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Burning Platform in Healthcare. The key is to change before the flames startThe gaps at UMHS:Quality: Not all diabetic patients on statins, aspirinSafety: Still have wrong site surgeryEfficiency: Days waiting for a PICC IV line; nurse shortageAppropriateness: generic rate around 55%Bottlenecks at UMHS:Budgeted 4% activity increase, but only have 0.8% available bed capacityOR shortage led to elimination of storage and doctor workstationsStress of overwork (muri):Physicians, nurses, cler32236
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1. Application of Lean Thinking to Health CareDevelopment of the“Michigan Quality System” at the U of M Health System John E. Billi, M.D.
Associate Dean for Clinical Affairs, Medical School
Associate Vice President for Medical Affairs
University of Michigan
jbilli@umich.edu
http://sitemaker.umich.edu/jbilli
http://med.umich.edu/i/mqs/
2. Burning Platform in Healthcare The key is to change before the flames start
The gaps at UMHS:
Quality: Not all diabetic patients on statins, aspirin
Safety: Still have wrong site surgery
Efficiency: Days waiting for a PICC IV line; nurse shortage
Appropriateness: generic rate around 55%
Bottlenecks at UMHS:
Budgeted 4% activity increase, but only have 0.8% available bed capacity
OR shortage led to elimination of storage and doctor workstations
Stress of overwork (muri):
Physicians, nurses, clerks running faster
Payments dropping
3. Crossing the Quality ChasmIOM’s 6 Aims of Health Care Health care should be:
Safe
Effective
Patient-centered
Timely
Efficient
Equitable - not vary due to gender, ethnicity, geography, socioeconomic status
5. What is Lean in Health Care?
6. Lean in Health Care? Can healthcare use:
- the Toyota Production System
- product development - production
- supplier management - customer support
- planning
-to transform waste into value?
Can a health system use:
- fewer inputs (time, human effort, materials)
- than traditional care process
- to produce a wide variety of “products”
- with fewer “defects” more quickly
with less stress?
Lean is not about working harder or faster, it is about finding waste and transforming it into value our customers want.
7. Lean = Mean or downsizing or outsourcing or working harder…
The Toyota Production System (TPS)
Transform waste to optimize value creation
Lean Thinking and the Lean Enterprise
Rethink our entire business
Based on what we do that provides value to our customers
8. The 5 Steps of LeanCan Work in Healthcare Specify value from customer’s perspective
Identify the value stream for each product, and remove the waste
Make value flow without interruptions from beginning to end
Let the customer pull value from our process
Pursue perfection– continuous improvement
Do this every day in all our activities
9. The clinic appointment You call the clinic, go through 3 voice prompts, are put on hold, and leave a message
The clerk calls you back and sets a date in 3 weeks
You arrive for the visit, check in, sit in waiting room
You are called into the exam room, wait for doctor
The doctor sees you, saying she’s been waiting for you to arrive; diagnoses a URI, and BP is worse
The doctor prints an antibiotic prescription, goes to the staffroom to get it. You are allergic to that drug.
You wait to pick up the prescriptions.
The doctor says she wants to see you back in a week, no appointment is available.
The MA does an EKG.
10. The clinic appointment You call the clinic, go through 3 voice prompts, are put on hold, and leave a message
The clerk calls you back and sets a date next week
You arrive for the visit, check in, sit in waiting room
You are called into the exam room, wait for doctor
The doctor sees you, saying she’s been waiting for you to arrive; diagnoses a URI
The doctor prints an antibiotic prescription, goes to the staffroom to get it. You are allergic to that drug.
The MA does an EKG.
