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Daily Continuous Improvement Program

Daily Continuous Improvement Program. Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality Improvement and Patient Safety. Disclosures. I have no conflicts of interest to disclose. Lean Concepts.

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Daily Continuous Improvement Program

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  1. Daily Continuous Improvement Program Trey Coffey MD FAAPFRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality Improvement and Patient Safety

  2. Disclosures • I have no conflicts of interest to disclose

  3. Lean Concepts • Origins in Toyota Production System c. 1930s • Term coined and applied to western manufacturing c. 1980s • Processes analyzed from the point of view of customer value • Focus on eliminating waste of all kinds in the system • Deference to expertise – executives on the factory floor (“Gemba”)

  4. Getting to know youYour prior experience with LEAN is best described as: • A. I am not very familiar with LEAN. • B. My healthcare organization is doing some LEAN things and my reaction is… “meah.” • C. My healthcare organization (or other organizations I am familiar with) did some LEAN and it was an unmitigated disaster. • D. My healthcare organization is completely LEAN

  5. Different Levels of Process Improvement Very few Large issues Few Medium issues Many Small issues Adapted from: “The Toyota Way Fieldbook” by Liker and Meier

  6. Objective • To tell a genuinely enthusiastic • firsthand account • of a unique Lean Management System, • which: • is new to SickKids • is not yet fully realized nor perfected • might be revolutionary…

  7. New Job • Paediatric Medicine Quality Committee c. 2005

  8. 2011: Emergency Department Performance Improvement Program We used Lean to improve Door-to-Floor times!

  9. Reality sets in… Again.

  10. Impact Feb 2012: Learning Partnership with ThedaCare • ThedaCare group of hospitals and clinics in Appleton, Wisconsin. • Early adopter of Lean methods 8 years ago • ThedaCare Business Performance System to address sustainability and to develop a culture of daily continuous improvement 32% improvement in patient satisfaction 21% reduction in hospital cost per case

  11. Awaiting my invitation… • Rapid process improvement workshop? • Kaizen event?

  12. Manager Daily Status Sheet

  13. Manager Daily Status Sheet

  14. A few weeks later this appears

  15. Daily Improvement huddle: M,W,F 1:15-1:30

  16. Daily Improvement Board Collect Improvement Cards Just do its Completed Prioritize Issues More challenging problem solving (PDSA3)

  17. Daily Improvement Huddle Board

  18. Early signs of success: Engagement of frontline nurses on 7B raised hand hygiene compliance

  19. Daily CIP’s Goal: Develop people to solve problems and improve performance

  20. Different Levels of Process Improvement Large Projects Very few Large issues Six Sigma Few Medium issues Lean Event Many Small issues Focus of Daily CIP Adapted from: “The Toyota Way Fieldbook” by Liker and Meier

  21. Status Sheet: Manager, Director and VP Manager Status Sheet Director Status Sheet VP Status Sheet Charge Nurse Manager Director VP DAILY WEEKLY EVERY 2 WEEKS

  22. Status Sheet: Links Between Levels Manager Status Sheet Director Status Sheet Charge Nurse Manager Director DAILY WEEKLY

  23. A wise man once told me: “Behavior drives culture” From: To:

  24. New and Improved Paediatric Medicine Quality Leadership Team • We still meet monthly to discuss trends in performance and to prioritize which metrics to improve upon • Except now… • I had to get a much bigger room! • I am currently looking for an even bigger room! • Staff come in on their OFF DAYS! • I look forward to it instead of dreading it 

  25. Monthly Score Card: Driver and Watch indicatorsThis scorecard dictates the unit focus for the month

  26. Falls, Entrapment, Strangulation, Entanglement documentation scores

  27. Three day Equipment Improvement Event Situation Overview Approach Impact Finding supplies is difficult 5S Sort Set-in-order Shine Standardize Sustain a place for everything everythingin its place

  28. RESULTS • Staff-driven problem solving: Over 65 improvement ideas identified and executed since April 2012 • Median of 19% Improvement in Engagement Scores

  29. Key ingredients Self-Determination Theory • 1. INTRINSIC MOTIVATION • •Provide opportunity for self-leadership • •Provide choices • •Help members acquire skills and knowledge • •Assign tasks but make connections • •Coach • 2. DISCIPLINE • Simple behaviors repeated over and over

  30. Enterprise wide picture • 12/22 units doing Daily CIP • 20 yellow belts trained • 178 green belts trained • Larger projects/value streams: Ambulatory, Surgical, Procurement, Pharmacy, Administrative.  • ~20 Rapid Improvement Events completed to date

  31. How much does this cost? • “Lean Promotion Office” • Office of Process Improvement • Director, five staff, and an assistant • hired from industry and consulting firms • $1 million/year (approx)

  32. The Hand Hygiene graph continued….

  33. Questions for consideration • Are we going to be able to tackle the big stuff? • How is this experience going to vary across units? • How are we going to substantively engage physicians?

  34. Acknowledgments • SickKidsnursing and operational leaders: • Kate Langrish, RN, Lynn Mack, RN, Linette Margallo, RN, Dinarte Viveiros, RN • SickKids Office of Process Improvement: • Shiraz Bhajwa, MBA, Travis Beamish, MBA • Ali Shahzada, MBA • Executive sponsor: • Jeff Mainland, EVP Strategy, Performance, Quality and Communication

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