Post on 13-Apr-2017
Host: Mark GrabanVP of Improvement Services
mark@kainexus.com@markgraban
How Leadership Commitment and a
Systematic Approach Spread Improvement
Presenter: Karen Kiel-RosserVice President /
Chief Quality OfficerMary Greeley Medical Center
Presenter: Ron SmithProcess Improvement Coordinator
Mary Greeley Medical Center
Agenda & Logistics• Presentation (40 minutes)• Q&A (15 minutes)
– Use the GoToWebinar Meeting Panel to submit a question atany time
• Recording link & notes will be sent via email– Or, see “handouts’” in the GoToWebinar control panel
Objectives• Describe how to develop leadership
to support a culture of managing for daily improvements
• Share a systematic approach for documenting and managing improvements
Mary Greeley Medical Center• Located in Ames, Iowa• 220 bed acute care facility
– 1,300 employees– 200 physicians– 500 volunteers– 8,000 admissions per year– 26,000 emergency room visits per year
• Governed by city-elected five memberBoard of Trustees
How We Enable and Spread Improvements
Leadership• Commitment• Communication• Accountability
Methodology• Simple• Consistent• Disciplined
Technology• KaiNexus
MGMC Improvement Philosophy
Do Work Improve Work
Two Jobs for every
employee at MGMC
Do Work
Improve Work
Leadership Commitment What the Experts are Saying
MGMC Leadership Commitment (2009)
• Vision: Reduce Waste, Eliminate Risk• Objectives:
– Common vocabulary (communication)– Develop a supportive system to ensure
accountability
Build a culture where every day, everyone of our 1,300+ employees are engaged and empowered to make improvements.
• Proactively plan for the future • To do the right thing, and ONLY the right thing• Those closest to the work need to be involved• Sustainability is everyone’s job• Learning from each other is critical to the
success• Eliminate errors, reduce variation
The Why Behind the What
MGMC Board Commitment Education - 2009
Penny Exercise – hands on assembly-line concept; shift pennies from one inspector to the other. Engages several participants in a process to demonstrate flawed workflows.
Lessons Learned:• Batch and queue is less efficient than single piece flow• Inspection wastes time• Trust can be empowering and make work easier• You can have increased capacity with less work and the same number
of staff
Did you know?• The P.O. Box numbers on the backs of insurance cards are sometimes
as small as the date on a penny? If you send the claim to the wrong one, the claim may be denied!
Lean Training for Leaders September, 2010
Yellow Belt Training • The Toyota Way & The Rules In Use• 6S• Visual Management• Value Stream Mapping• A3 Thinking & Problem Solving• Understanding the Current Condition• Leading Change
Engaged Leaders through a group 6S Project
Before After
Training Philosophy
• See one • Do one• Teach one
Leadership Challenge
• 6S project in your department
• Key learnings – and celebration of success– Best practice for various KanBan systems– Lean ‘champions’– Lean walk
GI Visual Inventory System
Minimum reorder quantity included in plastic bag; when bag must be accessed, it’s time to reorder!
FIFO System (First In, First Out)
Consume from the left, replenish on
the right
GI Visual Inventory System
Kanban cardCard pulled and delivered to
Reorder Mailbox
Cardiopulmonary Visual Inventory System
Kanban card
When first bottle behind bungee cord is accessed, card is pulled for reorder
When first bottle in plastic tub is accessed, card is pulled for reorder
Form Follows Function
• Standard Work – Created Standard Work Steering Committee
• Systematically identify and select projects• Organize work• Create standard work documentation process
Organize our WorkStandard Work
Standard Work is the known best method (safest, highest quality or most efficient) to perform a task, broken down into elements which are sequenced, organized and repeatedly followed. Standard Work is dependent upon those closest to the work helping to design and continuously improve their work processes.
Identify Key Work Processes
Standard Work Steering Committee identifies key work processes at Mary Greeley
49+ Work Processes!