At check out you ask the cost – clerk says they’ll bill you
11. The 5 Principles of Lean Work Specify value from customer’s perspective
A quick clinic visit
Identify the value stream for each product, and remove the waste
Time on hold, callbacks, walking
Make value flow without interruptions from beginning to end
No waiting
Let the customer pull value from the process
Pull the appointment when you want it
Pursue perfection – continuous improvement
Every clerk, doctor and nurse works to redesign for better value to the customer
12. Understanding the Root Causes of Waste The simple Toyota approach
Go and see
Analyze the situation
Use one piece flow and problem alerts (andon) to surface the problems (detect abnormal immediately)
Ask “Why?” 5 times
Uncovers the root causes of waste and error, not the symptoms
Avoids blame – another form of waste (5 “whos”)
GM: “will not accept, build, or ship a defect”
13. Lean Tools Are Needed in Health Care Standard work – 4 ways lab results get to me
Pull systems – no signal (kanban) when OR ready
One piece flow – 36 step process to make an orthopedic appointment – PT = 27 min., LT = 23 days;
- All patients arrive at 8AM
Visual workplace – each exam room has forms in different colored, opaque folders – common ones gone
Cellular layout – ORs are mirror images – half wrong
Multi-process (cross-trained) operators – RN clean OR
Iterative questions (5 “whys”) – patient left without being seen in ER, due to long wait, due to long stay patient, due to lack of inpatient bed, due to gap in discharge planning…
Andon cord – “Stop the Line” in surgery
14. Are Lean Tools Needed in University Operations? Standard work – Does each DPS staff follow clearly written standard ops, that they wrote?
Pull systems – Can staff pull repairs or supplies JIT?
One piece flow – Do budget or capital requests proceed without stopping through campus approval?
Visual workplace – Can managers and workers tell at a glance how work flows, current status, problems?
Cellular layout – Have we laid out workplace for maximum efficiency, or did it evolve?
Multi-process (cross-trained) operators – DPS/OSEH?
Iterative questions (5 “whys”) – UM sued, due to ankle injury from visitor tripping, due to a broken step that staff stepped over for a month, due to no easy way to report repair needs and to backlog of repairs
Andon cord – How do I report water on parking stairs?
15. Clinical Examples of “Right Every Time” Stephen Spear: Learning to Lead at Toyota
Design and specify process steps well
Embed testing in work: immediately signals a problem has occurred. “Tell normal from abnormal right now” (Toyota President Cho)
Improve work close to problem occurrences in time, place, process and person.
Spear: catheter-related sepsis – a lot of little things:
No sink, no soap, no sanitizer, no doormat reminder or buzzer
Gloves missing, wrong size, old and rip, on other side of patient
92% of nurses faced with impediments constructed ad hoc workarounds
Laryngoscope that detects misplaced tube, signals the operator, and downloads to QI lead
CPR chest cover gives immediate feedback on hand position, depth, ventilation rate and depth, and stores for QI
Paul O’Neill – know everything that went wrong, every day
16. Fixing Health Care From Inside, Today – Steven Spear Work is designed as a series of ongoing experiments that immediately reveal problems
Problems are addressed immediately through rapid experimentation
Solutions are disseminated adaptively through collaborative experimentation
People at all levels of the organization are taught to become experimentalists
18. How is it Harder to Use Lean Thinking in Health Care than Manufacturing? Who is “customer” and what do they value?
Patient/family vs. Employer, Payer, Government
But patient and doctor insulated from cost of choices
A “distortion of value”
As if the driver didn’t pay for the car
Lots of invisible work
Patient encounter often involves a process or decision as the outcome -- not a tangible “product”
Examples: decision to operate, clinic scheduling, lab results ordering & reporting
More privacy issues
19. Diversity in Healthcare as a Challenge to Lean Large number of “product lines”
Adult vs. Peds
Specialty vs. Primary Care
Inpatient vs. Outpatient
Surgical vs. Non-surgical
Chronic vs. Acute Care
“Each patient is unique”
More like a custom repair (job shop) than an auto manufacturer
Almost infinite variability in mix of diseases and symptoms
Variable: age, family, gender, race, social, insurances factors
Variable: health habits, tobacco/alcohol/drugs, compliance
Mental health as a primary or complicating problem
Patient preferences must be respected
20. How Does Health Care Differ from Manufacturing? Organizational and professional culture issues
