Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior...

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Lean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado © 2007 Denver Health Medical Center

Transcript of Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior...

Page 1: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver HealthPhil Goodman, MS, HSA, RRTSenior Lean FacilitatorDenver Health Medical CenterDenver, Colorado

© 2007 Denver Health Medical Center

Page 2: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver Health

Outlinen Why Leann Implementing Leann Using tools—examplesn Sustaining Improvements

Page 3: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

RightPeople

Right Environment

Right Communication

and Culture

Right Process

Right Reward

Getting It RightGetting It RightIT

©

Page 4: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver Health

n Why did we choose Lean?q A philosophy, set of principles and a tool

setq Philosophy fits for health careq Tool set is intuitiveq Meaningful employee engagementq Initial rapid resultsq Power to change culture

Page 5: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver Health

n Implementation-Trainingn Fall 2004-June 2005

q “Black Belts” – 50 Physician Directors/Nursing Directors/Service Line Administrators/Mid-Managers

q Extensive Lean Trainingq Key “day to day” implementersq Launched Organization-Wide 5S Campaign

Page 6: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver HealthLean at Denver Health

n Respiratory TherapyScavenger hunt 20 pieces of equipment by 20

therapistsTime to find 14.4 minutes to 8.7 minutesNumber of steps 762 +185 to 465 +123Pieces of equipment not found: 45 to 1 Financial impact ~ $10,000/yrClinical impact

Page 7: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver Health

n Lean-5SEngineering Departmentq 21 number of sites for inventory before q 19 number of sites for inventory afterq Materials Managementn $ cost before – 2004 $1,034,631; 2005 –

$1,155,500n $ cost after – Actual 2006 savings $869,766

(24.7% reduction expense over prior year)

Page 8: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver Health

n Utility of starting with 5Sq Easy/Intuitiveq Applicable to clinical areas and support

functionsq Creates safetyq Improves moraleq Large number of employees engagedq Immediate resultsq Basis for other Lean toolsq Begins spread of culture of Leann A must now for space requests and moves

Page 9: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver Health

n Role of Black Beltsq Originally two projects/year (pre RIE approach)q Now – way of doing business; monthly reports

from every BB to CEOq Some impressive ongoing efforts

Page 10: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver Health

n Examples Black Belt Use of Leanq Emergency Departmentn Standardized roomsn Mapping work flow-regained space

q Paramedicsn Mapping change over- create vehicle stocking

techq Legal n Transform paper process to electronic

Page 11: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver Health

n Outcome of Black Beltsq Imbedding lean in cultureq Dollar savings $701,337

Page 12: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver HealthImplementation

n June 2005-Presentn Rapid Improvement Event n Simpler

n Radically different problem solvingq Intense self-reflectionq Highly focused, outcome directed

Page 13: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

n 5 Strategic Value Streamsq Accessq Outpatientq Inpatientq Operating Roomq Billing

Lean at Denver HealthLean at Denver Health

Page 14: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver Health

n RIE Teamq Facilitator – Coaches in use of Lean; owns

pre and follow-up dataq Team Leader – Manages one day to day

processq Process owner – In the focused area;

responsible for sustaining changeq New eyes – Someone from non RIE areaq No more than 1/3 new RIE team members

Page 15: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver Health

n RIE level Metricsq Easily measurableq Financial metricq Quality metricq Employee metric

n Production board on siten Ongoing measurement

Page 16: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Rapid Improvement Event Week:Rapid Improvement Event Week:•• Monday (8 hrs) 8 amMonday (8 hrs) 8 am--9:30 am training 9:30 am training ––mapping mapping process; waste walkprocess; waste walk•• Tuesday (8 hrs)Tuesday (8 hrs)––design new processdesign new process••Wednesday (8 hrs) Wednesday (8 hrs) -- pilot new processpilot new process••Monday Monday ––Wednesday Wednesday ––four pm report out tofour pm report out to

Executive staffExecutive staff••Thursday (8 hrs)Thursday (8 hrs)–– create standard workcreate standard work••Friday 8 amFriday 8 am--9 am9 am-- all team report out to all team report out to Executive Staff and CEOExecutive Staff and CEO•• 9 am9 am--10 am Training10 am Training

Lean at Denver HealthLean at Denver Health

Page 17: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Access Value Stream: Inpatient Enrollment RIE Team