Safe, Clean & Quiet
Environment
Nutrition
Education & Communication
Medication
Non-InvasiveIntervention
Reasses
Sterile Processing
Facilities
Clean Rooms
Laundry
Materials
Unrestricted Diet
Restricted Diet
Operative & Invasive
Procedures
In Patient
Out Patient
ED
Intervention(Treatment &
Therapy)
Bedside(In Patient Only)
OR
Cath Lab
GI
Pain Clinic
Wound Clinic
Birthways
Radiology
Radiation Therapy
Cardio Treatments
Rehab & Wellness Therapy
Esp. Out Patient
Top Ten Work Processes1. Operating Room2. Emergency Room3. Lab4. Medication5. Continuum of Care6. Home Health7. Registration8. Pre-Authorization/Pre-Admitting9. Bed Placement Schedule10. Discharge
Multiple Methods of Improvement
Events
(RIE, VSM)
Projects
Managing for Daily Improvement (MDI)
Project Management Support
Our Improvement Journey
Time
Perfo
rman
ce
20112010 2012 2013 2014 2015 2016 2017
•6S (dozens)
•Rapid Improvement Events (13)
•Value Stream Mapping (5)
•A3 Problem Solving (hundreds)
SW Steering Committee
Our Improvement Journey
Time
Perfo
rman
ce
20112010 2012 2013 2014 2015 2016 2017
•6S (dozens)
•Rapid Improvement Events (13)
•Value Stream Mapping (5)
•A3 Problem Solving (hundreds)
SW Steering Committee
Energize our Leaders
100 Day Workout
Identify an improvement project in your area• Can be completed in 100 days• Results in cost savings or revenue generation• Use KaiNexus to manage project
Do Work Improve Work
Two Jobs for every
employee at MGMC
Do Work
Improve Work
100 Day Workout Kick-Off - 2014
January 24 100 day work out projects due
February 6 Senior leaders review and approve all projects
February 3 Meet with KaiNexus to establish final 100 day plan
February 25 First 30 day follow up with Suz and teams; select projects report to management team
March 25 2nd follow up with SuzMay 2 Final 100 Day Workout – Report out
100 Day WorkOut Final Results
• 54 opportunities for improvement completed• $722,661 financial impact – hard savings
– $675,475 1st year savings– $47,186 1st year revenue generation
• 5,209 labor hours saved per year– $116,101 in soft savings
Our Improvement Journey
Time
Perfo
rman
ce
20112010 2012 2013 2014 2015 2016 2017
•6S (dozens)
•Rapid Improvement Events (13)
•Value Stream Mapping (5)
•A3 Problem Solving (hundreds)
SW Steering Committee
100 Day Work Out
Managing for Daily ImprovementsJanuary 2015 – Employee Kick-off
To encourage and harvest staff generated ideas on how to improve the organization and the care it provides.
The Bright Ideas Program aims to improve clinical outcomes, increase efficiency, provide for greater employee involvement and increase retention.
Purpose
Do Work Improve Work
Two Jobs for every
employee at MGMC
Do Work
Improve Work
Daily Improvements
• To date we have received 1,146 OIs submitted from 458 unique managers/staff members
• 769 of these OIs have been completed; with 507 (66.2%) resulting in a change
• Impact– $148,792 recurring cost savings– 9,375 hours saved ($209,642 soft savings)– 75% (381) resulted in some component of staff satisfaction– 45% (219) resulted in some component of quality
improvement
Our Improvement Journey
Time
Perfo
rman
ce
20112010 2012 2013 2014 2015 2016 2017
•6S (dozens)
•Rapid Improvement Events (13)
•Value Stream Mapping (5)
•A3 Problem Solving (hundreds)
SW Steering Committee
100 Day Work Out
Managing for Daily Improvements
Multiple Methods of Improvement
Events
(RIE, VSM)
Projects
Managing for Daily Improvement (MDI)
Lessons Learned• Leader’s challenge
• Let the process work• Allow time for habits to change• Set clear expectations (Standard Work is mandatory)• Persistence w/audits and improvements
• Ties to the big picture• Patient Satisfaction, Employee Satisfaction
HOW DO WE ENABLE AND SPREAD IMPROVEMENT IN AN ORGANIZATION?
Leadership• Commitment• Communication• Accountability
Methodology• Simple• Consistent• Disciplined
Technology• KaiNexus
Capture Capture
Share Implement
Measure
1-2% Implementation 75% ImplementationAVG KaiNexus Customers
Methodology Is A Key Difference
Multiple Methods of ImprovementRapid Improvem
ent Event
sProjects
Managing for Daily Improvement (MDI)CULTURE
“Daily Improvements Kickoff” Agenda – Mark Graban
• 3 Days – December 2014• Two Departments• 3-Hour Introduction Class on Day 1 (All Management)
– Department 1: 3A (Surgical) – Department 2: Materials Management
Notes:• Internal P.I. people will/can be with Mark the entire time• Executive sponsor(s) are welcome to participate or shadow any
time• Much of the timing is flexible based on people’s schedules
Daily Improvements Rollout Strategy
• Coach Leaders to Coach and Develop Staff– Leadership vs. Management– Trust and Empower vs. Control
• 2-3 Departments at a Time• 2 ½ Weeks per Group – 4 Meetings
HOW DO WE ENGAGE PEOPLE TO PARTICIPATE, NOT JUST THROW OUT IDEAS?
