objectives - imec · process results customer-focused results workforce -focused results leadership...

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Ron Smith, Performance Improvement ManagerMary Greeley Medical Center

Sustaining your Lean Transformation Journey – An Organizational Engagement Strategy

Objectives

1. Enhance sustainability through the use of the Baldrige Framework

2. Identify engagement strategies for leadership buy-in of lean culture

3. Share strategies to involve those closest to the work

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• Located in Ames, Iowa• 220-bed acute care

hospital• 1,300 employees• 200 physicians• 500 volunteers• 8,000 admissions per year• 26,000 emergency room

visits per year• Governed by five-member

Board of Trustees

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Two Fundamental Principals

1. Respect for the work2. Learning by doing

Lessons Learned throughout the Journey• Make Baldrige about how you do business. . .everyday.• Senior leader engagement is vital. • Be willing to accept feedback and focus on

incremental improvement.• Focus on beneficial results rather than on winning. • Never lose sight that your organization is improving,

even if you haven’t achieved your ultimate goal. • Don’t cram for the test (site visit), let your employees

live it.• Build your internal expertise to support the work you

do every day.

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Years of Examiner Experience

611

19

31

42

51

6065

2010 2011 2012 2013 2014 2015 2016 2017

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Baldrige Framework for Excellence

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• Proactively plan for the future (1.1c(2) create a focus on action)

• To do the right thing, and ONLY the right thing (1.1c(2) identify needed actions)

• Those closest to the work need to help design and re-design their work (5.1a(4) workforce accomplishment; 6.1a service and process design)

• Learning from each other is critical to the success (4.2b knowledge management; best practices; organizational learning)

Why Lean?

6 Traits of a Lean Leader:

1. Makes lean an integral part of our strategy – not a ‘project’ or flavor of the month.

2. Accepts continuous improvement and rejects the status quo.1. Is curious about possibilities and alternatives

3. Places the customer at the beginning and end of all improvement and innovation.

4. Looks to simplify . . .with an eye for waste.5. Spends time where the work is done – impacting

employees and customers.6. Lead by example; respect for the people and

their work.

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2010 Scoring Range by Category Item

0102030405060708090

1.11.2

2.1

2.2

3.1

3.2

4.1

4.2

5.15.2

6.1

6.2

7.1

7.2

7.3

7.4

7.5

Leadership

Strategy

Customers

Measurement, Analysis and Knowledge Management

Workforce

Operations

Healthcare and Process Results

Customer-Focused Results

Workforce-Focused Results

Leadership and Governance Results

Financial and Market Results

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Form Follows Function – 2011Continuous improvement and Innovation 4.1c(2)

• Standard Work Steering Committee – To further support our lean culture – Focus on where improvement is needed – Systematically identify and select projects– Organize work– Create standard work documents

ManagingBedside Equipment

Expected Benefits:• Less shortages of key equipment• Less traveling for pumps

(inventory locations closer to use)

• Less searching (fewer & standard locations)

• Self-serve (eliminates TDSS requests, Tranpsort wait time, Central Stores involvement)

Improvements:• Reduce the number of locations where critical equipment is stored• Clearly defined cleaning responsibilities & priority• Extra units stored next to highest volume users

Sitting: Amanda Lass, Laura Deal, Melissa K. PetersonStanding: Ron Smith, Karen Kiel Rosser, Matt Aitchison, Cathy Wright, Jon Barton, Brendy Pierce, Andrew Dinsdale, Tim Bartholomew

Baxter’s Big Adventure!This swim lane chart shows the steps

required to locate a clean Baxter IV pump today. The majority of the steps add no

value to the patient.

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3. Clean Clamp and Cord with CAVI Wipes* CAVI wipe dwell (wet) time = 3 minutes

Bedside Equipment CleaningB Braun Stackable IV Pumps

B Braun IV Pumps

Personal Protective Equipment SuppliesGloves CAVI Wipes

* Bleach towelettesrequired for special contact precaution isolation.

4. Inspect pump – send to SPD, if grossly soiled Complete and tag with FAILED EQUIPMENT FORM

6. Wrap cord counterclockwise and secure

1. Disassemble clamp and pumps 2. Clean each pump with CAVI Wipes*Remove Clamp Separate pumps Outside of pump Inside of door

Depress button and squeeze handle

Pull to slide and remove clamp

Depress button and slide to separate pumps

5. Reassemble pumps and clamp

Name Title Date

Cathy Wright Director of Guest Services

Melissa Peterson Supervisor of Guest Services

LeAnn Hillier Infection Control

Matt Aitchison 2 South Clinical Supervisor

Amanda Lass ADT Nurse, 3 South

Approvals:

•Grooves and face•All sides, top and bottom

To open door press and hold power.

Clean:•Inside of face•ChannelTo close, lift door and

hold power for 3 secs.

Project Management Software

• Document and manage improvement projects• Central location for resources and team

member communication.

