LEAN, Six Sigma, Root Cause Analysis… and More

1. LEAN, Six Sigma, Root Cause Analysis… and More Taking the Mystery Out of Process Improvement Tools

2. “Great Moments in Medicine”

3. Overview • Background • Leadership Strategies • Process Improvement Strategies

5. Process Improvement Drivers • Pay for Performance • Maximize profit potential • Workforce challenges • Patient Safety • Push to automation • Regulatory • Quality Report Cards, Dashboards

6. Why? • IOM Study: 44,000-98,000 deaths per year in the U.S. hospitals due to medical error • Patients and providers expect perfect service and error-free information • Employees want an opportunity to work in an organization that provides the best possible care • Quality is cost effective

7. IOM Characteristics of Quality Healthcare • Safe • Effective • Patient-centered • Timely • Efficient • Equitable

8. Lessons from High Risk Industries • Systems to manage known risks • Take safety seriously but may not have safe cultures • Developing culture gradually vs. driven by top down

9. Characteristics of High Performance Organizations • Leadership - Engaged and adaptive - Set goals and measurements centrally - Recognizes employees as most valuable asset • Organization - Culture based on engaged employees - Process improvement is decentralized - Looks for results

10. Baldridge Performance Excellence Program • Improve the competitiveness and performance of US organizations • Builds effectiveness, innovation, organizational learning, integration • Defines criteria for performance excellence • Specific tracks for industries including healthcare

11. High Performing Organizations Baldridge Award to High Performing Healthcare Organizations • Visionary leadership • Patient-focused excellence • Organizational and personal learning • Valuing workforce • Focus on the future • Manage by fact • Social responsibility and community health

12. High Performing Organizations – JC View • All individuals are focused on continuous excellence • Leaders create this culture - take actions to create this state - encourage internal/external reporting - focus on systems and processes over individual - ongoing learning - adapt to changes in the environment

13. Ready in a Minute

15. “The worst of the wise may err.” Aeschylus On Errors

16. Errors • Institute of Medicine (IOM) • Adverse Event: Medical Intervention by a healthcare worker that results in unintended injury • Joint commission (JC - JCAHO) • Sentinel Event: "Unexpected occurrence involving death or serious physical or mental injury or risk there of." • Institute of Medicine (IOM) • Error: “Failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim." • Agency for Healthcare Quality and Research (AHRQ) • Diagnostic Error: Failure of a test to describe accurately the disease process in an individual patient."

17. Types of Errors • Automatic - Slip: commission - Lapse: omission • Judgment • Mistake • Violation

18. Causes of Human Error • Lack of knowledge • Memory failure • Inconsistent workflows • Incorrect decision • Environment

19. Impact of Errors • Active • Results are immediate • Latent • Results are remote from the error

20. Reduction of Human Errors • Minimize factors that increase their likelihood • Fix the system – not the people • Avoid reliance on education • Minimize situations that require pure thought • Use technology • Provide immediate feedback • Build in redundancy

21. One fish, Two fish

22. Dennis Quaid

23. “The torment of precautions often exceeds the dangers to be avoided.” Napoleon Bonaparte Taking Risks

24. Risks • Characteristics • Significant • Measurable • Controllable • Categories • Pre-analytic • Analytic • Post Analytic • Non-analytic

25. Risk Identification • Incident or safety reports • Satisfaction surveys • Complaints • Inspections • Observation • Analysis

26. Risk Assessment • Identify all risks - What might go wrong? - What needs to be controlled to reduce/prevent error? - What must go right? • Rank the risks - Magnitude - Likelihood • Assign and control each risk • Develop a contingency plan for retained risks

27. Risk Control • Accept the risk with current controls • Avoid or eliminate risk • Balance the risk • Control or minimize • Share the risk • Manage the risk

28. Benefits of Risk Management • Reduce operational loss • Reduce expenses • Early warning of potential failures • Reduce future exposure

29. Risk Management • Accept no unnecessary risk • Accept risk when benefits outweigh the cost • Manage risk by planning • Make risk decisions at the right level • Pre-implementation • Periodically

30. Insert Image from “Dirty Harry”

31. “It takes all the running you can do to stay in the same place. If you want to get somewhere else, you must run at least twice as fast as that” The Red Queen On Change

32. Change Management is Two-Fold • Develop Change Management Plan - Analyze, design, communicate • Understand the individual and the organization - Individual: Reason, emotions - Organization: Reason, culture

33. Types of Organizational Change • Mission • Strategy • Operation or structure • Technology • Culture

34. Change Management • Structured approach to transitioning from a current state to a desired future state • Specifies objectives, content and process of change • Empowers and supports employees in accepting and implementing changes

35. Change Management • What is the goal of this change? • Why is this change important? • How will we know its successful? • Who is impacted by the change? • How will they respond?

36. Change ManagementKotter’s 8 Step Model • Increase urgency • Create the change team • Define the right vision • Communicate for acceptance • Empower action • Look for short-term wins • Keep moving • Make change stick

37. Change ManagementLewin’s Stages • Unfreeze • Transition • Refreeze

38. Change Management Plan • Systematically defines the current state • Defines the objectives, content and process of change • Defines the need for change and ability to change

39. Change Management PlanContent • Business case for change • Communication • Education • Resistance • Monitoring

40. Change ManagementImplementation • Face-to-face communications are important • Participants have an opportunity to plan and implement change • Managers facilitate change – Employees do their best • Understand current and future states • Plan transitions in achievable increments

41. Change ManagementHuman Factors • Type 1: Process-oriented • Type 2: Adaptable • Kubler – Ross grief cycle

42. Evaluate Your Audience Rank participants from 1 – 5 (1=not at all; 5=100%) Awareness of need to change Desire for change Knowledge needed to change Ability to change Reinforcement

44. “How can you do the new math with an old math mind?” Charlie Brown Learning

45. Learning Styles • Approach to learning • Environmental Factors • Human Factors

46. Characteristics of Adult Learners • Prefer hands on experiences • Think for themselves • Need to be comfortable • Must apply what is learned

47. Learning StylesKolb • Visual: Seeing and Reading • Notes • Color • Isolate stimulations • Auditory: Listening and Speaking • Verbalize lessons • Talk when bored • Kinesthetic: Touching and Doing • Active • Rely on direct experience

48. Learning Style Indicator When learning a new procedure I prefer to: • Read the instructions first • Listen to the explanation • Prefer trial and error

49. Environmental Factors • Formal vs informal • Sound level • Temperature • Lighting • Mobility