oahhs lean webinar november 11, 2014 · takt time; cycle time . fishbone; 5 why . opportunity...

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OAHHS LEAN WEBINAR NOVEMBER 11, 2014

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• A3 Improve Key Components • Improve tools • Deeper dive into a tool • Questions?

Overview

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DMAIC

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Date: Project Title and Area: Organization:

Authors:

Defin

e M

easu

re

Impr

ove

Cont

rol

Project Y Project charter SIPOCS VOCS (SWOT; Affinity; CTS; Kano) Communication Plan

Pre-

Hoshin Kanri VOCS VSM

Data collection plan Gemba MSA Process flow charts Spaghetti diagrams Scatter plots

Set Goal – “SMART”

Quantifying the waste & variation Visual display of current process

Define the problem

Future State Map Hypothesis Testing Correlation Regression Gap analysis (current/future) Root cause – why gaps exist

Understanding the waste & variation Y = f(x)

Control Plan Visual controls Kan ban 2 bin systems Poke yoke

Preventing recurrence of the waste and variation

Select Project

Removing the waste & variation

Target state Prioritize solutions Impact/Effort Affinity Multi-voting List Reduction

Anal

yze

Pie charts; Bar graphs Control Charts Pareto Process capability (DPMO; Sigma score) Takt time; cycle time

Fishbone; 5 Why Opportunity prioritization Risk/Frequency Affinity diagram Multi-voting/List Reduction families of variation

Team Selection Exec sponsor Process owner

Gantt chart Kaizen newspaper Small tests of change PDCA Quick change-over Cellular layout 5-S

Gantt Chart

Standard Work

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The Improve phase

• Establish the Target state • Identify the necessary changes to achieve the

Target state • Pilot as necessary • Execute implementation plans

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Small test of change

• Done quickly • Small scale • Anticipating the next cycle • Be prepared to respond quickly to problems

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The Model for Improvement

• What are we trying to accomplish? • How will we know when a change is an

improvement? • What changes can we make that will result in an

improvement?

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Before and After Improvement “ Confirm the change really improved the process”

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Date: Project Title and Area: Organization:

Authors:

Defin

e M

easu

re

Impr

ove

Cont

rol

Pre-

Set Goal – “SMART”

Define the problem

Understanding the waste & variation

Preventing recurrence of the waste and variation

Select Project

Removing the waste & variation

Anal

yze

What x’s and processes were measured to understand the stated problem?

Why this problem?

How does this project move the organization to its goals?

Quantifying the waste & variation

1. Business case has been explained 2. Problem statement in measureable terms 3. Data provided to describe the problem 4. Performance gap is described 5. Metrics are specified

1. Current state performance is described 2. Visual representation of process is shown 3. Data describing problem/process is provided 4. Project objectives/goals are specified

1. Proposed changes are specified 2. Visual representation of Target State is shown 3. Implementation plan is detailed 4. Results of Implementation are specified 5. Spread is in Implementation Plan if applicable

1. Primary obstacles and barriers are specified 2. Root causes are specified 3. Method of identifying root causes is shown 4. Goals regarding root causes are shown

1. Process owner is specified 2. Plans for follow up monitoring is detailed

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Project management is the discipline of planning, organizing, securing, and managing resources to bring about the successful completion of specific project goals and objectives.

Source wikipedia.org on 7/21/2011

Improve Phase - Project Management

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The Project Management Cycle

Initiating Planning

Executing Controlling

Closing

Initiating Planning Executing Controlling Closing

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Initiating Phase – Revisit the Project Charter

• Objectives • Scope • Project plan and status • Deliverables • Stakeholders • Assumptions and constraints

Initiating Planning Executing Controlling Closing

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Project Planning

Creates the workable approach to accomplishing the project objectives

Initiating Planning Executing Controlling Closing

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Outputs of the Planning Phase

• Specify tasks/activities • Determine schedule • Establish responsibility • Confirm the budget

Initiating Planning Executing Controlling Closing

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Task Analysis

Identify and describe for the tasks: • Start/stop or duration • Milestones • Dependencies • Sub-projects • Responsible party • Critical path

Initiating Planning Executing Controlling Closing

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Scheduling/ Gantt Chart

Initiating Planning Executing Controlling Closing

Task Start End Who 1/1 1/8 1/15 1/22 1/29 2/5 2/12 2/19 2/26

First task 1/1/11 2/1/11 Don

Second task 1/15/11 2/1/11 Sally

Third task 1/21/11 2/15/11 Tammy

Fourth task 2/7/11 2/18/11 Tammy

Fifth task 2/7/11 2/11/11 Don

Sixth task 2/15/11 2/28/11 Tammy

Seventh task 2/25/11 2/28/11 Don

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Executing

• Managing Risk • Anticipate delays • Keep the project going according to plan

Initiating Planning Executing Controlling Closing

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• Project control for status reporting - Compare actual to planned - Change is inevitable - Adjusting the plan

