Engaging Staff in Daily Improvement

Transcription

1 Engaging Staff in Daily Improvement Virginia Mason Medical Center World-Class Management Management by Policy Aligning Vision with Resources The World-Class Management System is a leadership system that provides focus, direction, alignment, and a method of management for daily work 3 4 1

2 Traditional Health Care Management System? Leaders have a disproportionately large effect on the cultures of organizations. By their behaviors, leaders create the conditions that either hinder or aid innovation. - NHS Institute Visual Controls Create linked visual systems that drive action. Discussion and Sharing What leadership behaviors are important to make visual management successful? What does your team produce? How would you measure it? Accountability Process Establish rounding process at all levels. 7 2

3 Accountability Tier Reporting Tier 1 Reporting: Senior Executive Leadership reports updates on key metrics to the Board of Directors Stand Up Tier 2 Reporting: Vice Presidents, KPO and Administrative Directors report updates on key metrics to the Chief Executive Officer Discussion and Sharing What are some current or foreseen challenges with huddles/daily accountability? What attributes of daily huddle would make them valuable to staff? PeopleLink Tier 3 Reporting: Managers report to department staff and Administrative Directors 9 10 Leader Standard Work and Discipline Routinely complete key activities necessary to run and improve the business. Discipline Accountability: Executive Genba Rounds Go to the place, look at the process, talk with the people Consistently verify the health of processes and systems The appearance of information boards and other examples of visual controls is far less important than how they are used. 13 3

4 Discussion and Sharing What are critical elements for all leaders to manage at your organization? Compare and contrast what standard work might look like for a front line leader versus executive. Root-Cause Analysis Ask why and use data and analysis to attack problems. 14 It s all about Respect Daily Kaizen Coach staff ideas through Daily Management 17 4

5 Engaging staff is Simple Go See Ask Why Show Respect A lean journey is a learning journey. TM 18 5

6 Objectives Transforming Health Care Describe the transformation journey of Virginia Mason Describe the key elements of VMPS philosophy Understand VMPS as a management method Describe the leadership requirements needed to sustain VMPS Describe the key methods and tools used in VMPS An Overview of the Virginia Mason Production System 2 Virginia Mason Health System Virginia Mason Institute 300+ combined years of experience implementing and supporting lean culture transformation. Virginia Mason Integrated health care system 501(c)3 not-for-profit Two Hospitals Seattle Yakima Valley Memorial Hospital Nine locations 500+ physicians 5,000 employees Graduate Medical Education Research Institute Foundation Virginia Mason Institute With diverse backgrounds and extensive experience in a variety of health care settings: Operational leadership & management Physician practice & leadership Quality & patient safety Nursing clinical practice 3 4 1

7 Healthcare Transformation Virginia Mason Production System Success A Sense of Urgency, Year 2000 Medicine Overall was Changing Patient expectations Economics Provider expectations Virginia Mason Change in leadership Economic challenges Concerns about quality and safety of the care we provide 5 6 The Virginia Mason Quality Equation Q: Quality A: Appropriateness O: Outcomes S: Service W: Waste Q = A (O + S) W 2016 Virginia Mason Medical Center 7 8 2

8 Transforming Healthcare Requirements for Transformation From Provider First Waiting is Good Errors are to be Expected Diffuse Accountability Add Resources Reduce Cost Retrospective Quality Assurance Management Oversight We Have Time Patient First Waiting is Bad Defect-free Medicine To Rigorous Accountability No New Resources Reduce Waste Real-time Quality Assurance Management On Site We Have No Time Sense of Urgency Visible & Committed Leadership One Improvement Method Technical & Human Dimensions of Change Shared Vision Aligned Expectations 9 10 Aligned Expectations Visible & Committed Leadership Leader Compact Physician Compact Board Compact Dr. Kaplan reviewing the flow of the process with Drs. Jacobs and Glenn

9 Virginia Mason Production System Respect for People We adopted the Toyota Production System key philosophies and applied them to healthcare Listen to understand Speak up 1. The patient is always first 2. Focus on the highest quality and safety 3. Engage all employees 4. Strive for the highest satisfaction 5. Maintain a successful economic enterprise Keep your promises Be encouraging Connect with others Walk in their shoes Grow and develop Be a team player Express gratitude Share information Leadership Requirements Requirements to Sustain the Transformation Management by Policy Aligning Vision From Boardroom to Front Line 1. Set priorities that align with the vision 2. Use VMPS tools & methods 3. Lead change 4. Allocate resources to VMPS 5. Require accountability 6. Implement standard work for leaders

10 Principal Elements Tools and Methods of VMPS 17 VMPS Methods and Tools Relentlessly Driving Out Waste Just in time Operate with the minimum resource required to reliably deliver Just what is needed. In just the required amount. Just where it is needed. Just when it is needed. To Make things the Right Way People Materials Machines Standard Work Standard Work in Process Kanban Andon Operational Availability Takt Time Production One Piece Flow Production Supermarket System Pull System Production Jidoka One-by-one confirmation to detect abnormalities. Stop and respond to every abnormality. Separate machine work from human work. Enable machines to detect abnormalities and stop autonomously. Waste: Any task or item that does not add value from the perspective of the customer. Leveled Production (Heijunka) Cost Reduction Through The Elimination of Muda (Waste or Non-Value Added)

11 HOURS/DAY 8/19/2016 Eight Wastes of Information Just in Time (JIT) Definition: Producing Just what is needed Just the amount needed Just when it is needed Using the Minimum number of people Minimum materials Minimum equipment Minimum space Heijunka Jidoka Maintaining Clinic Flow: Level Loading Skill Task Alignment Jidoka is a method to increase productivity by implementing intelligent automation and defect elimination strategies Patient Flow Manager Physician RN Care Manager NP/PA Pharmacist IT

12 Check in Wait Room and Vitals Wait Exam Wait Plan of Care Wait Testing 8/19/2016 Time Lead, Cycle and Takt VMPS Flows of Medicine Lead time the entire time required to provide a product or service, from request to completion Cycle time the time required for one operator or machine to complete one cycle of work Takt time the pace of customer demand S Setup A strategy that helps to keep our workplace safe and organized Time spent preparing to provide the next product or service Setup reduction is a method to reduce or eliminate setup time to increase capacity and flexibility

13 Mistake-Proofing Defects are mistakes that go uncorrected The purpose of VMPS is to ensure zero defects Basic Elements of Mistake-Proofing Inspection Standard work Visual control Devices Plan. Do. Study. Act. (PDSA) How do we do our work? Vigorously pursue waste Use the PDSA method Plan-Do- Study-Act Continuously test/refine ideas Focus on results Example: defects down 66 A lean journey is a learning journey. TM 31 8