Profit = Measures - Saskatchewan Health Authority · costs a lot of money, as manufacturers...

©1996-2013, John Black and Associates LLC

Licensed Materials – USA Copyright Laws Apply 1

Mod 19 – Measures

19 Measures v20130525

Global Production System

Product/Patient Quantity Analysis

Kaizen Kaikuku

Just-in-Time

Measures

Standard

Operations

Heijunka

(Leveling)

Continuous

Flow

Total

Productive

Maintenance

Poka-yoke (mistake

proofing)

Kanban

Setup Reduction

Changeover

Multi-process

Operations

Jidoka (human

automation)

GPS

MUDA MUDA

Visual

Control

Andon

TAKT TIME ONE PIECE FLOW PULL PRODUCTION

R

e

d

e

p

l

o

y

m

e

n

t

Committed Leaders

Profit =

Price - Cost

TAKT Time Map

Capacity Tables

Cost Reduction By Eliminating Waste

GPS Depth Study

NVA/VA-

Functions/Mgrs

Quality Cost Delivery

Morale Safety

Value Stream Mapping

5S • Sorting

• Simplifying

• Sweeping

• Standardizing

• Self Discipline

3P Prod Prep

7 Flows Medicine

7

Wastes

RPIW

7 Flows

Factory

4 No’s

© 1996-2013, John Black and Associates LLC

(modified from Hiroyuki Hirano, Productivity Press).

Measures

Module 19

Mod 19 – Measures

2 ©1996-2013, John Black and Associates LLC

Licensed Materials – USA Copyright Laws Apply 19 Measures v20130530

Measures: Key Points

World Class Measures Quality, Cost, Delivery, Safety,

and Morale (QCDSM) lead to full customer satisfaction.

You can’t improve what you can’t measure.

Cascading measurement and accountability creates

alignment.

Strategic Visibility process, Weekly wall walks focused on

Service Lines, and Visual Daily Management are

components of this alignment process.



Mod 19 – Measures


Measuring World-Class Quality Ensures

Survival Through Full Customer Satisfaction

World-Class

Quality for Total

Survival

Quality

Cost

Delivery

Safety

Morale

Full

Customer*

Satisfaction

Ass

ura

nce

of Q

ual

ity

Everyone Cares

For Provider

For Patient

Right Amount

Right Time

Right Place

Price Effective

Cost Effective

Reliability

Responsiveness

Assurance

Empathy

Tangibles

* Patient



Mod 19 – Measures


Weekly Stand-Up Meeting Wall

Park Nicollet Health Services/Used with Permission



Mod 19 – Measures


Visibility Room

Park Nicollet Health Services/Used with Permission

Mod 19 – Measures



Quality Products and services received by the customer must fit

their precise intended use, while serving the customer’s

needs better than do the products and services of

competitors.

These products and services must meet customer

requirements and conform to customer specifications.

They must be accompanied by excellent service before,

during, and after their sale or delivery.

In health care, the Customer is the Patient.



Mod 19 – Measures


“Quality in a product or service is not what the supplier puts

in. It is what the customer gets out and is willing to pay

for. The product is not quality because it is hard to make and

costs a lot of money, as manufacturers typically believe. This

is incompetence. Customers pay only for what is of use to

them and gives them value. Nothing else constitutes quality.”

-- Peter F. Drucker

Professor and Management Consultant,

1991

Mod 19 – Measures



Quality Measures in Health Care Patient Defects, examples include:

Surgical site infections

Ventilator acquired pneumonia

Central line infections

Patient/Client/Resident Experience Data - Surveys

Patient Complaints

Patient Health Outcomes

Patient Stories


Mod 19 – Measures



Quality Quality of Care

• In alignment with the overall goals

of the organization, each Service

Line Leader reports their quality

of care metrics in the form of

defects as they relate to kaizen

activities such as RPIWs and 5S

events.

• Examples of Quality of Care

metrics include surgical site

marking defects (for surgery),

standard rooming defects

(primary care), door to discharge

>120 minutes (emergency).



Mod 19 – Measures


Used with permission, Florida Hospital Zephyrhills

Mod 19 – Measures



Quality

Clinical Quality

• These goals are determined by

the organization and outside

affiliates (ie JCAHO).

• Goals such as anticoagulation,

MRSA, falls, Diabetes measures,

ventilator-assisted pneumonias

etc are tracked and incorporated

into Kaizen activities such as

RPIWs.



