Lean 101 for Healthcare CIOs

Transcription

1 Lean 101 for Healthcare CIOs A Complimentary Webinar From healthsystemcio.com Your Line Will Be Silent Until Our Event Begins at 12:00 ET Thank You!

2 Housekeeping Moderator Anthony Guerra, editor-in-chief, healthsystemcio.com Ask A Question We will be holding a Q&A session after the formal presentations. You may submit your questions at any time by clicking on the QA panel located in the lower right corner of your screen, type in your questions in the text field and hit send. Please keep the send to default as All Panelists. Download the Deck Go to Download today's deck at: Shortened URL at bottom of all slides View the Archive You will receive an when our archive recording is ready. Separate registration is required.

3 Agenda Approximately 45 Minutes 30 minutes: Robert Slepin, CHCIO, Director, EHRs, Johns Hopkins Aramco Healthcare minutes: Q&A w/robert Slepin

4 Lean 101 for Healthcare CIOs

5 Speaker Bio: Robert Slepin, PMP, CPHIMS, CHCIO, CGEIT Robert Slepin is Director of Electronic Health Records for Johns Hopkins Aramco Healthcare. He received his B.A. from Duke University. His professional certifications include Certified Healthcare CIO (CHCIO), Project Management Professional (PMP), Certified Professional in Healthcare Information and Management Systems (CPHIMS), and Certified in the Governance of Enterprise IT (CGEIT). He blogs on health IT topics for and CHIME Time at and is a contributing writer to The Chief Information Officer's Body of Knowledge: People, Process, and Technology.

6 About Johns Hopkins Aramco Healthcare Joint venture between Saudi Aramco, a world leader in energy, and Johns Hopkins Medicine, one of the world s leading academic health systems. A health care organization designed to drive and enhance the wellbeing of the community in an environment of growth and learning, by providing innovative, integrated and patientcentered care to Saudi Aramco s employees and health care beneficiaries.

7 Learning Objectives Understand the critical success factors to identify process waste and reduce every workflow to its bare essentials Define Lean and its origin Recognize two forms of waste Identify two Lean tools Discuss one way to start exploring or adopting Lean

8 Lower cost Faster delivery Better value Higher quality Better service

9 Customer Focus 1 Know your customer 2 Understand how your customer defines value 3 Focus key processes to continuously increase value 4 Pursue perfect value creation processes (zero waste) Adapted from Lean Enterprise Institute

10 1) Overproduction: Producing ahead of what s actually needed by the next process or customer. The worst form of waste because it contributes to the other six. 2) Waiting: Operators standing idle as machines cycle, equipment fails, needed parts fail to arrive, etc. 3) Conveyance: Moving parts and products unnecessarily, such as from a processing step to a warehouse to a subsequent processing step when the second step instead could be located immediately adjacent to the first step. 4) Processing: Performing unnecessary or incorrect processing, typically from poor tool or product design. 5) Inventory: Having more than the minimum stocks necessary for a precisely controlled pull system. 6) Motion: Operators making movements that are straining or unnecessary, such as looking for parts, tools, documents, etc. 7) Correction: Inspection, rework, and scrap. Source: Lean Lexicon 5th Edition

11 "lean" was coined to describe Toyota's business during the late 1980s by a research team headed by Jim Womack, Ph.D., at MIT's International Motor Vehicle Program. He co-authored Lean Thinking. Quotation from Lean Enterprise Institute, Photo from

12 What is Unique and Compelling About Toyota?

13 phy/toyota_global_vision_2020.html

14 Common Misconceptions Lean only applies to manufacturing Lean is a short-term cost reduction program Lean is a set of tools, e.g. value stream mapping, A3, gemba walks Adapted from Lean Enterprise Institute

15 Lean Can Help IT Win CIO Director Applications Director Business Intelligence Director Infrastructure Director PMO Manager Clinical Apps Manager Reporting Manager Help Desk Portfolio Manager Manager Business Apps Manager Database Admin Manager Telecom/Network Project Manager Manager Systems Project Manager

16 Improve help desk service! Cut cost by 20%. Just do it! IT Faces Numerous Tough Challenges CIO Implement ERP upgrade on schedule, whatever it takes! Director Applications Director Business Intelligence Director Infrastructure Director PMO Manager Clinical Apps Manager Reporting Manager Help Desk Portfolio Manager Manager Business Apps Manager Database Admin Manager Telecom/Network Project Manager Manager Systems Project Manager

17 Means and Lean is Management By Objectives V Intelligent Automation Pursue Perfect Processes Start here >>> Respect and Engage People at all Levels

18 For Example, Access Control I have a new employee starting Manager next week that needs access privileges IT Access control provisioning process User Modified access privileges granted Who is responsible? What sequence of steps and timings? How do we measure success? How are we performing? How should we be performing? What do we need to do to improve? How fast did we provision this request? How accurately? How satisfied was the requestor?

