cycle Time
LT=Lead Time
%C&A=% Complete & Accurate
0.0833 hrs.
1 mins.
1 hrs.
28 mins.
2 hrs.
15 mins.
7 hrs.
1 mins.
0.0333 hrs.
1 mins.
0.5 hrs.
3 mins.
LT = 11.4 hrs.
CT = 49 mins.
CT/LT Ratio = 7.14%
Lead Time = 45 mins.
Lead Time = 5 days
Prep Patient,
Conduct Exam,
Transmit Images
(Tech)
Cycle Time = 28 mins.
% C&A = 90 %
2
Check-in
Patient
(Imaging)
Cycle Time = 1 mins.
% C&A = 98 %
3
Read/Dictate
Exam
(Radiologist)
Cycle Time = 15 mins.
% C&A = 95 %
2
Review
/Sign
(Radiologist)
Cycle T ime = 1 mins.
% C&A = 95 %
2
Reports
(Imaging)
Cycle T ime = 1 mins.
% C&A = 99 %
22 mins. 30 mins.60 mins.
E Pay
Excel
Symposium
Internet
Waiting Room
Management
System
Fax Order
Solutions
PACS
5 mins.
Set-up
Reduction
Remove
Redundant
Check-in
Standard
Work
Pull System
(Supplies
Kanban)
Visual
Workplace
Voice
Recognition
Batch
Reductions
5S
Co-locate
Standard
Work
Work
Balance
Continuous
Flow
Value Stream
Alignment
Auto Fax 80%
Us Mail 15%
MD Mailbox 5%
Rolled First Pass
yield = 59%
Rework Loop
via Fax 10% of
the time
Customer Demand:
15 patients per Day
(Takt Time = 32 minutes)
8 hours per day
23
4 56 7 8 9
Risk
Reduction
(Joint Commision)
Meditech
420 mins.
1
Value Stream Champion: Paul Scanner
Created July 20, 2005
120 mins.
Reduce Data
Entry
Requirements
Standard
Work
Cross
Training
Standard
Work
© 2008 Karen Martin & Associates 15
Outpatient Imaging Improvement Results
ProjectedMetric Current State Future State % Improvement
Lead Time 32.5 hrs 11.4 hrs 65%
Process Time 56 Mins 49 Mins 13%
Activity Ratio 2.9% 7.1% 145%
RFPY 30% 59% 97%
# steps 11 8 27%
Report rework 25% 10% 60%
Tech Morale Poor Good Significant
Value Stream
1 2 3 4 5 6 7 8 9 10 11 12
2 Improve quality of referral KE Sean O'Ryan
3, 4Reduce lead time beween schedulingand preregistration steps
PROJDianne
Prichard
5, 6Eliminate the need for two patient check-ins
KEMichael O'Shea
6 Eliminate bottleneck in waiting area KEDianne
Prichard
9Eliminate lead time associated with transcription step
PROJ Sam Parks
10 Eliminate batched reading KE Sam Parks
7Reduce inventory costs, regulatory risk and storage needs
KEMichael O'Shea
12 Reduce delay in report delivery PROJ Martha Allen
12 Reduce delay in report delivery KE Martha Allen
Future State Implementation Plan
Executive Sponsor
Value Stream Champion
Value Stream Mapping Facilitator
Implementation Plan Review Dates
11/1/2007
Outpatient Imaging
Date Created
11/21/2007
Allen Ward
Sally McKinsey
Dave Parks 12/13/2007
10/18/2007 1/10/2008
Type OwnerImplementation Schedule (weeks) Date
Complete
Block
#Goal / Objective Improvement Activity
Implement standard work for referral process
Signature:
Date: Date: Date:
Signature: Signature:
Value Stream Mapping Facilitator
Increase percentage of physicians
receiving electronic delivery (rather than
hard copy)
Approvals
Executive Sponsor Value Stream Champion
Implement voice recognition technology
Reduce setup required
Cross-train and colocate work teams
Implement additional fax ports
Collect copays in Imaging
Balance work / level demand
5S CT supplies area; implement kanban
© 2008 Karen Martin & Associates 17
Kaizen Event – Definition
A two- to five-day focused improvement activity during which a sequestered, cross-functional team designs and fully
implements improvements to a defined process or work area, generating rapid results and learned behavior.
