THE ZSFG WAY. Susan Ehrlich, MPP, MD Joint Conference Committee May 23, 2017

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1 THE ZSFG WAY Susan Ehrlich, MPP, MD Joint Conference Committee May 23, 2017

2 ZSFG TRUE NORTH 2

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4 BACKGROUND December 2014 Implemented lean tools such as kaizen workshops, value stream mapping, daily management system November 2016 Implemented lean tools such as daily management system, tiered huddles, icare, no meeting zone, leader standard work, principle-based values, competency evaluations, and personal development plans. ZSFG set forth True North goals Thus far, ZSFG has not been able to meet True North goals through the use of improvement tools, separately or in combination. 4

5 CURRENT CONDITIONS Key Points (1)ZSFG has not been able to consistently meet True North goals or targets True North Scorecard True North Category Measure Owner Safety Patient Harm Events Williams & Inouye Events 11 3 Measure Unit Jan Feb Mar Apr YTD 7/month (14 YTD) On- Off- Target Safety Safe Discharge Home TJR Cases Williams & Inouye % % 53% 60% Quality Reduce Readmissions Marks & May % 15.52% 15.28% 15.08% 15.29% 15.04% Quality Reduce LLOC Patients Marks & May # Patients Target <10 Quality Reduce ED Average LOS Marks & May # Minutes (2)We understand our current state and desired future state. However, we do not have a clear path between the two. Current State How do we get there??? Future State Quality Reduce Time on Diversion Marks & May % 67.0% 68.0% 59.9% 65.0% 40% Care Experience Care Experience Care Experience Patient Satisfaction: "Courteous & Respectful Communication" Patient Satisfaction: "Food Taste" Patient Satisfaction: "Food Preference" Workforce Total Staff Trained in A3 Care & Thinking Development Workforce Leaders Adopting Leader Care & Standard Work Development Andrew & Johnson % 63.0% 70.0% 65.7% 70% Andrew & Johnson % 35.7% 29.6% 32.3% 30% Andrew & Johnson % % Ehrlich & Nguyen % 91% 91% 91% 95% 95% 100% Ehrlich & Nguyen % 0% 0% 0% 0% 100% Workforce Care & Reduce Voluntary Turnover Rate Hill & Woods % Development Workforce Care & Development Reduce Staff Injuries Williams # Events <15/month Financial Meet Capital Project and Budget Stewardship Milestones Financial Meet EHR Project and Budget Stewardship Milestones Financial Meet Monthly Expenditure Stewardship Targets Boyo & Carlisle Dentoni & May Inouye % Variance YTD (FY) -1.4% -1.1% -1.8% -1.8% 0% 5

6 CURRENT CONDITIONS The Impact of Leading Differently Leaders will effectively exhibit behaviors that understand what our patients want, need and value Leaders will develop other leaders to problem solve root cause, right problem, right resources Leaders will exhibit a continuous improvement mindset ZSFG will be able to achieve True North 6

7 PROBLEM STATEMENT ZSFG has not met its True North goals in the areas Equity, Safety, Quality, Care Experience, Workforce Care and Development, and Financial Stewardship. 7

8 TARGET AND GOALS Jan 2018 Ensure all Expanded Executive members trained in A3 thinking Jan 2018 Ensure all Expanded Executive members have adopted Leader Standard Work and No Meeting Zone Oct 2017 Oct 2018 Oct % of true north metrics will be at target 80% of true north metrics will be at target 90% of true north metrics will be at target 8

9 COUNTERMEASURE No Root Cause Proposed Countermeasures Impact Difficulty Status 1. Professional Development Recreate and align Exp Exec Committee, establish Coaching and Mentoring training so there is successive planning and competency development. Develop individuals to time manage and problem solve through ongoing structured coaching 2. Culture Create and align Leader Standard Work w/org values and principles Ensure staff understand purpose of lean, the tools, improvement work, and organization principles 3. Education A3 thinking, lean certification, 360 evaluation, leader standard work 4. Strategic Tools Develop cohesive and structured improvement tools and sustainable plans for consistent deployment. Develop operating system strategies and deployment plans. Develop Hoshin and retreat strategic plan on an annual basis. Strategize and align DMS/value stream/a3 thinking work/improvement tools to ensure alignment with True North 5. Communication Create meaningful name for improvement/operating system and create ZSFG-wide communication plan for True North to align with ZSFG culture. Ensure communication supports that purpose of the improvement work Medium Medium In process High High In process High Medium In process High High In process Medium Medium In process 9

10 ACHIEVEMENTS Strategic Tools As of April 18 th, 95% of Expanded Executives completed A3 Thinking training Culture Developed The ZSFG Way Introduced Leadership Principles and 360 Surveys Introduced No Meeting Zone and Leader Standard Work 10

11 The ZSFG Way Tools THE ZSFG WAY How we align, enable and improve to achieve True North Our principles and improvement work align to True North ALIGN (The purpose) ENABLE (The people) IMPROVE (The process) Create Value for the Customer Think Systematically Constancy of Purpose Lead with Humility Respect Every Individual Transparency through Visual Management Seek Perfection Ensure Quality at the Source Embrace Scientific Thinking Focus on Process Establish Direction Motivate, Mentor, Inspire Break-through Thinking Strategic Plan (X Matrix) Principle-based Leadership Strategic, Operational, and Active A3 Status Report Performance Metric True North Scorecard Leader Standard Work Performance Metric Countermeasure Summary A3 Thinking No Meeting Zone PDSA Tools: Value Stream Mapping, Kaizen Workshops icare Model Cells Daily Management System 11

12 NEXT STEPS Review Monthly True North Metric Dashboard Review Monthly Leader Standard Work Adoption 12

13 THE ZSFG WAY SUPPLEMENTAL DOCUMENTS 13

14 ADOPTING LEADER STANDARD WORK (LSW) Standard Steps Completion Standard Implement LSW 1. Buy white board / use easel pad paper 2. Show distinction of Daily, weekly, and monthly commitments 3. Align expectations to lean leadership and principles (align, improve, and enable) 4. Share commitments with executive for feedback Executives to observe regular basis Implement NMZ 1. Block 8 AM 10 AM daily 2. Utilize the block to: a. Going to the Gemba to observe the work b. Removing barriers for staff by huddling with team c. Removing barriers for the day d. Reviewing performance drivers/metrics e. Staff Meetings, icare Rounding, Tiered Reporting Executives to observe regular basis

15 COUNTERMEASURE SUMMARY REPORTING 15

16 Terry Dentoni Susan Ehrlich FIELD OBSERVATIONS: LEADER STANDARD WORK 16