19 Lean in Action: Healthcare IT Example Hospital CEO We need to reduce cost by 30% by 2020 in order to be financially viable as a health system. Information is required now to support strategic decisions about our future direction. We need two week turnaround time for critical-priority report requests ASAP!

20 Common Management Response: What Can We Do? Let s Brainstorm Ask the CEO what other requests we should stop working on. Hire five more report developers. Work harder. Implement self-service BI cubes. Photograph:

21 Action Item List Item Description Owner Due Date 1 Prepare request to add an FTE to the reporting department. 2 Write business case to purchase new software tool to increase efficiency. Brett June 15 Mohammad June 22

22 Source: Leeds Museums and Galleries

23 A Lean Thinking Approach What is our vision and direction? What is happening now (current condition)? What should be happening (target condition)? What obstacle are we working on now? What do we need to do? What is the next step? When can we go and see? Adapted from Mike Rother Photograph: on.cfm?workshopid=13

24 A Lean Thinking Approach What is our vision and direction? What is happening now (current condition)? What should be happening (target condition)? What obstacle are we working on now? What do we need to do? What is the next step? When can we go and see? Photograph: on.cfm?workshopid=13

25 Improved community health and personalized patient care at an affordable cost Vision Challenge Next Target Condition (date) Current Condition Experiments At the Current Knowledge Threshold By Mike Rother

26 Priority 1 management report requests available within one week, no errors Vision Challenge Next Target Condition (date) Current Condition Experiments At the Current Knowledge Threshold By Mike Rother

27 A Lean Thinking Approach What is our vision and direction? What is happening now (current condition)? What should be happening (target condition)? What obstacle are we working on now? What do we need to do? What is the next step? When can we go and see? Photograph: on.cfm?workshopid=13

28 What is happening now? - Process analysis - Observe and interview front line staff - Gather facts and review data Challenge Vision Next Target Condition (date) Current Condition Experiments At the Current Knowledge Threshold By Mike Rother

29 Process Map Request Assign Develop/ Test Accept 5 min. 1 X days 30 min days hrs days 25 min. Change request system Drive by Meeting Total Lead Time = 3 Days to Never

30 Current Condition IT customer survey indicates overall low satisfaction with reporting services 1,120 open requests for reports in the queue Employee survey of all 10 report developers indicates stress level is high Data Governance Committee attendance is inconsistent Work priorities set according to who screams loudest Developers receive and accept requests from: Change request system Drive-by requests from users via , phone calls, meetings or visits to their cubicles IT manager escalated requests None of the developers follows the published standard report development and quality assurance process 25% of reports delivered are returned by users to IT for rework 75% of reports in process are lower priority level requests

31 A Lean Thinking Approach What is our vision and direction? What is happening now (current condition)? What should be happening (target condition)? What obstacle are we working on now? What do we need to do? What is the next step? When can we go and see? Photograph: on.cfm?workshopid=13

32 Report developers should be following the standard development/ QA process and working only on requests assigned by manager. 100% compliance with standard process No more than 10 reworked requests for the first quarter 0 drive-by requests in process for last month of first quarter Customer satisfaction level of 3 at end of first quarter Employee stress level of 2 on average by last month of quarter Vision Next Target Condition (date) Challenge Current Condition Experiments At the Current Knowledge Threshold By Mike Rother

33 A Lean Thinking Approach What is our vision and direction? What is happening now (current condition)? What should be happening (target condition)? What obstacle are we working on now? What do we need to do? What is the next step? When can we go and see? Photograph: on.cfm?workshopid=13

34 What is now preventing the report developers from being able to work according to the target condition?

35 Obstacles Users work around the process, constantly asking for reports to meet urgent, operational requirements that never get to the Top Ten list Lack of adherence to standard development process by developers Large number of requests work in process is overwhelming Governance committee attendance poor direction Report developers set their own priorities Inadequate reporting tools Inconsistent information in report requests Changing business priorities Users don t know where to find reports in the system

36 A Lean Thinking Approach What is our vision and direction? What is happening now (current condition)? What should be happening (target condition)? What obstacle are we working on now? What do we need to do? What is the next step? When can we go and see? Photograph: on.cfm?workshopid=13

