Enhancing healthcare efficiency with Lean Six Sigma methods

1. Optimizing PACE Operations and Efficiencies (OPOE) Program May 2017

2. Agenda • NPA: • Introduction to Optimizing PACE Operations and Efficiencies (OPOE) • Learning Collaborative Members • Novaces Team: • Lean Six Sigma in Healthcare • Program Description and Milestones • Roles & Responsibilities • Readiness Assessment • Logistics • Questions & Discussion

3. Intro to OPOE II 2nd round of Optimizing PACE Operations and Efficiencies (OPOE II)

4. OPOE II Member Sites • Learning Collaborative Members • Center for Elders Independence (Oakland CA) • McGregor PACE (Cleveland OH) • Neighborhood PACE (Boston MA) • On Lok (San Francisco CA) • PACE CNY (Syracuse NY)

5. NOVACES Team • Brian MacClaren • Liaison to NPA • Dr. Bahadir Inozu • Project Director • Marliese Bartz • Program Manager and Mentor • Ed Vasko • Trainer and Mentor • Charles Mount, CAPT USN (Ret.) • Project Advisor

6. What is Lean Six Sigma? • To your organization … • Increased value delivered to the patient • A methodology for continuous improvement • A management philosophy • A data-driven culture • To you … • A new way of thinking • A focused approach to problem-solving • Management and leadership skills development

7. Lean in Healthcare • Frank and Lillian Gilbreth (Cheaper by the Dozen) wrote numerous articles regarding efficiencies in healthcare • First to promote nurses handing instruments to surgeons, eliminating unnecessary motion • Henry Ford actively promoted patient focused care as more efficient • Examined nursing process to eliminate unneeded steps citing that more time is spent in motion, than caring for patients • A 2009 ASQ Hospital Study showed that 53% of the hospitals reported some level of lean deployment. Examples include: • Clinical deployment • Surgery/operating room (61 percent of hospitals) and emergency department (60 percent) • Ancillary/support services deployment • Admissions/discharge (43 percent) and radiology/imaging (43 percent) • Non-clinical/support deployment • Purchasing/supply (36 percent), information systems (24 percent) and administration (24 percent)

8. Exposure to Lean Six Sigma • What have you seen, learned about or experienced with: • Lean Six Sigma? • Process Improvement? • Continuous Quality Improvement?

9. OPOE Program Components ACTIVITIES • Change Readiness Assessment • Champion Training • Readiness Assessment Results • Steering Committee • Green Belt Training • Two Rapid Improvement Events per site • Ongoing Coaching/Mentoring • 3 more webinars OUTPUTS • 2 completed projects per site • 3 Certified Green Belts per site • Final Report

10. OPOE Master Schedule

11. Next Steps – Change Readiness • Change Readiness Assessment • Link with instructions sent to point person at each organization • Within 24 hours, email to your entire org, with a due date of 5/10 • Ideally, you want responses from all levels of the organization • NOVACES Mentors will work with each site on the Assessment results and recommendations in 5 areas: • Communications • Culture • Leadership • Organization • Skill Readiness • Discussion: Breakout sessions at Champion Training

12. PACE OPOE Collaborative Webinars • Description • Virtual sharing of experiences, lessons learned, challenges, and updates on sites’ progress • Commitment • Total of 4 one-hour webinars (including this one) • Participation in preparing and delivering short presentations • Audience • Champions, Green Belts, NPA Leaders

13. What Are Rapid Improvement Events (RIE)? • A fast-paced and focused problem-solving event • Both action and team-oriented, that uses data to make rapid improvements to a process • A cross-functional team focuses on designing solutions to achieve well defined goals • Other common names are Kaizen and Rapid Improvement Event • Run as a single event, which typically lasts 5 days or less • Follow-Up Phase is designed to complete an action plan and sustain improvements

14. RIE 1 & 2 at Each Site • Commitment • 3.5 days for RIE at site location • Weekly update calls/meetings with team (as determined) • Bi-weekly mentoring calls (Green Belts only) • Implementation of improvements (as needed) • Audience • PACE Green Belt Candidates and SME’s (Team) • Time-Frame • Staggered July 2017 through May 2018

15. First Steps – Candidate Selection • Select Champions for 2-day training • Champions should come to training prepared to work on project selection for the Green Belts • Select Green Belts for 4.5-day training • Pre-select candidates now; could potentially shift a bit after Champion training • Green Belts should have at least one project identified before coming to training • NOVACES Mentors can offer guidance on selection