Karen Martin & Mike Osterling
The Kaizen Event Planner, 2007
© 2008 Karen Martin & Associates 18
Kaizen Events: Defining Characteristics
� Typically linked to a value stream map
� Aggressive, measurable objectives
� Sequestered cross-functional team (100% focus)
� Short duration: 2-5 consecutive days
� Professionally facilitated
� Emphasis on the elimination of unnecessary non-value-adding activities
� Low cost� Define and exploit the “technical boundaries” of existing
resources
� “Creativity before capital” thinking
� Rapid Implementation (during the event)� Not simply planning for change
ACTION!
© 2008 Karen Martin & Associates 20
Examples of Healthcare Kaizen Events
�Patient flow
� Imaging
� Emergency Department
� Surgery
� OB/GYN
� Cardiac
�Ancillary services
� Lab / pathology turnaround
�Administrative
� Payroll
� Recruiting/hiring process
� Claims
� Medical Records
� Physician Credentialing
�Space
� 5S Nursing areas
� 5S Laboratory
© 2008 Karen Martin & Associates 21
5-Day Kaizen: Sample Structure
Day 1 & 2 Analyze current state and Plan perform root cause analysis;
design future state
Day 3 & 4 Design & test improvements Do, Check using Lean tools; obtain
buy-in
Day 5 Finalize improvements; train Check, Act process workers and
affected stakeholders; provide closeout briefing; CELEBRATE!
© 2008 Karen Martin & Associates 22
Interim Briefings to Leadership
�Every day or two
�Team presents their ideas; leadership assures team has considered all options and thought through all implications
�Leadership’s role – not to say “no”� To say “Have you considered this?” “How would we
handle…?” “What if…?”
�Workforce grows stronger as they learn how to identify and eliminate waste
�Leadership grows stronger as they’re able to shift their focus to strategic planning, performance monitoring, and coaching staff.
© 2008 Karen Martin & Associates 23
Kaizen Event Phases
Execution2-5 Days
FollowUp
4-8 Weeks Post
Planning4-6 Weeks Prior
Workforce
Training
1
2 1
3 2
4 3
5 4
5
1 6
2 7
3 8
4 9
5 10
1
2 1
3 2
4 3
5 4
1
2
3
4
Every day 3:30 - 4:30
Conference Room A
Signature:
No backup if a non-team member tech calls in sick
Executive SponsorPotential Joint Commission surprise audit
Sally McKinsey
Possible Obstacles Approvals
Allen Ward Dave Parks
Marlene Diosdado
IT
MD advisotry board pres
Jerry Gambrell
Dave Madden
Standard work for referral process / patient education piece Function
Radiologist practice president
Potential Deliverables On-Call Support
Reduce LT for report sign-off from 16 hrs to 7 hrs (65% improvement)
Reduce waiting area time from 3 hrs to 30 mins (83% improvement)
Eliminate patient check-in at Admitting
Improve quality of referral from 65% to 90% (38% improvement)
Event Goals and Objectives
Patient dissatisfaction re: "hassle factor"
100% tech turnover in 6 months
Ann Marie
Losing patients to new outpatient imaging center Function
Referring physician complaints re: slow report turnaround
Interim
Briefings
Location
Value Stream
Event Drivers / Current State Issues Team Members
3/27/2008
3:30 - 4:30 pm
Team
Presentation
Event Boundaries &
Limitations
$1,000 budget
No major program changes to Medi-TechEvent Coordinator
Allen Ward
Last Step Referring physician receives report
First Step Physician's office calls scheduling department
Imaging
Outpatient ImagingExecutive Sponsor
Event Name
Team Lead
Kaizen Event CharterEvent Scope Leadership Schedule
Sean Michaels
Dave Parks
Specific Conditions CT ScansValue Stream
Champion
Facilitator
Sally McKinsey
Process Trigger Referral from physician
3/24 - 3/27/2008
7:30 am - 4:30 pm
FacilitatorValue Stream Champion
3/27/2008; TBD (11 am - 1 pm)
Name
Dates
Start & End
Times
Signature: Signature:
Name
Date:Date: Date:
© 2008 Karen Martin & Associates 25
Imaging
Scoping: Refining the Focus
Inpatient
Outpatient
Nuc Med
MRI
CT
X-Ray
Nuc Med
MRI
CR
X-Ray
© 2008 Karen Martin & Associates 26
Kaizen Event Facilitator Traits
� Skills / Knowledge� Lean tools� Root cause analysis� Project & time management� Team building / facilitation� People effectiveness – from front line workers to execs
� Authority / Respect� Designated change agent / influence leader� Trustworthy� Comfortable removing obstacles & reaching out to senior leadership
� Personality / Energy� Challenging, yet supportive� Positive, upbeat, energetic� Pushy without irritating ☺
� Objectivity / Fairness� No attachment to outcome
© 2008 Karen Martin & Associates 27
The Kaizen Team
� The single greatest determinant of event success
� No more than 10
� Cross-functional composition� Process workers
� Upstream suppliers (internal)
� Downstream customers (internal)
� Subject matter experts
� Outside eyes
� External suppliers / contractors
� External customers
� Administrative support (if needed)
� Union representatives (if relevant)
� Maintenance / facilities representatives
� Management (limited representation)
� Sequestered; Must be relieved of regular duties
© 2008 Karen Martin & Associates 28
Kaizen Event Phases
Execution2-5 Days
FollowUp
4-8 Weeks Post
Planning4-6 Weeks Prior
© 2008 Karen Martin & Associates 29
Team Dynamics
Forming
Storming
Norming
Performing
Tuckman Model Bruce Tuckman, 1965
Adjourning
© 2008 Karen Martin & Associates 30
Kaizen Commandments – “Top Twelve”
