“It has the potential to be revolutionary with sufficient investment and provider buy-in. I think Lean man-

agement gives people from all professional backgrounds the tools to make their lives and the lives of their

patients tremendously better.” That is what Weston Scott Fisher, M.D., assistant medical director of Langley Por-

ter Adult Psychiatry Clinic, said after completing the intensive five-day UCSF Health Lean Fundamentals Boot Camp.

Fellow boot camper Juliia Bowden, narcotics auditor

for UCSF Medical Center, put it this way: “It makes

you step back, get out of your comfort zone and

look at problems and problem solving in a new

way.”

To stay competitive, make access to our world-class

health care easier, and provide an enriched patient

experience while reducing costs, we must work in a

new way — the Lean management way.

The Lean management system, as adopted from

Toyota, is the foundation of our continuous process

improvement. And our Lean management move-

ment is gaining momentum as news of success from

Hepa-

tology

to

Adult Infusion spreads, and more faculty and staff want to be part of the

positive changes to the UCSF Health culture.

Lean management recognizes that the focus should be on the process,

not blaming individuals; eliminates waste in processes; increases value

for patients from the patients’ point of view; reduces variation that

leads to waste; and respects people by allowing employees of all levels

to share in problem solving at the front lines. Over the past three

years, embracing Lean has made patient transport more efficient and

reliable, drastically reduced cycle times for obtaining insurance authori-

zations, right-sized supply inventories, and reduced the turnaround time

for taking a biopsy sample and communicating the final results.

The Lean Management Movement

I N S I D E T H I S

I S S U E :

Cover &

News 1

Lean Tools &

Methods 2-3

Daily Huddle

CPI Partner

Spotlight

4

CPI Announcements

U C S F H E A L T H

Transformations O C T O B E R 2 0 1 5 V O L U M E 1 , I S S U E 7

C P I

N E W S L E T T E R

It takes courage and

inspiration to change

the status quo.

The First Tests of Change begin soon for UBLTs in

Quality & Safety. Their in-progress A3s—

documents outlining the work of each improvement

cycle—are posted on the CPI website, under Our

UBLTs. Areas include reducing C. dificile, CLABSI

and CAUTI infections, increasing new patient access,

and improving HPV vaccination rates.

T H E C P I

F O R E C A S T

O C T

Leadership selects

next group of

UBLTs for Janu-

ary and starts

outreach

N O V

Improvement

Cycle focuses on

Value

D E C - J A N

Scale up Lean

training cycles for

UBLTs

E D I T O R

Holly Houston, APR

Want to share a great story of CPI? Email cpi@ucsf.edu. Visit our website at cpi.ucsf.edu.

Participants in the September 21-25

Lean Fundamentals Boot Camp

On September 10, 2015, the UBLTs received finan-

cial data from the inpatient Decision Support Ser-

vices team and Ambulatory leaders Dave Morgan

and Dave Rein. These presentations were recorded

and can be found on the CPI website under Past

Events. In October, the CPI Hub will share unit-

specific financial data with the UBLTs to prepare for

the value improvement cycle starting in November.

Lean Milestones

Nearly 900 people trained

70 Kaizens conducted

12 Value Streams

undertaken

C-Suite Lean Expert &

Advocate Hired

Cont’d on Page 2

P A G E 2

Unit Based Leadership Teams

(UBLTs)* are building and

owning the Lean management

system for each clinical unit.

UBLTs are being trained as

quickly as possible.

Fully implementing Lean effec-

tively throughout UCSF

Health, however, is not an

overnight endeavor.

“Like baseball, we win by mak-

ing hits, not by holding out for

the big homeruns,” said Execu-

tive Director and Lean expert

Cynthia Chiarappa. “A cultural

transformation is underway

that is going to take coura-

geous leadership, commitment

and patience. We’ve begun a

deliberate journey that every-

one at UCSF Health will be

asked to embark on in the

next five years.”

In this newsletter, we will in-

troduce you to several key

tools and concepts that are

integral to Lean: terms, A3

thinking, 5S, kaizen, and daily

huddles—all being successfully

adopted here at UCSF.

