Leading With Lean at Rouge Valley Central East LHIN Board of Directors April 25, 2012 Rik Ganderton President & CEO, RVHS 1
1. What is Lean? Agenda 2. Transforming with Lean at RVHS Leadership Examples of Improving the Patient Experience through Lean 3. Where are we now? 4. Lessons Learned 5. Opportunities and Next Steps for RVHS 2
What is Lean? Lean is a management philosophy by which customer value is maximized, while waste is minimized. Lean is a process for optimizing value for customers, while making the most effective use of resources. Lean is not mean quite the opposite it respects and engages team members Lean does not mean cutting jobs in the name of cutting costs (In fact, cost cutting should not be connected with Lean) Our customers are patients. Lean puts patients first through these basic tenets Respect for People Respect patient/family time, input, privacy, dignity e.g. deliver on our Patient Declaration of Values Respect staff skills involve staff and physicians; use their time wisely; optimize the processes in which they work; connect their role wherever they work to the corporate vision/mission The elimination of waste Waste is non-value-added activity; Value is defined by patients Making good quality repeatable, sustainable Eliminate long wait times 3
Fundamentals of Lean What is Lean? Data driven measurement If you can t measure it you can t manage it Visual Management transparency and accountability you have to see it to manage it See the exceptions, measure them, fix them You have to be visible to manage Management is about coaching and developing not telling and doing Front line staff know more about the problems and solutions than the manager
Transforming with Lean at RVHS Since 2008, we have been using Lean as our enterprisewide management philosophy and supporting tool kit to help our resource-constrained management team address the broad scope of change required; all leaders are required to lead and manage using the Lean Management Philosophy We provide extensive Lean training and management development to give all leaders a consistent approach for how we expect the organization to be run We established a Transformation Management Office (TMO) to assist leaders and frontline staff with ongoing coaching, support, facilitation and basic training (we use a 4 step approach: engagement, improvement, sustainment and spread) We access external Lean expertise (less every year) for regular coaching, advanced training, facilitation of new techniques We have developed the STAR framework (see next slide) to communicate a common set of expectations for all departments " In a lean environment, the expectation is that everyone has two responsibilities. The first is to run the business on a day-to-day basis. The second is to improve the business, or contribute to improving it continuously." (David Mann in Creating a Lean Culture: Tools to Sustain Lean Conversions ) 5
Continuous improvement Our STAR Framework Defining Goals for Lean Deployment and Sustainment STANDARD All of the following are in place: Process Control Boards Performance Trending Boards 6S A3 Rounding Kaizen Participation Leadership has had Lean Expert Tools Training ADVANCED All of the following are in place: Sustainment of Standard level Kamishibai (daily quality audits) Safety Calendar Idea Board with problemsolving huddles Department leads and sustains its own kaizen events (at least 2 per yr) ROLE MODEL All of the following are in place: Sustainment of Standard and Advanced levels Internal knowledge sharing (joint kaizen with another dept; facilitator for another dept s Lean event; lead an in-service; internal article or poster presentation) External knowledge sharing (e.g. joint kaizen event with external partners; conference presentation; published article) Use of one or more higherlevel Lean tools (e.g. Kanban, Andon, SMED/changeover, etc.) 2010/11 90% 10% 0% 2011/12 100% 40% 10% 2012/13 100% Target achieved 67% 33% 6
Embracing Lean as a Management Philosophy Lean thinking helps in moving leaders from crisis management mode to a greater focus on improvement, innovation and strategy Innovation Top Management Maintenance Traditional perception of job functions Middle Management Line Management Front line Kaizen, Imai, 1986 Improvement and Innovation Maintenance Top Management Middle Management Line Management Front line World class perception of job functions 7
Visibility Communication Accountability Role Models Self-Reflection A New Brand of Leadership Strong Leadership Attention is Key Dedicated hospital-wide Gemba Time, 2 hours/day Transformation Rounds (twice per month by entire senior team) Regular Senior team walkabouts with the CEO Transformation Updates in monthly Leadership Forum, Town Halls, President s Blog, newsletters, President s Report to the Board and a standing agenda item in key meetings such as Medical Advisory Committee Public blogs on how Lean works for patients routinely posted Presentation on Transformation at every orientation session for new staff Lean incorporated into Personal Business Commitments Lean sustainability measure reported on the corporate scorecard STAR Framework sets expectations for all departments Senior leaders deliver workshops on Lean topics Lean Leadership Culture Survey conducted every 6 months 8
Lean and the Board Lean used to drive and support the implementation of corporate strategy Board involvement is a key part of the oversight of our accountability framework: Lean orientation and education Monthly Transformation Updates as part of President s Report to the Board Monthly reporting on Lean indicators related to sustainability and engagement on corporate scorecard Evaluating CEO performance on Personal Business Commitments (PBCs) related to Lean 9
