How will Healthcare Reform Impact Reengineering Strategies to Transform Healthcare Delivery?

1. How will Healthcare Reform Impact Reengineering Strategies to Transform Healthcare Delivery? Learning from Experience Presents: David Belson, PhD, Editor-in-Chief, Journal Society of HealthcareImprovement Professionals & Imran Chaudhry, FACHE, Regional Executive, Operational Excellence, Providence Health & Services

2. Speaker’s Profile Imran Chaudhry Imran Chaudhry is the Regional Director of the Operational Excellence and Project Management Offices for Providence Health and Services, southern California. He is responsible for providing the overall leadership for the deployment and execution of the Lean, Six Sigma, Change Management and Project Management methodologies across the Providence southern California hospitals. Dr. David Belson David Belson, Ph.D. has helped dozens of hospitals and clinics improve their productivity. He applies his background of over 30 years as a professor in Industrial Engineering. He has developed classes on improving healthcare operations and written articles regarding Lean and other methods for radiology, surgery, emergency departments and other hospital functions. He has initiated research projects funded by the California HealthCare Foundation as well as the federal and California governments.

3. “Insanity is continuing to do things the way you’ve always done them and expecting the results to be different.”Albert Einstein

4. About Providence Health and Services • Not-for-Profit faith based healthcare organization • 2nd largest healthcare provider in the Los Angeles County • 9th largest employer in Los Angeles County • 700 licensed beds in the region • 12000+ Employees and Medical Staff Members • 2.7 Million Uninsured people in the county

5. History of Six Sigma and Lean 1986 Bill Smith originated Six Sigma as a metric 1990’s GE and AlliedSignal (Radical changes in products and services) 1970’s Toyota Production System…”Lean” 2003 Providence California Lean Six Sigma 2002 Providence Health System 1980’s Rolled out in Motorola 1988 Malcolm Baldridge National Quality Award

6. Commitment and Involvement of the Senior Leadership!!

7. OE Growth 2011 Certified first batch of 13 Change Facilitators Introduced Design Thinking and Innovation to the organization Expanded focus to include the Medical Institute. Expanded team to include Project Management 2006 6 Resources 2011 120 Resources

8. VOC VOP VOE VOM • Become Leaders in markets where we serve • High Performance Organization • Achieve Strong Financial Results Providence Big Y’s • Reduce Days to Bill • Increase throughput / Decrease LOS • Patient satisfaction Year Imperatives – Y’s Direction of Impact • Reduce cycle time • Reduce turn around time • Reduce infection rate • Reduce medication errors Process Y’s Begin Investigating Here! x2 x3 x4 x1 Linking Business Y’s to Process Y’s

9. Levels Of A Process

10. Prioritize Opportunities

11. Why Define a Standard Metric What is the Definition of: • ED Door to Doc • OR First Case Start Time • Patient Discharge Time

12. PROJECT SCOPING Define: Understanding the Scope Out of Scope As Necessary In Scope What will not be assessed or reviewed in this project What’s in the scope of the project What may be looked at Make Sure all team members are on the same page

13. Discuss Resources and Time Commitment Upfront!A project SHOULD NOT TAKE more than 4 – 5 months to complete (few exceptions)

14. Methodologies Design for Six Sigma H “Change in Paradigm/Futuristic” Variation and Defect Rate Reduction Six Sigma/ Lean Six Sigma High Complexity CAP (“the glue”) “Data-driven” Lean M “Waste Elimination” Flow/ Cycle Time Reduction Medium Complexity Work-OutTM “Expert-driven” All tools/processes are used synergistically

15. Don’t Silo the Methodologies, its all about Continuous Improvement!!

16. Change Acceleration Process Quality x Adoption = Result • Q x A = R • x 4 = 28 • x 4 = 32 • 7 x 7 = 49 Focus on Q Instead focus on A Big Impact It’s All About the Acceptance

17. Change Acceleration Process Leading Change Creating A Shared Need Shaping A Vision Mobilizing Commitment Current State Transition State Improved State Making Change Last Monitoring Progress Changing Systems & Structures