Peg Burnette Executive SponsorCarol Lovseth EnrollmentChristine Lassiter Patient AccountingJoe Masi Office of IntegrityNancy Holtzmaster Information SvcsRichard Castro Community HealthCesar Rodriguez EnrollmentLuz Collins Community HealthRafael Gomez-Gaitan AdmissionsVera Stelter FacilitatorSara Richardson Facilitator

Lean at Denver Health RIE Case Studies

Page 18: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver Health RIE Case Studies

Inpatient Enrollment RIE Inpatient Enrollment RIE

n AIM : Reduce inpatient Self-Pay charges and increase Enrollment

n SCOPE : Inpatients arrive without proof of insurance/program (trigger) presenting in an unscheduled admission (done)

Page 19: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver HealthIn Patient Enrollment RIE

Communication Plan/Follow Up

n Track how process is working with Enrollment Specialists

n Train OP registration staff, Billing and Customer Service departments of upcoming changes

n Track and graph data for metrics, using a 12-month rolling average, and distribute it to RIE team and Enrollment Specialists (Production Board)

Page 20: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver HealthIn Patient Enrollment RIE Results

Self Pay Charges90 Day Rolling Average

$-

$200,000

$400,000

$600,000

$800,000

$1,000,000

$1,200,000

$1,400,000

$1,600,000

$1,800,000

Jan-06 Feb-06 Mar-06 Apr-06 May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06

Target: $1,074,99030% Reduction

Page 21: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

MemorandumTo: Carol Lovseth

From: Team Award Committee:-Peg Burnette, Phil Mehler, M.D., Kay Daugherty, Mike O’Malley

Date: 1/29/2007Re: Team Incentive Plan Project SubmissionCongratulations! The Team Award Committee has approved your Team Award project submission “Inpatient Enrollment RIE”! The committee has also verified that you have achieved the targeted metrics as outlined in your project submission! Payout per teammember will be $500 (before deduction of taxes) and will appear on the February 13th, 2007 paycheck! This is the maximum award amount under the Team Award policy! Please note that if you are a CSA employee, payout will appear at the end of the calendar year in which the payout was made. Please contact a Committee member if you have any questions.

CONFIDENTIALRightPeople

Right Process

Right Communication

and Culture

Right Environment

Right Reward

Lean at Denver HealthGetting It Right:Putting the Pieces Together

Page 22: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver Health

n Financial outcome of access value stream -- $638,817

Page 23: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver HealthRIE Case Study: Value Stream: Patient Billing Financial CounselingRIE January, 2006 (1st Pass)August, 2006 (2nd Pass)

Page 24: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver Health Financial Counseling RIERIE Team:

Executive Sponsor: Peg Burnette (CFO)Team Leader: Cheryl StephensonFacilitator: Amit KarkhanisTeam Members:Rafael Gomez-Gaitan (Process Owner)Carol LovsethLuis PicardoBettina SchneiderTom McCloskeyNancy KlockNancy McDonald

Page 25: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver Health Financial Counseling RIE

Aim: Expand financial counseling processes established in Jan’06 RIE

Scope: Insured, Self-Pay and CHS InpatientsWhen patient is contacted by financial counselor (trigger) to payments are received or account goes to collections (done)

Page 26: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver HealthFinancial Counseling RIEMetrics

Measurement Baseline Target

n Collections $10,108 $75,472(Oct-Dec’06)

n No. of payment 1 per day 4 per dayagreements per counselor

Page 27: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver HealthFinancial Counseling RIEProblem Identification• No standardized referral process• Excess human capacity due to limited scope

of previous RIE• No consistent attempt to collect from

inpatient commercial insurance patients prior to discharge (learn from Willie)

• Cumbersome manual tracking of information• Limited communication between insurance

verifiers and financial counselors Willie Sutton

1901-1980

Page 28: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver HealthFinancial Counseling RIE