Improving Patient Experience through Lean Because of our application of Lean our patients now Wait less time for Emergency department care at RVC and RVAP (plus improved ambulance offload times) Lab & diagnostic imaging results (hours vs. days) Go home sooner thanks to improved patient flow, discharge planning Walk less distance at pre-admit clinics / our professionals come to them Thanks to our pre-admit clinic introducing one-stop-shopping to reduce the # of steps walked by patients with bad hips and knees Cancel fewer surgeries thanks to enhanced pre-surgical screening Waste less of their time filling in forms 10
Operating Room Changeover Kaizen Event Start of Kaizen End of Kaizen Manual cycle time (sum of time spent for all staff involved) OR changeover time # of room exits to clean room # of operating procedures performed each year at RVAP 53.3 minutes 33 minutes 15.6 minutes 12.7 minutes 12 5 6700 Reducing OR changeover time on every procedure by only 3 minutes saves 335 hours per year that can be used for more procedures! 11
RVAP Pre-operative Screening Visit Redesign (new) Average Visit Length Patient Movement % Patients Screened Pre-operatively Cancellations of surgery because patient not fit Timeliness of Surgery Antibiotic Use Before Kaizen After Kaizen 7.56 hours 1 to 3 hours 493 steps Patients travelled to various departments (Lab, DI, ECG) 246 steps Patients stay in one room; staff come to patient and use coloured fingers for visual management 20% 90-100% (some by telephone) 37 (08/09) 7 (09/10) Surgery delayed due to incomplete documentation Unknown (but much less than 100%) 95-100% of charts complete one day prior to surgery and 93% of patients ready by 30 minutes pre-booked Operating Room time 100% of patients given IV antibiotics pre-total Joint surgery as per national guidelines Sustained and spread to Fracture Clinic at RVAP 12
6S on Inpatient Medicine Unit Metrics Pre-6S Post-6S % Change 2W Audit Score Clean Utility Room Room 11% 59% 81% 2W Audit Score Medication Room 18% 68% 73% 2W Audit Score - Hallways 5% 77% 93% Avg Monthly Medication Cost TBD TBD TBD Avg Monthly Medical Supplies Cost TBD TBD TBD Staff Satisfaction (n=12) 35% 79% 44% 131
Human Resources Recruitment Kaizen: Time to fill job vacancies Before doing a kaizen on recruitment, average time to fill was 83 days. With the improvements made, the department has been able to handle a 70% increase in volume 14
Where we are now? Lean improves current state, while being an investment in the future Almost all areas of the hospital have made some form of Lean improvement (we have done close to 100 Lean events since 2008) Financial and operational stability have occurred at the same time as we have preserved or enhanced the quality of care We are building internal capacity to deploy and sustain Lean over the long-term consistent with LHIN and Ministry directions (we have provided over 300 hours of Lean training) Cultural Change is happening (greater trust, transparency and accountability; Lean terminology is widely used; high use of A3 thinking) Voluntary turnover is down and 2010 staff survey results indicate that trust, involvement in decision-making and satisfaction with the organization have increased since 2008 Physician leaders are engaged Lean used to support corporate priorities including accreditation, enterprise risk management, redevelopment, pandemic planning Positive change in our reputation with our community partners (e.g. LHIN, CCAC, EMS); joint kaizen events with other health care organizations Growing external recognition for our achievements 15
Lessons Learned Lean is not a project it is a long-term journey Lean is 80% culture and 20% tools Having a corporate or system-wide burning platform to stimulate change is essential but not sufficient; individual value propositions are also necessary for real buy in What s In It For Me! Strong, ongoing, united leadership commitment is essential Lean is harder for leaders than for frontline staff Leaders must Learn to lead differently Be visible in the gemba Empower staff to identify problems and find solutions Make problems transparent and not take it personally Lean has to be supported by a rigorous accountability framework 16
Lessons Learned Physician involvement is critical But be strategic about it because they really are busy Expect growing pains as Lean becomes standard Staff can feel frustrated or constrained (transitional states) Improved results can be difficult to sustain and setbacks are to be expected Lean tools and creating more standard work can be perceived as loss of the freedom staff members have to be impactful. This is a growing pain. The more the process and tools are used, the better the engagement. Training and coaching staff to think and work within an increasingly Lean environment is key to future progress, innovation for patients. Lean is not about cost savings It is about the patient experience Good quality costs less Communicate, Communicate, Communicate! Did we mention communicate? repetition helps 17
Opportunities and Next Steps 1. Sustain our gains and further embed (or hardwire ) Lean thinking in the fabric of our organization to help us to be The best at what we do. 2. Foster a culture of daily continuous improvement 3. Continue to build internal capacity and invest in our leaders 4. Strengthen the link between quality and Lean transformation 5. Collaborate with health system partners on transformation initiatives (e.g. region-wide value stream analysis on diabetes) 6. Position RVHS to be an industry leader in a new health care environment in which Lean is endorsed by funders and hospital revenue and leadership compensation are tied to quality, performance and efficiency. 18
Questions / Discussion Thank you 19