Mod 19 – Measures



Mod 19 – Measures



Weekly Stand-Up Wall Walk

Patient Experience

The organization measures patient experience not only with Press Ganey and

other survey types, but through precise measurement of lead time and

reported out by the Product Line Leader.



Mod 19 – Measures





Mod 19 – Measures


Patient Stories


Mod 19 – Measures



Cost

Products and services must be cost-effective.

During planning, design, and delivery, these products and

services must be cost-effective for the producer.

To ensure strong demand for services, they must be

priced effectively.

World-class organizations make concentrated efforts to

eliminate waste, and they do only those things that add

value for the customer.

These organizations also control costs with suppliers and

vendors, resulting in lower costs for the same product or

service over time.

Mod 19 – Measures



Cost Measures in Health Care

Cost of supplies per surgical procedure.

Productivity gain or loss.

Inventory.

Lost time, sick time.

Cost of overproduction.

Duplicate lab tests and digital imaging.

Cost of excess laundry delivered and not used.

Mod 19 – Measures




Patient Cost

Here patient cost is measured

through cost per unit of service and

operating margins for the specific

service line as reported by the

Service Line Leader.

Mod 19 – Measures




Profit or Margin

Profit is displayed as it relates to

FTEs as defined by the organization

and reported by each Service Line

Leader.

Mod 19 – Measures



Delivery Superior delivery of products and services is critical.

Customers must receive the right amount, in the right

place, at the right time, in the right package.

Delivery must be timely, reliable, and courteous.

Customer satisfaction depends greatly on company

responsiveness, which comes from having short cycle

times to product or service delivery.

As demand increases, customers receive benefits of

economies of scale and organizational learning.

Finally, customers expect reliable new product or service

development systems, so that they can be assured that

your delivery will continue to meet their needs in the

future.

Mod 19 – Measures



Delivery Measures in Health Care

Patient appointments available on day of choice.

Volume of patients waiting for service (waitlist).

Length of time patients wait for service.


Mod 19 – Measures



Safety

The importance for the customer of safety and security in

using an organizations products and services is obvious.

Providing full satisfaction to the customer also means

ensuring safety and security for all employees who

produce those goods and services.

Customers cannot be assured of quality if employees

work in unsafe conditions or insecure places.

Furthermore, a company’s products and services must

be environmentally safe, avoiding pollution and ensuring

reuse or recycling of materials.

Mod 19 – Measures



Safety Measures in Health Care

Patient critical incidents.

Patient falls.

Adverse events, near misses.

Hand hygiene.

Staff injuries.

Needle sticks.


Mod 19 – Measures



Visibility Room Review

Safety

• The safety category displays the organization’s adverse events and high

level safety indicators.

• Other information is related to infection control, blood and body fluid

exposure, and falls.

• Adverse events and high level safety indicators call for root cause analysis

and poke-yoke implementation.

Mod 19 – Measures



Seattle Children’s Bellevue Surgery Clinic/

Used with Permission

Employee and Patient

Safety Visibility Wall

Mod 19 – Measures



Morale

Workmanship, product reliability, and substantive quality

require that people have high morale and competence.

Employee morale and education become critical aspects

of full customer satisfaction.

Customers must be assured that the people who deliver

their products and services really understand and care

about doing a good job.

Mod 19 – Measures



Morale Measures in Health Care

Employee Survey Results.

Staff turnover.

Staff retention.


Mod 19 – Measures



Visibility and Alignment of Measures As referenced in the World Class Management Module, Visibility and

Alignment of measures is done across the 3 Management System

Components: Management by Policy (Hoshin Kanri)

Monthly Reviews of Strategic Visibility Room

Cross Functional Management

Weekly Wall Walk of Operational Wall, by Service Line, QCDSM

Daily Management

Daily Huddles at Visual Daily Management Boards

Measures identified as part of a Break Through Initiative (Hoshin)

can and usually will cascade From the Strategic Visibility Room,

through the Weekly Wall Walk, right to Visual Daily Management

Boards (as identified on the next chart).

However, measures on the Strategic Visibility wall are focused on the

Breakthroughs only and do not cover the entire operation (as

represented on the second following chart).