1. No interruptions from outside the Event.
2. No veto power from outside the team.
3. Rank has no privilege.
4. Abandon departmental / silo thinking.
5. Finger-pointing has no place.
6. Avoid scope creep.
7. Use creativity before capital.
© 2008 Karen Martin & Associates 31
Kaizen Commandments (continued)
8. Think “yes, if…” instead of “no, because…”
9. Get good data, then add experience and “instinct” to the mix.
10. Seek the wisdom of ten rather than the knowledge of one.
11. Keep an open mind. Challenge existing paradigms. Challenge everything!
12. Improvements implemented today are better than planning to implement in the future.
© 2008 Karen Martin & Associates 32
Execution Phase Activities
�Document the Current State Plan
�Perform Root Cause Analysis
�Brainstorm and Prioritize Improvements
�Design the Improvement(s) Do
�Test the Design(s) Check
�Finalize the Design(s) Act
�Implement the Improvement(s)
© 2008 Karen Martin & Associates 33
Execution Phase Activities
�Document the Current State
�Perform Root Cause Analysis
�Brainstorm and Prioritize Improvements
�Design the Improvement(s)
�Test the Design(s)
�Finalize the Design(s)
�Implement the Improvement(s)
© 2008 Karen Martin & Associates 34
Current State Documentation Tools/Activities
�Go to Gemba
�Spaghetti Diagrams
� Calculate motion / transportation costs and productivity losses
�MBPM
�Videotape
�Product samples
�Floor plans / blueprints
�Photos
�Process measurements
© 2008 Karen Martin & Associates 35
What to Look for at Gemba
�“Waste walk”�Workplace organization�Variation in how the work is performed�Work-in-process
� Quantity, oldest in queue, “problem” work, etc.
�Layout� Where people are located relative to their upstream
suppliers and downstream customers� Where people, equipment, and supplies are located
relative to each other
�Ergonomic concerns�Environmental issues – noise, temperature, air
quality, etc.
First, Seek to Understand: Go to Gemba
Spaghetti DiagramEmergency Services
Benefits Verification
Patient History
VitalsPhysician
Office
Imaging
Exam Room
Laboratory
Check-out / Billing
Waiting Area
ORDER CASH
© 2008 Karen Martin & Associates 38
The Cost of Unnecessary Motion
�Distance traveled to printer
� Work Group A = 92 ft. per occurrence
� Work Group B = 696 ft. per occurrence
�120 occurrences / day = 4,656 miles/year
�Walk pace = 1 mile per hour = 582 days/year of unproductive, non-value-adding time = 2.2 FTEs
Understand the Current State: Metrics-Based Process Mapping (MBPM)
Future State Projected Results
Projected
Metric Value Units Value Units Up Down Improvement
Critical Path PT Sum 140.0 minutes 65.0 minutes 53.6%
Critical Path LT Sum 2325.0 minutes 405.0 minutes 82.6%
Activity Ratio 6.0 % 16.0 % 166.5%
Rolled First Pass Yield 23.8 % 75.3 % 217.1%
# of Activities 16 activities 8 activities 50.0%
Projected
Metric Value Units Value Units Change
Sum of Total PTs 155.0 minutes 65.0 minutes -58.1%
Occurrences per Year 37500 occurrences 37500 occurrences 0.0%
Staffing Requirements 46.6 FTEs 19.5 FTEs -58.1%
Desired Direction
Summary Metrics
Projected Future State
Pre-Defined Performance Metrics
Current State
Staffing Metrics
Current State Projected Future State
© 2008 Karen Martin & Associates 41
Execution Phase Activities
�Document the Current State
�Perform Root Cause Analysis
�Brainstorm and Prioritize Improvements
�Design the Improvement(s)
�Test the Design(s)
�Finalize the Design(s)
�Implement the Improvement(s)
© 2008 Karen Martin & Associates 42
Root Cause Analysis
© 2008 Karen Martin & Associates 43
Root Cause Analysis
�Waste is a symptom.
