mr. potato head: a lean, mean quality improvement teaching machine! · 2019. 11. 11. · mr. potato...
TRANSCRIPT
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Mr. Potato Head: A LEAN,
Mean Quality
Improvement Teaching
Machine!
Beth Murphy, MD
Ambulatory Block
QI Session #2
2013-2014
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Mr. Potato Head Facts
• Created by George Lerner in Brooklyn, NY
– Jumble of accessories meant to pierce a real potato
– Sold idea for $5000 to a cereal maker in 1951
• 1952- Rights acquired by “Hasbro”
• 1952-First toy advertised on TV and the first marketed directly to kids
• 1987-“Spokes spud” for ACS Great American Smokeout
• Resurgence in 1990’s with Toy Story Movies/Disney
• 2000-RI State Family Travel Ambassador & License Plate
• > 100 million have sold over past 60 years
Source: Yankee Magazine, Dec 2012
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Mr. Potato Head
LEAN Simulation Exercise • A fun, interactive, innovative way to demonstrate:
– Quality Improvement concepts
– Patient Safety/Medical Errors
– LEAN Process Management
– Teamwork
– Communication
• Can do with 4 to >100 learners
• Can do with learners of all levels and disciplines
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Mr. Potato Head has Traveled
California Adventure
Anaheim, CA
Downtown Disney
Orlando, FLA
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Mr. Potato Head
• Created by Eric Dickson, MD
• UMMHC President and CEO
• ER physician
• Professor of Emergency Medicine
• Institute for Healthcare Improvement
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Lean Process Management
• Derived from Toyota Production System
• Efficiency and Quality are both important
• Every step in process should add “VALUE”
• Eliminate all “WASTE” from the system
• EVERY member of the team is valued for
their contributions to the process AND their
ideas for improving the system/insuring
safety
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“At Toyota we get brilliant results from
average people managing a brilliant
process. Others get average results from
brilliant people managing broken
processes.”
--The Toyota Motor Company
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Even Mr. Potato Head has Gone
“Lean”
BEFORE A Slimmed Down Spud
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LEAN BELT PROGRESSION
YELLOW BELT=SOME TRAINING
GREEN BELT=USES TOOLS
BLACK BELT=PROJECT LEADER
WHITE BELT=AWARENESS
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• What do your patients value?
• What do you value as an employee?
Value
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TYPES OF WORK
Work/Service the patient cares about and is willing to pay for
Face time, Diagnosis, Treatment Non-Value Added
(Required)
Non –Value Added
PURE WASTE
Value Added
Value-Added Work
No value in the patient’s eyes, but can’t be avoided
o Billing, Regulatory tasks
Consumes resources but doesn’t add value.
o Looking for supplies
o Patient/Staff waiting
o Re-work, redundant paperwork
Required Non-Value Added Work
Pure WASTE – Non-Value Added Work
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Forms of Waste: DOWNTIME
• Defects • Overproduction • Waiting • Not Utilizing the Creativity of all Employees • Transport • Inventory • Motion • Extra-processing
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There’s been a terrible accident!
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The Situation…
• A bus filled with 16 Potato Head family
members is in a terrible crash!
• EMS arrives at the scene to find only
potato body parts scattered about.
• Luckily, there is an electronic medical
record showing what each family member
looks like.
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The Game
• Your “team” is the Trauma Team in the ER
• The goal of the game is to accurately assemble as many “patients” as possible in 7 minutes
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The Rules 1. Only 2 people from each team can
physically implant the Potato Head body parts (”Implantation Specialists”)
2. Completed “patients” must be inspected.
3. There are no other rules.
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Before we start…
We need 3 brave volunteers
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System 1 System 2 System 3
Systems & “Waste”
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First Lessons Learned
• Quality is influenced more often by the SYSTEM than the individual players
• How much “waste” is actually in “the system”
• Think LEAN!!
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ASSEMBLE YOUR TEAMS
• Choose your 2 “Implantation Specialists”
• Patient photos in the bag
• Bring assembled patients to
Check Out
• You have 2 minutes to plan
your team’s “system”
• You have 7 minutes to
process all 16 patients.
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TAKE A FEW MINUTES..
Take 2 Minutes to
plan your team’s
system.
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Inspection Stations
Bring completed
patient AND
photo to your
designated
inspection
station
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• http://www.online-stopwatch.com/full-screen-stopwatch/
• Why did we pick 7 minutes?
– If it takes 20-30 seconds to correctly assemble one Potato Head with no waste in the system, it should take maximum of 8 minutes to assemble all 16 if only 1 assembler. You have an entire team!
• Guinness Book of World Records’ fastest assembly of a Mr. Potato Head: Samet Durmaz of Turkey.
7 Minutes!
6.62 seconds!
http://www.online-stopwatch.com/full-screen-stopwatch/http://www.online-stopwatch.com/full-screen-stopwatch/http://www.online-stopwatch.com/full-screen-stopwatch/http://www.online-stopwatch.com/full-screen-stopwatch/http://www.online-stopwatch.com/full-screen-stopwatch/http://www.online-stopwatch.com/full-screen-stopwatch/http://www.online-stopwatch.com/full-screen-stopwatch/
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Tracking Your Data/Progress
PDSA 1 # built # errors # started Time to 1st
assembly
Team 1
Team 2
Team 3
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PDSA Cycle #1
• How many patients did you treat correctly during this cycle?
