Lake Health’s Lean Journey Innovative Improvement for Independence

1. Lake Health’s Lean Journey Innovative Improvement for Independence

2. A little bit about us Cleveland Ohio • Team Members = 3,000 • Inpatient Beds = 270 • Adult Admits = 17,000 • Births = 1,900 • Surgical Cases = 14,000 • ER Visits = 76,000

3. Presentation Roadmap Reason for Action: Why did we decide to embark on this journey? Initial State: Where were we when we started? Target State: Where do we want to be in 3…5…10 years down the road? Identifying Gaps: What are the major barriers that must be overcome? Solutions: What needed to be done to overcome those barriers? Rapid Experiments: Early successes/failures along the way? Completion Plan: Getting started on our journey! Confirmed State: Have we moved the dial? Insights: Lessons learned

4. 1. Reason for Action What is LEAN? • Toyota Business System • The practice and process of identifying and removing waste • Waiting • Unnecessary Motion • Defects • The concept and practice of continuous improvement • The power of respect for people (Front line decisions)

5. 1. Reason for Action Organizations Practicing LEAN? • 3M • Boeing • Avery Dennison • Dow Chemical • General Electric • Ford Motor Company • Sears • GlaxoSmithKline • GEICO • US Army, Navy, Air Force and Marines • Virginia Mason • Mayo Clinic • ThedaCare • Denver Health • Stanford Hospital & Clinics • Lake Health!!

6. 1. Reason for Action Why did we decide to embark upon this journey? • Desire to remain an independent, community-based health system • Recognition that the status quoor incremental changes in quality, cost and patient experience would not be sufficient to achieve goals • Require a shared disciplinedapproach to innovative improvement, that will transform the way we do business • Success of the transformation will ultimately depend on the participation of allteam members, volunteers and physicians

7. 1. Reason for Action May 14-16, 2012 Leadership Retreat

8. 2. Initial State Where were we when we started? • Operating in a dynamic/competitive market • Desiring to improve clinical quality and patient experience. • Needing to extend focus beyond acute episodic care to continuum of care • Reimbursement not keeping pace with increasing expenses • Mediocre team member engagement • Average community perceptions

9. 3. Target State Where do we want to be in 3…5…10 years down the road? • Improved patient and family value through: • higher quality • lower cost • improved safety • Waste eliminated from processes • Instill a culture of continuous improvement

10. 4. Identifying Gaps What are the major barriers that must be overcome? Availability of space Staff Support Budget Structure Conflicting Priorities “Program of the Month”

11. 5. Solutions Deciding where to begin… • Identify potential areas to begin • Identify the criteria for areas selected • Number of patients touched • Opportunities for improvement • Highest impact on the organization • Select ones that complement each other

12. 5. Solutions What needed to be done to overcome those barriers?

13. 5. Solutions Addressing Space/Staffing

14. 5. Solutions Addressing Structure Measure Analyze Improve Sustain Define • RIE • Review Pre-work • Validate observations • Brainstorm solutions • Try-storm solutions • Validate improvements • Follow-up • Educate • Tweak final changes • Sustain new process • Continuously improve through MDI Pre-work • Lean overview • Observations • Stakeholder analysis • RIE planning

15. 5. Solutions Addressing Structure

16. 6. Rapid Experiments Early successes/failures along the way? • Nurse to Nurse Handoff • Initial: • Average time from ED to inpatient bed 79 minutes and up to 250 • ED staff took patient to inpatient unit then had to find the nurse • Solution: • Inpatient nurses pull the patients from the ED within 15 minutes • Developed new clinical summary screen to facilitate face to face handoff • Benefit: • Reduced time to inpatient bed from 79 minutes to 40 • Improved perception of care from patients • Improved quality and safety of hand off. • Second Pass improvements Solution: • Time reduced an additional 20 minutes!

17. 6. Rapid Experiments Early successes/failures along the way? • Periops • Initial: • Increasing Cost/UOS • Different patient types cared for by same staff • Causing uneven patient flow through SDS • Need to expand SDS area to support patient volume $3M project • Solution: • Developed flow/standard work based on procedure • Identified specific locations in SDS for each patient type • Benefit: • Improved flow avoided need for additional SDS beds.  • Saved $2.5M in capital.

18. 6. Rapid Experiments Early successes/failures along the way? • Physician First • Initial: • Median time Door to Doc was 40 minutes • Protocol Care creating excessive ordering • Patient satisfaction for arrival less than desired • Solution: • Implement Physician first concept at peak volume times • Triage by physician • Earlier implementation of care • Benefits: • Patient satisfaction with arrival improved by 57% • Door to Doctor time decreased by 48%

19. 7. Completion Plan Never complete… • Review the System-wide Transformational Plan of Care • Integrate into System-wide plan. • Looking to expand to new areas within the system • Expanding the number of facilitators • Implemented Management for Daily Improvement Boards • Managing for Daily Improvement (MDI) is focused on implementing a management system that creates, accommodates, and sustains a culture of continuous improvement • The MDI System facilitates an ongoing transformation to a data driven, action oriented, engaged & empowered lean organization

20. 7. Completion Plan Daily Activities • Manage “Flow” of process outputs (Visually) • Identify and prioritize anomalies of performance and make improvements • Encourage associates to identify and eliminate waste • Create an environment where associates are responsible for identification (and assisting in the elimination) of waste

21. 7. Completion Plan MDI Goals Convert from being a reactive firefighter, whose attention and priority is focused on the self- perpetuating, never-ending fires whenever they occur (always on the edge of out of control) TO… A proactive Lean thinker who is managing and controlling his priorities and ultimately his destiny

22. 7. Completion Plan RIE Events Improvement Level RIE Events Daily MDI Activity Incremental Daily Event based improvement Improvement (coupled with events) Incremental daily improvement supplemented with Rapid Improvement Events

23. 8. Confirmed State Have we moved the dial? • 20 months into our journey… • $5.9M in Hard Dollar Savings • Patient satisfaction with the arrival process improved by 57% • Avoided $2.5M in capital expense by improving patient flow • Falls reduced by 55%

24. 9. Insights Lessons Learned? Reason for Action: Leadership focus on the “what” not the “how” Initial State: Must have 100% commitment from all (especially physicians). Target State: Double the good…or…half the bad Identifying Gaps: Focus on the process…not the people Solutions: - Creativity over capital Rapid Experiments: The best laid plans… Completion Plan: A disciplined approach Confirmed State: Hope is not a strategy…countermeasures Insights: Some people will want to get off the bus…let them.

25. 9. Insights “Having a great partner, like Simpler, is essential to guiding an organization through such a transformative process.” “Committed and trained senior leadership, without question, is the key component in successfully transforming an organisation through lean initiatives”