Physicians, some world renowned
Nurses, many irreplaceable
Other health professionals
Professional autonomy
vs. teamwork and systems thinking
Mission-driven (at least some)
Non-profit orientation
Production of social goods
21. How is Health Care Similar to Manufacturing? Process dependence
Huge variability, often unjustified
Aversion to standardization
Pressure to innovate and use new technology
Need for high reliability systems
(patient safety leaders learn from airlines, nuclear power industry)
Lack of embedded testing
No “instant awareness of every error”
Trillion dollar industry
Continuous Quality Improvement orientation
22. What Advantages Does Lean in Health Care Have Over Manufacturing? We expect change: new treatments, drugs, devices
We have scientific literature to guide us
We accept standardization in research protocols
We (mostly) accept standardizing treatment of common conditions:
“evidence-based medicine” and practice guidelines
We accept standardization to improve patient safety
We use root cause analysis in safety and quality
We are working on transparency to improve safety
We have external pressures for efficiency, safety and quality
Pay for performance
Public reporting
23. Use Lean tools to transform waste into value from the customer’s perspective. Is There Waste (Muda) in Health Care? Defects in products
Overproduction of goods
Inventories of goods awaiting future processing or consumption
Unnecessary movement of workers
Overprocessing Unnecessary transport of goods
Waiting(for process equipment to finish or on an upstream activity)
Design of goods and services which do not meet users’ needs
24. Muda in Health Care ImpactsQuality, Safety, Efficiency & Appropriateness Quality and Safety
Defects in products
Appropriateness
Design of goods and services which do not meet users’ needs
Efficiency
Overproduction of goods
Inventories of goods awaiting future processing or consumption
Unnecessary movement of people
Overprocessing
Unnecessary transport of goods
Waiting(for process equipment to finish or on an upstream activity)
28. Genesis ofLean Thinking at UMHS Why Lean?
“Michigan Quality System” concept
GM Agreement
Two tracks:
Model lines
Internal awareness and training programs
Coordination across UMHS units
29. Why Lean? Best way to:
Transform waste into value
Reduce errors and quality problems
Decrease our stress
Defines value from the customer’s perspective
Focuses on processes that add value
Helps us improve our way of doing work by understanding the root causes of waste
A learning approach
“Work as learning”
Not just process improvement
Aligns the organization from top to bottom
Includes philosophy, people, problem-solving
30. Principles of the Toyota Way- Jeff Liker 14 Principles in 4 Categories
Philosophy (1)
Process (7)
People (3)
Problem solving (3)
31. “Michigan Quality System” MQS Concept Create
a health system-wide
consistent approach
to quality and process improvement
adapting the principles of the Toyota Way
building on CQI base
Incorporate 4 goals of Michigan Value :
Quality
Safety
Efficiency
Appropriateness
32. Perceived (and Real) Barriers to Application of Lean in Health Care (Add your barriers here)
33. Perceived (and Real) Barriers to Application of Lean in Health Care “Just the Management Flavor of the Month – this too shall pass.”
Must show it is a learning approach, not just some projects
“We’ve done well, why change?” “The autos had to do it”
Lack of a burning platform/overriding reason to change (national v. personal)
“Let each unit choose QI process it finds most useful.”
Some see no value in uniform QI approach; miss the synergy
“Who can lead this?”
Lack of expertise/clinical champions
“I’ll join when I see that the leaders are on board.”
If not led from the top, many will not engage
“How much are we spending on this new program?”
Will the “return on time invested” be there?
“A 3 day workshop??!!”
They’ll spend 3 days over 3 years and not change anything
34. Perceived (and Real) Barriers to Application of Lean in Health Care “Is this cost cutting disguised as QI?”
The term Lean is misunderstood
1990s CEP (Cost Effectiveness Program) = lay offs
“I can’t do this on top of my day job.”
Isolated projects will not change the corporate culture – it will never become management’s job
I can’t risk my area’s performance to optimize the whole product line throughput
Accountability, teams, and incentives must cross silos and levels of the organization
Evaluation of middle management must match corporate goals
The Peace Health example
“Creativity is our most important asset – standard work will stifle creativity.”
Can you innovate if you have not first standardized???
Do you want your cardiologist innovating or giving you statins and aspirin?
