E1: From the C-Suite to the Front Lines and Back: A World-Class Management System for Spreading Improvement

Transcription

1 E1: From the C-Suite to the Front Lines and Back: A World-Class Management System for Spreading Improvement IHI 23 rd Annual National Forum December 7, 2011 Presented by: Sarah Patterson Executive Vice President and COO Virginia Mason Medical Center Seattle, WA This presenter has nothing to disclose. Objectives Identify the necessary steps to engage the entire organization in setting goals and improvement agendas Describe the key tools that promote the spread and sustainability of improvements throughout the organization

2 World-Class Management Virginia Mason Medical Center An integrated health care system 501(c)3 not-for-profit 336-bed hospital Eight locations (main campus and regional centers) 450 physicians 5,000 employees Graduate Medical Education Program Research Institute Foundation 4

3 The Virginia Mason Production System We adopted the Toyota Production System philosophies and practices and applied them to health care because this industry and we were so lacking in an effective management approach that would produce: Customer first Highest quality Obsession with safety Highest staff engagement A successful economic enterprise We still don t have stability in our processes

4 Implementation < 100% Our current management system? DC Comics

5 World-Class Management The World-Class Management System is a leadership system that provides focus, direction, alignment, and a method of management for daily work This Or This The 4Ps (Liker, 2004) Problem Solving Continual organization See for yourself Make Decisions People and Partners Grow leaders Respect, develop and challenge your people Respect, develop and challenge your suppliers Philosophy Create process flow Use pull systems Level out workload Stop the line Standardize tasks Use visual control Use only tested technology Base management decisions on a long-term philosophy

6 World-Class Management World-Class Management requires: An understanding of VMPS concepts, methods, and tools Regular management presence where the work happens A transparent environment Clear and complete goals Constructive and helpful feedback from top management World-Class Management Management Manages daily work Management by Policy Provides focus and direction World-Class Management System Cross-Functional Management Aligns across the organization toward full customer satisfaction

7 e attract World-Class Management Patient Vision To be the Quality and transform health Mission care To improve the health and well-being of the patients we serve Values Teamwork Integrity Excellence Service Strategies People Quality Service Innovation Long Term Vision 5 Year Plans develop the best team We relentlessly pursue the highest quality outcomes of care We create an extraordinary patient experience We foster a culture of learning and innovation nia Mason Team MedicineSM Foundational Elements Responsible Integrated Education Research Virginia Mason Governance Information Foundation Systems Virginia Mason Production System Annual Goals Quality and Safety 1. Ambulatory Prevention Bundles 2. Optimize Care Transitions 3. Zero Nosocomial Injuries Fall Prevention Health-care Acquired Infections 4. Patient Safety Curriculum 5. Innovative Clinical Value Streams KPO Priorities World Class Management Elements of Management by Policy Reflection Environmental Scanning Review 5 Year Plans Check and Review Compare performance to plan Occurs at all company levels Catchball Idea exchange Feedback, engagement Identify resources / roles Set measurement criteria Deployment Production plan Understanding/ awareness Develop strategies for entire organization departments individuals Adapted from elements of World Class Management, Management by Policy

8 World-Class Management Management by Policy Reflection Vision Customer Requirements/Customer Satisfaction Data Feedback from management Environmental Scan SWOT Analysis Focus for Scanning Customers (daily living, values, community profiles, etc.) Emerging or changing market features and business outlooks Current and potential profitability of different products Technology (near and far-term forecasting) Suppliers Environmental/consumer protection attitudes and trends Demographics (customers and employees) Competition strategies Strategic focus impacts on operations World-Class Management Management by Policy - Catchball We need more visibility for the IT strategy and when things are going to be rolled out. We will create a production plan that shows the plan for each of the IT strategies and post it on VNET.

