How To Manage In A Lean Environment And Link Organizational Strategy To Continuous Daily Improvement

Transcription

1 How To Manage In A Lean Environment And Link Organizational Strategy To Continuous Daily Improvement October 4, 2012 Larry Sobal ThedaCare System Vice President of Cancer and Cardiovascular Services

2 Focus Of Today s Presentation Who is ThedaCare? Context Strategy Deployment and True North Metrics Who is Lori? Background What triggered the creation of BPS? Mechanics How does BPS work? Deliverables Examples of BPS in action in various CV settings Where to go if you want more information? 1

3 Is a comprehensive, community-owned healthcare system focused on achieving measurable, better value for our customers. Our mission is to improve the health of our communities. Appleton Medical Center 160-Bed Acute Care Medical Center Theda Clark Medical Center 260-Bed Acute Care Medical Center New London Family Medical Center 25-Bed Acute Care Medical Center Riverside Medical Center 25-Bed Acute Care Medical Center ThedaCare Physicians Employing Over 125 Physicians At 22 Locations Orthopedics Plus The New Standard for Quick, High Quality Orthopedic Services In The Fox Cities ThedaCare at Home Home Health, Hospice, DME, Respiratory Therapy, Infusion, Pharmacy Services Shawano Medical Center 25-Bed Acute Care Medical Center Ingenuity First Offers Innovative Solutions to Employers For Health Care Costs Fox Cities Community Clinic A Free Clinic Jointly Owned With St. Elizabeth Hospital The Heritage/ Peabody Manor Continuing Care Campus for Older Adults ThedaCare Behavioral Health Inpt and Outpt Mental Health, Substance Abuse Services Gold Cross Ambulance Service Jointly Owned With Affinity Health Systems CV Division ThedaCare at Work Occupational and Employee Health Services, Employee Assistance Program 2

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5 ThedaCare s Owner Expecta2ons Continual Improvement In Community Health Access to Coordinated Care Better Health at Lower Cost Than Other Communities Leadership in Healthcare Value Prudent Financial Oversight

6 What Are True North Metrics? True North Metrics: Establishes measures of our organizational health and provides our focus for improvement Five Areas of Focus: Safety, Quality, Customer Loyalty, People, and Financial Stewardship Triangle: Our True North Metrics are built around a triangle to visually emphasize the need to stay balanced and keep our customers in the center of what we do 5

7 ThedaCare True North Metrics Safety System Patient Safety Bundle D.A.R.T & Customer Lori Quality Preventable Mortality 30 Day Readmission Net Promoter Score People Engagement Index Health Assessment Score Financial Stewardship Operating Margin Productivity 6

8 What Lori Wants - Key Drivers Key Drivers: First tier attributes are most actionable across the ThedaCare system. These attributes are consistently rated by customers (Lori) as most important and have strong impact on customer loyalty. They are also core to our system strategy. Attributes Listening: Description My care team/providers listened carefully to me Care planning with my input: My care team/providers delivered a care plan designed with my input Appointments on my terms: I was able to see my provider at a time that worked well for me and it was when I wanted to be seen Understanding provider roles: Working to lower costs: I understood the role played by each of the care team/providers involved in my care My care team/providers worked hard to reduce out-ofpocket costs 7

9 We Want To Create Connection and Engagement 8

10 Creating Alignment at ThedaCare 1. Strategy: Our True North Metrics 2. Deployment of Strategy: through A3 s and Value Streams 3. Continuous Improvement through the Business Performance System 9

11 History - ThedaCare s Lean Journey Began In 2004 Value Stream Analysis Rapid Improvement Events Action Plans 10

12 While There Were Clear Successes ThedaCare Was Hitting A Wall In Lean Implementation" 11

13 It become apparent there was a gap between Value Stream-based Improvement Event work and how we were managing in a Lean Culture Like pouring new wine into old skins The ultimate arrogance is to change the way people work but not to change the way we manage. 12

14 Call for Action We were on a continuous improvement cultural transformation, but current systems for managing the business were not in alignment with new expectations. No one way to manage Uncertainty on how to measure performance The right information was not being escalated for leadership to help Leadership intervention was clunky 13

15 Hypothesis Problem We were not consistently performing in all aspects of necessary organization al improvement Root Cause Lack of standard management systems and processes Countermeasure IF: We create a business management system THEN: Managers will understand performance, know the problems affecting it, and respond to problems in a timely manner IF: We create tiers of progression THEN: We can developmentally coach through the management system and managers will have clear performance expectations IF: We create standard work to support each piece of the system THEN: We will have consistent management expectations across divisions and for each level of leadership IF: Our management system employs the performance criteria from the Human Development Value Stream THEN: We will have a balanced approach to leadership development 14

