Download - + A3 - CAD CABG VS - Rev. 2

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Title: CAD CABG Value Stream Revision: 2 Date: 9/12/082. Initial State:1. Reason for Action:

3. Target State:

4. Gap Analysis:

Team

: Raj

Cha

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t, Sh

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Cha

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5. Solution Approach: 6. Rapid Experiments:

8. Confirmed State:

7. Completion Plans:

Sponsor: Raj Chakravarthy Leader: Deb Wisnet Facilitator: Shawn Chartier Sensei:

9. Insights:


CAD (Coronary Artery Disease)

CABG (Coronary Artery Bypass Graft)

Value-Stream Site/Location: AMC Sponsor: Raj Chakravarthy Team Leader: Deb Wisnet Facilitator: Shawn Chartier Sensei: TBD Date: TBD


CAD CABG Value-Stream

Team Members: Team Role: Raj Chakravarthy Sponsor Deb Wisnet Team Leader Shawn Chartier Facilitator Dr. Robert Ferrante Physician Lead Christie Dreier Process

Owner Bob Olson Process Owner Dan Collins Process

Owner

© 2007 ThedaCare All Rights ReservedO:\ThedaCare Improvement System\Blank Forms\A3-A4 Forms

Reason for Action 38% of isolated CABG patients experienced an adverse

outcome in 2007.

Postoperative atrial fibrillation and prolonged ventilation were the most common adverse outcomes experienced.

CABG treatment resulted in a $1,355,000 contribution margin but a ($723,000) net income in 2007.

Scope: CABG patients from day of surgery to discharge.

Note: Isolated CABG is a surgical procedure in which CABG is the only major cardiac surgery performed.


Initial State

2007 AtrialFibrillation Rate = 30%

($723,000)Net Income

Loss

2007 Pronged

Ventilation = 11%


Target State

Measure Initial2007

Target Dec 2008

Quality Post-op Atrial Fibrillation

Initial Ventilation < 6 Hrs

30%

27%

15%

54%

Business Contribution Margin per Case

$6,831 $9,073

Employee Engagement

% of OHS Care Team Members Involved in Value-Stream Improvements (VS, RIE, Project, A4, Team Leader/Core Team Member)

0% 100%

Metrics: Data is for isolated CABG patients


Gap AnalysisValue Stream Readiness:


Solution ApproachOHS Care Team Development:


Rapid ExperimentsMay 2008 OHS Care Teams developed – Inpatient Surgery (pre-existing), ICU and 2 South

June 2008 Value Stream Core Team expands to include OHS Care Team reps (meets biweekly) Project held with OHS Care Team members to map Value Stream, determine gaps Individual OHS Care Teams begin meeting weekly, begin identifying metrics Value Stream daily huddle begins with reps from each OHS Care Team and support departments

July 2008 Value Stream Core Team expands to include RT, Rehab and Pharmacy Individual OHS Care Team daily huddles begin (exception – Inpatient Surgery) OHS Care Teams each develop metrics and improvement boards Project held to determine Care Team leadership structure

August 2008 Care Team leadership structure finalized OHS Care Teams continue improving metrics, working toward goals and completing improvement projects

September 2008 Care Team leadership structure implemented in ICU


Confirmed StateQuality

Customer

BusinessEmployeeEngagement

Measure Initial(2007)

Target Achieved(Date)

Quality Post-op Atrial Fibrillation

Initial Ventilation < 6 Hrs

30%

27%

15%

54%

Business Contribution Margin per Case

$6,831 $9,073

Employee Engagement

% of OHS Care Team Members Involved in Value-Stream Improvements (VS, RIE, Project, A4, Team Leader/Core Team Member)

0% 100%

Within 5% of GoalOff goal >10%


InsightsWhat went well? What did not go well?

Actions

• OHS Care Team huddles

• OHS Value Stream huddle

• ICU team development (exceeding expectations)

• Silos breaking down – departments working together

• Engagement and pull among all teams (and support depts.) increasing

• Daily continuous improvement “on steroids”

• Value stream metrics improving and/or meeting goals

• OR OHS Care Team – delay in progress - staffing issues/summer vacations and leaves

• 2 South OHS Care Team – delay in progress – desire direction and clear expectations

• Finding time with surgeons for improvement work – very busy schedules and summer vacations

• Communication to non-OHS Care Team members concerning changes and goals

• Every team is unique – must adapt to the separate needs of each team as they develop

• OR OHS Care Team – resolve staffing issues, place increased focus on team

• 2 South OHS Care Team - provide direction, expectations and increase focus on team

• Develop effective communication plan that includes OHS Care Team members AND non-members

Download - + A3 - CAD CABG VS - Rev. 2

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