• How many errors did your team make?
• How long did it take you to complete first one?
• What changes will your team make for next cycle to eliminate waste and improve both quality and efficiency?
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Sharing Best Practices
• Team with Most # Patients Seen
• Team with Least # Errors
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PDSA CYCLE
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TYPES OF WORK
Work/Service the patient cares about and is willing to pay for
Face time, Diagnosis, Treatment Non-Value Added
(Required)
Non –Value Added
PURE WASTE
Value Added
Value-Added Work
No value in the patient’s eyes, but can’t be avoided
o Billing, Regulatory tasks
Consumes resources but doesn’t add value.
o Looking for supplies
o Patient/Staff waiting
o Re-work, redundant paperwork
Required Non-Value Added Work
Pure WASTE – Non-Value Added Work
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Forms of Waste: DOWNTIME
• Defects (Medical Errors) • Overproduction (Unnecessary testing) • Waiting (Patients and Employees) • Not Utilizing the Creativity of all Employees • Transport (Moving patients) • Inventory (Equipment, Discharge delays) • Motion (Physical Plant/Flow) • Extra-processing (Retesting, Readmissions)
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BACK TO YOUR TEAMS
Take 2 Minutes to
discuss how your
team will improve
the quality and
efficiency of your
patient care.
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Start PDSA CYCLE #2
• Switch Bags!
– You don’t see the same patients every day!
• Notice there are many differences in each
body part (i.e. ears, eyes, mouths)
– Demonstrates how each patient is unique!
• You have 7 Minutes!
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• http://www.online-stopwatch.com/full-
screen-stopwatch/
7 Minutes!
http://www.online-stopwatch.com/full-screen-stopwatch/http://www.online-stopwatch.com/full-screen-stopwatch/http://www.online-stopwatch.com/full-screen-stopwatch/http://www.online-stopwatch.com/full-screen-stopwatch/http://www.online-stopwatch.com/full-screen-stopwatch/http://www.online-stopwatch.com/full-screen-stopwatch/http://www.online-stopwatch.com/full-screen-stopwatch/
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PDSA Cycle #2 • How many patients did you treat
correctly during this cycle?
• How many errors did your team make?
• How long did it take you to complete your first patient?
• How would you plot your data?
• What changes will your team make for next cycle to eliminate waste and improve both quality & efficiency?
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Tracking Your Data/Progress
PDSA 2 # built # errors # started Time to 1st
assembly
Team 1
Team 2
Team 3
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RUN CHART: Plotting Your Data/Progress
0
2
4
6
8
10
12
14
16
PDSA 1 PDSA 2 PDSA 3
Team 1
Team 2
# P
atie
nts A
sse
mb
le
d
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For PDSA Cycle #3 • There’s been a change at work.
• Your Implantation Specialists have decided to work for your competing medical system across town and you now have Locum Tenens MDs filling in.
• Implantation Specialists must switch tables!
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BACK TO YOUR TEAMS
Take 2 Minutes to
discuss how your
team will improve the
quality and efficiency
of your patient care
with NEW TEAM
MEMBERS!
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Start CYCLE #3
• Switch Bags Again!
• You Have 7 Minutes!
• http://www.online-stopwatch.com/full-screen-
stopwatch/
http://www.online-stopwatch.com/full-screen-stopwatch/http://www.online-stopwatch.com/full-screen-stopwatch/http://www.online-stopwatch.com/full-screen-stopwatch/http://www.online-stopwatch.com/full-screen-stopwatch/http://www.online-stopwatch.com/full-screen-stopwatch/http://www.online-stopwatch.com/full-screen-stopwatch/http://www.online-stopwatch.com/full-screen-stopwatch/
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Review PDSA Cycle #3
• How did your new team do?
• How did having new team members effect your quality and/or efficiency?
• Did you change your system?
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If we did PDSA Cycle #4… • Unfortunately, Federal Budget
cuts continue and reimbursements from Medicare and Medicaid are down substantially.
• We have to lay off one team member from each team…
• The tallest person on the team has to step away from the table and observe
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Team Outcome Review
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What I learned from Mr. Potato Head:
1. The system is the critical determinant of performance.
2. Good communication is essential for a high-functioning team.
3. Good ideas for improvement can come from anyone on the team.
4. Data is essential to drive improvement efforts.
5. Repeating PDSA cycles is a valuable process.
6. Efficiency is enhanced when value-added work is increased and waste is reduced. (LEAN)
7. With very simple changes in system, you can improve quality, efficiency, and safety!
8. QUALITY IMPROVEMENT CAN BE FUN!
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MEDICINE IS A TEAM SPORT!
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Remember…There are “Different” ways
to achieve the same goals…
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Suitcase of Tools
Thank you for participating!
Be sure to take these tools
back with you to your clinics,
wards, ward/ICU teams!
With very small changes, you
can make BIG differences in
both safety and efficiency!
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Questions/Comments?
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