Lean Health Care at UMHS: Update on Plans for Michigan Quality System

1
Lean Health Care at UMHSUpdate on Plans for
Michigan Quality System

• February 2005

2
Use of Lean Thinking inHealth Care at UMHS

• Michigan Quality System concept
• GM Agreement
• Two tracks
• Model lines
• Internal awareness and training programs
• Coordination across UMHS
• Issues and feedback

3
Lean Thinking The endless transformation of
waste into value from the customers perspective

• 5 Principles of Lean (Womack and Jones)
• Specify value from customers perspective, by
  product line
• Identify the value stream for each product
• How do we add value from the customers
  perspective?
• Make value flow without interruptions
• Let the customer pull value from our process
• Pursue perfection apply continuously

4
Michigan Quality System MQS Concept

• Adapt lean thinking concepts for use at UMHS as a
  consistent approach to quality and process
  improvement
• Incorporates quality, safety, efficiency, and
  appropriateness
• Leads to Michigan Value

5

• Uniform process improvement across UMHS
• Across Missions education, research,
  clinical/service
• med students in clinic flow
• Across Goals
• Quality - Efficiency
• Safety - Appropriateness
• a VSM created to improve efficiency can be used
  in an effort to improve safety (root cause
  analysis following an adverse event)
• Spread to Adjacent Areas merging projects
• ED gt Radiology gt OR
• Training Synergy
• Transferability of training received for one
  project when working on other projects

6
GM Agreement

• Project facilitation
• Help facilitate 6 lean model lines
• Education
• Access to GMS training at Pontiac
• Visits to GMs premier lean facility (Lansing
  Grand River)
• Assist developing UM education materials

7
MQS Model Line Projects

• What are they? Why use them?
• Institutional examples of lean in healthcare
• Proof of concept at UMHS
• Can expand upstream, downstream and laterally
• Why not train all managers first?
• Best way to learn Learn Lean By Doing
• Training long before use is less valuable

8
MQS Model Line Selection Process and Criteria

• Model line criteria
• Institutional priority/visibility
• Potential for creating an exemplar
• Opportunity to expand upstream, downstream,
  sideways
• Opportunity for improvement (access/waits/bottlen
  ecks, financial, satisfaction, errors)
• Process dependence
• Existence of a clinical champion
• Selection
• Denton and Spahlinger selected areas
• Project leads determined scoping and sequence

9
MQS Model Line Sequence

• Vascular access Right line at the right time
• Orders Management Project (OMP) Pharmacy
  end-to-end
• --------------------------------------------------
  --------------------------------------------------
  --------------------------------------------------
  --------------------------------------------------
  --------------------------------------------------
  --------------------------------------------------
  -
• Radiology CT or timing of inpatient studies
• Emergency Department Ideal patient flow
• OR
• ? 3 Head and Neck rooms (clinic through OR)
• ? ADP one day LOS throughput
• Care transition
• Discharge planning
• Cross silo patient flow

10
UMHS Awareness and Training

• GM Lansing Grand River Tour (9/04)
• GMS training in Pontiac 18 staff/faculty trained
  (2004)
• Pontiac in Ann Arbor (February 3) 24
  staff/faculty
• Coordination with Leadership Development Program
• Bill Lovejoys session for LDP 3
• Lovejoys LDP 1 2 alumni session (Feb 9)
• LDP 3 Group Project Clinic Access Improvement
• Leadership Day (May 26)
• Keynote Gary Kaplan Lean in Healthcare at
  Virginia Mason
• Hands-on exercise Value stream mapping
  Long/Ebbitt (GM)

11
UMHS Internal Training

• Planned
• Just-in-time training for model line project
  teams
• will learn value stream mapping at Day 1 of
  workshop
• Engineering course, 5 day Lean Healthcare
• April 18-22, 2005 (some places are available)
• Internal development of UMHS training program
• HR Integrated with Leadership Training Pyramid,
  Masters Series topic for more seasoned managers

12
MQS Training Development

• Goal Build training for wide application of lean
  thinking to projects and daily problem solving in
  UMHS
• Levels General awareness, team member,
  facilitator
• Long Term Goal Managers job optimize the value
  stream map of their product line
• Resources
• Current 4-hour CQI training plus past courses
  (Deming-PDCA)
• Patient safety and risk management training
  programs
• GM training materials (4-hour, 8-hour, 3-day)
• John Long, M.D. 8-hour workshop curriculum, ?
  Virginia Mason
• Work Group
• Jack Billi (EVPMA/Medical School)
• Richard Coffey (Program and Operations Analysis)
• Deb Guglielmo (CQIP)
• Judy Hallas (Organizational Effectiveness)
• Van Harrison (Medical Education)
• Jeanne Kin (Medical School)
• Jeanne Rizzo (HHC, ACA)

13
MQS Issues for Discussion

• 1. How best to coordinate across UMHS groups with
  Process Improvement expertise and resources
• CQIP (Hospitals QI program)
• Program Operations and Analysis
• OCA/Safety/Risk Management
• Faculty Group Practice
• Departmental expertise

14
MQS Issues for Discussion

• 2. How do we encourage wide acceptance of one
  philosophy and set of tools for quality and
  process improvement to allow synergy across
  projects?
• Med Education projects in clinical areas
• Clinical research clinical flow interface
• Cross-silo or cross-department improvement

15
MQS Issues for Discussion

• 3. Value stream improvement is managements
  responsibility. (Rother Shook)
• What steps can facilitate us moving toward MQS
  being the way that UMHS managers view their role?
• Management has to understand that its role is to
  see the overall flow, develop a vision of an
  improved, lean flow for the future and lead its
  implementation. You cant delegate it. You can
  ask the front line to work on eliminating waste
  but only management has the perspective to see
  the total flow as it cuts across departmental
  and functional boundaries. Learning to See.
  Rother and Shook

16
MQSIssues for Discussion

• 4. What is optimal coordination model/location
  within Health System for
• Ongoing training
• Project management
• selection, assignment of facilitator/coach,
  actual day-to-day management and coordination
  (especially for cross-silo projects)
• OIC? Amb Care? FGP? CQI Program? POA?
• Decentralized?
• LDP 3 (Ortho Access)
• Departmental initiatives (Livonia ACS)
• Line Managers (Denton, Calarco, Rizzo, Spahlinger)

17
Other Feedback?