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1. *6 Mute your Line *7 Un-mute your line Please do not put your phone on hold. 1-800-504-8071, code 8422006

2. Kaizen Model for Continuous Improvement July 23, 2010 1-800-504-8071, code 8422006

3. Minnesota Enterprise Lean

4. Enterprise Lean • A coordinated state government initiative for improving organizational performance and results in Minnesota's state government agencies

5. Approach • Lean/Kaizen events • Six Sigma tools • TQM philosophy • Tools and training to help state government work better for its customers and employees.

6. What is LEAN? • Maximize customer value • Minimize waste • Empower workers • Derived from Toyota Production System

7. Foundational Elements of Lean • 7 wastes • 5S • Standard work

8. 7 Wastes • Overproduction • Waiting • Transportation • Processing • Inventory • Motion • Defects

9. 5s • Method for organizing work space • Sort • Shine • Set in order • Standardize • Sustain

10. Before 5S

11. After 5S

12. Standard Work • A simple written description of the safest, highest quality, and most efficient way known to perform a process or task. • The only acceptable way to do the process it describes. • Expected to be continually improved

13. Kaizen = change for the better • Identify the current state • Develop the future state • Implement improvements immediately • Standardize the process • Train on the new process • Track sustainment

14. Selecting a Kaizen project • Affects many stakeholders/customers • Consumes a lot of resources • Is highly visible to stakeholders/ customers • Is clearly not working well • Is a core business process • Has leadership support • Has worker support

15. A Kaizen team • Facilitator • Sponsor • Team leader • Members • No rank – all members have equal voice

16. Kaizen process • Day 1 – current state swim lane map • Day 2 – future state swim lane map • Day 3 – make and document changes • Day 4 – document and train on standard work • Day 5 – present results

17. Swim Lane Map

18. Swim Lane Map • Define the scope • Walk the process • Document the process • Characterize the process • Include time, people, tasks

19. Swim lane tips • Move chronologically left to right • Use post-it notes • Hand-offs indicate a lane change • Hand-off usually indicates wait time • Assign average times to tasks and waits

20. Sustain Improvement • Overall improvement plan • Visible and engaged management • Clear roles and responsibilities • Accountability for work • Communication about improvement • A system to support standard work

21. Ensure that infants who screen positive for metabolic, genetic, or hearing disorders are referred for diagnostic confirmation receive appropriate intervention and receive long-term follow-up services. It will start at the point that the lab provides a presumptive positive. Newborn Screening Kaizen Event

24. Observations of Current State Lots of handoffs Lots of double storage Lots of re-entry of data Redundancy – some good, some bad We are contacting the same people There are necessary waits in the process We are waiting on people outside our agency It is hard to completely map these processes There is a lack of trust in the data systems

25. Recommendations • Set up tools (Quickplace, sharefolders, case conferences) to promote better communication • Redesign the process, train staff in LIMS, and document standard work • Develop Access database. Long-term create a functional, child-based, interoperable system for MDH and its stakeholders. • Clarify roles in the process and share key information • Institute case conferences

27. Improvements from new process • 59% reduction in tasks • 66% reduction in waits • 58% reduction in handoffs • 81% reduction in decisions • 69% reduction in file/stores • 56% reduction in cycle time

29. Improvements from new process • 49% reduction in tasks • 54% reduction in waits • 34% reduction in handoffs • 50% reduction in decisions • 65% reduction in file/stores • 61% reduction in cycle time

30. Benefits of Future State Save some trees and staff sanity Families are better and more efficiently served Will be able to move forward with more initiatives Will have more time to be proactive instead of reactive Laid the groundwork for future changes Staff will be used more effectively, and less frustrated

31. 30 - 60 day Action Plan

32. 30 - 60 day Action Plan, Continued

33. What must we and the agency do to implement and sustain this effort? • We need to have follow-up meetings of this group through implementation and evaluation of the new process • Maintain respectful and open communications at all levels • We need management and staff support • We need some IT resources to implement new process

34. Quality Improvement in Iowa Service Contracting Kaizen Event Erin Barkema Iowa Department of Public Health Presented July 23, 2010

35. Why a Kaizen event? • Customer concerns about the service contracting process • Grant application process • Issuance of contracts • Reimbursement of expenses

36. Pre-event activities • Identified a facilitator • Identified participants • Developed a charter • Scope • Objectives • Goals • Gathered data

37. The Event - November 2-6, 2009 Agenda • Overview of Kaizen • Flow charting • Brainstorming • Identifying a new process • Results • Assigning homework • Gaining buy-in from leadership

38. Flowcharting

39. Brainstorming 7 ideas for improvement 7 different ways to implement main idea

40. Brainstorming Small groups • Discuss options • Identify solutions • Prioritize solutions I M P A C T DIFFICULTY

41. New Process

42. Homework • Twenty-three steps identified on a variety of topics • Training curriculum • Policies and procedures • Standardized forms • Use of technology • Communication plan • Measures to determine change or improvement • Assigned to members of the team • Due dates established

43. Buy-in • Report outs to Deputy Director throughout the week. • Presented the results of the week to the IDPH Executive Team. • Developed a newsletter to keep people informed of the progress.

44. Post-event activities • HOMEWORK, HOMEWORK, HOMEWORK!!! • Follow-up meetings • 30 day* • 60 day* • 90 day* • 120 day • 150 day • 6 month* • Communication • Celebration!

45. Accomplishments & Lessons Learned • Accomplishments • Implemented an electronic document library • Provided training to over 101 IDPH staff on the new service contracting process • Completed 90% of homework assignments to date • Lessons learned • Kaizen was a great team building experience. • Large scale quality improvement work takes time. • Improved processes and increased satisfaction will be worth all of the hard work!

46. Questions

47. Information • Service Contracting Process • http://www.idph.state.ia.us/mphi/quality_improvement.asp • Contact Information: Erin Barkema Iowa Department of Public Health ebarkema@idph.state.ia.us (515) 242-5524

48. Reflections and Questions

49. Announcements from NNPHI

50. Site Visits and Final Learning Congresses • Schedule is posted on MLC page of website • Please let us know the dates of final sessions/learning congresses • 2010 Open Forum September 15-17thWashington, DC • Please register/reserve your room. Spots still available for the workshops on Sept. 14th! • More information regarding presentations/display space is coming soon. Thank you for your patience!