@MarkGrabanMark@MarkGraban.com

FromtheBoardroomtotheFrontLine:AlignmentthroughLeanManagementSystems

PlanDoStudyAdjust

Startfromneed.

Whatproblemarewetryingtosolve?

What’saManagementSystem?• Whatareleadersexpectedtodo?• HowareleadersexpectedTOBE?

– Isthereclearalignment?Aretheregaps?– Or"justgetresults"???

• Howisthistaught,modeled,andreinforced?– Whathappenswhentherearegaps?

WhyaLeanManagementSystem?

StrategyDeploymentinHealthcare(Scott & White)

WhatisStrategyDeployment?• Aka"Hoshin Kanri"

– Hoshin ="compass"– Kanri ="management" or"control"

• "Aprocessforembeddingstrategyandaligninganorganizationtowardcommongoals"

• DevelopedbyDr.YojiAkao– (YokogawaHewlett-Packard)

StrategyDeployment=PDSA

• UsingPDSAcyclesto:– Creategoals– Choosemeasurementpoints– Linkdailyactivitiestohighlevelgoals

– Driveresults&learning

FromGoalDeploymentto"CatchBall"

Source:LeanHospitals,Graban

TheRoleofLeaders• Definepurposeclearly• Identifythebiggestobstacles• Createanatmosphereconducivetoinitiativeandcreativity

• Reducehassle• Leadbyexample!Modelbehaviors.Teach

Source(1-4):Andy&MeandtheHospital(Dennis)

"TrueNorth"• Broadgoalsanddirection

– "Briefexpressionofdirection,purpose,commitment,andvalues"

– "Whatweshould do,notwhatwecando"– Speakstotheheart

"TrueNorth" Statements• "Nowait,noharm."• "Eliminateallunnecessarydeathorillness."• "Measurablybettervalue."• "Toprovidehigh-qualityhealthcaretoall,regardlessof

theirabilitytopay."• "____willcareforpatientsthewaywewantmembersof

ourownfamiliestobetreated,whileadvancinghumanity'sabilitytoalleviatehumansufferingcausedbydisease.Wewillprovidetherightcareintherightenvironmentandattherighttime,eliminatingwasteandmaximizingvalue."

StrategyDeploymentasaSeriesofHypotheses

Hypothesis#1:

Ifwefocusourimprovementeffortsandcloseperformancegapsinthesefour(orfive)areas,wewillthereforeperformwellasanorganization,thisyearandoverthelong-term.

http://www.leanblog.org/SD1

"TrueNorth" FocusAreas

Source:ThedaCare

SAFETY&QUALITY PEOPLE PATIENT

SERVICE FINANCIAL

TRUENORTHWALL

BuildingConsensus

LessonsLearned• Don’tcopyothers’TrueNorth• Gothroughtheprocessofgainingconsensusaroundwhattheseshouldbe

• TrueNorthmustresonatewithyourpeople• "Thebeststrategydeploymentsystemintheworlddoesn’tmakeupforthewrongstrategy." (Toussaint)

StrategyDeploymentasaSeriesofHypotheses

Hypothesis#2:

Ifwecanimproveandcloseourperformancegapsinthesekeyperformanceindicators,wewillsatisfyourneedforimprovementinourkeyfocusareas,andthereforewewillbesuccessfulasanorganization,overall.

http://www.leanblog.org/SD1

"TrueNorth" Metrics

Source:ThedaCare

SystemLevelMetrics

Source: Thinking Lean at ThedaCare (DVD)

AnnualPDSACycles

• Goals&Metrics– Howdidweperform?– Whydidwehavethatperformance?– Werethosetherightgoals?– Arethesestilltherightgoals?

SAFETY&QUALITY

PEOPLE PATIENTSERVICE

FINANCIAL

TRUENORTHWALL

STRATEGYA3

STRATEGYA3

STRATEGYA3

a.k.a."MOTHER"

A3

MEASURE1

MEASURE2

MEASURE3

MEASURE1

MEASURE2

MEASURE1

MEASURE2

MEASURE1

MEASURE2

MEASURE4

MEASURE3

MEASURE3

MEASURE4

TheA3ManagementDiscipline

Heading

PlanDo

Study Adjust

Footnotes

17"

11"

A3(PDSA)StoryBoard

CyclesoflearningandcontinuousprocessimprovementDevelopingpeopleandimprovingprocesses

Plan(Hypothesis)

Do(Try)

Study(Reflect)

Adjust(Act/Adjust/Abandon)

GrasptheSituation

Strategy A3

InitialStrategyA3Work

"BreakthroughA3" - Safety

• Expect 20 to 50% improvement in these breakthrough A3s

TrueNorthCanEvolve

11/1/12 Rev: 10

Safety• System Patient Safety Bundle• D.A.R.T

People• Engagement Index• Health Assessment Score

Customer"Lori"