�Causes often lie very deep.
�Must discover the root cause to:
� Avoid band-aid fixes
� PERMANENTLY eliminate the waste.
© 2008 Karen Martin & Associates 44
Key Root Cause Analysis Tools
�Five Whys
�Cause-and-Effect diagrams (aka Fishbone or Ishikawa diagrams)
�Check Sheets / Pareto Charts
© 2008 Karen Martin & Associates 45
Execution Phase Activities
�Document the Current State
�Perform Root Cause Analysis
�Brainstorm and Prioritize Improvements
�Design the Improvement(s)
�Test the Design(s)
�Finalize the Design(s)
�Implement the Improvement(s)
PACE Improvement Prioritization Chart
High LowAnticipated Benefit
Ease of Implementation
Dif
fic
ult
Ea
sy
20
7
513
4 23
1
228
9
2
10
16
11
6
12
1419
15
17
321
18
© 2008 Karen Martin & Associates 47
Execution Phase Activities
�Document the Current State
�Perform Root Cause Analysis
�Brainstorm and Prioritize Improvements
�Design the Improvement(s)
�Test the Design(s)
�Finalize the Design(s)
�Implement the Improvement(s)
Building a Lean Enterprise
Standardize Work
© 2008 Karen Martin & Associates 50
Install Kanban
Time to ReplenishOK
AFTERBEFORE
Organize the Workplace
© 2008 Karen Martin & Associates 52
Execution Phase Activities
�Document the Current State
�Perform Root Cause Analysis
�Brainstorm and Prioritize Improvements
�Design the Improvement(s)
�Test the Design(s)
�Finalize the Design(s)
�Implement the Improvement(s)
�Celebrate!
© 2008 Karen Martin & Associates 53
Implementation = Training
�Training must occur within the Kaizen Event itself.
�Therefore, it must be innovative� Stand-up sessions at the work site
� Multiple offerings in a conference room
� Conference call sessions
� Voice mail blasts
� Web-based support
� Email blasts (NEVER sole training method!)
� Designated mentors
54
55
Event Name
Event Dates
5
6
7
1
2
3
4
• 30-Day List
• Process being addressed
• First & last steps
• Specific conditions
• Event drivers / current state issues
• Objectives
• Boundaries & limitations
• VSM and/or MBPM review
• Relevant metrics
• Photos (if relevant)
Opening Comments
• Key improvements and accomplishments implemented during the event
• Tools used
Kaizen Event
Final Presentation AgendaValue Stream Champion
Agenda Item
Facilitator
Scope and Objectives
• Team introductions
• Agenda
• "Rules" for attendees
"Before" Condition
Key Improvements Implemented
"After" Condition
• Potential obstacles that could prevent attaining projected performance
levels
• New process description
• Projected results (direct and collateral)
Key Open Action Items
Sustainability Plan
Presenter(s)
© 2008 Karen Martin & Associates 56
Kaizen Event Phases
Execution2-5 Days
FollowUp
4-8 Weeks Post
Planning4-6 Weeks Prior
© 2008 Karen Martin & Associates 57
Sustaining Improvement
�Hold weekly follow-up meetings
� Full team presence highly desirable
� Event Facilitator or VS Champion leads
� Monitor process, refine if needed
� Transition improvement oversight from Kaizen Team to area supervision/management
�Execute Sustainability Plan
�Update VSM
�Conduct 30-Day and 60-Day Audits
58
Plan to Succeed – The Sustainability Plan
59
Sustainability Plan – Page 2
60
© 2008 Karen Martin & Associates 61
Karen Martin, Principal7770 Regents Road #635San Diego, CA 92122(858) [email protected]
Additional Questions