16 What Emerged Was BPS The Business Performance Systemhow to connect Strategy to daily Continuous Improvement 15

17 The Foundations of the Business Performance System 1. Leader Standard Work at all levels 2. Visual Tracking Of Key Drivers 3. Consistent Processes for Problem Solving, Corrective Action and Escalation of key information 4. Leadership Development 5. Leadership Discipline -and- 16

18 Emphasis on Teaching and Coaching as an EXECUTIVE Responsibility Desired Leadership Behaviors: ü Dirty hands ü Know the tools ü Develop People 17

19 Ideal State Information Flow Staff Staff Lead Status of the Business: ü Continuous Improvement Opportunities ü Metrics ü Escalation Staff Supervisor Manager Leadership s Role: ü Strategy ü Coaching ü Weekly/Monthly Assessment ü 10-25% Standard Work Staff s Role: ü Continuous Improvement ü Daily assessment ü 50-75% Standard Work VP Sr VP CEO Level 1 Level 2 Level 3 Level 4 Level 5 Level 6 Level 7 Vision Goals Purpose ü Mentoring ü Teaching ü Barrier Removal ü Strategy ü True North 18

20 The Business Performance System Daily Huddle Monthly Scorecard Daily Stat Sheet Leadership Team Unit Flow Waste Removal Monthly PDSA Performance and Countermeasures Review Meeting Leader Standard Work Visual Management Sustaining Improvement Thru Training and Managing to SW 19

21 Where do we begin? Learning and Understanding the Business 20

22 The No Meeting Zone 8am 10am 21

23 The Business Performance System Daily Huddle Monthly Scorecard Daily Stat Sheet Leadership Team Unit Flow Waste Removal Monthly Performance Review Meeting PDSA and Countermeasures Leader Standard Work Visual Management Sustaining Improvement Thru Training and Managing to SW 22

24 The Daily Stat Sheet Learning and Understanding the Business 23

25 Cultural Transformation Leaders need to rely on their daily stat sheet to understand what they need to know to run their business 24

26 Ex: Cardiology Practice Daily Stats Tell me about any safety risks patients/staff/family today? Tell me about medications Any near misses with our patients? Are there any incident reports to discuss? What is a potential quality problem for today? Tell me how me how we are doing on our key metrics? Do you have all the resources you need to do your job today? Who is going to need the most support today? Are all the charts prepped for today s clinic visits? 25

27 Ex: Cardiology Practice Daily Stats Who or what should we celebrate or recognize today? How? What might be show stoppers for our customers today? Who has openings for New or Return visits today? What is our planned number of office visits today? Who is absent or tardy? Who is over their FTE for the week? How many people missed lunched yesterday? What are are we doing to avoid that today? Are there any patients or procedures that might be a good media opportunity? 26

28 The Business Performance System Daily Huddle Monthly Scorecard Daily Stat Sheet Leadership Team Unit Flow Waste Removal Monthly Performance Review Meeting PDSA and Countermeasures Leader Standard Work Visual Management Sustaining Improvement Thru Training and Managing to SW 27

29 Daily Huddles Use The Stat Sheet As The Basis For Daily Review of Operational Performance And Identification Of Improvement Opportunities Daily Problem Solving in Gemba 28

30 Cardiology Practice Daily Huddle 29

31 Improvement Ideas Are Captured In A Standard Way 30

32 The Business Performance System Daily Huddle Monthly Scorecard Daily Stat Sheet Leadership Team Unit Flow Waste Removal Monthly Performance Review Meeting PDSA and Countermeasures Leader Standard Work Visual Management Sustaining Improvement Thru Training and Managing to SW 31

33 The Leadership Team The support to see performance, understand problems and implement responses 32

34 Cultural Transformation The Entire Leadership Team Owns the performance of the business, not just a single leader 33

35 Ex: Leadership Team For Cardiology Practice Metric Review Practice Manager Lead RN Lead MA Supervisor: Scheduling/Call Center EPIC Optimizer Financial Analyst 34

36 The Business Performance System Daily Huddle Monthly Scorecard Daily Stat Sheet Leadership Team Unit Flow Waste Removal Monthly PDSA Performance and Countermeasures Review Meeting Leader Standard Work Visual Management Sustaining Improvement Thru Training and Managing to SW 35

37 The Monthly Scorecard Knowing our Numbers 36

38 Cultural Transformation The monthly scorecard reports the stability, trends and overall performance of the business unit, putting the FOCUS on the Driver Metrics! 37

39 The Business Performance System Daily Huddle Monthly Scorecard Daily Stat Sheet Leadership Team Unit Flow Waste Removal Monthly Performance Review Meeting PDSA and Countermeasures Leader Standard Work Visual Management Sustaining Improvement Thru Training and Managing to SW 38