18. Lean vs. Six Sigma

19. Health Care Operations Improvement Work David Belson, Ph.D. USC Department of Industrial and Systems Engineering HCE Conference David Belson 2012

20. How do we improve healthcare performance? Example projects • Emergency Department, Lean • Mammography clinic, simulation • Surgery patient flow, mapping • Primary care, doctor’s office, redesign • Technology solutions, RFID, EMR HCE Conference David Belson 2012

21. Fixing the Emergency Departmentwith Lean HCE Conference David Belson 2012

22. The most popular tool is LeanToyota method, Lean-Six Sigma, … • Hospitals, clinics, suppliers, hospital systems • California Hospitals • Providers nationally HCE Conference David Belson 2012

23. Maximizes participation, reality (Kaizen) 23 HCE Conference David Belson 2012

24. LEAN Tools • Standardize & simplify • Visual Controls • Standard work • Kanban • Level & continuous flow • A-3 • PDSA / DMAIC • & more … • Kaizen, participation • Waste reduction • Mapping • 5 S • Value Stream mapping • 5 Whys • Cause & effect • Pull 24 HCE Conference David Belson 2012

25. Lean event; • ED department • “Lean” triage • Eliminated waste • Results; • lower cost and less waiting HCE Conference David Belson 2012

26. Ideas from hands-on staff: HCE Conference David Belson 2012

27. Results ED’s Triage now: • Fewer forms used • Quicker handling of patient visit • Less waiting time • Fewer patients who left without being seen (the original objective) HCE Conference David Belson 2012

28. Fixing the Patient Flowwith computer Simulation HCE Conference David Belson 2012

29. Simulation HCE Conference David Belson 2012

30. Computer Simulation

31. Input Data • Observation & timing • Following patients and staff, interview • Hospital data

32. Analysis showed how mammography department could serve 50% more cases with no increase in staff or equipment. HCE Conference David Belson 2012

33. Fixing Surgerywith Mapping HCE Conference David Belson 2012

34. HCE Conference David Belson 2012

35. Lean Value Stream Map from Focus Group Kaizen HCE Conference David Belson 2012

36. Value Stream Map – Hospital Discharge HCE Conference David Belson 2012

37. Spaghetti Diagram HCE Conference David Belson 2012

38. Entry from outside Hospital Inpatient Bed Inpatient Bed Admitting, registration Operating Rooms Pre Op Pre Op Holding Recovery (PACU) Exit, return home Basic Surgery Flow Q Q Q Q Q Q Q Q Improve with pull HCE Conference David Belson 2012

39. Wheels In Time Wheels Out Time USC HCE Conference David Belson 2012

40. Surgery Operational Problem AreasIssues are similar among hospitals. HCE Conference David Belson 2012

41. Fixing the Primary Care Doctor’s Office with Redesign HCE Conference David Belson 2012

42. Old Process HCE Conference David Belson 2012

43. New Process HCE Conference David Belson 2012

44. Fixing Patient Waiting with Technology HCE Conference David Belson 2012

45. Patient wristband with RFID chip HCE Conference David Belson 2012

46. Staff can see what patient is where and how long they have been there. HCE Conference David Belson 2012

47. Who does Healthcare improvement? • External consultants • Designated internal department • Responsibility of managers • Certified or uncertified • Corporate vision (or not) HCE Conference David Belson 2012

48. Results are significant • Time for a given activity reduced by over 50 % • Amount of human effort needed reduced by > 50 percent. • Defects reduced by > 90 % • Injuries and sick days reduced by over 50% • Cost of a given activity reduced by 30 – 50 % • Work force dissatisfaction and turnover reduced dramatically. HCE Conference David Belson 2012

49. http://www.jship.org/home/ David Belson, Ph.D. USC Department of Industrial and Systems Engineering http://healthcareengineering.usc.edu belson@usc.edu HCE Conference David Belson 2012