Lan

Introduction to Continuous Improvement and How Unit

Education Needs Assessment Align with the New Strategy

Deployment Cycle

Lance Mageno, MHSA, BS

The ground is fertile thanks to Dr. James

MEDICATION

SUPPLIES

PATIENT

PROVIDER

INFORMATION

FAMILY

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Clinical Programs

Culture Focus• Focus on Systems and Process

Design • Focus on Culture where

Improving the work is the work

• Communicate the why and focus on local autonomy to drive improvement

• Lean tools and projects are not the focus, although they are used

• Front Line Engagement• Improvements come from

everyone and increase exponentially over time

Improvement Approaches

Imp

rove

men

t

Time

Project Focus• Quick Wins, but lack of

sustainability• Based on Using Lean Tools• Few People Involved• Improvements Top-Down

Culture Focus

All Organizations have the same InputsThe difference in Outcomes is the Methodology

Input + Method = OutcomesMan What is Our Method? Patient/Employee Safety

Material Patient Satisfaction

Machine Cost/Case

Employee Satisfaction

Continuous Improvement is a method for engaging

all staff, leaders, and physicians throughout the

organization in systematically increasing the value provided to our patients and members.

Foundation Principle #2

Continuous Improvement is HOW We Deliver Extraordinary Care

Zero Harm

First Time Quality through Prevention, Detection, and

Correction

StandardizationClinical Programs - Clinical Services

Stability, Flexibility, and Visibility of Processes

Continuous Improvement MethodStrategy Deployment, Visual Management, Daily Improvement, Closing the Loop, Problem Solving, Value Improvement Projects,

Best Practice Integration

Engagement of Employees and Physicians in Continuous

Improvement Efforts

Zero Waste

The Right Steps in the Right Sequence, at the Right Time, and in the

Right Place

PrinciplesRespect Every Individual, Lead with Humility, Seek Perfection, Embrace Scientific Thinking, Focus on Process, Assure Quality at the Source, Flow

& Pull Value, Think Systematically, Create Constancy of Purpose, Create Value for the Customer

Intermountain Continuous Improvement Framework

Continuous Improvement Principles

Respect Every IndividualLead with Humility

Seek PerfectionEmbrace Scientific Thinking

Focus on ProcessAssure Quality at the Source

Flow & Pull ValueThink Systematically

Create Constancy of PurposeCreate Value for the Customer

Define clear expectations of what it means to be successful at each level of the organization

Install Visual Management systems to align activities and see problems in real time

Engage employees through team-based problem solving, daily improvement and recognition

Engage management through reaction protocol, coaching and standard follow up

Consistent methodology to attack problems and engage teams in scientific problem solving.

Utilization of tools to identify innovative breakthrough approaches to increase value in the organization.

Best Practice Integration and lateral deployment

“What does it mean to be SUCCESSFUL? ”

“Are we SUCCESSFUL?”

“If we have GAPS what are we doing about it?”

“As leaders how can I help you WIN more often?”

“How do we ATTACKPROBLEMS?”

“How do we INNOVATE?”

“How do we LEARN?”

Intermountain Operating Model

• Seven Key Systems • Each Key System has several

Elements• Key Systems and Elements help

leaders create a culture of Continuous Improvement

• Leaders own the culture so that we can sustain the Intermountain Operating Model

Key System: STRATEGY DEPLOYMENT

“What does it mean to be successful?”

Clear expectations of what it means to be successful at each level of the organization, coupled with aligned strategies, tactics, and actions to attain goals.

LDS Hospital, W6 Surgical Unit

Key Elements• Catch Ball Process• Strategy

Connection Tool• Scorecards• Huddle Board• One on One’s• Step back reviews

STRATEGY DEPLOYMENT

Systems and processes are designed to help leaders and staff see problems in real time.

Key System: VISUAL MANAGEMENT

“How do we know that we’re successful?”

Key Elements• Metric Indicators• Process Signals• Resource Demand

Tool• 5S

VISUAL MANAGEMENT

Surgical Unit, McKay-Dee ICU, McKay-Dee

Employees are engaged through team-based problem solving, idea generation, and recognition.

