Creating a Lean Culture Transformational Leadership for Lean Health Care Bruce Roe, MD President and CEO Executive Champion, Transformation February 15, 2017
St.Boniface Hospital 180 Departments 7 Separate buildings on 20 acres of land Number of employees 3,854 Number of beds 538 Patient days 169,265 Number of admissions 26,769 Outpatient activity 233,189 Doctors with admitting privileges 597 Annual budget $302,680.00
About St. Boniface Hospital Tertiary care hospital, affiliated with the University of Manitoba Our major clinical programs include Cardiac Sciences (provincial referral centre), Woman and Child, Internal Medicine, and Surgery 3,800 employees Total admissions in 2015: 20,147 Total outpatient visits in 2015: 228,705
Our vision To deliver the safest and highest quality of care to every patient, every encounter, every day, with the best outcomes. At a price we can afford!
2007 Lean in Health Care? Patchy improvements in quality Could lean help? In healthcare? Few pioneers Local business - mentors
Let s Talk About Lean What are your assumptions about lean? What role do leaders play in lean transformation? What does an effective lean leader look like?
Emergency Cardiac Patients Presentation to EKG Interpreted RIE (example) Measure Initial State Confirmed State Patient handoffs 7 4 Patient Distance Traveled 306 ft 306 EKG Tech Distance Traveled 1390 ft 10 ft
Rapid Improvement Event #1 ACS Triage to EKG Interpreted New EKG room Team work Trials
Mission Control and Visual Management
People are everything! Improvement ideas come from those who do the work, or experience the care
You ve put the fun back into Health Care This gives us hope!
A Few Of Our Proudest Moments... ER Results Direct Admit ACSS Surgical Safety Checklist Clinical Documentation Staff Scheduling Cardiac Transitions Accounts Payable Process Staffing Absences & WCB Nurse-to-Nurse reports Surgery On The Move Inventory Right-Sizing Prevention of Falls
Reflection Point Lots of activity Pockets of improvement Fragmented deployment not connected Engagement at front line and connection to goals and vision missing
Lean tools are great! A3 Value streams & mapping Kaizen Rapid Improvement Events 5S 6S 3P Kanban Audits /Kamishibai But are they delivering the results you are looking for? One-piece flow
Tools, if not anchored in systems or principles, will not drive culture 5S One-piece flow
Engaging SBH in Reflection Source: Institute for Enterprise Excellence www.shingoprize.org REFLECTION POINT Long-term Sustainment Tool-based Architecture The Whirl-Wind Cause & Effect Relationship of Tools & Results Cause & Effect Relationship of Principles & Results
Thinking that Drives Complexity Thinking that Drives Continuous Improvement Resultoriented Processoriented Result- Knower s Fragmented Thinking Learners Knower s Systems thinking Fragmented Thinking Defensive Command & Control Engaging Defensive Leader as a teacher Command & Control Source: LEI
Shingo Model of Operational Excellence 1. There is a relationship between principles, systems and tools. 2. We focus on both key results and the best behavior to achieve those results. 3. We actively leverage our systems to drive the best behavior.
