Vegas summit

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Lean, Six Sigma Process Improvement
in Healthcare Summit
The next generation of Lean Six Sigma
Innovation (LSSI) In Healthcare
by Bob
King
WCBF
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• Survival is not mandatory! - W. Edwards Deming
  1984

Innovation New ideas
Common Objective Best Practices
Six Sigma Error variation
reduction
Lean Speed
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LSSI Culture

• Shifts focus to customer, not service provider or
  organization structure
• Uses common methodology for process improvement
  and decision making
• Uses common metrics
• Ensures decisions are data driven
• Aligns projects with strategy and business
  objectives
• Focuses on waste, variation, and defect reduction
• Increases effectiveness of investments
• Improves ability to meet expectations of customers

Overview -
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Factors Supporting Project Success

• Regular management reviews
• Team knowledge of process
• Adequate measurement system
• Constant environment
• Bias for urgent action
• Measurable goals
• 90-day maximum execution timeframe

Overview -
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Objectives of this talk

• Help participants develop a roadmap of
  improvement for their organization
• Clarify strategy and get alignment of all levels
  of staff and physicians.
• Enrich lean six sigma with innovation
• Pick the projects and tools that will best help
  you achieve your strategy.
• Use time management to free up time for
  improvement efforts

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Simplify and map strategy Southwest example
Increase profitability
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Simplify and map strategy Southwest example
Increase profitability
Fewer planes
More passengers
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Simplify and map strategy Southwest example
Increase profitability
Fewer planes
More passengers
Lowest cost
On time flights
Fast turn around
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Simplify and Map Strategy - Hospital
Profitably Improve Health of the Community

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Simplify and Map Strategy Hospital
Profitably Improve Health of the Community

Patient Satisfaction Payer Satisfaction
Good Outcomes
Economical
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Simplify and Map Strategy Hospital
Profitably Improve Health of the Community

Patient Satisfaction Payer Satisfaction
Good Outcomes
Economical
Transparency
Reduce Waste in Processes
Patient Safety
Patients Get Better
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Barriers

• Joint Commission
• Medicare CMS
• Strategy Plan written by outside consultant

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Enriching Lean Six Sigma with Innovation

• Improve the improve step of DMAIC
• Need to choose process and tools by experience of
  your team.
• Need to choose process by type of change
• If some other part of organization has done it,
  then the 7MP tools will work
• To do something that you havent done, but
  another organization has, use 7 Creativity tools
• To do something that no one else has done before,
  use Advanced Innovation TRIZ.

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Pick strategic projects and tools

• The more your projects are tied to strategy the
  better the chance of success.
• Pick the elements of six sigma, lean and
  innovation that will help you succeed in your
  improvement effort.

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Example 1 Reducing Falls

• Reducing falls during the hospital stay.
• Reducing falls when the person returns home after
  being in the hospital to treat a previous fall.

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Prevalence of Falls

• Data shows fall related injuries in older adults
  are the largest number of trauma admissions at
  the hospital.
• Falls are also the leading cause of injury EMS
  runs.
• Falls are the leading cause of injury visits in
  the emergency department.
• Falls are the leading cause of injury death in
  those over 65.

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Selecting tools for falls teams

• Six Sigma applications.
• Kinds of falls, causes of falls
• Lean applications.
• Processes of care, lag time from coding a person
  as a fall risk to taking action
• Innovation applications.
• Identify ways of preventing falls, preventing
  harm
• Ways to educate families, discharge instructions.

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Example 2 Improve IT Capital Asset Tracking

• Number of items purchased vs. number of items
  tagged.
• Relevance?
• Six Sigma of variances from process
• Lean What are unnecessary steps and delays in
  the process? Mistake-proofing.
• Innovation Analogies of dependable processes.

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Example 3 Reduce time to transfer Paper Medical
Record to EMR

• Issues of quality of information that is being
  transferred. Easier to access wrong information
• Understanding the differences between ED reports
  and in-patient reports.
• How long to process an inch of rehab, an inch of
  cardio, to see if there are efficiencies that can
  be gained there as well.

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Electronic Medical Records

• Six Sigma What is the quality of the original
  records, quality of transmission? Who are the
  customers of the records? What do they want?
• Lean What are the steps in developing the
  records, what are the steps in transcribing the
  records? Where are the delays?
• How can innovation help find the best ideas for
  these questions?

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Pharmacy Project

• Wide variation on special formulations
• One patient expected a 30 minute wait and left
  after 75 minutes resulting in a 3,000 loss to
  the hospital.

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Affinity Chart of ideas
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ID for drivers
Pharmacy staff assignment to better handle ACC
workload 5 in 0 out
Dispersing workload by scheduling patients
according to their medications 1 in 4 out
Maintain consistent/accurate med orders to
improve efficiency of RPh entry 1 in 4 out
Consistent delivery times and locations to
increase awareness of when medications are
available 4 in 1 out
Early/real time notification that the patient
has arrived 2 in 3 out
Coordinate pharmacy inventory, workflow and
compounding with ACC orders 2 in 3 out
Green Process Drivers Nov. 12, 2008
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Heuristic Redefinition for focus
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Using Innovation to Correct the Problem of delay
time

• Level 1 Use the 7 Management and Planning tools
  to get ideas from people working in the system
  and from similar problems that has been addressed
  in the hospital
• Level 2 Use the 7 creativity tools to adopt
  other solutions to lag time in other hospitals
  and other industries.