35. Perceived (and Some Real?) Barriers to Application of Lean in Health Care
OR,
People are not automobiles…
36. Michigan Quality System: The Value Proposition Uniform process improvement across UMHS
Across missions: education, research, clinical/service
med students in clinic flow
Across goals:
Quality - Efficiency
Safety - Appropriateness
A VSM created to improve “efficiency” can be used to improve “safety” (root cause analysis following an adverse event)
Spread to adjacent areas: merging projects
ED => Radiology => OR
Training synergy
Transferability of training received for one project when working on other projects
37. Model Line Projects What are they? Why use them?
Institutional examples of lean in healthcare
Proof of concept at UMHS
Can expand upstream, downstream and laterally
Why not train all managers first?
We Learn Lean By Doing
Training long before use is less valuable
“Learn-do-reflect-discuss” cycle of a learning organization
38. Model Line Sequence- through the 3 d workshop phase Vascular access – “Right line at the right time”
Delayed discharge, cross silo (nursing, MD, radiology)
Results: PICCs placed
w/i 12h – up 43%
w/i 24h – up 40%
% needing Interventional Radiology cut by 46%
39. Model Line Sequence- through the 3 d workshop phase Orthopedic consult – from request to scheduling
Chronic problem, delayed appointments, frustrated referring physicians/patients/orthopedists
Results:
Pre project process time = 27 min; waiting time = 23 days
Post project MedSport = 89% of appointments made on first call (2.5 min)
Radiation oncology scheduling and treatment planning
Results:
54% treatment begins day of call (goal was 48h) for brain metastases
40. Model Line Sequence- through the workshop phase Orders Management Project (CPOE) – Medication management end-to-end
Redesign new workflow when implementing new information technology
High institutional visibility and impact
Emergency Department – Patient flow (a series of projects for patient journey)
41. Model Line Sequence- through the workshop phase Operating Rooms
Sinus, otology (“decision to incision”)
Scheduling OR, missing consents, pre-op, right site confirmation, delay in surgeon start
Redesign before we move to new Ambulatory Surgery Center
Faculty appointment, credentialing, insurance enrollment
Care transition – Discharge planning, tracking before RV
42. Model Line Projectsunderway/planned Radiology and Lab – Misdirected results (ordering clinician does not receive report)
Scheduled admissions
Wound care
CT scheduling and throughput
Institutional Review Board
43. A UMHS Patient
44. UMHS Lean “Model Line” Projects
45. Determining Scope is Not Easy Emergency Department:
Idealized patient flow?
Chest pain patients?
Observation patients?
Patients needing CT scan or MRI?
Patients waiting for inpatient beds?
Patients needing consults?
Non-acute patients – in the wrong place?
Operating Rooms
Admission Day Procedure patients?
with one day length of stay (LOS)
All sinus surgery?
Including clinic phase?
All cases to be moved to new ambulatory surgery center?
Room turnover?
46. PICC Current State Map – V.A.S. (Part 1)
47. PICC Current State Map – I.R. (Part 2)
48. PICC Brainstorms – V.A.S.
49. PICC Future State Map
52. Orthopaedics MedSport Current State Map
53. Orthopaedics Taubman Current State Map
54. Orthopaedics Future State Map
55. MQS Training Development Goal: Build training for wide application of lean thinking to projects and daily problem solving in UMHS
Levels:
General awareness: orientation, new manager, senior manager
Just In Time: Team member
Coach training through graded responsibility, tool training
Long Term Goal:
Managers understand their job is to optimize the value stream map of their product line
Employees understand their job is to identify immediately when something goes wrong and help solve the root cause
56. Issues for Discussion How do we… create a blame-free, responsible culture - to learn from every error, every day?
get all to use the same tools for QI?
coordinate improvement efforts?
move beyond “projects” to “every day”?
choose where to start?
Are patients are interested?
What is the leader’s role in a Lean Organization?
57. Issue: blame free culture Where there is an error, there is the opportunity to learn and improve.
Learn from every error, every day
How to create a blame-free, responsible enterprise?
The 5 why’s, not the 5 who’s
“The goal is prevention”. Jim Bajian, VA Chief of Patient Safety
Respect the workers: thanks for what you’ve done
58. Issue: one improvement model How do you encourage wide acceptance of one philosophy and set of tools for quality and process improvement to allow synergy across projects?