Key System: DAILY IMPROVEMENT“If we have gaps, what are we doing about them?”

Park City, Idea Card

DAILY IMPROVEMENT

Key Elements• Idea Boards• Idea Innovation Time

• Implemented Idea Metric

• Idea RecognitionPark City, Idea Board

DAILY IMPROVEMENT

Key Elements• Idea Boards• Idea Innovation Time

• Implemented Idea Metric

• Idea Recognition778

1684

2781

4094

5481

6978

8102

9378

1051311368

1213712297

0

2000

4000

6000

8000

10000

12000

14000

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Tota

l Id

eas

Ideas Implemented

Goal (9000 Ideas) Cumulative System Total

Management is engaged through reaction protocols, coaching, and standard follow-up.

Key System: CLOSING THE LOOP“As a leader, how can I help you

be successful more often?”

CLOSING THE LOOP

Managem

ent A

ctio

n a

nd S

upport

Key Elements• Leader Standard Work• Rounding For Outcomes• Daily Tiered Huddles• 4S (Standardize, See,

Solve, Sustain)• Recognition

•Review Hospital Status

•Take Action for escalation

•Review past due Significant Events

•Report on constraints

•Share lessons learned

•Recognize team members

•All team leaders meet daily

•Report on current status and performance

•Share corrective actions and lessons learned

•Escalate issues to management team

•Recognize Team members

•Front line Team meets by shift

•Review Abnormalities

•Escalate issues

•Discuss Corrective Actions

•Ideas for improvement

•Recognize Team members

Escala

tion

8:30

9:30

10:00

Consistent methodologies to approach problems and engage teams in scientific problem-solving.

Key System: PROBLEM SOLVING“How do we approach problems?”

Key Elements• 8 Disciplines of Problem

Solving • Problem Solving Tools

(5 Whys, A3, Fishbone, Six Sigma, etc.)

• 100% Participation Frontline Tools

• Significant Event Tracking & Metrics

Medical Group, Fishbone (taught in ATP)

PROBLEM SOLVINGPotential causes for failure to communicate

abnormal vital signs to physicians

Key Elements• 8 Disciplines of Problem

Solving • Problem Solving Tools

(5 Whys, A3, Fishbone, Six Sigma, etc.)

• 100% Participation Frontline Tools

• Significant Event Tracking & Metrics

Porter Clinic

PROBLEM SOLVING

Use tools to identify innovative breakthrough approaches to increase value in the organization.

Key System: VALUE IMPROVEMENT PROJECTS“How do we achieve large innovations?”

Medical Group, 3P Event

Key Elements• Expectations• Project Prioritization and

Visual Tracking System• Innovation Tools and

Activities (Value Stream Maps, Rapid Improvement Events, 3P, etc.)

• Standard Project Mgmt tool• Clinical Program Initiatives• System Projects• Improvement Wiki

VALUE IMPROVEMENT PROJECTS

Method to prioritize, share, and track application of lessons learned throughout the organization.

Key System: BEST PRACTICE INTEGRATION“How do we learn from one another?”

North Region, Lateral Deployment Process

Key Elements• Best Practice Escalation• Best Practice Integration Goals • Lateral Deployment Process • Best Practice Reviews

BEST PRACTICE INTEGRATION

Lateral Deployment Process Tracking

Key Elements• Best Practice Escalation• Best Practice Integration Goals • Lateral Deployment Process • Best Practice Reviews

BEST PRACTICE INTEGRATION

Phase 3(Innovation)

Proactive Improvement

• A3/VSM/Tools

Phase 2(Problem Solving)

• Reactive Problem Solving process

• Daily Escalation

• RCA process

Phase 1(Accountability)

• Strategy Deployment/Employee Ideas

• Huddle, Huddle boards Idea Systems

2015 2016 2017 2018 2019

Senior Leader onboarding & commitment

Develop CI method w/ System support

Introduce CI Method through Zero Harm

System CI Organizational structure implemented

Region CI Organizational Structure Implemented

Value Add Metrics Developed:

-Number of Ideas Implemented-Project Savings--Number of front line projects completed-Leader Certification

Expand Value Improvement projects & Best Practice Integration key system pilots to all

areas throughout System

Pilot Autonomous Healthcare Structure at one hospital

Monitor Metrics, peer auditing and assessments on CI implementation

Expand Strategy Deployment, Closing the Loop, and Visual Management Systems pilots to all areas throughout the System.

