REDUCING WAIT TIME WE HAVE HACKS FOR THAT

Transcription

1 REDUCING WAIT TIME WE HAVE HACKS FOR THAT

2 AGENDA Understanding the Impact and our Perceptions of Wait Time Lean Continuous Quality Improvement Principles Problem Statements Case Studies and Outcomes 2

3 LEGO Duck Introduction 3

4 UNDERSTANDING THE IMPACT AND OUR PERCEPTIONS OF WAIT TIME

5 WHAT IS WAIT TIME IN THE HEALTH CARE SYSTEM? Total wait time in health care can be defined and examined in by segments: 1. The time it takes from referral by a general practitioner to consultation with a specialist; 2. The time it takes from the consultation with a specialist to point at which patient receives treatment. 5 Barua and Ren, 2016

6 Median Waiting Time in the Canadian Health Care System 9.3 weeks 18.3 weeks 20.0 weeks ait time Between referral from a general practitioner and receipt of treatment Barua and Ren,

7 Total number of procedures for which people were waiting in 2016 was 973, % of Canadians were waiting for treatment in Barua and Ren, 2016

8 Barua and Ren,

9 Barua and Ren,

10 The cost of wait times in Canada $1.7 billion of lost wages and time in 2016 Or $1,759 of lost wages and time per patient Barua,

11 HOW DOES THIS COMPARE TO OTHER COUNTRIES?

12 Take out your Smart Phones Go to: Sift.ly Ender code:77v2 12

13 What are some popular reasons for Wait times? Go to: Sift.ly Ender code:77v2 13

14 WHY IS IT SO CHALLENGING TO REDUCE WAITLISTS? OR ANY OTHER PROBLEM FOR THAT MATTER. 14

15 Why is it so difficult to reduce wait times? Go to: Sift.ly Ender code:77v2 15

16 PROBLEM STATEMENT

17 Example Problem: DEFINE THE PROBLEM 17

18

19 THE DUCK FACTORY Module L2-M03

20 Welcome to the Duck Factory What is Success?

21 Let s Build Some Ducks! Welcome to your first day at The Duck Factory! The goal of this simulation is to make as many ducks in the time provided (2 minutes) Each duck should look like the picture below. The picture is also on your card 21

22 1. Stock keeper Hand out supplies to production workers 2. Feet and legs Attach the leg brick to the foot plate 3. Body Add the 2x4 brick on top of the legs 4. Bill and Tail Place the bill and tail onto the body 5. Head and Eyes Install the head. Use a marker to draw eyes on either side of the head 6. Inspection Inspects each duck to ensure it meets the customer requirements Jobs on the Assembly Line Explained in pictures on the next slide 7. Packaging Package completed ducks in a zip-lock bag and deliver to customer 22

23 Duck assembly actions Feet & Legs Attach the yellow leg brick to the red foot plate Body Attach the 2x4 brick on top of the legs Bill & Tail Place the red bill and yellow tail on the body Head &Eyes Install the head on top of red beak. Use a marker to draw eyes on either side of the head 23

24 Opening Inventory of Parts at Your Workstation Topic: Welcome to the Duck Factory Feet & Legs Body Bill & Tail Head & Eyes Above is your opening inventory to start building your part of the duck When you run out, go to the warehouse and get 3 more 24

25 And There are Rules Each step of the process must produce 5 good units before passing to the next step Customer will only take 5 ducks at a time as well 25

26 Welcome to the Duck Factory What is Success?

27 Vision of Success, and the Desired Outcomes Making quality ducks for our customers in a safe and sustainable manner Vision of Success Outcomes Quality All ducks are delivered to the customer s requirements Safety Zero harm to our people Sustainabili ty Financially stable operation 27

28 LEAN CONTINUOUS QUALITY IMPROVEMENT PRINCIPLES

29 LEGO TIME! A Find Keep Seven Your Eyes Lego Closed Bricks Which and in of feel a the PACE B s B s Duck Bag! Helped A? Partner B Hide Your Up and Duck Assign Again1 Why? Or Why Not? bag per person Assign names A and B to A Try In to each the Build Absence the Exact partner of Information Duckwe make A assumptions Look Close Your Eyes Look for facts and Turn make Away decisions based on those and not B Build your a assumptions! Duck, once you are done building it hide it!! 29

30 A3 PROBLEM SOLVING Module L2-M04

31 Introduction The Plan Phase The Do Phase Breakout Exercise 1 The Check Phase The Act Phase Breakout Exercise 2 Summary

32 The Problem is how we solve problems It takes a different kind of thinking to solve a problem than the kind of thinking that produced the problem The different kind of thinking Is based on a Plan-Do-Check-Act (PDCA) Cycle, and Is called the A3 Problem Solving Methodology 32