Cross-silo or cross-department improvement
Value Stream Map for improved efficiency also can be used to improve patient safety
Med Education projects in clinical areas
“Clinical research – clinical flow” interface
A Learning Approach, not just a process improvement model
4P Model (Jeff Liker)
Problem solving
People and partners
Process
Philosophy
59. Issue: coordinate improvement How best to coordinate across your groups with Process Improvement expertise and resources?
For example, UMHS has:
CQIP (Hospital’s QI program)
Program and Operations Analysis
Chief of Staff office/Safety/Risk Management
Faculty Group Practice
Ambulatory Care
Departmental expertise
Health Services Research faculty
60. Issue: beyond “projects” to every day “Value stream improvement is management’s responsibility”.
(Rother & Shook)
How can you facilitate “value stream management” as the way that managers view their role?
Value Stream Map high level product lines
“Projects” merge into daily management
Require current and future state value stream maps for all capital, IT, space requests
Park Nicollet: no request for resources without proof of working at tact time, leveling, and other TPS metrics
Embed facilitators in units (1-3% of workforce?)
61. Issue: where to start? Do we start at top (leaders), at middle (middle management), or at bottom (front line workers)?
Wherever you start, the problem will be at another level.
Plan on all levels
Do you change culture first or do projects first?
“Easier to act your way to a new way of thinking than to think your way to a new way of acting” (John Shook)
“Culture = education, training, rewards” (Jeff Liker)
Culture arises from management reacting to actions/behaviors
Are learners or risk-takers rewarded, encouraged, tolerated, or discouraged?
Are silo-protectors rewarded, encouraged, tolerated, or discouraged?
62. Issue: are patients ready? Will the public flock to high reliability health care as they have to high reliability auto manufacturers? (like JD Power)
Can we guarantee that no one loses his/her job as we improve?
“Transforming waste into value”
v. “Eliminating waste”
High market demand – expert staff shortage
“No job loss” commitment essential to Lean
Who would create a Future State Value Stream Map with their job eliminated?
Requires management of personnel issues first
63. Lean Transformation “Management has to understand that its role is to see the overall flow, develop a vision of an improved, lean flow for the future and lead its implementation. You can’t delegate it. You can ask the front line to work on eliminating waste but only management has the perspective to see the total flow as it cuts across departmental and functional boundaries”.
Learning to See. Rother and Shook
Leader as
- Problem Solver - Teacher - Servant
- Mentor - Coach
64. Thoughts and Feedback?
65. Additional Materials Some Lean terms
References
Liker’s 14 Principles of the Toyota Way
UMHS Model Line Project selection process and steps
Value Stream Mapping information
Waste categories
Full report on one model line project (PICC)
66. Lean Terms Jidoka – designed not to pass on a defect; really “machines working for people”
Poka-yoke – error proofing – forcing functions of built-in quality, designed not to build a defect
JIT – Just In Time, for pull systems
Andon Cord – to correct the error and its root cause in real time; if needed, to “stop the line”
Andon Board – tracks “down time” by cause
Kaizen – continuous improvement, or “burst”
Sensei – teacher or master
Muda – waste
Muri – waste of stress, leads to Karoshi (death from overwork)
Heijunka – leveling the workload
Kanban – signal for pulling work
67. References UMHS Lean Website: www.med.umich.edu/i/mqs
Liker J. The Toyota Way.
Womack J and Jones D. Lean Thinking.
Rother M and Shook J. Learning to See.
Marchwinski C and Shook J, eds. Lean Lexicon.
