Leading High Reliability Organizations in Healthcare Richard Morrow, MBA, MBB Author/Founder RPM Exec (847) 989-3333 rpm@rpmexec.com www.rpmexec.com 1
Baseline Performance Healthcare Compared 2
Organizations Excelling in Reliability 3
Payers are driving value by redistributing* $1.9B in reimbursement through Value-Based Purchasing Today s Lesson: How to Become Paul *CMS FY2018 IPPS Final Rule estimate 4
Reimbursement is Shifting to Reliability = Clinical Outcomes and Value Source: CALHIIN 5
How Much Is At Stake for Your Organization? 6
Then, Paul can lose it all in readmission and hospitalacquired conditions penalties The cost of poor reliability comes to healthcare 7
Becoming a High Reliability Healthcare Organization What is reliability? How bad is it today? What causes poor reliability? What improves it? How do we sustain it? 8
HIGH RELIABILITY is: CAPABILITY IN ACHIEVING THE EXPECTED OUTCOME THROUGH TIME 9
High Reliability is Not Just about safety Six wrong site surgeries every week Patient and caregiver satisfaction below national median Readmissions being big business for you Entertaining your State Inspectors 10
Comparing Complexity and Reliability Skills INDUSTRY Complexity HEALTHCARE HEALTHCARE Reliability Skills INDUSTRY If this is true, how are you going to compete and win the margins to sustain your mission? 11
Required: Systems Approach to High Reliability 12
Step 1: Safety Engineering - Leadership s Role I was absolutely amazed that the NASA people I argued with against the launch didn't even mention to other members of the mission management team that there was a concern 13
High Reliability Healthcare 14
Step 2: Reliability Engineering principles taught to leadership and staff (Yellow Master Level) 15
High Reliability Organizations Utilize 3Ms: 1.Measure daily 2.Manage to that measure 3.Make it easy to do the right thing 16
Utilize the 3Ms of Performance Reliability 1. Measure the Process - Daily 17
Failure Mode and Effects Analysis the Right Way & the Healthcare Way HRO Starts FMEA Healthcare Starts FMEA Bad Event 18 Process FMEA
2. Manage to the Measure Every Day The movie, Lincoln, Directed by Steven Spielberg Don t accept failure 19 19
3. Make it easier for teams to solve problems Circulate among followers consistently, Abraham Lincoln The movie, Lincoln, Directed by Steven Spielberg 20
Favorable What Can Be Achieved 85 th % 40 th % Improvements Begin Benchmark for clinical outcomes Center of Excellence Top 5% in Value-Based Purchasing with Zero Penalties Leads the market and wins the margins 21
How to Build Reliability Skills - Example of a High Reliability Training System 1 2 3 4 5 6 7 8 9 10 11 12 Culture People Process (Improvement) Leadership s Four Critical Success Factors for High Reliability Just Culture Preoccupation with Failure Quality fundamentals Reporting Culture Reluctance to Simplify Learning Culture Safety Culture Sensitivity Mindfulness to Operations Informed Culture Commitment to Resilience Reliability and Teamwork Training Leading High Reliability Organizations Reliability Principles for Healthcare Flexible Culture Deference to Expertise Population Health (System Reliability) Clinical Technology Human/Technology Interface Workflow that utilizes technology effectively Supplier Resource Management 22
Productivity metrics, employee engagement and enablement "Avenue" Quality metrics & data analysis Core "Avenue" questions and common tools. All decisions on "Main Street" are required. Get a Roadmap to Improve Reliability in Healthcare Roadmap to High Reliability Utilizing 3Ms Measure Manage to the measure Make it easier Lean Six Sigma Define the issue Measure capability and control of Y and Xs Improve and Design What does the customer value? Analyze validating contributing factors Achieve capability and stability Control Reinforce CI Prepare for change -Train, Envision, Engage, Enable and Empower Experiment, Explore, while building consensus with stakeholders Train, Enable, Empower, Hold Accountable Leading Change Explore Together Explain Celebrate Primarily What is the What is our Who are the What does improving quality Voice of the Key Questions: purpose? customers, who