Formal pilots in all Regions, Medical Group, Select Health, and key support areas (Supply Chain, IT, Home Health, Others????) Value Improvement Projects and Best Practice Integration Key Systems.

Implement Value Improvement Projects for Provider and Supplies Flow

Continue to build consulting capability and promotion through tours, consulting and industry consortiums

Promote Intermountain CI through tours, industry networks and Healthcare consortiums

Ramp up System CI office capabilities to prepare for System Value Improvement Projects, and

Best Practice Integration. In support of system support areas. Finance, HR, etc.

Formal pilots in all Regions, Medical Group, Select Health, and key support areas (Supply Chain, IT, Home Health, Others????) in Strategy Deployment, Closing the Loop, and Visual Management Key Systems.

Monitor Metrics to validate CI system. Add Strategy Deployment, close loop and Visual

management to Self-Assessment expectations add compliance to clinical pathways to CI

metrics

Value Stream Mapping: Information Flow and Clinical Engineering

Communications: Best Practice Sharing Forums, iStories, and Messaging at key leadership

forums

Monitor Metrics to validate CI system. Audited peer auditing and assessments on CI implementation

Huddles, Huddle Boards, Idea System in all Regions

System CI office to develop a standard set of Problem Solving tools for each level in the

organization.

Intermountain’s High level path to Implementing Continuous Improvement

Communications: Best Practice Sharing Forums, iStories, and Messaging at key leadership forums

Support and coaching for early adopters around ICIM Key Systems for Strategy Deployment, Visual Management, Daily Improvement and Closing the Loop.

Intermountain’s Continuous Improvement Method Introduction for all Senior Leaders, Administrators, Ops Officers and Directors.

-Leadership CI method Introduction Training (Coaching Camp)

-Go and See (NR, Seattle Children’s, Stanford)-Project Implementation with (Huddles, Huddle Boards and Idea Systems)

Communications: Best Practice Sharing Forums, iStories, and Messaging at key leadership forums

CI pilots w/ Huddles, Huddle Boards, Idea System in all Regions, Medical Group, Select

Health, and key support areas (Supply Chain, IT, Home Health, Others????).

Monitor Metrics w/ addition of CI process implementation Metric and Self-Assessment around Huddles, Huddle Boards and Idea Systems Leader Certification

Promote Intermountain CI through tours, industry networks and Healthcare consortiums

Initiate Value Stream Map around Patient Flow and Medicine Delivery

Training and DevelopmentZero HarmCI Method/Structure

Outcomes/MetricsValue Improvement ProjectsPromotion/Best Practices

Key

Regional CI Structure

Medical GroupSystem

Analytics

AVP CI

CI Director Region

RVP

CI Nurse or Technical Expert

CI Medical Director

Medical Group System SME’s

CI AnalystImprovement

Facilitators/Management Engineers

3.0 FTEs 3.0 FTEs 0.5 FTE 2.0 FTEs 1.0 FTE

Strategy Deployment Process

Strategy Deployment Cycle

Key System: STRATEGY DEPLOYMENT

“What does it mean to be successful?”

Clear expectations of what it means to be successful at each level of the organization, coupled with aligned strategies, tactics, and actions to attain goals.