Elective Surgery Collections

$1,533 $1,170 $2,242$4,112 $3,944 $2,864 $3,085

$12,632

$26,033

$19,822

$-

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

Feb-06

Mar-06

Apr-06

May-06

Jun-06

Jul-06

Aug-06

Sep-06

Oct-06

Nov-06

Target

1st Pass2nd Pass

Page 29: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver Health

n Financial outcome billing value stream --$531,687

Page 30: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver HealthRIE Case Study: Clinic FlowWestside Peds/Teen HCP-Provider Flow Cell Team

q Paul Melinkovich, MD, Director of Community Health Services, Executive Sponsor,

q Mary O’Connor, MD, MPH, Clinic Team Leadq Tricia Mestas, RN Program Managerq Cherie Spinks, PAq Perla Garfio, HCPq Jenny McCoy, Lowry NPq Jeff McNally, IS Web Applications Supervisorq Vickie Leger, CHS Director of Nursing, Team

Leaderq Dana Ballai, Facilitatorq Amie Staudenmaier, Facilitator

Page 31: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver HealthWestside Peds ClinicRIE n Aim : To increase

provider & HCP productivity, decrease waiting and improve patient cycle time

n Scope: Time HCP calls patient (trigger) to the time patient leaves the room (done)

Page 32: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver HealthWestside Peds RIE Metrics

Users per FTE- improve by 5%UPFTE

Patients per Provider Session- improve by 20%PPS

Clinic Flow Time - Door to Door- improve by 10%Flow Time

Discipline Specific Quality Outcomes- improve by 5%

Clinic Outcome

Staff Satisfaction - improve by 5%Satisfaction

Value Stream Metrics

24 m45.6 mCycle time

>109.3Patients per provider session

TargetBaseline

RIE Metrics

Page 33: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver HealthWestside Peds RIE Spaghetti Diagram

n Pre n Post

Page 34: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver Health Westside Peds RIE Results

n Reduced cycle time by nearly 50% on first day of implementation

n Reduced movement/motion for HCP & Providern Created tight connections between HCP and

providern Used multiple/rapid PDSA to make adjustmentsn Addressed Value Statement & Business Case

created during Value Stream Mapping

Page 35: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver Health Westside RIE Follow Up

n Pilot teams will maintain daily control board and track cycle times

n Facilitators will observe and monitor pilot teams and make necessary adjustments during 3 weeks post RIE

n Attend monthly staff meeting to ensure changes are sustained

n Will strategically roll out new model to remaining Provider/HCP teams

Page 36: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver Health

n Financial outcome clinic value stream -- $457,006

Page 37: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

n Medicine Service Line Administratorn Nurse Anesthetist (CRNA)n Facilitatorn Infection Control RNn ID Pharmacist n RNn Consultants:

q Chief of Infectious Disease, Medical Director, ITq Surgeons, Medical Director of Anesthesiologyq HIM/IS Regulatory Compliance Coordinator

Lean at Denver Health RIE Case Study: Value StreamValue Stream--ORORSurgical Site Infection (SSI) RIE Surgical Site Infection (SSI) RIE June, 2005June, 2005

Page 38: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

n Changed point of administration of antibiotics from pre-op to anesthesiologist in the OR

n Documented standard work for application-process-timeliness

n Met with surgeons from each service to review process

Lean at Denver HealthSSI RIEInterventions

n Change process effective June 5, 2005n Communication letters sent to all personnel as

follow-up to face to face communication

Page 39: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver HealthSurgical Site Infection RIE Results

n Antibiotics within 1 hour of cut timepre target post

65-75% 100% 96%

Page 40: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Sustaining Results atDenver Health

Antibiotics Within 60 Minutes of Surgery

0%

20%

40%

60%

80%

100%

120%

May '0

5 (n=

12)

July

'05 (n

=26)

Augus

t '05 (

n=29

)

Sept '0

5 (n=

28)

Oct '05

(n=2

2)

Nov '0

5 (n=

22)

Dec '0

5 (n=

28)

Jan '

06 (n

=7)

Feb '

06 (n

=16)

March '

06 (n

=23)

April '0

6 (n=

20)

May '0

6 (n=

20)

June

'06 (

n=25

)

July

'06 (n

=27)

Augus

t '06 (

n=23

)

Sept '0

6 (n=

14)

Oct '06

(n=2

4)

Nov '0

6 (n=

22)

RIE WeekJune 3-6, 2005

Exec Staff Redefined Process Owner

Page 41: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

n Facilitatorn Director of Anesthesiologyn Director of Perioperative Servicesn OR Charge Nursen Surgical Techniciann Two RN’sn Practice Administrator

