FAHE Paper 1. Using Lean Management Strategically Kent L. Miller, MHA, CHESP, T-CHEST Association for the Health Care Environment

Transcription

1 FAHE Paper 1 Using Lean Management Strategically Kent L. Miller, MHA, CHESP, T-CHEST Association for the Health Care Environment

2 FAHE Paper 2 Abstract Health care is under enormous stress today. This comes as a result of the Affordable Care Act, state and federal regulatory pressures, internal financial pressures, competition, human resources and supply management. The questions are: Do you know what your metrics are for the patient experience? How do you meet the organization s goals? Do you know how well your quality meets the regulatory and/or organization s expectations? How do you meet the organization s goals? Do you know how well your colleagues are engaged? How do you meet the organization s goals for colleague engagement? Do you know how you stand financially as a department? How do you compare to the organization s financial sustainability? And, how do you meet the goals of population health within your own department? And, how does that meet the organization's goals? The Environmental Services leader needs to "step up to the plate" and determine how they can survive in this new environment. Lean process will assure we achieve success. An Environmental Service's leader as a Lean leader needs to be patient, inquisitive, keenly interested in problem-solving, a good communicator, and a mentor who likes to see people succeed. This proactive leader will be in the middle of the action, not directing from a desk. The Environmental Services leader can be all of these. This paper will propose a proven strategy for becoming a Lean department through the leader's eyes.

3 FAHE Paper 3 Using Lean Management Strategically There are two sides to Lean Management. Numerous organizations have gone to the side of using the Lean process with flow charts drawing out waste. However, there is another side to Lean that is related to leader behaviors when associated with the Lean process. There are three areas that an Environmental Services Lean leader needs to look at as they work through their day, they are: align, enable (teach), and improve. Each of these answers several questions: ALIGN What are the goals for your area? What's your vision? How do you measure department initiatives? When you are losing or behind, how do you adjust? Can you see a clear link between your improvement efforts and your area goals? ENABLE (teach) Do you meet on a regular basis to discuss the barriers to meeting your goals? What behavior do you want to see rewarded in your area? What really motivates your colleagues? When you need support in solving problems who do you turn to? IMPROVE Can you see normal from abnormal conditions in your departments? How do you visually see this at a simple glance? How do you know if you have done your work correctly? Are there standards? What are the barriers that keep you from doing your jobs? How do you address these? When you see a problem how do you address it is there a systemic process? Becoming strategically minded As an Environmental Services leader becomes strategically minded they become aware of three levels to be involved in and aware of strategically. First, there is the need to look at their organization's strategy (True North metrics), then a look at how the Environmental Services' department aligns with the organization s strategy, and finally what metrics can the Environmental Services' department use to meet both the organization's strategy, the department s subsequent strategy, and finally the metrics that will show how the alignment is lined up.

4 FAHE Paper 4 A simple means for performing this task is using a One-Page Strategic Plan. The form is designed to read from the left to the right. The far left is the corporation's key strategies, values, core measures and any other key corporate measures that are consistently looked at. Next are the organizations same key strategies, values, core measures and any other key corporate measures that are consistently looked at. These should line up with the corporation's key initiatives. As we move to the right, an Environmental Services leader now can get into the individual key strategies for the year for the organization (which ties directly to the previous two columns). The True North Metrics for the past two years have been Patient Experience, Quality and Safety, Colleagues, Financial Stewardship, and Population Health. The organization then lists key metrics for each area. Following to the right is the Environmental Services leader's annual key initiatives. These line up directly with the organizations and up to the corporate initiatives as well. As an Environmental Services leader looks at the metrics for each of the organization s strategies (True North metrics) the first one is Patient Experience. This is an obvious one for the Environmental Services' department now and impacts the organization directly. It is the key driver for hospitals today, Hospital Consumer Assessment of Healthcare Providers and Systems (HCHAPS) survey related to "Was your room and bathroom always clean?" The key metrics for this is taken directly off of the HCAHPS website ( Next, we have Quality and Safety the Environmental Services' department. This year, the Mercy Health Saint Mary's Environmental Services' department implemented a new quality assurance program. Thus, this was a simple insert into the annual department strategic plan. The metric s percentage improved after beta testing. Following Quality and Safety we have the Colleague section which is dedicated to colleague engagement for all departments including the Environmental Services' department. This is based on the annual Colleague Engagement and Safety Survey. Also, each department leader is required to perform colleague rounding on each colleague once per quarter asking four required questions. Metrics are assigned by percentage completed and Colleague Engagement and Safety Survey results. After the Colleagues section there is the Financial Stewardship section of which the Environmental