33 The Plan-Do-Check-Act (PDCA) Cycle Plan Do Check Act W. Edwards Deming ( ) 33

34 The word A3 has two meanings What is an A3? 1. As the A3 Problem Solving Methodology that uses a step-by-step approach to uncover the real problem, develop actions to address it, and make it happen 2. As the A3 Report You Create Which documents the status of your investigation and improvements. It refers to the fact that is documented on one page (originally of A3 size) 34

35 Introduction The Plan Phase The Do Phase Breakout Exercise 1 The Check Phase The Act Phase Breakout Exercise 2 Summary

36 Overall purpose of the PLAN phase Plan Do Check Act The Plan phase is documented on the left side There are 4 planning activities required to make sure we a have properly prepared ourselves before taking action (the DO phase) 36

37 Overview of the PLAN phase (2 of 2) Problem / Impact Statement What is the problem and how does it affect us? We have a problem. This is an effect that we don t like. Current Condition Describe what today looks like Target Condition Describe what the future will look like Root Cause Analysis Determine the real cause of our problem This represents the gap to be closed This is where we find the real cause of our problem (effect). 37

38 Problem / Impact Statement Provide a clear statement of the problem to be solved Don t state a solution how you plan to fix it (that comes later) Don t disguise the solution by saying the problem is lack of <something> Do you think or do you know? Back up the problem with some evidence (data) Describe how the problem impacts (affects) your organization List impacts on the organization s desired outcomes (objectives) Shows why this important to solve

39 Duck Factory Example: Problem Statement During the past 6 months (July- December 2016), the Duck Factory has produced 62,200 ducks of which 6220 were rejected by the customer. Impacts Quality Financial Sustainability

40 Current Condition Provide a high-level overview on how things currently work Use data to better describe the problem Include a high-level process description (major steps taken in the work ) Provide more background on the problem; additional words, data or charts Include a picture or hand drawing 40

41 Target Condition Provide a high-level description of how things could/should be Use data to better describe the goal (target) Include a picture or hand drawing Duck Factory Example: Goal is to improve the Duck Making Process to reduce the defect rate from 10% to 1%, without increasing the WIP 41

42 Root Cause Analysis (1 of 2) Root Cause Analysis This is where you investigate the process to uncover what is really causing the problem; This is called the root cause of the problem Be curious.wonder why that is? Want to treat the cause of the problem; not treat the symptom 42

43 Root Cause Analysis (2 of 2) Duck Factory Example: Defect rate of 10% Root Cause Analysis Why are ducks rejected by the customer? The customer is not satisfied with them Why are the customers not satisfied? The ducks do not meet their requirements; The heads are often on backward Why don t all the ducks meet their requirements? We didn t know what their requirements were. Different people build them differently And so on 43

44 Plan the Countermeasures Countermeasure an action taken to counteract a danger or threat. If we do a very good job of finding the root causes, it will be much easier to plan a suggested a countermeasure to counteract the root cause We are moving from root cause identification to root cause elimination Root Cause Elimination Root Cause Identification 44

45 Meanwhile, back at the Duck Factory Phase Phase Output In the Duck Factory PLAN We found some root causes (RC) Root Cause Identification We planned/designed appropriate counter measures (CM) RC: We didn t know the customer requirements CM: Interview customer to determine requirements RC: Different people build them differently CM: Set a work standard which meets requirements CM: Train everyone on the standard Root Cause Elimination 45

46 Introduction The Plan Phase The Do Phase Breakout Exercise 1 The Check Phase The Act Phase Breakout Exercise 2 Summary

47 Plan Do Check Act Work the plan! Interview customer to determine requirements. Alice Jan 10 th, 2017 Set a work standard which meets requirements Bob Jan 20 th, 2017 Train everyone on the standard Catherine Jan 30 th, 2017 What? Who? When? 47

48 Work the Plan..one countermeasure at a time Interview customer to determine requirements. Alice Jan 10 th, 2017 Set a work standard which meets requirements Bob Jan 20 th, 2017 Generally speaking If you make all changes at once, you won t know what did/did not work. Things are entangled. After you implement one countermeasure the process has changed. Your prior analysis may not be appropriate 48

49 Introduction The Plan Phase The Do Phase Breakout Exercise 1 The Check Phase The Act Phase Breakout Exercise 2 Summary

50 A3 Problem Solving at the Duck Factory (1 of 2) For this exercise Gather into your Duck Factory Teams Use the A3 Problem Solving Methodology You have 10 minutes to 1. Fill out the PLAN section Identify a root cause. There can be many; but find at least one Design appropriate countermeasure(s) 2. Fill out the DO section Make it actionable 50