Strategy Deployment Definitions

• True North Statement is a directional description of the ideal state that supports the Vision of the organization

• KPI (Lagging Metrics) are metrics that do not change year over year and validate how well the organization is moving towards the Vision of the organization

• Initiatives are the approaches taken to achieve the True North Statement(s) and associated KPI(s)

• Leading Indicator/Metric(s) are measures that provide insight into progress towards achieving strategic initiatives

• Tactic is a milestone, or broad action within a strategy

• Action is a measurable step taken to achieve a tactic

Key Elements of Strategy Deployment

Why

What

How

Do

Mission, Vision, Values

Initiatives

KPI’s/Goals

Daily Actions

ClarityAlignmentAccountability

Why Do Strategy Deployment?

DIMENSION OF CARE: True North Statement

–What value does team bring? What job are you hired to do?

–Concept, not true goal

–Unchanging, Constant

–Provides direction

–Should do vs. can do

– Ideal conditions

–Challenge status quo

Safety - Patients and caregivers experience Zero Harm.

Executive Team True North Statements

• Fundamentals of Extraordinary CareSafety Quality Patient

ExperienceAccess Stewardship Engaged

CaregiversPatients and caregivers experience Zero Harm.

Always deliver evidence-based care that meets each individual’s healthcare goals and leads to top performance nationally.

Patients and customers have an Intermountain experience that leads to lasting loyalty.

All customers receive the care and information where, when, and how they want it, with seamless coordination across the system.

Be an indispensable community partner, achieving the healthiest communities with the lowest cost per person in the nation. Be recognized globally as a financially sound, forever organization.

Caregivers have an unparalleled work experience that supports them in delivering the fundamentals of extraordinary care.

Intermountain System - Serious Safety Events

Key Performance Indicators (KPI’s)

• KPI’s are measures of True North statements

• Don’t change year over year

• Validate how well the organization is moving towards mission and vision of organization

• Measurable and clear to everyone in organization

• Measure value provided to customers: patients and other teams

Key Performance Indicators (KPI’S)

• Examples of True North statements with associated KPI’s:

True North Statements Key Process Indicators (KPIs)

Zero Employee illnesses and injuries Employee Injury Rate

100% Quality % of CPM’s followed trend

Provide lowest cost for community Case mix adjusted cost

100% Accessibility Average wait time/Visit

Executive Leadership Team SDCT

North Region Strategy Connection Tool

Zero Harm Action Plan DetailCategory What Quarter Due Date Who Notes

Zero Harm/Eliminate Problem ReoccurrenceZero harm integration committee OngoingSupport development of tiered escalation, standard calendar, and huddles Q3 ongoing SS Needs more definitionSafety event corrective action Q4 Ongoing BC Robin is chairing

Set up follow up rhythm to support pilots 1/16/17 SS

Bonnie has set up next meeting but we need to make sure we can participate during huddle discussion

Strategy to integrate ZH/CI training at front lineError Prevention Training integration with CI - Central Office Entities (Non-Clinical) Q4 ongoing LM

Determine how to operationalize closed-loop system into leader's work Q2 BC

Develop reactive Problem Solving Process OngoingWork with Richard Memmot for Safety net report for all regions 12/15/16 JH

Teri Chase Dunn has a report currently

Develop business case for robust problem solving systemCapture the current state, (Safety Net, Employee Health, RCO etc) 1/15/17 BCFor cross functional team to develop process and develop RFP

Partnership with Quality to Operationalize Standards/Prevent Problem Reoccurrence in progress

LM

collobrate w/Kim Harrison on A3 8D training for cause analysis 12/15/16 LM

Closed loop system for internal and external Auditing findings 12/31/16 LMKristen Jordon, Karen Bronson, Jen Conley

Closed loop system VBPClosed loop for CMS QAPICI/ZH organizational structure and chartering

Integrate CI /ZH champion for central entities 12/15/16 LM

Approaches taken to achieve True North Statements, Goals, and KPI’s

True North Initiatives

Focused Initiatives

Stay constant through time, and are only realized

through broad and deep engagement from the

organization

Are realized through focused efforts from a

smaller team

Initiatives

Safety

True North Strategic Initiative

Put processes and systems in place that nurture a culture that results in zero harm to our patients,

employees, visitors and other care providers.