• Coach Leaders to Coach Employees– 1 on 1 with each
employee (rounding)– Introduction to Software
(Log in and Submit OIs)– Understanding that ideas
will become their projects– Ideas should be process
related and aimed at making their work better
Capture
Implement
Measure
Share
HOW DO WE ENGAGE PEOPLE TO PARTICIPATE, NOT JUST THROW OUT IDEAS?
• Lessons Learned– Keeping staff focused on
what they can control• 3’ Radius• There is no “somebody”
that works here– Capture OIs first then
Log in– Ask the right questions
Capture
Implement
Measure
Share
HOW DO WE ENGAGE AND DEVELOP STAFF IN IMPROVEMENT EFFORTS?
• Coaching Leaders to Coach Employees– Standardized
Assignment Process• Thanks for the Idea• Provide Direction/Investigate• Offer Assistance/Questions
– What is the Problem? – Root cause? Ask why?– Small Tests of Change– Plan, Do, Check, Act
Capture
Implement
Measure
Share
HOW DO WE ENGAGE AND DEVELOP STAFF IN IMPROVEMENT EFFORTS?
• Lessons Learned– Managers willingness
• to allow staff to try things• to allow staff to fail
(learning/development)• resist the tendency to solve
problems– Employee expectations
that manager will solve their problems
– Don’t forget the “check” in PDCA
Capture
Implement
Measure
Share
HOW DO WE DOCUMENT AND MEASURE IMPROVEMENT EFFORTS?
• Resolution Process– Change vs. No Change– Categorized OIs
• Strategic Initiative• Department• Honor Roll
– Measured Impact of OI• Staff and Patient Safety• Staff and Patient
Satisfaction• Cost and Time Savings• Revenue Generation
Capture
Implement
Measure
Share
HOW DO WE DOCUMENT AND MEASURE IMPROVEMENT EFFORTS?
• Lessons Learned– Time Savings vs. Cost
Savings– Seek Partial Improvements
vs No Change– PDCA is an iterative model…
when we “check” a change, we might learn it is not an improvement. This is a learning opportunity, not a “failure.” Learn from what you tried and then try something different.
Capture
Implement
Measure
Share
HOW DO WE SHARE IMPROVEMENT EFFORTS AND LEARN FROM OTHERS?
• Software Utilization– Transparency– Broadcast/Publish OIs
• Department Huddles– Reward and Recognize
• First Friday Report Out
Capture
Implement
Measure
Share
HOW DO WE SHARE IMPROVEMENT EFFORTS AND LEARN FROM OTHERS?
• Lessons Learned– Easily
forgotten/overlooked– Creates new idea
generation– Creates additional
improvement cycles– Promotes spread– Models culture and
behaviors
Capture
Implement
Measure
Share
Some Final Thoughts.....WHERE ARE WE HEADED NOW?
• Gravitate toward early adopters (pull vs. push)• Provide ongoing review and coaching for leaders• Make time for improvement
– Leaders schedule time to review OIs/provide direction– Leaders schedule time for staff to work on OIs
• Drive accountability through key performance measures– % of Staff Logged In– % of Staff Submitted an OI– % of OIs Completed with a Change
Other Resources
KaiNexus.com/webinars
blog.KaiNexus.com
Next Webinar
• “Go Slow to Go Fast: Using Practical Problem Solving to Spread Kaizen”– Jon Miller of
Gemba Academy
• January 12, 2016at 2 pm ET
Contact Info Q&A• Web:
– www.kainexus.com– blog.kainexus.com
• Past Webinars:– www.kainexus.com/webinars
• Social media:– www.twitter.com/kainexus– www.linkedin.com/company/kainexus– www.facebook.com/kainexus Mark Graban
@MarkGrabanmark@KaiNexus.com
Karen Kiel-Rosserkielrosser@mgmc.com
515-239-6757
Ron Smithsmith@mgmc.com
515-239-2415