40 The Monthly Performance Review Meetings 39

41 Monthly Performance Communication Diagram Leadership Teams, Monthly Scorecards and Monthly Performance Reviews System Leadership Team Monthly Performance Review System Leadership Team True North Metrics 3 rd Week of the month Vice President Leadership Team Monthly Performance Vice President Leadership Review Team VP Drivers 6 th or 8 th Business Day Lessons Learned Shared Stratification of Red Metrics Manager Leadership Team Manager Leadership Team Monthly Performance Review Business Unit Drivers Mgr Repeat for each VP Lessons Learned Shared Stratification of Red Metrics 4 th or 5 th Business Day Repeat for each Manager 40

42 Ex: My Leadership Team For CV Business Line Monthly Review CV Director* Practice Manager Cardiology/CV Surgery* CV Invasive Services Manager CV Diagnostics Manager Supervisor Scheduling/Call Center Inpatient CV Manager CV Value Stream Manager* System Business Line Marketing Manager System Finance VP CV imbedded LEAN facilitator 41

43 CV Division North Metrics Safety CV Inpatient Complication Rate & Customer Lori Quality CHF and AMI 30 Day Readmission rate AMI Compliance Bundle Pioneer ACO metrics Net Promoter Score CGCHAPS (practice) HCAPS (inpatient) People CV employees Health Assessment Score CV employees Engagement Score Financial Stewardship CV Cost Per Unit Of Service CV Productivity CV Market Share

44 CV Division North Metrics Safety CV Inpatient Complication Rate & Customer Lori Quality CHF and AMI 30 Day Readmission rate AMI Compliance Bundle Pioneer ACO metrics People CV employees Health Assessment Score CV employees Engagement Score Net Promoter Score CGCHAPS (practice) HCAPS (inpatient) Financial Stewardship CV Cost Per Unit Of Service CV Productivity CV Market Share 43

45 CV Division Monthly Watch Indicators Watch Indicators: The Performance we are watching and may only respond to if the metric is changed to a DRIVER. COLOR BOTH THE MONTH AND YEAR To Date RED OR GREEN Category of Measure Source TN, SD, HD, HI HW Watch Indicators Owner Target or Trigger (only if there is one) Previous Year or Baseline Estimated Completion Date Jan Feb Mar Jun Jul Aug Sept Oct Nov Dec YTD Avg YTD % Change vs. Baseline) Direction of Metric UP or DOWN Safety/Quality TN HF order set utilization (Admit) Dan 80.0% 0.0% 12/31/2012 Safety/Quality TN HF order set utilization (Discharge) Dan 20.0% 0.0% 12/31/2012 Safety/Quality TN Diabetic BP <= 130/80 Dan 65.0% 5.0% 12/31/2012 Safety/Quality TN Hand-off Communication Pam 95% 65% 12/31/2012 Safety/Quality TN Chart prep 3 days Tom 93% 12/31/2012 Safety/Quality TN Decrease 30 day readmits for HF Dan 11.7% 18.0% 12/31/2012 People TN AMI bundle Dan 100.0% 18.0% 12/31/2012 People TN Improve Emploiyee Engagement Tom 12/31/2012 People TN Improve Emploiyee Engagement Mike 12/31/2012 People TN Improve Emploiyee Engagement Pam 83% 83.4% 12/31/2012 People TN Increase provider engagement in HF events Dan 12/31/2012 People TN 12/31/2012 Customer Satisfaction TN CTO cases scheduled accurately to template Mike 80.0% 12/31/2012 Customer Satisfaction TN 1st available NP slot 3 days out Pam /31/2012 Customer Satisfaction TN Press Ganey Dan 12/31/2012 Customer Satisfaction TN 12/31/2012 Customer Satisfaction TN 12/31/2012 Customer Satisfaction TN 12/31/2012 Plan > 65.0% 65.0% 65.0% 70.0% 70.0% 75.0% 75.0% 80.0% Actual > 22.2% 61.5% 24.0% 40.7% 34.2% Plan > 20.0% 20.0% 20.0% 20.0% 20.0% 20.0% 20.0% 20.0% Actual > 0.0% 0.0% 32.0% 44.4% 0.0% 0.0% 12.7% Plan > 65.0% 65.0% 65.0% 65.0% 65.0% 65.0% 65.0% 65.0% 65.0% 65.0% 65.0% 65.0% Actual > 58.1% 57.7% 57.3% 59.1% 59.7% 60.3% 57.7% Plan > % Actual > % Plan > 93.0% Actual > 79.0% 80.0% Plan > 11.70% 11.70% 11.70% 11.70% 11.70% 11.70% 11.70% 11.70% 11.70% 11.70% 11.70% Actual > 15.63% 5.71% 25.71% 24.00% 17.90% 16.19% Plan > 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% Actual > 95.0% 97.0% 100.0% 100.0% 96.7% 95.8% Plan > Actual > Plan > Actual > 98.0% Plan > % Actual > Plan > Actual > Plan > Actual > Plan > 80.0% 80.0% 80.0% 80.0% Actual > 100.0% 50.0% 75.0% 0.0% Plan > Actual > Plan > 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% 90.0% Actual > 90.0% 90.0% Plan > Actual > Plan > Actual > Plan > Actual > up up up up up down up up down up up up up down up up up down Financial Stewardship TN Decrease cost per case for HF (AMC) 12/31/2012 Plan > $8, $8, $8, $8, $8, $8, $8, $8, $8, $8, $8, down Dan Actual > $3, $7, $2, $4, Financial Stewardship TN Reduce the number of no Shows in cardiac rehab Hedy 10/mo 22/mo 12/31/2012 Financial Stewardship TN Expense/UOS Mike 12/31/2012 Financial Stewardship TN Productivity for Device Clinic Pam /31/2012 Financial Stewardship TN Productive hours/uos Mike 12/31/2012 Financial Stewardship TN Clinical Staff Hours for 4501 Pam /31/2012 Plan > Actual > Plan > $1, $1, $1, $1, $1, $1, Actual > $1, $1, $1, $1, $1, Plan > Actual > Plan > Actual > Plan > 4, , , , , , , , , , , Actual > 4, , , down down down down down Financial Stewardship TN Plan > down Actual > Financial Stewardship TN Productivity Tom /31/2012 Financial Stewardship TN Expense/UOS Tom 12/31/2012 Plan > Actual > Plan > Actual > down down 44