Access

Focused Strategic Initiative

Expand the footprint of our region to create competitive delivery networks, complement our

existing facilities, and meet community healthcare need.

Tier 1- Manager

Tier 2- Director

Tier 3- Operations Officer

Tier 4- Hospital Administration

Tier 5- Region Administration

Tier 1- Manager

Tier 2- Director

Tier 3- Operations Officer

Tier 4- Hospital Administration

Tier 5- Region Administration

Examples - Executive Leadership Teams InitiativesSafety: Implement CI Zero Harm to create an environment where caregivers feel safe, responsible and empowered to identify and resolve safety concerns.

Stewardship: Develop and implement System-wide community rounding plans on elected, business, and community leaders.

Quality: Create a quality system that prevents problem occurrence and eliminates reoccurrence by implementing proactive quality management and problem solving systems.

Stewardship: Develop and implement plans to consistently identify and address community health needs.

Quality: Develop and apply evidence-based practices through Clinical Programs, Clinical Services and the Continuous Improvement Method.

Stewardship: Develop plan to utilize shared services to reduce overall cost while maintaining local involvement.

Quality: Eliminate unnecessary procedures and testing. Stewardship: Utilize Continuous Improvement Method to share best practices

Quality: Utilize Continuous Improvement Method to operationalize standards and processes to ensure top performance on the CMS and regulatory requirements with an initial focus on risk-adjusted mortality, complications, infections, and readmissions.

Engaged Caregivers: Create an environment where Intermountain is the employer of choice for caregivers.

Quality: Integrate and automate clinical pathways and standards into iCentra workflows.

Engaged Caregivers: Create a culture where everyone is a caregiver.

Patient Experience: Maximize patient and member experience through consistent application of signature service initiatives and other standards that ensure all caregivers practice the Healing Commitments.

Engaged Caregivers: Implement the CI Method to engage physicians and caregivers at all levels in improvement

Patient Experience: Implement mobile technology and tools to improve the patient, member, and caregiver experience.

Growth: Develop new revenue sources through innovation, strategic investment, and business development.

Access: Create an enterprise scheduling plan to improve patient experience and leverage existing capital.

Growth: Create detailed plans for clinic and service line growth.

Access: Develop and implement a plan to improve flow and access. Growth: Create marketing and sales plans to increase SelectHealth membership.

Stewardship: Create and implement plans to reduce supply costs. Growth: Develop and implement plans to grow market share for outreach services.

ExamplesSAFETY Stewardship

True North

Patients and Caregivers will experience zero harm Be an indispensable community partner, achieving the healthiest communities while lowering cost burden of care to patients and their families.

KPI Employee injury rate $cost spent on contracted coding$cost/coded record

Initiatives Expand evidence-based employee harm reduction training

Decrease dependence on contracted coding and harness gains from centralized staffing model.

Tactic (Team)

Integrate evidence-based employee harm reduction training into simulation training based on employee injury trends

Develop a visual system to identify capacity across the entire enterprise so demand can flow seamlessly across regions.

Action (Team Member)

Jenny Simmonds to develop proposal by 9/8/17

Jenny Simmonds to review proposal with Leadership by 9/15/2017

Mary Staub will meet with Business Development and IS to brainstorm options by 9/8/17

Joe Finlinson will develop application by 9/15/17

What is a Strategic A3?

• More than the size of Paper– it is a way of thinking to support improvement

• Strategic A3 Components– Background– Current Condition Situation– Future State/Target – Plan– Results– Return to Green Plans– Additional Measures

3

5

1

Zero Harm Action Plan DetailCategory What Quarter Due Date Who Notes

Zero Harm/Eliminate Problem ReoccurrenceZero harm integration committee Ongoing

Support development of tiered escalation, standard calendar, and huddles Q3 ongoing SS Needs more definitionSafety event corrective action Q4 Ongoing BC Robin is chairing

Set up follow up rhythm to support pilots 1/16/17 SS

Bonnie has set up next meeting but we need to make sure we can participate during huddle discussion