9 World-Class Management Management by Policy - Deployment World-Class Management Management by Policy - Check and Review regular checks and reviews are critical determines current status of goal achievement conducted regularly (e.g., daily, monthly, quarterly) includes intensive, objective study of data joint problem-solving, planning, and follow-up may be required

10 World-Class Management Cross-Functional Management A management system for implementing breakthrough improvements that is always focused on the elements of full customer satisfaction Cross- Functional Management World-Class Management If there is a place where blame for silos and politics belong, it is at the top of an organization. Silos, Politics and Turf Wars (p.177) by Patrick Lencioni

11 World-Class Management Cross Functional Management Orthopedic Value Stream : Hospital Clinic & Corporate KPOs World-Class Management Management Repetitive daily activities and behaviors that leaders engage in to ensure customer demand is met and identify abnormal conditions: Know at a glance status of daily work? Completing planned work? Management Understand status of upstream and downstream processes? Standard work being followed? Know when to take action and what action to take? Engaging Staff

12 World-Class Management Management: s Have Two Jobs 1. Run your business 2. Improve your business Management At a glance: World-Class Management Knowing Your Business Management Staffing and Bed Capacity is understood. Demand is known.

13 World-Class Management Management: improving your business World-Class Management Improving your business: you aren t going anywhere if you don t have standards in place Management

14 World-Class Management Standard Work Management There are four principal elements of Management standard work Discipline Visual Controls Accountability

15 Standard Work Discipline Clinic Supervisor & Director List Standard work for leaders specifies the actions to be taken each day to focus on the processes in each leader s area of responsibility. standard work Accountability Visual Controls Visual Controls Discipline standard work Visual Controls Visual controls focus on the process and making it easy to compare expected versus actual performance Accountability Hitachi

16 Visual Controls Accountability Here s an example of how insurance payment closure understands their business daily Discipline standard work Visual Controls Visual signal for help Staff member can see & re-assign to help Visual Controls Discipline standard work Accountability Visual Controls At a glance: Provider covering Capacity after lunch WIP: Messages Forms Lab Results

17 Visual Controls Patients can see status Discipline standard work Accountability Visual Controls Visual Controls Discipline Clinic Project Status Communication standard work Accountability Visual Controls

18 Results with no process = GOOD LUCK Accountability Foundational Elements Hospital Nursing Care Geographic assignments Huddles every shift In-room handoffs RN:PCT integration Hourly rounds by caregivers Documentation near the patient leader rounds Discipline PeopleLink Boards updated and staff huddles done monthly standard work Accountability Visual Controls

19 Focus ship rounding is a key principle of effective leadership Standard Work for s is a 2010 target across all KPOs Genba Rounds in the hospital were initiated in 2008 Variability across all units Lack of standards for participants conducting rounds No consistent use of visual control s to determine status of unit Kaizen Event to 5 S Genba rounds in March, 2010 Accountability Hospital Genba Rounds Results Created Foundational Elements Progress Report based on organizational goals, and nursing foundational elements Created Peer review process prior to Genba rounds Created standardized Genba Rounds Agenda template Created standard work for each Genba round participant Saved in shared folder on common G drive Team Agreements, Level 4 5 S achieved Foundational Elements Progress Report Genba Rounds Agenda Accountability People Link Boards updated, and managed with set agenda Discipline standard work Accountability Visual Controls

20 Accountability Discipline standard work Visual Controls Have daily huddles with your team Accountability Example: Health Information Services Example: Inpatient Orthopedics Standard Work for s Establish a system for accountability with huddles/tiered reports WHAT? How Often? % of work standard Lead Huddles 2 x daily 80% Supervisor Floor check 50% Manager Lead weekly people link Weekly 25% Director/Section Head Spot check standard work Weekly 20% AD Review performance trends Weekly 15% VP/Chief Verify leader standard work Weekly 10%

21 Discipline It s Not About the Boards! Discipline standard work Accountability Visual Controls The appearance of information boards and other examples of visual controls is far less important than how they are used. VMPS Standard Work for s CEO Board COO Board VP Board Director Board Supervisor Board AD Board Front Line Board 2011 Virginia Mason Medical Center

22 I am just a biller I look forward to every Thursday morning at I look around the room and see people from such different backgrounds, ethnicities, beliefs, cultures, job duties and titles but what I see is a common language, a common goal, common rules. The Strategic Plan is the glue that binds us, that teaches us the common language we speak. Amy S. In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists. Eric Hoffer