16. PACE OPOE Collaborative Roles

17. Role: PACE Champion • Organizational Level • Senior manager with direct responsibility for the performance of a business unit or department and willing to take a democratic approach to continuous improvement • Enterprise Planning • Identifies the focus areas where an organization needs to be improved • Opportunity Selection • Identifies the highest priority improvement opportunities and allocate resources • Communicates the need for change with clear problem statements, metrics and goals • Workshop Execution • Ensures the team stays focused on problem resolution • Approves and communicates process improvement action plans • Removes obstacles and provides resources to support project activities

18. Champion Training • Description • Training on how to champion improvement projects, organization, staff performance and an overview of Green Belt training • Selection of projects for each site • Commitment • 2 days • Audience • PACE Champions/Executives • One Champion from OPOE I (Midland Care Connection) • Schedule • May 16 & 17 in Dallas, TX

19. Agenda for Champion Training • Introduction to Lean • Introduction to Six Sigma • Introduction to Constraints Management • Reducing Waste: MediSim Round 1 & Value Stream Analysis Exercise • Roles & Responsibilities • Project Selection & Chartering – Creation of draft Project Charters • Sample Project from OPOE I • Reducing Variation: Statapult Exercise • Change Readiness • Candidate Selection • Process Value Stream Analysis • Change Management • Program Sustainment (inc. Steering Committee and Top Priorities for When You Return from Training)

20. Green Belt Description • Organizational Level • Subject matter expert or newer manager/supervisor • Characteristics • High-performing in current role and/or on verge of promotion • Organized and prompt • Able to meet deadlines and challenge others • Strong analytical and problem-solving skills • Able to learn and apply data analysis to complex business problems • Able to maintain a high level of energy and sense of urgency about continuous improvement, with a drive for excellence • Proficient in Microsoft applications (Outlook, Word, Excel, PowerPoint)

21. Green Belt Description • Interpersonal Skills • Natural mediator who remains even-keeled in challenging situations • Strong management/leadership qualities and stakeholder management skills • Able to communicate effectively orally and in writing • Customer-focused in defining quality and establishing priorities • Able to lead and motivate others and facilitate projects from start to finish • Physical Effort • Able to facilitate meetings up to seven hours a day

22. Green Belt Training • Description • Training and hands-on simulations in Lean and Six Sigma concepts to lead continuous improvement projects • Mentoring on Project Charter development • First step in pursuing PACE Green Belt certification • Commitment • 4.5 days in central location (Alexandria) • Audience • PACE Green Belt Candidates • 2 candidates from OPOE I (Midland Care Connection)

23. Green Belt Certification • Complete Green Belt training • Successfully co-lead two improvement workshops under the guidance of a NOVACES consultant • Document improvements achieved • Goal: Become the resident expert at respective PACE sites and continueleading future improvement workshops independently

24. Top Priorities Before Champion Training … • Send out the Readiness Assessment • If still undecided, finalize your Green Belt candidates (engage your NOVACES consultant, if needed) • Brainstorm 3 – 4 potential projects for your Green Belts • Ensure all Champions are clear on the WHY for participating in OPOE

25. Logistics/Scheduling • Sam K. will facilitate activities for the Collaborative • Champion training, Green Belt training, Webinars and Conference sessions • Marliese Bartz from NOVACES will coordinate items for the Collaborative • Readiness Assessment, Steering Committee, group communications • Marliese Bartz and Ed Vasko from NOVACES will work directly with PACE sites for the improvement workshops, project-specific activities, and mentoring

26. Questions & Discussion QUESTIONS?

27. Appendix

29. Case Study (continued) Communication & involvement by staff is key !

30. Case Study • University of Alberta Hospital (2012) • Situation: • Emergency Department experiencing longer than desired emergency department length of stay (ED-LOS) for patients • Goal for ED-LOS was 8 hrs. ≥ 60% of Patients but increasing to 90% by 2015 • Average ED-LOS was 17.6 hrs. for Family Medicine & 16.3 hrs. for General Internal Medicine • Rapid Improvement Workshops held to find opportunities for improvement

31. Case Study (continued)

32. Case Study (continued) • Changes to ED process were piloted with the following results GIM LOS dropped 43% & FM dropped by 28%

33. Role: PACE Green Belt • Workshop Execution • Coaching from consultant to become a lead facilitator and pursue certification • On-site support of pre and post improvement workshop activities • Participation • 4.5 days of Green Belt training • RIE planning • RIEs (3 ½ days each) • Project Management of Improvement Action Plan • 3 PACE Collaborative Webinars

34. Role: PACE Team Member • Workshop Execution • Involvement in workshop as a subject matter expert • Supporting implementation of improvement action items • Participation • Involvement in RIE planning • RIEs (3 ½ days each) • Support of Improvement Action Plan • Selected Collaborative Webinars