Lean at Denver HealthOR Room Turnover RIETeam Composition

Page 42: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver HealthQuick Change RIEAugust, 2006

n Ophthalmology Room Turnover RIE Interventionsq Co-located equipment and medications (Point of Use)q Created and implemented standard work for ES

("Quick Turn")q Created and implemented standard work for SPD

for cataract casesq Modified schedules: Infected cases (cataracts) at

the end of the block q Using "wave schedule"

Page 43: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver Health OpthamologyRoom Turnover RIEMetricsMetrics

7.5812Room/ready minutes

785Case/day

posttargetpre

Backlog removedBacklog removed

Page 44: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver Health

-2%16,60916,947OR Hours

-1.0%$ 546 $ 551 Supplies per OR Hr

$979,424Total Impact

-0.9%$ 848 $ 856 OR Total Expense per OR Hour

2.5%$ 3,764 $ 3,673 OR Gross Charge per OR Hour

% ∆Jan-Dec 2006Jan-Dec 2005OR Financial Analysis

Page 45: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver Health

$14.09 $14.50 $12.61$10.27$9.58$8.92Total OR Expense

(million $$)

$546 $551 $468 $452 $434 $362 Supply Expensesper OR Hr

$848$856$741$689$676$566Total OR Expenseper OR Hour

$3,764 $3,673 $3,442 $3,365 $2,931 $2,469 Gross Charges per OR Hour

200620052004200320022001OR Financial

Trend

Page 46: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

q Facilitatorq Director of Support Servicesq Asst Chief of Nursingq RNq Asst Manager Environmental Servicesq Admin Asst Admissionsq Financial Apps Supervisorq Nursing Supervisorq Transportation Supervisorq Program Managerq Project Manager

Lean at Denver HealthRIE Case Study:Hospital Flow Value StreamED to Patient In Assigned Bed RIE Team

1st Pass: November, 2005

2nd Pass: April, 2006

3rd Pass January, 2007

Page 47: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver HealthED to Patient In Assigned Bed RIE Aimn Decrease the time from

patient bed assignment to the patient’s arrival to the bed.

Scope:n Patients being admitted

to 3B, 4B, 6A, 9A from the ED

Page 48: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver HealthED to Patient In Assigned Bed RIE Metrics

Value Stream MetricsED Divert %Unutilized Bed Time (Bed Fallow Time)

RIE MetricsBaseline Pilot Target

Cycle Time:Bed Assigned to Patient in Bed 2.5 – 3 hrs 38-75 min* 1.5 hrs

Pilot studied already cleaned rooms- room cleaning takes 24-45 min

Page 49: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver HealthED to Patient In Assigned Bed RIE Interventions

n Active notification to ED of bed assignmentn Floor nurse “pulls” patient to floor by calling to

request report from ED nurse.n Clarified roles and responsibilities, created

standard workn Scripted communicationn Set clear expectations with timelines

Page 50: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver HealthED to Patient In Assigned Bed RIE Results

Bed Assigned -> Patient in BedPatients Admitted from the ED

0:000:280:571:261:552:242:523:21

Average 3B Average 4B Average 6A Average 9A

11-20-06 through 1-24-07

11-20 to 11-2811-29 to 12-612-7 to 12-1212-13 to 12-1812-22 to 12-2612-29 to 1-41-5 to 1-24

Goal:1:30

Page 51: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver HealthED to Patient In Assigned Bed RIE Follow Up

n Continue education to nursing staffn Seek feedback from nurse managers and all

staff involved in new processn Study financial impact of new processn Review standard work and make changes as

new technologies roll out

Page 52: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver HealthED to Patient In Assigned Bed RIE Standard Work

November RIE“You’ve Got Bed”

ED to Floor Patient Handoff4 Positive Changes!!!!!!

Effective Monday, November 20,2006

ØED clerk receives a call from the floor charge nurse with bed assignmentØFloor nurse calls to get report from ED nurseØED Clerk verifies room ready (in Navicare) prior to transport ØED staff delivers admit paperwork to floor clerk before patient is taken to roomSee “Patient Flow Standard Work” for details

November RIE“You’ve Got Bed”

ED to Floor Patient Handoff4 Positive Changes!!!!!!