________

*UBLTs consist of physician, nurs-

ing and/or administrative leader-

ship dyads or triads paired with an

improvement specialist.

T R A N S F O R M A T I O N S

The one-page A3-T is an essential tool for problem solving. Filling out the A3-T helps employees observe current

conditions in the work environment, clearly define the problem, present data, spell out objectives and devise inno-

vative ways to achieve them. The A3-T is an

important Lean management tool that guides

all action. It is also a way of thinking.

While the tool disciplines cross-functional

teams to seek the root cause of a problem,

A3 thinking enables teams to recognize the

problem as a powerful opportunity for learn-

ing and improvement. Managers use A3

thinking to coach and teach; to assign clear

responsibility, ownership and accountability;

to get solid plans from subordinates; and to

mentor employees. Organizations use A3

thinking to make decisions, achieve objec-

tives, align teams along common goals, and,

above all, to learn for effectiveness, efficiency

and improvement. A3s are used to propose

projects, take initiative, sell ideas, gain agree-

ment and learn.

Lean Movement Cont’d from Page 1

Lean Terms Muda—waste; any activity, service or

supply that consumes time, money and

other resources, but creates no value

Kaizen—continuous incremental im-

provement

Value stream—the specific activities

required to provide a specific service to

a patient

Standard work—a prescribed repeata-

ble sequence of steps (or actions) that

balances people’s work

Gemba—where the work gets done,

e.g., the hospital floor

5S—sort, set in order, shine, standard-

ize, and sustain

A3 Thinking

An A3-T for UCSF Medical Center Emergency

Department at Parnassus Heights. A completed

A3 is the team charter that combines strategy

management and problem solving.

The Power of Kaizen P A G E 3 V O L U M E 1 , I S S U E 7

The ED’s 5S week included the

supply room (affectionately called

“Middle Earth”). It was the most

dramatically transformed. The

team:

Reviewed usage and par levels

Implemented color coding for

visual controls

Grouped “like” items

Removed a “little used” sink

and repurposed the area for

supplies

ED: 5S Kaizen

Kaizen, continuous incremental

improvement, happens at the front

lines. The front lines, or gemba,

where value is created, is where

managers must go to see what is

working and what is not—what is

waste and what is value added.

More than 70, 5-day kaizen work-

shops have been held since 2012.

Kaizens are conducted for designat-

ed value streams— specific activi-

ties required to provide a particular

service to a patient.

During a kaizen, faculty and staff

identify a problem and its root

cause, and then methodically work

Before, on the far left,

the elevator lobby was

filled with meal carts and

laundry, which obstruct-

ed the path for patients

on gurneys. After, on

the right, it is much easi-

er for transport staff to

move patients on and off

of the elevators.

Outcomes:

Reduced inventory by

46%, from $32,000 to

$17,000

Improved the environ-

mental, health and safety

level from a 1 to a 3 (out

of a maximum of 5)

together to find possible solutions,

which they test that week. This work

has allowed us to be more efficient,

effective, and responsive to our pa-

tients’ needs. Also, in just five days,

the interdisciplinary teams gain a new

appreciation for each other.

“We work in these silos and no one

understands what we do and what

our impact is on other silos,” said

Edwin Lager, Lean consultant, with

the Kaizen Promotion Office (KPO).

“During a kaizen the silos are broken

down and people learn to appreciate

how important each other’s role is in

providing an excellent experience for

the patient.”

ED Supply Room

Top: Before; Bottom: After

14M/L Kaizen

Edwin Lager, Pei-Lin Hung, and Christine Pollak are Lean consultants

in the Kaizen Promotion Office (KPO). They facilitate kaizen work-

shops and other Lean training and activities.

CPI Partner Spotlight

How We Can Help You

We are dedicated to reducing the risk of acquiring infec-

tions via risk assessment, surveillance, exposure follow-

up, interdepartmental collaboration, and education to

make UCSF a safer place to care, heal, teach, and discover.

