Hurley SmithTrinity HCAD Class of 2012
Thursday, November 5th 2015
Lean at Tenet
True North“Where do I fit in?”
True North
Why do we exist, really?........
For Our Customers
Who Have These Needs
We Provide
~Generic Mission~
Unlike Our Competito
rs
We Are Better in
These Ways
~Generic Vision~
“Loyola Jettisoned whatever traditional religious practices stood in the way…
…like praying...
…more accurately, praying according to the monastic tradition”
True North: Mission & Vision
St. Ingatius Loyola, SJ
Mission: Develop souls and propagate the faith.
Vision: To do so by focusing on education, speed, and adaptability.
True North
Why do hospitals exist, really?........
For Our Customers
Who Have These Needs
PatientsEmergent
Medical
Surgical
Women's
Diagnosti
cs
We Provide
Healthca
re
~ Generic Hospital Mission Statement ~
So… Are we any good?
So… Are we any good?
7
High Level
Business
Indicators
Service-Line Level
Business
Indicators
Process-Level
Business Indicators CAUTICLABSI SepsisReadmit
s
Service
VTE-1 STK-4 Falls with
Injury
CLABSI Infecti
on Rate
Readmissions Rate
Sepsis Excess Days Rate
Exparel Usage
Blood Utilizat
ion
PSMS Actual Score
TARGET 96% 92% 0.023 0.500 14.0% 29% 1.6 40% 72TENET 95% 85% 0.041 0.900 13.4% 29% 3.4 44% 72.0California 93% 59% 0.043 1.097 14.7% 26% 3.7 32% 71.9Central 99% 100% 0.000 0.395 12.7% 36% 5.2 59% 69.9Detroit 99% 100% 0.000 2.675 19.9% 35% 0.0 63% 72.3Florida 95% 97% 0.000 0.855 14.5% 37% 4.2 39% 70.4Northeast 98% 71% 0.186 0.513 13.1% 32% 0.0 45% 71.1PHOENIX MARKET 98% 100% 0.000 0.422 7.5% 29% 1.9 29% 67.2Southern 97% 100% 0.741 1.422 12.2% 25% 2.0 34% 72.0Texas 93% 86% 0.056 0.299 12.4% 24% 6.5 46% 75.0
Hospital Name
Process ValueBSC Metrics
Safety Outcome
LD
M
Managem
en
t Syst
em
3 West
ICU ER 2 North
Complicated vs. Complex
Requires lots of schooling.
Requires leadership.
Complex Systems: Why Hospitals Are Hard
1840 – Textile Mills
“Of more serious consequence to the workers... Company production innovations”
Source: There is Power in a Union, Philip Dray
The “Speed Up”
Running the machines at a faster pace
The “Premium System”
Reward the most productive workers with cash
The “Stretch Out”
Increase in the number of machines for which a worker is responsible
Quality Service Cost People Growth
“Volume cures all ills”
“Work faster”
“More market share”
“Cut costs!”
“Physicians are our number 1 customer!”
“EBITDA!!!!!”
Why did early managers do that?
W. Edwards Deming on Leadership
1. Lack of constancy of purpose to plan product and service that will have a
market and keep the company in business, and provide jobs.
No True North. No Economic sense of purpose.
2. Emphasis on short-term profits: short-term thinking (just the opposite
from constancy of purpose to stay in business), fed by fear of unfriendly
takeover, and by push from bankers and owners for dividends.
Emphasis on Cost and Growth (discounting the other 3
pillars)
3. Evaluation of performance, merit rating, or annual review.
Sub optimization (constraint theory)
Visual Management
Consensus
Is
Golden
“Quiet at Night”
Lean Daily Management
January, 2013 - “lais·sez-faire” Gemba
April, 2013 - Leader x-ray vision
November, 2013 - Look to the Glass Wall!
2014 – Propagate the faith
Spring, 2015 – Trail of tiers
Fall, 2015 – High Reliability
The evolution of a management system…
Vanguard
Tenet
High Reliability
People Developme
nt
Management System
Performance
Improvement
Strategy Deployment