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Using Innovation to Correct the Problem of delay
time, cont.

• Advanced Innovation TRIZ Use advance methods to
  create new ways of eliminating pharmacy that have
  never been tried or used before. Find the ideal
  solution.
• Note Team members need to become proficient at
  levels 1 and 2 before they should attempt level 3
  of innovation tools.

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How innovation will help your organization

• Lean Six Sigma has one key weak point coming up
  with the best idea of how to improve.
• Healthcare organizations who learn and use basic
  creativity and innovation tools will improve
  every aspect of their improvement effort.
• Better process improvement
• Better planning
• Better products and services

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How innovation will help your healthcare
organization cont.

• Use AFD Advance Failure Determination
• Most organizations use a whack a mole approach to
  patient safety jumping from one outbreak or
  mistake to another.
• Human factors methodology uses airline safety
  which is based on building redundant systems. It
  is an important contribution.
• AFD maps all the possible ways of harming a
  patient and uses innovation to prevent them at
  the most economic cost.
• Healthcare costs will prove human factors alone
  too expensive it will need to be supplemented
  with AFD to get to the next level at lower costs.

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Other Advanced Approaches

• In addition to these ideas there are other
  processes to improve the health system.
• Transformation This refers to alignment of
  people in the organization around a goal. In
  pharmacy different individuals and departments
  are responsible for different steps. One of the
  transformation tools is appreciative inquiry
  which looks at times when the process worked
  really well and focuses on making that happen
  more often.

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How Transformation will help your healthcare
organization

• Healthcare is based on silos. Transformation
  helps build alignment of each groups priorities
  into one unified approach
• The change that will be required in healthcare
  will be significant. There is already an
  epidemic of physician frustration and
  resignations.

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Other Advanced Approaches Getting to the
Essential

• 100X Healthcare Improvement
• Reduce deaths due to errors by 95
• Reduce healthcare costs below Medicare
  reimbursements.
• Increase chronic illness self-care from 25 to
  95.

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Jouslin-King Hierarchy
Gettingto the Essentials1
Customer focus

Transformation Breakthrough Management2
Unique org. capability
Total participation
Continuous improvement
Creativity Innovation
Societal networking
Idea generation Idea selection Idea implementation
7 Creativity Tools TRIZ, QFD Implementation steps
CQM (Shiba) Triangle
Lean Six Sigma
GOAL/QPC (King) Wheel
DMAIC DMADV Eliminate waste unnecessary steps
Emphasis of company plan Increased DOE Increased
reliability
TQM Total Quality Management
Customer driven Master plan Roadmap for
improvement
Daily Management Hoshin Planning QFD, CFM
7 QC Tools 7 MP Tools
SPC Statistical Process Control
Control Charts Design of experiments
Shiba Four Revolutions
Deming Profound knowledge
Seven step process
1.Getting to the Essentials Preserving the
company while preserving the planet. Recognizing
the spirituality in each person. Facing global
issues. 2.Transformation Alignment of individual
and company visions.
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What levels mean

• Level 0 - Chasing regulations/standards
• Level 1 - SPC, fixing special causes, get rid of
  noise then fix system problems
• Level 2 - TQM, get all employees involved
• Level 3 - Lean Six Sigma Vf(x)
• Level 4 Creativity and innovation for all
• Level 5 Aligning employee passions with
  hospital passions

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Level 6 Getting to the essential

• 100X improvement in Healthcare and public health
  quality
• Making the US the worlds healthiest nation
• Eliminate unnecessary deaths
• Reduce hospital costs below Medicare
  reimbursements
• Increase Chronic Illness self care to 98

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Author may be contacted at

• Bob King, GOAL/QPC 12 Manor Parkway, Salem, NH
  03079
• E-mail bobking_at_goalqpc.com
• Cell phone [phone]

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Appendix Additional slides for discussion
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Where Six Sigma came from

• HP 1983 commits to 10X quality improvement
• Motorola 1985 commits to 10X better that HP or
  100x improvement in quality.
• Calls it 6 sigma
• Six Sigma is a 100X improvement
• We need a 100X improvement in healthcare and
  public health quality

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Where we are today

• US ranked 29th as a nation on health care results
• US pays double what the nearest country pays
• Takes average of 17 years to implement best
  practice.
• 300K to 500K die in US each year due to errors.
• Healthcare 15 years behind industry in Quality.
• Perfectly organized for health needs of 1950s.
• Chronic illness 50-75 of patient needs today.

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So where is healthcare and public health today?

• Many hospitals are at level zero with a growing
  number at levels two to three and a few leaders
  at levels 4-5.
• Public health is mostly at level zero.
• RWJ has funded a project to help 15 states to go
  from level zero to level 1.
• So there is lots of room to grow.