Spear S. Fixing Health Care from the Inside, Today. Harvard Business Review. Sept 2005
Spear S. Learning to Lead at Toyota. Harvard Business Review. May 2004
Spear S, et al. Decoding the DNA of the Toyota Production System. Harvard Business Review. Sept 1999
68. 14 Principles of the Toyota WayCan Work in Healthcare 14 Principles in 4 Major Categories
Philosophy
Process
People
Problem solving
69. Principles of the Toyota Way Philosophy
Base management decisions on long term philosophy, even at the expense of short term goals
Generate value for the customer, society, and economy
70. Principles of the Toyota Way Process
Create continuous flow to surface problems
Use pull to avoid overproduction
Level the workload (heijunka)
Build the culture of stopping to fix problems, quality right the first time
Machines serving people (jidoka)
Signals for stopped flow (andon)
71. Principles of the Toyota Way Process, continued
Make standard work
If an improvement works, make it the new std
Use visual controls so no problems are hidden
Use only reliable, thoroughly tested technology that serves your people and processes
72. Principles of the Toyota Way People
Grow leaders that understand the work, live the philosophy, and teach it to others
Develop exceptional people and teams who follow the philosophy
Respect extended network and challenge suppliers to improve
73. Principles of the Toyota Way Problem solving
Go and see (the workplace - gemba)
Solve problems by going to the source to personally observe and verify data
Make decisions slowly, by consensus; implement rapidly
Discuss with all affected people (nemawashi)
Become a learning organization through relentless reflection (hansei) and continuous improvement (kaizen)
74. Model Line ProjectSelection Process Criteria:
Institutional priority/visibility
Potential for creating an exemplar
Opportunity to expand upstream, downstream, sideways
Opportunity for improvement – gaps
access/waits/bottlenecks, financial, satisfaction, errors
Process dependence
Existence of a “clinical champion”
A defined process, with a start and stop, and an owner. It has SIPOC
Suppliers, Inputs, Process, Outputs, and Customers
75. Model Line ProjectSelection Process Selection:
Selection of Areas:
Prioritization Committee (hospital COO, CFO, CON, COS; FGP Exec Med Dir)
Project leads: Determine scope, participants and timing
Decision panel: All the leaders who need to approve the Future State Value Stream Map
76. Model Line Project Flow Select area: institution leaders (CEOs, COOs)
Select project leads: MQS leaders
Determine actual project, scope, team members, timing: Project Leads
Pre workshop scoping: Project Leads, facilitators
Three day workshop model (one of many options)
Day 1: Decision Panel charge, learn Lean & Current State Value Stream Map on their data
Day 2: Future State Value Stream Map, Decision Panel approval
Day 3: Implementation plan, barriers, Decision Panel approval
77. Learning to Seeby Rother and Shook
78. Using the Value Stream Mapping Tool To set the stage for here we are going …
The current state must be an honest depiction of what is really happening
Arrow is the continuous improvement loop
Each step must be included in its entirety. The planning and implementation phase must be implemented with an effective “management check” system that is supported by visual controls.
The goal of this entire process is implementation of an improved future state. The maps on paper and all the work leading up to this point will have been wasted if the plan is not implemented !!!To set the stage for here we are going …
The current state must be an honest depiction of what is really happening
Arrow is the continuous improvement loop
Each step must be included in its entirety. The planning and implementation phase must be implemented with an effective “management check” system that is supported by visual controls.
The goal of this entire process is implementation of an improved future state. The maps on paper and all the work leading up to this point will have been wasted if the plan is not implemented !!!
79. Value Stream Mapping Make work visible
Understand work flow
Measure process performance in terms of cost, service, and quality
Redesign process to meet specific business objectives
Use Lean tools to achieve the redesigned process
80. Drawing a Value Stream Map to Achieve Future State Goals Is process-time too long?
Is wait-time too long?
Is lead-time (process plus wait-time) too long?
Can each be reduced?
If so, by how much?
How would you draw your map to meet this time goal?
Is overall quality (% complete and accurate) acceptable? Is there too much rework?
Can quality be improved and rework reduced?
If so, by how much?
How would you draw your map to meet this future state goal?
81. Future State Design Questions What are customer requirements?
Where and how will you trigger or sequence work?
How will you establish rhythm or milestones to pace the work (pitch)?
How will you make work flow smoothly?
How will you make work progress, delays, and problems visible?
What process improvements are necessary?