Mod 19 – Measures


BETTER CARE

0 NEVER EVENTS

Strategic Visibility

Room (Breakthroughs/

Hoshins) 3-5 Year

Outcome Targets

Weekly Wall Walk -

QCDSM

Daily Visual

Management

Target Progress

Patient mortality related

to L 3& 4 pressure

ulcers Service Line Leader

Front Line Mgrs

Pressure Ulcer

Level 3 and 4

#1 priority

Reduce level 3 & 4

pressure ulcers at LTC

Chart updated as of

______ Action to be taken

to return to

LTC Site 1 LTC Site 2

LTC Site 3 LTC Site 4

Strategy

The Management System and Visibility and Alignment

Senior Leader,

Breakthrough Leader Man

ag

em

en

t b

y

Po

licy (

Ho

sh

in K

an

ri)

Cro

ss

Fu

ncti

on

al

Ma

na

ge

me

nt

Daily

Man

ag

em

en

t



Mod 19 – Measures


Quality Cost Delivery Safety Morale

Hoshin 1 Hoshin 2 Hoshin 3 Strategic Visibility Room

(Breakthroughs Only)

Wall Walks

(Monthly; CEO

& Exec Team)

Daily Visual Management

(Daily or Weekly; Manager and point of care staff)

The Management System and Visibility and Alignment

Service Line #1

Service Line #2

Mod 19 – Measures



Strategic Visibility Room

Review: Key Points

Dedicated space outlining the overall strategic plan and

corresponding Kaizen activity related to the goals.

The review is lead by the CEO and mandatory attendees

include: senior/executive leaders, chiefs and VPs,

including the KPO VP.

Monthly review to assess progress toward Breakthrough

Plans and related targets and metrics.



Mod 19 – Measures



Kaizen

• Displays kaizen activities such

as RPIWs, 5S events, 3Ps and

their results.

• Shows the progress of lean

certification from a system-wide

perspective.

• Utilizes individual Kaizen

Operation Teams’ integrated

timelines for strategic planning

of events.



Mod 19 – Measures


Who are we?

• Identifies the organization as a whole

with one slide for each of the following:

• Core strategic elements (ie world

class continuum of care).

• Economic engine (ie what do we look

like yesterday v. today v. tomorrow).

• Priorities for the current year (ie

increased productivity and decreased

leadtime.

• Mission.

• Vision.

• Outcomes management.




Mod 19 – Measures


Visibility Room Review Strategic Objectives

• Displays overall view of how

the organization is doing as it

relates to the QCDSM

metrics.

• Identifies plans and progress

for the following:

Volume of Service, Lead

Time, Caring, Cost,

Outcomes, Safety,

Marketing, Facility

Management, Leadership

Development, Revenue

Management, Systems

Reliability.



Mod 19 – Measures



Critical Success Metrics

• Displays the organization’s progress in the following categories:

Equitability, Profit & Growth, Productivity, Joy, Market Share,

Asset Turns, Publications and Philanthropy.



Mod 19 – Measures



Critical Business Processes

• Displays the organization’s progress in the following categories:

Compliance and Accreditation, Recruitment, Planning, and Governance.



Mod 19 – Measures



Clinical Quality

• Through the display of high level Value Stream

Maps and a PQA of conditions, clinical quality

is tracked by progress in such areas as

Diabetes Management, Heart Failure, Wound

Care, Readmissions, etc.



Mod 19 – Measures


Used with permission Florida Hospital Zephyrhills



Mod 19 – Measures



Production Control

• Demand vs. Capacity, Resource Need vs. Actual and the

organizational Takt Time Map are production control.

• These areas help identify what is v what is needed to meet the

demands of the organization in regards to patients and employees.

• Production control displays trends in market growth in the community

as it relates to age, demographics, and disease conditions.



Mod 19 – Measures





Mod 19 – Measures


Visibility Room Review Pay for Performance &

Transparency

• Pay for Performance displays

financial data in regards to how

the organization collects dollars

for meeting condition-based goals

• Transparency identifies how well

the organization is doing as it

relates to others in the community

through Leap Frog, Press Ganey,

HCAPS, JCAHO, etc.

Mod 19 – Measures



Weekly Stand-Up

Wall Walk: Key Points

One level down from the Visibility Room, the Weekly

Stand-Up Wall Walk brings all service line leaders

together to review the progress of Kaizen activity in their

area through the use of standard control charts by each

KOT.

The Weekly Stand-Up Meeting Wall Walk is led by the

CEO at a standard day and time each week with each

Product Line Leader reporting their QCDSM metrics to a

Takt Time. Mandatory attendees include senior/executive

team, chiefs, KPO and KOTs, and directors.

This form of cascading communication allows for

transparency and comingling of information across

the organization.