5 FAHE Paper 5 Services department can look at several financial implications that the department can impact. For this past year, the department s project of the year was to reduce over-time. The department has struggled for several years with a shortage of Full-time Equivalents (FTEs) and thus has used over-time to cover shortfalls. The metrics was determined to be a 20% reduction. And lastly there is Population Health. This was a struggle to determine how the Environmental Services department would impact the hospital's strategic plan in this aspect. After a catchball session with the president it was determined to work on reducing call-ins. The metrics was determined to be a 10% reduction in sick call-ins. Throughout the whole Lean strategic process the Environmental Services department leaders will use what is commonly called catchball. Catchball is a participative approach to decision-making in which information and ideas are thrown and caught back and forth, up and down throughout the department and/or organization. The information and ideas are discussed until a final decision is made. Often "out-ofthe-box" ideas are thrown in and discussed. This can be very stimulating and informative. As the reader will note there is a lot of data collection related to strategic planning, much like going through flow charts. However, without data, the Environmental Services department leader cannot determine where shortcomings are and improvements are needed. Each quarter is planned out with a project for each strategic initiative, following in line with the metrics for accountability. This then is monitored on a Visual Center. Again, before I discuss the Visual Center, the Environmental Services leader needs to look at aligning, enabling, and improving their departments. The aforementioned paragraphs discuss how that can occur at a high level. To visually monitor this Lean strategic process a Visual Center is created. Typically this is mounted in the Director's office or a department conference room. To the far left is a copy of the master Strategic Plan first mentioned above, the quarterly strategic plan for each process, and the Environmental Services department director's own strategic plan associated with their own responsibility for the organization's strategic plan. The True North metrics action areas are listed with both watch metrics and driver metrics. Driver metrics can have a profound impact on the performance of the Environmental Services department because they

6 FAHE Paper 6 provide immediate feedback on how a process is running. The watch metric is the overlying metric. An example of this watch metric is the monthly HCAHPS scores for cleanliness and the driver metrics is the process you are incorporating into your daily process to improve the watch metric (e.g. increasing daily passes in patient rooms). To the right of the watch and drive metrics are each leader's responsibility per Lean strategic process. Metrics are then assigned to each leader's column. This is monitored and written on the Visual Center. When the Environmental Services department leaders meet for their weekly Environmental Services leader meeting each leader responds to their area of responsibility. The Environmental Services Leader s Lean day Aligning the Environmental Services department leader's day to Lean is a learning process. This has been a struggle for some leaders in our organization. The beauty of having a Lean strategic leader process is that it creates structure and meaning of the leader's existence in a much higher level than ever before. The first stage of this is creating a Leader's Standard Work checklist. This is a simple check list of what strategic efforts the leader needs to work on each day. The list is usually set up by the month and has several lines assigned for projects. What the Environmental Services department leader determines is important to monitor is put on this form. Some items to keep a check list on are: weekly meetings with the manager (called Gemba 1:1, to be described later); weekly Environmental Services department leader's Gemba 1:1; Quality Assurance rounds; Gemba Walks; and various other areas. Each ES leader would have to determine what they deem important to monitor. One activity that drives the Environmental Services department leader's daily activity is the Gemba. This is used to describe personal observation of work, or where the work is happening. This is also assigned to when leaders have meetings as well, meeting individuals where they are at. The term that was often used for this type of walk is Management by Walking Around (MBWA). The problem with MBWA is that was often just perceived as walking around to catch someone not doing their job. Gemba Walks are designed to talk to front-line colleagues when they are in their work environment. The details are finding out what, if any, barriers that the colleagues are seeing and then following up with them. The whole idea is to follow up with barriers, log them, and report what can or cannot be done.

