Profit = Price - Cost. TAKT Time Map Capacity Tables. Total Productive Maintenance. Visual Control. Poka-yoke (mistake proofing) Kanban.

Transcription

1 GPS Mod 19 Measures MUDA MUDA Cost Reduction By Eliminating Waste Just-in-Time Profit = Price - Cost GPS Depth Study NVA/VA- Functions/Mgrs Quality Cost Delivery Safety Measures Morale TAKT Time Map Capacity Tables Measures R e d e p l o y m e n t Jidoka (human automation) Setup Reduction Changeover Multi-process Operations Standard Operations Heijunka (Leveling) Continuous Flow Total Productive Maintenance Poka-yoke (mistake proofing) Kanban Visual Control Andon Module 19 RPIW Kaizen Kaikuku 3P Prod Prep 7 Flows Factory Product/Patient Quantity Analysis 7 Flows Medicine 4 No s Sorting Simplifying 5S Sweeping Standardizing Self Discipline 7 Wastes Value Stream Mapping ONE PIECE FLOW TAKT TIME PULL PRODUCTION Global Production System , John Black and Associates LLC (modified from Hiroyuki Hirano, Productivity Press). Committed Leaders 1

2 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. 19 Measures v

3 Assurance of Quality Measuring World-Class Quality Ensures Survival Through Full Customer Satisfaction Mod 19 Measures Quality Reliability Responsiveness Assurance Empathy Tangibles World-Class Quality for Total Survival Cost Delivery Cost Effective Price Effective Right Place Right Time Right Amount Full Customer* Satisfaction * Patient Safety For Patient For Provider Morale Everyone Cares 3

4 Weekly Stand-Up Meeting Wall Park Nicollet Health Services/Used with Permission 4

5 Park Nicollet Health Services/Used with Permission Visibility Room 5

6 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. 19 Measures v

7 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,

8 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 In health care, the Customer is the Patient. 19 Measures v

9 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). 19 Measures v

10 Used with permission, Florida Hospital Zephyrhills 10

11 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. 19 Measures v

12 12 Used with permission, Florida Hospital Zephyrhills

13 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. 19 Measures v

14 Used with permission, Florida Hospital Zephyrhills 14

15 Patient Stories Used with permission, Florida Hospital Zephyrhills 15

16 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. 19 Measures v

17 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. 19 Measures v

18 Weekly Stand-Up Wall Walk 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. 19 Measures v

19 Weekly Stand-Up Wall Walk Profit or Margin Profit is displayed as it relates to FTEs as defined by the organization and reported by each Service Line Leader. 19 Measures v

20 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. 19 Measures v

21 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. In health care, the Customer is the Patient. 19 Measures v

22 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. 19 Measures v

23 Safety Measures in Health Care Patient critical incidents. Patient falls. Adverse events, near misses. Hand hygiene. Staff injuries. Needle sticks. In health care, the Customer is the Patient. 19 Measures v

24 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. 19 Measures v

25 Employee and Patient Safety Visibility Wall Mod 19 Measures Seattle Children s Bellevue Surgery Clinic/ Used with Permission 19 Measures v

26 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. 19 Measures v

27 Morale Measures in Health Care Employee Survey Results. Staff turnover. Staff retention. In health care, the Customer is the Patient. 19 Measures v

28 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). 19 Measures v

29 Daily Management Cross Functional Management Management by Policy (Hoshin Kanri) Strategic Visibility Room (Breakthroughs/ Hoshins) BETTER CARE 0 NEVER EVENTS 3-5 Year Outcome Targets Mod 19 Measures The Management System and Visibility and Alignment Strategy Target Progress Senior Leader, Breakthrough Leader Weekly Wall Walk - QCDSM Pressure Ulcer Level 3 and 4 Patient mortality related to L 3& 4 pressure ulcers Daily Visual Management #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 Service Line Leader Front Line Mgrs 29

30 The Management System and Visibility and Alignment Strategic Visibility Room (Breakthroughs Only) Hoshin 1 Hoshin 2 Hoshin 3 Wall Walks (Monthly; CEO & Exec Team) Quality Cost Delivery Safety Morale Service Line #1 Service Line #2 Daily Visual Management (Daily or Weekly; Manager and point of care staff) 30

31 Strategic Visibility Room Review: Key Points Mod 19 Measures 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. 19 Measures v

32 Visibility Room Review 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. 32

33 Visibility Room Review 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. 33

34 Visibility Room Review Mod 19 Measures 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. 34

35 Visibility Room Review 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. 35

36 Visibility Room Review Mod 19 Measures Critical Business Processes Displays the organization s progress in the following categories: Compliance and Accreditation, Recruitment, Planning, and Governance. 36

37 Visibility Room Review 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. 37

38 38 Used with permission Florida Hospital Zephyrhills

39 Visibility Room Review 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. 39

40 Used with permission Florida Hospital Zephyrhills 40

41 Visibility Room Review Pay for Performance & Transparency Mod 19 Measures 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. 41

42 Weekly Stand-Up Wall Walk: Key Points Mod 19 Measures 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. 19 Measures v

43 Weekly Stand-Up Wall Walk Standard Work Mod 19 Measures STANDARD WORK Name of Activity: Weekly Wall Walk Role performing Activity: Leadership 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 1:00 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 2. CEO, CFO, COO, CMO leads a prayer 0:30 3. CEO, CFO, COO, CMO, CNO, KPO reports on the appropriate metrics for 10:00 the Overall category. 4. CEO, CFO, COO, CMO, CNO, KPO takes questions from the audience 5:00 related to their report out. 5. Director for Emergency Department reports on the appropriate metrics for 10:00 the ED service line. 6. Director for Emergency Department takes questions from the audience 5:00 related to their report out. 7. Director for Surgical Services reports on the appropriate metrics for the 10:00 Surgical Services service line. 8. Director for Surgical Services takes questions from the audience related to 5:00 their report out. 9. Director of Materials Management reports on the appropriate metrics for 10:00 the Materials Management service line. 10. Director of Materials Management takes questions from the audience 5:00 related to their report out. 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. 43

44 Number Of Days Weekly Stand-Up Wall Walk Run Chart Mod 19 Measures Pre-Service Leadtime G.I. Clinic Run Chart Used across all service lines, these standard charts make reading the metrics easy and consistent Q1: 2007 Q1: Delta: % 2006 Q2: 2007 Q2: Delta: % 2006 Q3: 2007 Q3: Delta: % 2006 Q4: 2007 Q4: Delta: 66.4 #VALUE 0 Q1 Q2 Q3 Q4 Week / Quarter Date Prepared: September 24, 2007 Report Contact: Demand Planning & Analysis, Gregg Teeter, Source: LastWord scheduling data mart Refresh Cycle: Weekly (1 week lag) Operational Def: 2006 vs 2007 weekly weighted AVG compared to goal (50% of Q AVG) Criteria: Weighted AVG appointment availability (weighting based on volumes of seen appointments by dept, facility, prov, appt type 2006 Actual 2007 Actual 2007 Goal Series1 Series2 44

45 45 Used with permission Florida Hospital Zephyrhills

46 Weekly Stand-Up Wall Walk Mod 19 Measures Growth Each Product Line Leader addresses their individual service line growth as it relates to the strategic plan for growth in the organization. 46

47 Weekly Stand-Up Wall Walk 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. 47

48 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. 19 Measures v