Our HEIC SharePoint site has various audit and bundle

reports for CDI, central line insertion, device related infec-

tion, hand hygiene in the OR, PI-care & maintenance,

acute and critical care CLABSI and CAUTI, and CDI/MRSA/

VRE/CHG bathing scorecards. To access these tools, please

visit https://teamcentral.ucsf.edu/sites/medctr/

infectioncontrol/default.aspx

On our website, you’ll find various resources for patient

room signage (see below), answers to frequently asked

policy questions, and other educational resources.

Alvin Rajkomar, MD. Principal Data Scientist Center for Digital Health Innovation

Catherine Lau, MD. Director, Patient Safety and Quality, Dept. Neurological Surgery

The Daily Huddle Lean leaders hold daily huddles with their teams.

These huddles help everyone prepare for the day.

The Lean leader gathers the team in front of a visual

board, which displays the daily stats, team goals and

improvement ideas. Hepatology implemented daily

huddles in August. Practice Manager Sirin Tgamol

and team discuss the following:

New patients, no shows, clinic lead times ex-

ceeding 60-minute goal

Staffing issues and coverage

Organizational/departmental updates

Staff ideas for department improvements

Staff recognition

Successful ideas to increase payments of copay fees

to 90% from 40% and to decrease the number of no

shows from 10% to 5% came from the daily huddle.

Hepatology

daily huddle

and the visual

board

Want to share a great story of CPI? Email cpi@ucsf.edu. Visit our website at cpi.ucsf.edu.

Kent Soo Hoo, Director of Healthcare Technology Assessment

“It takes everyone from the front

lines to the C-suite to make a

difference. It takes the collective

minds and hearts to allow us to

perform at the best we can be,”

says Dr. Cat Lau, who has dedi-

cated her career to improving the

quality and safety of health care

for patients. She is working with

the CPI team on multiple projects,

including reducing the catheter-

associated urinary tract infection

rate by 10%; and increasing the

patient discharge by noon rate to

greater than 20%. Dr. Lau is also

helping to lead the Postoperative

Debriefing Initiative that requires

a multidisciplinary post-procedural

timeout to communicate about

patient clinical management and

about what equipment and effi-

ciency issues can be improved.

James Stotts Patient Safety Manager

“What drives me...is the promise

that the work isn’t to add num-

bers on a computer screen, or to

put paper in someone’s filing cabi-

net. Everything we’re doing is to

improve the lives and health of

our patients. There’s a real con-

sequence to what we do, so it’s

vital that we do it with responsi-

bility, with energy and with pas-

sion.” Dr. Rajkomar collects, ana-

lyzes and translates big data into

better ways to treat patients. He

has used data to help physicians

standardize blood transfusion

practices, significantly decreasing

the risky indiscriminate use of

blood products. Now he is using

data to shorten the time it takes

for primary care patients to get an

appointment.

“We always knew there were

huge gains to be made,” says Kent

Soo Hoo when talking about the

Caring Wisely program “The OR

SCORE Project.” He and his

teammates collected data on the

amounts, types, and costs of OR

supplies in three surgical units.

Soo Hoo played a pivotal role in

determining what data was need-

ed and how to efficiently obtain it.

The objective was to eliminate

waste in the inventory and reduce

costs. Starting from a $45 million

baseline budget, the team set out

to cut 10% year over year. To

date $1.1 million has been cut.

“Physicians are good citizens and

scientists. If you put the data in

front of them, they’ll make sound

decisions.”

“If you see something, hear

something, or feel something

isn’t right, speak up,” says Jim

Stotts. “It’s important to have

an environment where people

feel free to speak up about po-

tential hazards and offer ideas to

improve patient care.” As a

patient safety manager who

reads 800 to 900 patient safety

events a month, Stotts values

prevention. That is why the

monthly “Great Catch” award

was created—to recognize facul-

ty and staff who take action to

stop the line to prevent harm.

Stotts says, “The patient safety

team would be nothing without

working with others. We work

hand in hand with everybody

else to make UCSF safer. “

CPI work is promoted daily by committed faculty and staff throughout the clinical enterprise who work collaboratively to achieve our goals. This month we focus on a few standout CPI partners whose work is making a difference.