46 The Business Performance System Daily Huddle Monthly Scorecard Daily Stat Sheet Leadership Team Unit Flow Waste Removal Monthly PDSA Performance and Countermeasures Review Meeting Leader Standard Work Visual Management Sustaining Improvement Thru Training and Managing to SW 45

47 PDSA Problem Solving And Countermeasure Summary 46

48 The Countermeasure Summary Please answer the following questions Are you meeting target, improving, consistent? What is your stratification telling you? What are the top contributors to the problem? (and how did you find them?) What will you do in the next 30 days to improve performance? 47

49 The Business Performance System Daily Huddle Monthly Scorecard Daily Stat Sheet Leadership Team Unit Flow Waste Removal Monthly PDSA Performance and Countermeasures Review Meeting Leader Standard Work Visual Management Sustaining Improvement Thru Training and Managing to SW 48

50 Leadership Standard Work 49

51 To Reduce Variation and Drive Improvement: Standard Work is The Glue that holds it all together Is there Standard Work? Have you trained to the Standard Work? Is the Standard Work being followed? Are we managing to SW? Is there a process to improve SW? 50

52 Ex: Manager Morning Standard Work Daily Stat Sheet 8-8:30 am: Update stat sheet with Supervisor Remove barriers-escalate when appropriate 51

53 Ex: Manager Morning Standard Work Defect Huddle 8:30-8:45 am: (See huddle SW) Identify defects Create assignments Establish daily priorities with the team Establish the discipline of daily follow through as a team 52

54 Ex: Manager Morning Standard Work Go To Gemba 9:15-10:00 am: Understand the work of the day Communication Coaching/Mentoring Audit: Use SW process to audit priority work Problem Solving: Managing improvement related to capacity and flow 53

55 The Business Performance System Daily Stat Sheet Daily Huddle Leadership Team Monthly Scorecard Unit Flow Waste Removal Monthly Performance PDSA and Countermeasures Leader Standard Work Visual Management Sustaining Improvement Thru Review Meeting Training and Managing to SW 54

56 Visual Management 55

57 Process Map 56

58 Leader Metric Wall 57

59 CV Inpatient Unit Target Improvement List 58

60 Diagnostic Metric Room 59

61 Key Processes (i.e. standard work) are regularly selected for review at daily huddles 60

62 Standard Work Observation Calendar 61

63 How we teach the BPS system 62

64 Business Performance System Deliverables Daily Stat Sheet Leadership Team Monthly Scorecard Monthly Performance Review Meetings Standard Work Calendar PDSA (A3) tool Visual tracking and escalation Lead and Supervisor Standard Work Observing/Managing to Standard Work 63

65 If You Want To Learn More 1. Type ThedaCare BPS in google. One resource will be an extensive article describing BPS in the Sept 2011 issue of the Joint Commission Journal On Quality And Patient Safety 2. The past CEO of ThedaCare, John Toussaint, has written a book about ThedaCare s LEAN journey: 3. The ThedaCare Center For Healthcare Value offers one and a half day learning sessions to visit ThedaCare and see this work in action. Go to: 64

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67 No Blaming Allowed! 66

68 Questions? 67