Building Systems to drive Right Behaviors Key Systems: Strategy Deployment Daily Management System Visual Management System Coaching System Leadership Development System Key Behaviors
Systems Roadmap 2017-2018
Strategy Deployment Thumbnail Sketch Purpose: Connect work to purpose at all levels. Create alignment, clarity, and focus problem solving efforts to get the best results ALIGN: Connect To Our Purpose Results: TN Metric Improvements Strategic Objective A3s (Plans and Results) Clear line of sight to results at all levels Key Behaviours Leadership Managers Staff Set high but achievable targets Align strategies to TN and Regional Priorities Organize and allocate resources Connect, translate, filter at next level Connect, translate, filter TN direction Align problem solving efforts to TN and strategic direction Allocate resources Connect work to purpose Monitor performance to TN visually Triggers Strategic Planning Annual Planning Enterprise Performance Meeting Tools True North Metrics Watch Indicators A3 Countermeasure Summary Process 1. Set Enterprise TN targets through Annual Planning 2. Catchball (Connect, Translate, Filter) at all levels 3. Define Strategic Objectives and resources 4. Deploy targets and objectives 5. Monitor, Maintain, Improve 6. Reflect Related Systems Strategy Development Daily Management Problem Solving Visual Management Renewal Annual
Visual Management System Thumbnail Sketch Purpose: Recognize abnormal conditions (winning/losing) at a glance & trigger a consistent response at the right-level in real-time. IMPROVE: Assure Quality At The Source Results: Near misses, good catches, defects resolved Containment Plans PDSA Leadership & Managers Set targets and make visual Respond in real-time to abnormal conditions Promote problem-solving & containment of defects at the source Engage staff or leadership in problem solving Key Behaviours Staff Huddle often Measure, monitor visually and report on performance daily Identify and embrace defects as opportunity to improve Triggers Huddles Gemba Follow-Up Shift Change Abnormal Condition Tools Visual Standards Andon Visual Management Centres Metrics / KPIs Escalation Standards Process 1. Define targets / normal vs abnormal 2. Make visual 3. Monitor Daily or Real-Time 4. Respond to Abnormal Conditions (Contain, Solve, Escalate) 5. Follow-Up Related Systems Strategy Deployment Daily Management Problem Solving Coaching Renewal Annual
SBH Management System (v1) Monitoring, Maintaining, & Sustaining Standard Work Leader Standard Work Process Observation Unit Performance Steering Team A3 Problem Solving Monthly Scorecard Unit Performance Meeting Countermeasure Summary Daily Stat Sheet Weekly Stat Sheet Unit Performance Management A S GTS 2 GAC P D Daily Status Exchange Daily Improvement Daily Improvement Huddle Visual Management
Model Cell Approach to Learning Wave 1 - Sep 2015 Apr 2016 (32 weeks) Pharmacy Cardiac Surgery Inpatient Unit Wave 2 : Sep 2016 Dec 2016 (16 weeks) Intensive Care Cardiac Surgery Internal Medicine Inpatient Unit (E5) CT Scan Ultrasound
Wave 2 Wave 1 Management System - Assessment Management System - Assessment Scores 2016 2017 Area Dimension Target June August September October November December January February March April Daily Status 4 4 4 4 4 4 4 Daily Improvement 1 2 2 2 3 3 3 Unit Performance & Management 3 1 3 3 4 4 4 4 Monitoring, Maintaining & Sustaining 1 1 2 3 3 3 3 Pharmacy Overall 1 1 2 2 3 3 3 Daily Status 2 4 2 Daily Improvement 2 3 2 Unit Performance & Management 3 1 2 1 Monitoring, Maintaining & Sustaining 1 1 1 CSIU Overall 1 1 1 Daily Status 2 Daily Improvement 1 Unit Performance & Management 3 1 Monitoring, Maintaining & Sustaining 1 ICCS Overall 1 Daily Status 3 3 3 Daily Improvement 3 3 3 Unit Performance & Management 3 1 1 1 Monitoring, Maintaining & Sustaining 1 1 3 E5 Overall 1 1 1 Daily Status 2 2 Daily Improvement 1 1 Unit Performance & Management 3 1 1 Monitoring, Maintaining & Sustaining 1 1 DI - CT/XraOverall 1 1 Daily Status 2 3 Daily Improvement 1 3 Unit Performance & Management 3 1 1 Monitoring, Maintaining & Sustaining 1 1 DI - US Overall 1 1
Management System Spread Wave 3 6 units Wave 4 8 units Wave 5 Wave 6 8 units 10 units Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2017 2018
Transformation Journey
Hubris is a dangerous enemy ~Pascal Dennis Relentless pursuit of perfection means just that; self-critique and facing one s problems ~Steven Spear
Questions?