Lean At Denver Health: Saving Lives, Saving Money, Saving Jobs

Phil Goodman

Director

Lean Systems Improvement

What is LEAN?

• LEAN can be defined as a systematic approach of

continuous improvement, based on the Toyota

Production System (TPS) of LEAN principles and

LEAN tools, used for the identification and

elimination of waste.

Lean Pillars of Transformation

Transformation R

esp

ect

for

Peo

ple

Con

tin

uou

s

Imp

rovem

ent

Lean Deployment at Denver Health

• Process Transformational Plan of Care Value Streams Rapid Improvement Events • Black Belts • Application in healthcare settings • Results

Selecting Value Streams: The Matrix

One Year

Enterprise Goals

Weight RankRxWRankRxWRankRxWRankRxWRankRxWRankRxWRankRxWRankRxWRankRxWRankRxWRankRxWRankRxWRankRxWRankRxWRankRxW

Financial: Improve Net

Revenue 10%5 5 25 5 25 5 25 5 25 2 10 4 20 5 25 3 15 5 25 4 20 5 25 5 25 5 25 5 25 5 25

Delivery (Timeliness)

Reduce Lead Time 50%4 4 16 4 16 4 16 4 16 3 12 2 8 3 12 5 20 5 20 4 16 4 16 4 16 2 8 4 16 4 16

VOC: 90th Percentile Pt

Satisfaction3 5 15 4 12 5 15 3 3 3 9 1 3 5 15 2 6 5 15 4 12 5 15 3 9 2 6 4 12 3 9

Growth/Access :

Increase Unduplicated 2 2 4 2 4 4 8 1 2 1 2 1 2 3 6 2 4 5 10 4 8 2 4 2 4 4 8 2 4 2 4

Quality: Reduce

Nosomial Infections1 1 1 3 3 5 5 5 5 1 1 1 1 1 1 1 1 3 3 3 3 5 5 2 2 2 2 3 3 1 1

Total

OB

60

Ca

se

Mg

mt

49

ED

Pt F

low

Ima

gin

g

Ph

arm

acy

Ca

th L

ab

OR

Wo

un

d C

are

Pt. T

ran

sp

ort

Me

d R

eco

rds

Pt R

eg

./S

ch

ed

.

Eq

uip

Mg

mt

61 60 69

Me

d/S

urg

51 34 34 73 59 65

La

bo

rato

ry

4659 56

Re

ve

nu

e C

ycle

55

CORE Processes

Selecting Value Streams

Value

Stream

Analysis

(VSA)

Value

Stream

Analysis

(VSA)

Value

Stream

Analysis

(VSA)

Value

Stream

Analysis

(VSA)

Rapid

Improvement

Event (RIE)

Rapid

Improvement

Event (RIE)

Rapid

Improvement

Event (RIE)

Rapid

Improvement

Event (RIE)

Rapid

Improvement

Event (RIE)

Rapid

Improvement

Event (RIE)

Rapid

Improvement

Event (RIE)

Rapid

Improvement

Event (RIE)

Rapid

Improvement

Event (RIE)

Rapid

Improvement

Event (RIE)

Rapid

Improvement

Event (RIE)

Rapid

Improvement

Event (RIE)

Rapid

Improvement

Event (RIE)

Rapid

Improvement

Event (RIE)

Rapid

Improvement

Event (RIE)

Value

Stream

Analysis

(VSA)

Transformation Plan of Care

(TPOC)

Enterprise Transformation Alignment

System Metrics

Value Stream Metrics

RIE Metrics

Quality Delivery

(Access)

Productivity Financial Human

Development

Nosocomial

Infections

ED Divert Visits per

Session

Expense per

D/C or

Encounter

Employee

Engagement

OB ED/

AUC

Spec

Clinic

Rev

Cycle HR MC Rx BHS RMP

DC RN OR CP Med

D/C

CHS

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

RIE

Enterprise LEAN Alignment “Constancy of Purpose”

2012 Value Streams Value Stream Executive Sponsor Value Stream Executive Sponsor

Emergency Department Phil Mehler MD, CMO Pharmacy Rick Dart, MD Director, RMPDC

Human Resources (HR)

Gregg Rossman, Chief HR Behavioral Health Stephanie Thomas Chief Operating Officer

Managed Care MC

LeAnn Donovan, Director, MC

OB/Gyn Chris Carey, MD Chief OB/Gyn

Nursing Kathy Boyle, CNO Ambulatory Care Paul Melinkovich, MD Chief Ambulatory Care

