oahhs lean webinar december 9, 2014 · 2018-07-16 · hoshin kanri . vocs . vsm . data collection...

Purdue Research Foundation© 1

OAHHS LEAN WEBINAR DECEMBER 9, 2014


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

Overview


DMAIC


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


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

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


The Control phase

• Show that you’ve built a new process that is performing at the desired level

• The new process is hardwired • Showing that measurements and monitoring

are in place • Roll out to other areas as applicable


Measuring the result

• What are the metrics you are tracking? • How will you know if you have made an

impact? • How can you make those metrics visible to

everyone?


Control Phase “Confirm the change really improved the process”


Training and Standards

Building Information into the Workplace

Warnings that Problems Exist

Physically Changing the Workplace

Eliminating the Causes of Problems

HIERARCHY OF CONTROLS


CONTROL PLANS

Project: Bed Management Goal: Time from ED request for inpatient bed to patient placed in bed < 30 minutes

Date: Pre-project average time = 166 minutes (2.7 hours)

# Metric w/Target Goal Collected

By Sample

Size/Frequency Collection

Method Frequency of

Review

1 Decrease average time from ED request for inpatient bed to patient placed in bed from 166 minutes to < 30 minutes

Jane Doe 100%/Daily Manual (already being collected

daily)

Daily at morning bed meeting

2 Decrease average time from ED request for inpatient bed to bed assignment from 90 minutes to < 5 minutes


daily)


3 Decrease average time from inpatient bed assignment for ED patient to nursing report from 48 minutes to < 10 minutes


daily)


4 Decrease average time from nursing report provided to ED patient placed in bed from 32 minutes to < 15 minutes


daily)


5 Eliminate ED bed diversions (averaging 18.75 hours/month)

Jane Doe 100%/Daily

Manual (already being collected

daily)



PURPOSE OF STANDARDIZATION

• Reduces variation – More reliable process and results

• Spreads and sustains improvement • Improves quality

– “Standardized Tasks are the Foundation of Continuous Improvement and Employee Empowerment”


PROJECT REPORT PRESENTATION

• Team Members should present to the Executive team • Project Aim

– Purpose and goal of project • Problem Statement

– Why was it identified to be a project? – What was the impact and extent of that impact

• What are the metrics?

• What was the state of the process pre-project? • What is the future state?


PROJECT REPORT PRESENTATION • What were the identified root causes?

– Identified constraints (sacred cows) • What were the identified solutions?

– Target area for each solution – Literature supporting the identified solutions

• What is the status of each solution? – Implementation Plan/Kaizen Newspaper – Gantt Chart

• What is the target state?


PROJECT REPORT PRESENTATION • What is the return on investment?

– Improvement realized as a result of the project – Expected improvements to be realized in future – Specify which Strategic Plan Breakthrough Goals

the project directly and indirectly assisted the organization to achieve or closer to achieving

• Obstacles, barriers, ongoing constraints requiring executive / leadership assistance


Lessons Learned

• Revisit your plan if you’re not achieving the stated goal

• Set plans to revisit the measurements in the future (6 months-1 year)

• Hand off the project to the process owner • Spread your learning and improvement to

others that may benefit


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

[email protected] Purdue Healthcare Advisors | Purdue University

mailto:[email protected]


Lean Story Preventing Inpatient Falls

& Decreasing Inpatient Fall Rate

Adventist Health

Tillamook Regional Medical Center

Julia Fontanilla, Quality/CIS Director


About Us

Tillamook Regional Medical Center • 25-bed critical access hospital in Tillamook, a rural coastal

community in Northern Oregon • Operated by Adventist Health since 1973; lease renewed

through 2045 • Services

– Hospital Acute Care Services – 5 Rural Health Clinics – Hospice/Home Care – Clinical Outpatient Therapy Services – Ambulance Services


Our Lean Project PREVENTING INPATIENT FALLS & DECREASING INPATIENT

FALL RATE PROBLEM – Our average fall rate in 2013 was 4.78 inpatient falls per 1000 days; Corporate’s 2013 rate was 2.5 inpatients fall per 1000 days or less. WHY? Right thing to do for our patients and our hospital

AIM STATEMENT - To reduce patient fall rates by standardizing our patient fall assessment process and implementation of fall reduction strategies Original Outcome Measure – patient falls per 1000 pt. days

Original Process Measure - Number of completed fall risk assessments completed within 1 hour of inpatient admission


Project Team

TEAM MEMBER ROLE

Chief Nursing Officer Senior Sponsor

Administrative Director Project Owner

Quality & CIS Director Facilitator (Green Belt)

3 Med-Surg RNs Planning/Implementation

Physical Therapist Planning/Implementation

Unit Secretary Planning/Implementation

Nursing Supervisor Planning/Implementation

Quality Manager Control Metrics

Clinic Director Project assistant (Yellow Belt)

Pharmacist Subject Matter Expert


Define

• TRMC is not consistently meeting patient fall targets for over 2 years

• Due to low patient volumes/patient days, one patient fall dramatically affects the pt. fall rate


Measure

CURRENT STATE – OBSERVATIONS & FEEDBACK

Variation noted in the following areas: • Time patient admitted to inpatient unit

to time initial fall risk assessment completed

• Implementation of specific fall risk precautions

• Interpretation of patient mobility assessment


Analyze

ROOT CAUSE ANALYSIS


Improve ROOT CAUSE SOLUTIONS Changes:

1)Standardize risk assessment procedure and EMR documentation

2)Standard implementation of fall prevention strategies

3)Patient/family education and involvement 4)No Pass Zone – teamwork in preventing

patient falls 5)Visual Cues – risk score, fall posters, 6)Hourly rounding includes fall prevention 7)Bedside shift nurse to nurse report

includes patient fall precautions


Control (Sustainability/Spread)

• Identified Process Owner – Administrative Director

• Sharing Control Metrics with all stakeholders • Involving Front Line Staff in all phases -

(auditing and reporting to Quality Council) • Utilizing other departments (No Pass Zone,

patient teaching) Phase II – Design Rewards & Demand Accountability – redesign job description; performance appraisals; coaching systems


Influencer – The Power to Change Anything by Kerry Patterson & others


Successes and Key Takeaways • PATIENT/FAMILY INVOLVEMENT?

– Feedback on teaching tools – Helpful, not helpful

• ADVICE? - Value the patient/family feedback – involve them in

understanding fall scores and precautions - Visual cues are beneficial - Involve front-line staff

OUR JOURNEY HAS JUST BEGUN – WE ARE EAGER TO SEE POSITIVE RESULTS FROM OUR

TEAMWORK!


Contact Information

• Julia Fontanilla [email protected] 503-815-2463 (work)

mailto:[email protected]


QUESTIONS?

oahhs lean webinar december 9, 2014 · 2018-07-16 · hoshin kanri . vocs . vsm . data collection...

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