Effective Monday, November 20, 2006

ØFloor charge nurse contacts ED clerk with bed assignmentØFloor nurse calls to get report from ED nurseØAdmit paperwork delivered to floor clerk before patient is brought to roomØFloor clerk immediately notifies assigned staff of patient arrivalSee “Patient Flow Standard Work” for details

Page 53: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver Health

n Total financial benefit of Lean --$3,446,457 (18 months)

n Saved $191,470/month

Page 54: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver Health

n Rapid Improvement Eventsq Positivesq Focused effortsq Results orientedq Employee involvement and acceptanceq Interns/Residents involvement-unique

opportunityq Does save dollarsq Changes culture

Page 55: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver Health n Lesson learnedq Having sensei q Right Value Streamsq Decide RIE order and schedule in

advanceq Create right size RIE—pre work and

eventq Defined RIE process—pre work and eventq Team Composition—no more than 1/3

new; cliniciansq Establish and Monitor metrics/outcomesq Needed full-time facilitatorsq Reluctance to remove employeesq Sustaining results (F/U)q Have patience

Page 56: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

n Monitoring metrics and outcomesq Executive staff member responsible for

each Value Stream (VS)q Facilitator responsible for each VSq Evaluation team-financial analyst, health

service research, senior facilitatorq Monthly review of metrics with CEOq Monthly review of process with Executive

Staffq Monthly meeting Executive Staff VS

sponsors and senseiq Monthly meeting CEO and sensei

Lean at Denver HealthHow To Sustain Process Improvements

Page 57: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver Health

•Lean Tools for Sustaining Improvements

q Standard Workq Executive Gemba Roundsq Visual Management: Production Boardsq Metricsq A3

Page 58: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Standardize and Solve to Improve and Sustainn Standard Work,

defined by the Rapid Improvement Team, “puts the hooks” in new process

PA

DC

STD WORK

Perform

ance

Time

PA

DC

PA

DC

STD WORK

Perform

ance

Time

Lean at Denver Health

Reprinted with permission from Simpler Consulting Inc

Page 59: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Sustaining Improvement Executive Gemba Rounds

n Review production boardsn Ask about standard workn Provide positive feedback!n Answer questions

Page 60: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Sustaining Improvement OR Production Control Board

Page 61: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Sustaining Improvements:MICU Production Control Board

Late Rounds (M&M Conference)

KM

EB

MH

Home IV, O2LW

TransportationPGComments

Discharge in next 24 hrs?Patient

Improve Std Work

Corrective Action

80/20 Problems

Rapid Improvement Target: Discharge Before Noon

Page 62: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Sustaining Improvements:Production Control Boards

Discharge Time

600

700

800

900

1000

1100

1200

1300

1400

1500

1600

1700

1800

1900

2000

2100

Tim

e Average

Goal

Date: 2/5/07 Date: 2/6/07 Date: 2/7/07

Page 63: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver HealthFinancial Counseling RIEControl Board

No. of Patient Contacts versus Payment Agreements Per Day

0

2

4

6

8

10

12

25 26 27 28 29

September

No. of payment agreementsper dayNo. of patient contacts perdayTarget for paymentagreements per day

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A3: Telling the Story,Showing the Sustainment

1. Reason for Action2. Initial State3. Target State4. Gap Analysis5. Solution Approach6. Rapid Experiments7. Completion Plan8. Confirmed State9. Insights

Page 65: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver Health

731611I understand Lean philosophy and how it works in our organization and helps maintain our mission

622612I see benefits of the Lean philosophy in doing right processes at DH

591130I have been involved in the Lean Initiative like 5S or RIE

% Agree% Neutral% Disagree

Impact of Lean on CultureImpact of Lean on Culture

Page 66: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver Health

n Employee engagement score 4.48 (1-5) n Single best correlation to engagement was being

on RIE

Page 67: Lean at Denver Health - · PDF fileLean at Denver Health Phil Goodman, MS, HSA, RRT Senior Lean Facilitator Denver Health Medical Center Denver, Colorado ©2007 Denver Health Medical

Lean at Denver HealthConclusion

n Lean is a philosophy and tool set that is readily adaptable to health care

n Lean is an approach the health care work force will embrace

n Implementing Lean requires senior leadership, focus, training, structure and monitoring

n Preliminary data suggest two year effort to really get to Lean; long term commitment