• Customer Loyalty Score

© 2011 ThedaCare

Financial Stewardship• Operating Margin• Productivity

Quality• Preventable Mortality• 30 Day Readmission

&

ImproveSafety

Inpatient

Med/Surg Telemetry

Outpatient

Clinics

ClinicA

PhysicianA PhysicianB

ClinicB

Surgery

EmergencyDept

Patient&Employee

Sprains&Strains

PatientFalls

TieredMetrics(3Levels)

Source:GroupHealthCooperative

Office

Clinic

PrimaryCareGroup(26clinics)

DailyManagementBoards

LessonsLearned• KPI=KEY PerformanceIndicator

– Trackingmoremetricsisn’talwaysbetter

• Don’tcopy:gainconsensusonthemetrics• Focusonmetricsthatarebestindicatorsofprogress&gap

closure• Isitwortharguingtoomuchoverexactgoals?• Getalignment,noteverybodymeasuringtheexactsamething

StrategyDeploymentasaSeriesofHypotheses

Hypothesis#3:

IfweactuallyexecuteandcompletethesetopXinitiatives,projects,events,andA3s,thenwewillmakethegreateststridestowardclosingthekeyperformancegaps(fromHypothesis#2)andthereforewe’llbemoresuccessfulinourstrategy.

http://www.leanblog.org/SD2

PrioritizationisaMust• Whatarethe"mustdo,can’tfail"initiativesforourorganization?

AGeneralization…• Mostorganizationshavetoomany:

– "Highpriority" or– "Toppriority" initiatives/projects

• Doesanyinitiativegetrejectedorpostponed?

• Howmanyofourtoppriorityprojectsaregettingcompleted??Photo: Dr. John Toussaint

"Deselecting"• Don’t implement every idea at once (Focus)• Deselect if it doesn’t meet immediate value stream project criteria

Source:ThedaCare

Project A3

BABYA3#1

BABYA3#2

BABYA3#3

BABYA3#4

BABYA3#5

BABYA3s

BABYA3#7

BABYA3#8

BABYA3#9

BABYA3#10

BABYA3#12

BABYA3#13

BABYA3#14

BABYA3#15

BABYA3#17

BABYA3#18

BABYA3#19

a.k.a"TACTICALA3"

#20

BABYA3#6

BABYA3#11

BABYA3#16

NursingUnitBoard

Source: Thinking Lean at ThedaCare (DVD)

Six Sigma

Projects

LargeKaizen

MediumKaizen

SmallKaizen

LeanEvents

Circle size is meant to roughly represent relative size of effort; Blue = tracked top initiatives ("Baby A3s")

Com

plex

ity

Daily Kaizen

Women & Children’s

3P

ElectronicMedicalRecord

ImplementationNew

Bed Tower

3 Types of Kaizen

LessonsLearned

• Don’ttakeontoomuch

• Gainingconsensusonthistakesalotoftime,too

• Maybeerronthesideof"toofew" keyinitiatives?

• Stopjumpingtosolutions!

• Don’tlet"alignment"stifleKaizen

StrategyDeploymentasaSeriesofHypotheses

Hypothesis#4:

WeactuallyhavetheorganizationalcapacitytocompletetheseXtopprioritiesinayearoragiventimeframe(andwiththerightquality).

http://www.leanblog.org/SD2

PDSAReviewCycles

• UsingPDSAcyclesto:– Checkprogresson:

• Activity• Results• Lessonslearned

TraditionalApproachGot Results

Didn’t Get Results

LeanApproach

Didn’t follow process Did follow process

Got Results

Didn’t Get Results

Mid-YearReview• Lean/S.D./A3/PDSAApproach:

– If"Red" (notmeetingtarget),ask:• Didwedowhatwesaidwe’ddo,butdidn’tgetresults?

– Doweunderstandwhy?– Whatdidwelearn?

• DidweNOTdowhatwesaidwe’ddo?– Doweunderstandwhy?– Whatdidwelearn?

Mid-YearReview• Lean/S.D./A3/PDSAApproach:

– If"Green" (meetingtarget),ask:• Didwedowhatwesaidwe’ddo,andgotresults?

– Whatdidwelearn?

• DidweNOTdowhatwesaidwe’ddo,butstillgotresults?

– Doweunderstandwhy?– Whatdidwelearn?

LessonsLearned• Don’tbeconfusedbyasingledatapointversusasustainedtrendinresults

• Don’twaituntiltheendoftheyeartosay,"Oops…"• PDSA– Studycapacityandprogress

– Adjustasneeded

• Ifthere’sanew"toppriority" initiative,whatareyougoingtodeselect?

Our4Hypotheses1. Wehavetheright

TrueNorth&categories2. We’vechosenthe

rightmetrics&gaps3. We’vechosenthe

rightinitiatives4. Wehavetherightcapacity

toexecutethem

Q&A/ContactInfo• www.MarkGraban.com• www.LeanBlog.org• mark@markgraban.com

www.PracticingLean.com