Strategy to integrate ZH/CI training at front lineError Prevention Training integration with CI - Central Office Entities (Non-Clinical) Q4 ongoing LM

Determine how to operationalize closed-loop system into leader's work Q2 BCDevelop reactive Problem Solving Process Ongoing

Work with Richard Memmot for Safety net report for all regions 12/15/16 JH Teri Chase Dunn has a report currentlyDevelop business case for robust problem solving system

Capture the current state, (Safety Net, Employee Health, RCO etc) 1/15/17 BCFor cross functional team to develop process and develop RFP

Partnership with Quality to Operationalize Standards/Prevent Problem Reoccurrence in progress

LM

collobrate w/Kim Harrison on A3 8D training for cause analysis 12/15/16 LM

Closed loop system for internal and external Auditing findings 12/31/16 LMKristen Jordon, Karen Bronson, Jen Conley

Closed loop system VBPClosed loop for CMS QAPICI/ZH organizational structure and chartering

Integrate CI /ZH champion for central entities 12/15/16 LM

Safety Goals• Reduce employee injuries by 10% • Reduce workplace violence by 10%

• What is the target condition for this year?

• Not all KPI’s are goals AND not all of our goals will be KPI’s

o KPI’s are a measure of true north and what matters most

o Goals focus team on areas where can improve value

• SMART languageo Decrease/Increase by 10%

• Avoid setting tasks or strategic initiatives as goals

o i.e. implementing, tracking, or developing are strategic initiative language

Examples

SAFETY Stewardship

True North

Patients and Caregivers will experience zero harm Be an indispensable community partner, achieving the healthiest communities while lowering cost burden of care to patients and their families.

KPI Employee injury rate $cost spent on contracted coding$cost/coded record

Initiatives Expand evidence-based employee harm reduction training

Decrease dependence on contracted coding and harness gains from centralized staffing model.

Tactic (Team)

Integrate evidence-based employee harm reduction training into simulation training based on employee injury trends

Develop a visual system to identify capacity across the entire enterprise so demand can flow seamlessly across regions.

Action (Team Member)

Jenny Simmonds to develop proposal by 9/8/17

Jenny Simmonds to review proposal with Leadership by 9/15/2017

Mary Staub will meet with Business Development and IS to brainstorm options by 9/8/17

Joe Finlinson will develop application by 9/15/17

Goal Decrease employee injury rate by 10% Reduce outside coding by 25%

System

Region

Hospital

Service Line

Department

Catchball

• Input from each level for the organization’s goals

• The process of selecting strategies to meet an objective at any level, then getting managers and their teams to engage in dialogue to reach agreement on their goals.

Catchball Concept

System

VP

AVP

DIRECTOR

Department

Leaders at Every Leadership Tier are included in process

• Why include all leaders?

– Closest to customer/patient

– Actually execute strategy and understand what works and does not work

– Represent company values to the majority of organization

– Leaders of organization in future

– Lead majority of 37K employees of Intermountain

Step-Back Reviews Return to Green Plans

Strategy Connection Tool

Huddle Boards

Leader Standard Work Scorecards

Strategy Deployment Sessions 2018 are in Process and Coming to you Soon!

Catchball

• Catchball is structure feedback on KPIs and KPI Targets, Strategies & Initiatives, and Goals

• Catchball happens during the third session – Today, August 28th

• While we Catchball vertically, we also must do so horizontally too

• VPs SD Sessions start in September

System

Region

Hospital

Service Line

Department

Example of Initiative Alignment

Healthy Futures Strategies & Initiative Integration

• There are 7 Healthy Futures Strategies

• The Initiatives are the sub-components of the Healthy Futures Strategies

• Initiatives are HOW we achieve the Healthy Future Strategies

• All leaders will utilize the Intermountain Management Operating System to execute on the Health Futures Strategies & Initiatives

• We will speak to our Caregivers and express our goals in the context of our Fundamentals of Extraordinary Care

ClarityAlignmentAccountability

Why Do Strategy Deployment?