Perioperative Svcs Kathy Boyle, CNO Revenue Cycle Peg Burnette, Chief Financial Officer

Clinical Processes Tom MacKenzie,MD Director Pt Safety and Quality

Medical Discharge Rick Albert Chief of Medicine

Rapid Improvement Event (RIE) Simpler

–Using LEAN Tools in Focused Manner

Day 1

Mon

• Examine a process/function or area

• Identify areas of waste, non-value added steps

• Identify metrics

Day 2

Tues

• Develop new process, standard work and communication to eliminate

identified waste and increase value

• Design rapid experiments

Day 3

Weds

• Implement the new processes, standard work

• Monitor production board and communicate standards

• Observe new process and any change in metrics

Day 4

Thurs

• Adjust and fine tune new standard work

• Put visual controls in place

Day 5

Friday

• Celebrate! Report out to executive staff

• 10 minute team reports

Lean Deployment at Denver Health

• Process Transformational Plan of Care Value Streams Rapid Improvement Events • Application in healthcare settings • Blackbelts • Results

Pediatric Access RIE Team

Let’s just say that there’s a certain level of bonding

that occurs in RIEs

Examples of RIEs Clinical Rapid Improvement Event Non-Clinical Rapid Improvement Event

Venous Thromboembolism

Prophylaxis

Standardized use of Low Molecular

Weight Heparin (LMWH),

Unfractionated Heparin (UFH), and

Sequential Compression Devices

(SCD)

Managing Facility Charge Denials

By putting rules in Med Assets,

putting standard work into place for

denials management and

communicating with registration, UM

and Contracts Management about

denials that can be prevented on the

front end, we believe we can reduce

outstanding denials by 15%, or

$225,000

Oct 2011 Baseline: 5.7% Target ( 15%): 4.9% June, 2012 Denials: 3.3%

Lean Deployment at Denver Health

• Process Transformational Plan of Care Value Streams Rapid Improvement Events • Black Belts • Application in healthcare settings • Results

Denver Health Lean Academy/

Black Belt Training Lean Tools to “Diagnose” Waste Lean Tools to “Treat Waste”

Process Mapping Standard Work

Time Observations Poke Yoke (Mistake Proofing)

Level Loading Diagram Kanban (Pull Systems)

Spaghetti Diagram 6S (Sort, Set, Shine, Standardize, Sustain, Safety)

Communication (Handoff) Circle Andon (Stop the Line)

Waste Walk Visual Management

A3 Problem Solving A3 Problem Solving

Black Belt Project Example:

Common Canister

Inhalers for Asthma and COPD: Combivent, Albeterol, Atrovent, and Flovent

Pharmacy/Respiratory Therapy “Common Canister” Black Belt Project: Pre Lean: 6,624 canisters/year

Post Lean: 2,381 Canisters/year

Savings in Acquisition Costs: $363,000!

(75% Reduction)

Lean Deployment at Denver Health

• Process Transformational Plan of Care Value Streams Rapid Improvement Events • Black Belts • Application in healthcare settings • Results

Pre-Hospital:

Denver Health Paramedic Value Stream Paramedic Division Response Time Performance Pre and Post RIE

700

720

740

760

780

800

820

840

860

880

EMS EMS EMS EMS EMS EMS EMS EMS

<48 48 49 50 51 52 53 1

Weeks of 2008-2009

Res

po

nse

Tim

e in

Sec

on

ds,

911

An

swer

to

Arr

ival

at

90%

Co

mp

lian

ce

RIE Conducted

This Week

Denver Health Paramedic Value Stream

Denver Health Paramedic Value Stream

Total Personnel, Operating Expenses and Revenue 2007-2012

Note Revenue >Operating Expense 2011-2012

Hospital Flow and Readmissions

Hospital Acquired Conditions

UHC Quality and Accountability Aggregate Score

Outpatient:

Community Health Services

2005 2006 2007 2008 2009 2010 2011

Total Patients 102710 101162 103826 108042 113003 117058 123614

0

20000

40000

60000

80000

100000

120000

140000

Total CHS Patients

Community Health Services

Improving Outpatient Quality

Improving Outpatient Quality

SUMMARY • Lean is a philosophy and tool set that fits for healthcare

• Eliminating waste improves quality of care

• Lean tools are intuitive

• Frontline staff must be respected because they understand where the waste exists and how best to eliminate it

• Lean has the power to change culture because it truly empowers employees to break down silos, rapidly implement change and own the process!