demand look or productivity? Customer? Issue? Defect? are involved? like? Data analysis Design Criteria? potential? Current process Can I measure Is my process capability of the data well? stable? meeting the customer's needs? What are the validated root causes, contributing factors? Counter- Best counter measures measures? successful? Will process Reinforced continue Is this the right All risks managed to Improvement with reliably? way? sustain the gains? our people and in Cadence of the value stream? Accountability Validating root causes and Tools: Charter template Stakeholder Surveys, Quality Analysis with plan Demand rate Function Main Street and to improve from Deployment Avenues on the engagement and customers. Takt (QFD), Pugh Roadmap minimize time. Matrix resistance Current State Measure- Statistical Capability of System Analysis Process chartered metrics (MSA). Gage Control Chart and key process R&R, Attribute (SPC) visual variables. Value Agreement management Quotient, Cpk, Ppk, Analysis Sigma level contributing factors using SPC, Hypothesis Tests, Confidence Interval Testing, Piloting Comparison of Pilot counter ideas using measures. Design important criteria of Experiments Measure frequently and FMEA, Visual Standard stop the management with Work, Job process if SPC, fail-safes, Instruction defects TeamSTEPPS and occurring. "Stop a Control Plan the line" Recognition for benefits Key Questions: What are the Which data What are the few Do I have all probable measure key process of the causes for the current state input variables inputs? key input and validate the (KPIV) to focus? variation? root causes? What does the data show? How can we Significant improve the differences? inputs? Statistically significant? Tools: Acronyms and Meanings Y = f ( x1, x2... xn ) Cause & Effect SIPOC Matrix with map Human Factors Analysis FMEA Data collection plan for baseline Y=f( x 1, x3 ) and root cause analysis Histograms, check sheets, pareto charts for narrowing of root causes/ contributing factors Before and after Counter measure comparisons, SPC, Hypothesis experiments. histograms, Testing, Design of pareto analysis, Confidence Experiments scatter plots, Intervals stratification CI Continuous Improvement Key Questions: VSM SIPOC Value Stream Map Supplier, Input, Process, Output, Customer map What is the value stream Areas to focus and its waste reduction? flows? Where are the key areas of focus for Performance Improvement and Future State vision? Disorganized workplace? Is process Layout allows equipment Flexibility among Is process failsafe? continuous operational when workers? improvement needed? Process waste Can we reduce Flow in small Can we smooth Replenish only Can the from set-ups, lead-time for Inventory wastes batches demand or at least on pull from process flex turnarounds and patient and present? possible? internally? customer? with demand? change-overs? customer? Tools: SPC JIT QFD Statistical Process Control Just-In-Time Quality Function Deployment Value Stream Map (Current State) by walking the process Kaizen, 8 Wastes, Spaghetti Diagram Value Stream Maps of target wastes (Future State) 5S Total Productive Maintenance and Cellular flow, Operational "focused Equipment factories" Effectiveness Observation, Turnaround Time, One-piece or internal vs. Multi-skilled staff Mistake-Proofing small batch external task time, flow spaghetti diagram, 5S Lead-time reduction Demand and Pull production replenishment smoothing (Mixed- (Just-In-Time, Model Point-Of-Use, Sequencing) Kanban) Quantity Inventory adapts to reduction to demand for improve service capable and reduce service waste Sponsor/Champion Tollgates FMEA Failure Mode & Effects Analysis Define Phase Tollgate with signed charter and current state map Measure Phase Tollgate for Baseline Capability Analyze Phase Tollgate for validated contributing factors Improve Design Phase Tollgate for design or improvements and pilot validation Rick Morrow. All rights reserved. Not to be reproduced. Control Phase Tollgate with process control plan, training, standard work Available free at www.rpmexec.com 23
What is your next step to reliability? 24