7 FAHE Paper 7 Bringing Lean thinking to the front-line colleagues A vitally important aspect of Lean thinking is not to keep it in the arena of the Environmental Services department leaders; it needs to be expanded to the front-line colleagues. This can be accomplished by creating focus groups to determine Lean initiatives that the department can do. As all Environmental Services leaders know, the work done in the Environmental Services department is done by the front-line colleagues. They often have the greatest ideas for improvements. One natural decision by the focus groups was to create some standardization of the department. The idea and discussion was to bring the idea of 5S to the department. Sort Remove unnecessary items and dispose of them properly Make work easier by eliminating obstacles Reduce chance of being disturbed with unnecessary items Prevent accumulation of unnecessary items Evaluate necessary items with regard to department/cost/other factors. Straighten Arrange all necessary items in order so they can be easily picked for use Prevent loss and waste of time Make it easy to find and pick up necessary items Ensure first-come-first-serve basis Make work flow smooth and easy Can also be translated as "set in order" Shine Clean your workplace completely Use cleaning as inspection Prevent machinery and equipment deterioration Keep workplace safe and easy to work Can also be translated as "sweep" Standardized Maintain high standards of cleanliness and workplace organization at all times

8 FAHE Paper 8 Maintain cleanliness and orderliness Maintain everything in order and according to its standard. Sustain To keep in working order Also translates to "Self-Discipline" meaning to do without being The Environmental Services department at Mercy Health Saint Mary's started with the equipment and supply rooms and have moved on to the Environmental Services department closets throughout the organization. Pictures are on the wall where equipment is to be "parked," lines are on the floor to separate each piece of equipment, and weekly checklists are used to be sure the areas are sustained, thus perfecting 5S. This is a very visual aspect of Lean for the front-line colleagues. Conclusion The question is then: does this Lean process help you improve your metrics within your department and ultimately within the organization you work for? Let us take a look at items listed in the abstract at the beginning of this paper. Do you know what your metrics are for the patient experience? How do you meet the organization s goals? We, after implementing our Lean Management system were able to monitor and quickly adjust to any negative movements in the patient experience. The department at Mercy Health Saint Mary's saw a 10% increase in HCAHPS scores within the first year. This directly impacted the organization s goal of improving the "Overall Rate the Hospital," which saw a 5% increase. Do you know how well your quality meets the regulatory and/or organization s expectations? How do you meet the organization s goals? After implementing the Lean Management system and monitoring the progress daily and weekly, as is mentioned above, the department has seen a cleanliness increase of 20% for the inception of a quality assurance program. This directly impacts HCAHPS again and the hospital s rate as well. We also noted that this inadvertently impacted colleague engagement as it allowed each of the colleagues to see how they were performing and what they needed to do to improve their areas/suites. Do you know how well your colleagues are engaged? How do you meet the organization s goals for colleague engagement? An Environmental Services leader should know that an engaged colleague will work to improve the environment and also the culture of safety within the

9 FAHE Paper 9 organization. The Lean process was able to put into practice a method to work with colleagues, without them knowing they are "doing Lean". The Mercy Health Saint Mary's colleague engagement score improved 8% from the previous year and there is an expectation that this will improve even more with a recent survey just completed. Do you know how you stand financially as a department? How do you compare to the organization s financial sustainability? All Environmental Services leaders should already have been monitoring their financial standing according to budget. However, the Lean leader brings this to a higher level. They look at their operational budget and how it can impact the bottom-line of the organization. Or, they determine that they can show how they directly impact the profitability of the organization as a whole. Mercy Health Saint Mary's has been the exception to the rule within the health care arena this past year. We have seen record census and thus record discharges. Despite this we are seeing that we are one of the top financial successes within the Trinity Health system. With the Lean leadership process we can see how we directly impact that "bottom-line". And, how do you meet the goals of population health within your own department? And, how does that meet the organization's goals? This area was a difficult one to determine, as to how Environmental Services can impact Population Health. During a catchball session with the president we decided to look at and monitor the number of sick calls that colleagues called in during the year. With some wellness projects, we had determined that they may assist with reduction in sick calls. One of the advantages of a Lean leader is being able to look "outside of the box" and then implement some trials. Again, through the monitoring of this and working with colleagues the department has seen a 15% reduction in call-ins, which also improved colleague engagement, which also indirectly improved the organization's Population Health initiatives. The Environmental Services leader needs to "step up to the plate" and determine how they can survive in the new health care environment. Using the management Lean process will assure we achieve success.

10 FAHE Paper 10 Author Note The author was asked to become part of an organizational Lean Management systems team for two years. This team consisted of five department directors. As we began to learn how to use the Lean process strategically we began to see the benefit of using it for success in each of our departments. Through bi-weekly meetings and teamwork each department has shown how it is supporting the organization and ultimately the corporate systems as well. This always directly impacts the care of patients, the ultimate benefit.

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