Mod 19 – Measures


Weekly Stand-Up Wall Walk Standard Work

Name of Activity: Weekly Wall Walk

Role performing Activity: Leadership

STANDARD

WORK

Location:

Wall in Administration

Department:

All

Document Owner:

Carla Breedlove, Director Kaizen Promotion Office

Date Prepared:

12/15/09

Last Revision:

12/17/09

Date Approved:

12/17/09

Standard Work Summary: Steps by which the weekly wall walk occurs; each presenter

has 10 minutes to report without interruptions from the audience and then can take up to 5

minutes to field questions related to their report out. KPO Director (or designee) will

monitor the takt time.

Task

Task Definition

Cycle Time (mm:ss)

1. KPO Director calls the wall walk to order at designated time by stating

“Welcome to this week’s wall walk. Today is week (x) and we will be

hearing reports on the metrics of (y).” (see reference below) and introduces

any guests who may be attending:

Wk 1: Goals, Integrated Timeline

Wk 2: Quality, Cost, Delivery

Wk 3: Safety, Morale, Patient Experience

Wk 4: RPIWs, 5S campaign, Lean Events

1:00

2. CEO, CFO, COO, CMO leads a prayer 0:30

3. CEO, CFO, COO, CMO, CNO, KPO reports on the appropriate metrics for

the “Overall” category.

10:00

4. CEO, CFO, COO, CMO, CNO, KPO takes questions from the audience

related to their report out.

5:00

5. Director for Emergency Department reports on the appropriate metrics for

the “ED” service line.

10:00

6. Director for Emergency Department takes questions from the audience


5:00

7. Director for Surgical Services reports on the appropriate metrics for the

“Surgical Services” service line.

10:00

8. Director for Surgical Services takes questions from the audience related to

their report out.

5:00

9. Director of Materials Management reports on the appropriate metrics for

the “Materials Management” service line.

10:00

10. Director of Materials Management takes questions from the audience


5:00

11. KPO Director adjourns weekly wall walk and dismisses group. 0:30

Standard Work

• The standard work is followed each

week and kept to a Takt Time by a

timekeeper.

• Each week focuses on a different

set of metrics. A sample is shown

here:

• Week 1: goals & timelines.

• Week 2: quality, cost, delivery.

• Week 3: safety, morale, patient

experience.

• Week 4: RPIWs, 5S, Lean.



Mod 19 – Measures


Weekly Stand-Up Wall Walk Run Chart

Pre-Service Leadtime

G.I. Clinic

0

10

20

30

40

50

60

70

80

90

100

1 2 3 4 5 6 7 8 910

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

Q1 Q2 Q3 Q4

Week / Quarter

Nu

mb

er

Of

Days

2006 Actual 2007 Actual

2007 Goal Series1

Series2

2006 Q1:

2007 Q1:

Delta:

70.4

57.8

-18.0%

2006 Q2:

2007 Q2:

Delta:

77.9

67.7

-13.2%

2006 Q3:

2007 Q3:

Delta:

70.2

61.8

-12.0%

2006 Q4:

2007 Q4:

Delta:

66.4

#VALUE

Date Prepared: September 24, 2007

Report Contact: Demand Planning & Analysis, Gregg Teeter, 3-9238

Source: LastWord scheduling data mart

Refresh Cycle: Weekly (1 week lag)

Operational Def: 2006 vs 2007 weekly weighted AVG compared to goal (50% of 2005 4Q AVG)

Criteria: Weighted AVG appointment availability (weighting based on volumes of seen appointments by dept, facility, prov, appt type

Run Chart

Used across all service

lines, these standard

charts make reading the

metrics easy and

consistent.



Mod 19 – Measures





Mod 19 – Measures


Weekly Stand-Up Wall Walk Growth

Each Product Line Leader addresses

their individual service line growth as

it relates to the strategic plan for

growth in the organization.



Mod 19 – Measures



KOT Product Line

Other metrics shown on KOT’s area of the wall are their own product line’s current

and future state (12 months out) value stream maps, integrated timelines, RPIW

and 5S matrices, results, audits, target sheets, newspapers and goals.

Mod 19 – Measures



Measures Summary

Quality, Cost, Delivery, Safety, and Morale are metrics

defined by the organization and the community (ie

JCAHO).

Using cascading communication from one level of the

organization to another through the use of the Weekly

Standup Wall Walk and Monthly Visual Room Review, the

organization can stay in alignment of its goals and

strategic plan.

Profit = Measures - Saskatchewan Health Authority · costs a lot of money, as manufacturers...

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Transcript of Profit = Measures - Saskatchewan Health Authority · costs a lot of money, as manufacturers...