37 Obstacles Users work around the process, constantly asking for reports to meet urgent, operational requirements that never get to the Top Ten list Lack of adherence to standard development process by developers Large number of requests work in process is overwhelming Governance committee attendance poor direction Report developers set their own priorities Inadequate reporting tools Inconsistent information in report requests Changing business priorities Users don t know where to find reports in the system

38 A Lean Thinking Approach What is our vision and direction? What is happening now (current condition)? What should be happening (target condition)? What obstacle are we working on now? Why is this happening? What do we need to do? What is the next step? When can we go and see? Photograph: on.cfm?workshopid=13

39 P-D-C-A Cycle 1 (aka PDSA) Plan CIO and Reporting Manager to meet with reporting team to learn why developers are accepting requests directly from users. These are known as drive bys. Target: Understanding of volume and causes of drive by requests accepted by developers. Do Meet with reporting team at 8:00 am on Monday to make request. Check Huddle daily at 8:00 am with team to review drive by volume and evaluate progress and next steps for any counter measures. Act Based on daily findings, determine next steps.

40 Drive bys Reports development Monday meet with team to discuss need to stop drive bys Learn why developers are accepting drive bys. By Mike Rother

41 Drive bys Reports development Monday meet with team to discuss need to stop drive bys. Learn why developers are accepting drive bys. Asked why drive bys are occurring. Listened to staff. It is hard for the developers to say no to customers! By Mike Rother

42 Drive bys Reports development Monday meet with team to discuss need to stop drive bys. Learn why developers are accepting drive bys. Asked why drive bys are occurring. Listened to staff. It is hard for the developers to say no to customers! Tuesday provide developers standard message. Developers use standard message. 0 drive bys. By Mike Rother

43 Drive bys Reports development Monday meet with team to discuss need to stop drive bys Learn why developers are accepting drive bys. Asked why drive bys are occurring. Listened to staff. It is hard for the developers to say no to customers! Tuesday provide developers standard message Developers use standard message. 0 drive bys. 1 drive by from Revenue Cycle Director. Director comes to morning huddle and makes requests. By Mike Rother

44 Drive bys Reports development Monday meet with team to discuss need to stop drive bys Learn why developers are accepting drive bys. Asked why drive bys are occurring. Listened to staff. It is hard for the developers to say no to customers! Tuesday provide developers standard message Wednesday have a talk with the Revenue Cycle Director Developers use standard message. 0 drive bys. 0 drive bys 1 drive by from Revenue Cycle Director. Director comes to morning huddle and makes requests. By Mike Rother

45 Drive bys Reports development Monday meet with team to discuss need to stop drive bys Tuesday provide developers standard message Wednesday have a talk with the Revenue Cycle Director Learn why developers are accepting drive bys. Developers use standard message. 0 drive bys. Asked why drive bys are occurring. Listened to staff. 1 drive by from Revenue Cycle Director. It is hard for the developers to say no to customers! Director comes to morning huddle and makes requests. 0 drive bys 0 drive bys Expectations need to be set and reinforced with users. By Mike Rother

46 Company on Lean Journey Engage with Lean department Lean Leader training Go and see trip Ask for a coach Practice Pilot Spread How to Get Started Company not on Lean Journey Read book(s) on Lean Commercial training Go and see trip Find a coach Practice Pilot Spread Just exploring Read book(s) on Lean Attend conference Try it yourself: 5 Whys Toyota Practical Problem Solving Methodology A3/PDCA

47 Critical Success Factors to a Lean Approach to Removing Waste and Creating Value Transformational and strategic, not a tactical project Not just tools a mindset shift Do the work, improve processes, and build people Overcome resistance through coalition-building and quick wins Practice Old habits are difficult to shake; new habits hard to form A good coach is essential Lead the way Do it yourself

48 Q&A Click on the Q&A panel located in the lower right corner of your screen, type in your questions in the text field and hit send. Please keep the send to default as All Panelists. If you want one year of prosperity, grow seeds, If you want ten years of prosperity grow trees, If you want one hundred years of prosperity, grow people. Chinese proverb

49 Thank You! Thanks to our featured speaker: Robert Slepin! You will receive an when our archive recording is ready. (Separate registration is required) CHIME CHCIO Credits Attending our Webinars = 1 CEU Questions/Comments Anthony Guerra aguerra@healthsystemcio.com Go to to view our upcoming schedule and see the last 12 months of archived events.