51 A3 Problem Solving at the Duck Factory (2 of 2) Problem Statement During the past 6 months (July- December 2016), the Duck Factory has produced 62,200 ducks of which 6220 were rejected by the customer. Impacts Quality Financial Sustainability Current Condition Defect Rate: Currently 10% defect rate (6220 of the 62,200) Each defective ducks cost $31.41 WIP: Currently Work-in-Progress (WIP) of 25 partially assembled ducks/shift This ties up approximately $87/shift Target Condition Quality: 1% defect rate WIP: not worse 51

52 Introduction The Plan Phase The Do Phase Breakout Exercise 1 The Check Phase The Act Phase Breakout Exercise 2 Summary

53 The purpose of the CHECK phase of A3 Problem Solving Plan Do Check Act In the Check Phase: When a countermeasure is completed, check to see if it has made a difference We don t know until we check Assume we are checking the 3 Rd (i.e. Las) countermeasure (all DO s done) The Current Condition showed 10% defective ducks. Now we are down to 5% What we do next is ACT! 53

54 Introduction The Plan Phase The Do Phase Breakout Exercise The Check Phase The Act Phase Summary

55 The purpose of the ACT phase of A3 Problem Solving Plan Do Check Act ACT on what CHECK told us! If we aren t getting the expected results we need to do something. 55

56 Phase DO Are we there yet? In the Duck Factory Interview customer to determine requirements Set a work standard the meets requirements Train everyone on the standard CHECK The Current Condition showed 10% defective ducks. Now we are down to 5% But the Target Condition was asking for 1% ACT on our findings. What do we do next? 56

57 What Next? Plan-Do-Check-Act Take the Win Make the improvement the way we work from now on Close the A3 (e.g. we wanted 1% defects, but reduced from 10% to 5%: not bad!) Plan-Do-Check-Act.Do Other countermeasures waiting to be implemented Cycle to DO to implement the next planned countermeasure Remember we wanted to do them one at a time Plan-Do-Check-Act.Plan You have implemented all the countermeasures and haven t made improved You feel the root cause analysis is sufficient Cycle to Plan a new/different countermeasure Plan-Do-Check-Act.Plan You have implemented all the countermeasures and haven t made improved Cycle to Plan to uncover a deeper root cause 57

58 Introduction The Plan Phase The Do Phase Breakout Exercise 1 The Check Phase The Act Phase Breakout Exercise 2 Summary

59 Act on Your Findings For this exercise Gather into your Duck Factory Teams Act on your findings You have 2 minutes to Fill out the ACT section UPDATE The A3 is a methodology and a report Time to update the report Tell us what s your next step? Take the win: make it the new way you work; institutionalize the change Cycle to DO: implement next countermeasure Cycle to PLAN: develop new countermeasure from existing root cause analysis Cycle to PLAN: need a more work on root cause 59

60 Introduction The Plan Phase The Do Phase Breakout Exercise 1 The Check Phase The Act Phase Breakout Exercise 2 Summary

61 How the process works now A3 in a nutshell The A3 Problem Solving Methodology Is based on a Plan-Do-Check-Act cycle (PDCA) Used to make an improvement to your process (this is one cycle of improvement) When a cycle is completed, your improved process is the starting point for the next cycle of improvements. That is, your destination is now your next starting point! Identify and Eliminate Waste Plan Do Check Act A new and improved process Our Starting Point ( you are here) 61 Our Destination

62 NHLC CONFERENCE DUCK SELFIE! We are really good at bad selfies! Please make my wish come true!

63 CASE STUDIES We have found in working with a series of clients on the same issue and based on research there are proven ways to reduce wait times in the health care sector 63

64 MONARCH RECOVERY SERVICES Assessment process for programs

65 Problem: The intake process for different programs varied and caused delays in services.

66 Process mapping Current Conditions

67 (1)to have all the assessments done by the assessment office Target Conditions (2) to reduce the wait time for services (3) to make the assessment forms more user friendly/shorter (4) and to make access to services better for clients.

68 Results 66% time reduction to conduct assessments was accomplished. Assessments went from taking 60 to 120 minutes, to an average of 20 to 30 minutes to complete. The waitlist for PPOP was eliminated within 2 weeks of implementation!

69 CANADIAN MENTAL HEALTH ASSOCIATION Extended Hours Project

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71 EXPLORE Current Conditions Extended Hours Project

72 ACHIEVE Target Conditions Extended Hours Project

73 NORMALIZE The increase hours offer the ability to double intake capacity to an additional potential of servicing another 125 individuals Results Extended Hours Project 73

74 In Closing... the hacks we are sharing are simply to help you get to the root cause of your avoidable waitlist problems as quickly as possible. 74

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