Emerging Approaches to Drive Change in Health Care Use of Lean

1. Emerging Approaches to Drive Change in Health CareUse of Lean Patricia A. Gabow, M.D. CEO and Medical Director Denver Health

2. Lean in Health Care • Goals • Template for transformation • Implementation process • Outcome –tools and examples • Challenges

3. Denver Health Denver Health Medical Center Rky Mtn Regional Trauma Ctr Rocky Mtn Center for Medical Response to Terrorism 911 Public Health Regional Poison Center & Nurseline Family Health Centers Denver Health Medical Plan School-based Health Centers Correctional Care Detox Unit

4. Perspective for Transformation Architecture/Environment Efficiency Quality Transformation Patient Safety Customer Service Workforce Development

5. Lean in Health Care IT Right People Right Process Right Communication and Culture Right Environment Right Reward

6. Lean in Health Care • Why did we chose Lean • Philosophy and a tool set • Intuitive tools • True employee empowerment • Potential for rapid results

7. Lean in Health Care • Waste is disrespectful of humanity because it wastes scarce resources • Waste is disrespectful of individuals because it asks them to do work with no value President Toyota • Waste is disrespectful to patients by asking them to endure things with no value

8. Value Stream Mapping Lean Building Blocks Leadership and Strategic Planning for * Continuous Improvement * Pull Systems / Visual Signals (Kanban) One-Piece Flow / Reduced Batch Size TPM Quality at Source / TQC POUS Quick Changeover Standardized Work DFM-A / Concurrent Engineering Teams 5S and Visual Systems Flexible Workforce Plant Layout

9. Lean in Health Care • Implementation of Lean • Broad General Knowledge • In house experts • Trained 50 people as “Black Belts” in Lean • Outside expert facilitators • Start with the easy stuff and move up

10. Lean in Health Care • Respiratory Therapy • Scavenger hunt 20 pieces of equipment by 20 therapists • Time to find 14.4 minutes to 8.7 minutes • Number of steps 762 +185 to 465 +123 • Pieces of equipment not found: 45 to 1

11. Lean in Health Care • Primary process—rapid improvement events • New way of problem solving • Focus on 5 strategic VS • Multidisciplinary teams--Executive sponsor • Tools—VSM, standardized work, one piece flow • 5/month-to 10/month • Use of outside consultant as teacher

13. Bed Pull Process RIE • Standardizing the process • Rapid deployment for pilot • Significant impact on metric: Time Bed Empty to Bed Cleaned Benchmark - 2.58 hours Pilot - .88 hours 65.9% Improvement • Sustained the accomplishment for over 12 weeks

14. Lean in Health Care • Positive outcomes • High level of enthusiasm and engagement • Quick wins • Challenges • Learning as we go • Co-ordination • Organized infrastructure • Initially more work for leaders/managers • Rolling RIE improvements to VS improvements • Rolling VS improvements to system level improvements

15. Lean in Health Care • Conclusion • Lean is a philosophy and a tool that is readily applicable to health care and can be embraced by health care professionals and staff • Using it requires a top leadership engagement and commitment • Willingness to enter uncharted territory • Willingness to radically change problem solving method