82. Waste in Health Care ImpactsQuality, Safety, Efficiency & Appropriateness Quality and Safety
Defects in products
Appropriateness
Design of goods and services which do not meet users’ needs
Efficiency
Overproduction of goods
Inventories of goods awaiting future processing or consumption
Unnecessary movement of people
Overprocessing
Unnecessary transport of goods
Waiting(for process equipment to finish or on an upstream activity)
85. Waste in the Current State: Causes and Countermeasures
86. Lean Culture Transformation
87. Issues for Discussion What is optimal coordination model/location within a health system for:
Ongoing training
Project management
Selection, assignment of facilitator/coach, actual day-to-day management and coordination (especially for cross-silo projects)
Decentralized? Give them the training and get out of the way
Departmental initiatives
Line Managers
Troubleshoot overlapping projects
Two groups working on misdirected lab results
Lean and 6 Sigma for prescription security problem
88. Lean PICC Project
89. PICC Line Overview
Special intravenous (IV) catheter used when IV therapy or antibiotics are administered for a long period of time
Inserted primarily by Vascular Access Services nurses, at the patient’s bedside
90. Why Improve the PICC Line Process? Provide high quality patient care
Maximize resource utilization
Reduce long lead times
Manage growth in volume
91. Purpose Statement Streamline the PICC process end to end in order to provide the highest quality and efficient patient care by providing the right line at the right time within 24 hours of the order (or VAS referral, for IR PICCs). Remember… What Makes a Strong Purpose Statement?
Include two key elements:
Reason for conducting the project
Definition of the problem
Why improve the process?
What is the improvement to the business?
Metrics to measure project success
Reduce lead time by x%
Improve FTQ by y%
Reduce structural cost by x%
Eliminate rework by x%
Reduce the number of handoffs by y
Decrease work-in-process by x
Remember… What Makes a Strong Purpose Statement?
Include two key elements:
Reason for conducting the project
Definition of the problem
Why improve the process?
What is the improvement to the business?
Metrics to measure project success
Reduce lead time by x%
Improve FTQ by y%
Reduce structural cost by x%
Eliminate rework by x%
Reduce the number of handoffs by y
Decrease work-in-process by x
92. Where’s the Waste? Discrepancies between paper order and referral
Pending discharge PICC orders receive priority
Discrepancies in patient location
Patient preparedness
Delays in chest x-ray process
Lack of standardized IR scheduling process
Lack of standardized consent documentation
93. Project Schedule Scoping session and pre-work
SIPOC
In & out of scope
Identify participants
2-Day Workshop
Confirm current state
Develop future state
Develop implementation plan
Reviews with leadership
30, 60, 90 day post-workshop
Ongoing monthly updates
94. Current State Map – VAS
95. Current State - Brainstorms
96. Future State Map - VAS
97. Level schedule with designated slots for PICC placement in radiology with no bumping
Assistive personnel ensuring completion of written order, labs, scheduling patient prior to PICC nurse traveling to the bedside
Potential to use the electronic referral as the legal order (using e-signature)
Potential process change to close the loop on PICC adjusts by routing that information through the VAS department, rather than the ordering physician Bold Moves
98. Performance Metrics - VAS Update metrics from draft current state map.
This slide is a Built in Quality Control point.
The summary metrics chart should be completed from the current state map. The Timeline (if done properly) should contain the total Process Time and Lead Time. FTQ may have a value for the entire system or there may be a couple points of reference along the map but no overall FTQ.Update metrics from draft current state map.
This slide is a Built in Quality Control point.
The summary metrics chart should be completed from the current state map. The Timeline (if done properly) should contain the total Process Time and Lead Time. FTQ may have a value for the entire system or there may be a couple points of reference along the map but no overall FTQ.
99. Performance Metrics - I.R. Update metrics from draft current state map.
This slide is a Built in Quality Control point.
The summary metrics chart should be completed from the current state map. The Timeline (if done properly) should contain the total Process Time and Lead Time. FTQ may have a value for the entire system or there may be a couple points of reference along the map but no overall FTQ.Update metrics from draft current state map.
This slide is a Built in Quality Control point.
The summary metrics chart should be completed from the current state map. The Timeline (if done properly) should contain the total Process Time and Lead Time. FTQ may have a value for the entire system or there may be a couple points of reference along the map but no overall FTQ.