• Communications – With the team – With Leadership/management – With organization

Initiating Planning Executing Controlling Closing

Controlling

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• Acceptance of project results • Redeployment of resources • Closure of cost accounts • Turnover of project results

Initiating Planning Executing Controlling Closing

Closing the Project

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Roles and Responsibilities

• Project Manager • Sponsor • Stakeholders • Team • Others

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Lessons learned from Project Management

• Communicate, communicate, communicate • Overcoming resistance • Facilitating the team members • Accountability to achieve targets • Managing expectations • Leadership and Motivation • It takes discipline

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Brian Hudson, MS, LSSBB | Senior Advisor – Lean Six Sigma 765-496-0099 (office)|765-404-3255 (mobile)

hudson70@purdue.edu Purdue Healthcare Advisors | Purdue University

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QUESTIONS?

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LEAN HEALTHCARE: Preventing Pressure Ulcers on the Medical/Surgical Unit

St. Charles Redmond Medical Center

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About Us St. Charles Redmond Medical Center

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Our Lean Project

Pressure Ulcer Prevention

• Pressure ulcers are a national concern due to patient morbidity, treatment cost, and reimbursement issues.

• Previously, St. Charles Redmond Medical Center had not implemented any best practices for pressure ulcer prevention (PUP).

• AIM: implement PUP best practices for 100% of cases by December 31, 2014 .

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Project Team Pressure Ulcer Prevention Team Members and Roles

Name Job Title Lean Project Role

Adam Angeles, MD Wound Care Physician/Plastic Surgeon

Physician Champion

Susan Boucher, RN Wound Care Nurse Team Member

Laura Grasle, RN Quality Improvement Coordinator

Lean Facilitator

Kelly Kindle, RN Med/Surg Supervisor Process Owner

Bethany Klier, RN Wound Care Nurse Team Member

Natasha Luff, RD Nutritionist Team Member

Karen Sagner, RN Med/Surg Nurse Process Owner

Pam Steinke, RN Executive Sponsor Executive Sponsor

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Define

In May 2014, the IHI best practices for pressure ulcer prevention were implemented in only 77% of Medical/Surgical Unit cases at St. Charles Redmond Medical Center.

Preventing Pressure Ulcers in the Medical/Surgical Unit at St. Charles Redmond Medical Center Implementation of Best Practices -- May 2014 Audit Results

Best Practice Number of Best Practice-Implemented Patient Cases

Total Number of Patient Cases

Best Practice Implementation Rate

Conduct a Pressure Ulcer Admission Assessment for All Patients 20 30 66%

Reassess Risk for All Patients Daily 28 30 93% Inspect At-Risk Patient Skin Daily 3 6 50%

Manage Moisture: Keep the At-Risk Patient Dry and Moisturize Skin 6 6 100%

Optimize At-Risk Patient Nutrition and Hydration 2 6 33%

Minimize Pressure around the At-Risk Patient 6 6 100%

Total 65 84 77%

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Measure

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Analyze

High-Risk Barriers: • Variation in skin assessment occurrences and techniques • Lack of RN confidence in completing skin assessments and staging pressure ulcers • Variation in Nutrition Consult ordering decisions; variation in EMR ordering processes • Lack of communication related to pressure ulcer prevention • Lack of patient engagement related to pressure ulcer awareness and skin self-care

Root Causes: • Low incidence of pressure ulcers/short patient length-of-stay • No standard procedure or tool for conducting skin assessments • Deficits in staff knowledge/training related to skin assessments and pressure ulcer prevention • No standards or standard processes for ordering Nutrition Consults • Lack of focus on pressure ulcer prevention throughout the St. Charles Healthcare System

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Improve

Goals: • Conduct standard daily skin assessments for 100% of at-risk patients • Order Nutrition Consults for 100% of patients with “poor” Braden Assessment nutrition

scores

Outcomes: • In September 2014, standard daily skin assessments were conducted for 98% of at-risk

patients. • In September, Nutrition Consults ordered for 100% of patients with “poor”

Braden Assessment nutrition scores.

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Control (Sustainability/Spread)

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Advice to Others & Lessons Learned

• PUP Advice: Survey nurses/frontline caregivers (VOCS) for help identifying barriers to PUP best practice implementation.

• Key Learning: Our multidisciplinary team was almost too multidisciplinary and motivated, making it hard to keep the project in scope.

• Advice (Based on Key Learning): At team meetings, include only those team members with a direct relationship to the agenda/project task.

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Contact Information

Laura Grasle Quality Improvement Coordinator St. Charles Redmond Medical Center

541-526-6523 lcgrasle@stcharleshealthcare.org

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QUESTIONS?