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Healthcare and Innovation

• Healthcare even further behind on creativity and
  innovation
• Some experiments over the last three years
• Mayo Clinic and Massachusetts General Hospital
  reporting creativity centers teaching
  brainstorming three years ago.
• Memorial hospital in South Bend, Indiana is at
  level three for last three years, benchmarking
  nations most innovative companies.

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Where quality technology is going

• We are at level four on the quality hierarchy in
  some leading hospitals today.
• Innovation has hit the tipping point in 2007
  (have you ideated your ideating yet? IBM
  television ad) and will be the next major phase
  in healthcare. It will be a major force in
  solving the patient safety and cost crisis.
• Transformation, the next phase, will help with
  the human dimension, coaching and alignment.

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Healthiest nation plans

• Infant mortality
• Life expectancy
• Obesity

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So what does all this mean for your hospital?
Would you like to

• cut your employee healthcare costs by 25,
• free up beds currently occupied by low margin
  patients to create space for high margin
  patients,
• reduce the need for capital expenditures to get
  more beds?
• The following example will tell you how.

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Controllable Health Care Costs

• Lack of Chronic illness self-care causes over 50
  of total health care costs
• Cost shifting from Medicare, Medicaid, uninsured
  is almost 25 of healthcare premiums.

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Successful chronic illness self care programs

• Hannaford Bros. supermarket stores
• City of Asheville, North Carolina
• Increased self care participation levels from 25
  to 80
• Reduced total cost of treatment by 50

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Areas for research by the worlds top quality and
innovation experts

• Getting public health organizations to the
  cutting edge of quality, innovation and
  transformation.
• Getting JACCHO on the cutting edge of quality,
  innovation and transformation.
• Help CMS better support a continuous improvement
  model and reduce unnecessary paper work and too
  frequent procedure changes with lack of lead
  time.
• Helping public health organizations implement
  lean and other quality improvement, innovation,
  and transformation methods. Provide the training
  for this.

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Areas for research by the worlds top quality and
innovation experts

• 5. Redesign national health report cards so they
  reflect the best of performance management and
  improvement technology.
• For further information on the preceding themes
  see www.Thehealthiestnation.com

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Getting hospital costs in line with Medicare
reimbursements

• The new CEO of Dartmouth Hitchcock Medical Center
  in Hanover, NH had the foresight to coin this
  challenge.
• It is akin to the peak of the Quality Hierarchy
  Getting to the essential.
• Current proposals for Medicare cuts would put 10
  of Americas hospitals out of business.
• Current gap between costs of service and Medicare
  reimbursements is considerable and is cost
  shifted to those who are paying, contributing to
  runaway healthcare costs.

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The hospital quality and cost national
demonstration project

• Twenty years ago, Don Berwick brought in
  industrial quality experts to see if industrial
  quality would work in healthcare. It does and
  that is why you are here.
• However, today's methods are not adequate to
  solve tomorrows problems. That is why we need a
  new demonstration project to bring the most
  advanced quality and innovation tools to a dozen
  hospitals.
• There are still openings for your hospital to
  participate in the first round.

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Who is involved?

• An advisory panel of the top quality and
  innovation people in the world has agreed to
  donate their time to this effort.
• Local consultants around the country will use the
  top quality and innovation tools as outlined in
  this talk.

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Making U.S. patient safetythe best in the world

• This will be part of the national demonstration
  project and will begin with 12 hospitals.
• Participants will learn the first 5 levels of
  innovation on the innovation hierarchy.
• Focus will be on the AFD tool to map all possible
  ways to harm patients and eliminate these
  situations effectively and efficiently using the
  appropriate innovation tools.

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Ten tasks for the new U.S. President to improve
healthcare

• Commit to making the U.S the healthiest nation
  and put the resources behind it.
• Develop a plan to transform the healthcare system
  into a health system.
• Fix the national report cards based on where we
  need to improve to be number one.
• Help CMS better support a continuous improvement
  model and reduce unnecessary paper work.
• Save money by insuring everyone a job for the
  states.

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Ten tasks for the next U.S. President to improve
healthcare, cont.

• Help redesign the healthcare system so it better
  meets the need of the chronically ill.
• Get public health organizations to the cutting
  edge of quality and innovation.
• Put resources and energy behind reversing the
  obesity epidemic.
• Expand the federal effort to do research on
  alternative medicines and make findings widely
  available.
• Take control of the FDA away from the
  pharmaceutical companies.

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References for further study

• The Six Sigma Memory Jogger II
• The Black Belt Memory Jogger
• The Lean Enterprise Memory Jogger
• AFD Manual
• Coaching in the Workplace pocket guide
• The Transformation Desktop Guide
• The Transformation Fieldbook
• The Transformation Case Study Book

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Author may be contacted at

• Bob King, GOAL/QPC 12 Manor Parkway, Salem, NH
  03079
• E-mail bobking_at_goalqpc.com
• Cell phone [phone]