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Preventable Harm Index

2011-2012 Scoring Range by Category Item

0102030405060708090

1.11.2

2.1

2.2

3.1

3.2

4.1

4.2

5.15.2

6.1

6.2

7.1

7.2

7.3

7.4

7.5

2010 2011 2012

Leadership

Strategy

Customers


Workforce

Operations






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Standard Work forRapid Improvement EventsContinuous Improvement and Innovation 4.1c(2)

Pre-work meeting(30 days prior to event)

3 Day Rapid Improvement Event

Finalize Logistics• Schedule Room• Confirm/Invite Participants• Gather Background Information• Additional Event Preparation

First Friday Report Out*

30 Day Follow-up Meeting



*First Friday of the Month Following Event Completion

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Identify Key Work ProcessesKey Work Processes 6.1a(2) and Support Processes 6.1b(3)


0102030405060708090

1.11.2

2.1

2.2

3.1

3.2

4.1

4.2

5.15.2

6.1

6.2

7.1

7.2

7.3

7.4

7.5

2010 2011 2012 2013

Leadership

Strategy

Customers


Workforce

Operations






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100 Day Workout

Identify an improvement project in your area• Can be completed in 100 days• Results in cost savings or revenue generation• Use KaiNexus to manage project

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100 Day Workout Timeline - 2014

Jan. 2014 Feb. 2014 March 2014 April 2014 May 2014

100 day work out projects due

Senior leaders review and approve all projects

Meet with VP to establish final 100 day plan

First 30 day follow up with VPs; select projects reported to leaders

2nd follow up with VPs; Check-in/Questions from Leaders

Final 100 Day Workout report out celebration

Project results validated w/ Finance

100 Day Workout Common Themes

• Cost Savings– Contract Renewals/Re-Negotiations– Inventory Management/Reduction– Savings on Medications/Supplies

• Revenue Generation– Sell used equipment– Review charges for accuracy– Increase volumes

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100 Day Work Out Final ResultsControl Overall Costs of Operations 6.2a(1)

• 54 opportunities for improvement completed• $722,661 financial impact – hard savings

– $675,475 1st year savings– $47,186 1st year revenue generation

• 5,209 labor hours saved per year– $116,101 in soft savings

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0102030405060708090

1.11.2

2.1

2.2

3.1

3.2

4.1

4.2

5.15.2

6.1

6.2

7.1

7.2

7.3

7.4

7.5

2010 2011 2012 2013 2014

Leadership

Strategy

Customers


Workforce

Operations






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Time

Perf

orm

ance

20112010 2012 2013 2014 2015 2016 2017

•6S (dozens)

•Rapid Improvement Events (13)

•Value Stream Mapping (5)

•A3 Problem Solving (hundreds)

SW Steering Committee

100 Day Work Out

Time

Perf

orm

ance

20112010 2012 2013 2014 2015 2016 2017

•6S (dozens)

•Rapid Improvement Events (13)

•Value Stream Mapping (5)

•A3 Problem Solving (hundreds)

SW Steering Committee

100 Day Work Out

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Multiple Methods of Improvement

Events(RIE, VSM)

Projects

Managing for Daily Improvement (MDI)

Our culture takes a significant shift!

Events(RIE, VSM)

Projects

Managing for Daily Improvement (MDI)

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Asking Every Day

• Are there any problems interfering with your work?

• With patient care?• Have you had any

ideas for improvement lately?

• Do you have what you need to do your job?

MGMC Improvement PhilosophyOrganizational Culture 5.2a(1)

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2015 National Baldrige (MBNQA)Scoring Range by Category Item

0102030405060708090

1.11.2

2.1

2.2

3.1

3.2

4.1

4.2

5.15.2

6.1

6.2

7.1

7.2

7.3

7.4

7.5

2015MBNQA 2014IRPE

Leadership

Strategy

Customers


Workforce

Operations






2016-2019 Strategic Plan Strategic Planning Process 2.1a(1); Vision, Values 1.1a(1) and Strategic Objectives 2.1b

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Preventable Harm Index

227

213

172

189

161174

148

0

50

100

150

200

250

2010 2011 2012 2013 2014 2015 2016

Overall Preventable Harm


0102030405060708090

1.11.2

2.1

2.2

3.1

3.2

4.1

4.2

5.15.2

6.1

6.2

7.1

7.2

7.3

7.4

7.5

2015MBNQA 2016MBNQA

Leadership

Strategy

Customers


Workforce

Operations






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MGMC Senior Leaders visit Baldrige award winning Midway USA

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Work Systems MappingBest Practices 4.2b(2)

How do we use the map?• Recruiting/Interviews• Orientation for new staff• Identify Best Practices (What we do

well)• Identify Issues (Areas to improve)• See your individual contributions • Show the organization and other

departments “What you do.”• Understand how you interact and

connect to other departments

Organization Goals

Key Work System

Department Processes

Individual Processes

Work System Map Development

1. Director, Supervisor, Manager set direction by identifying Department Processes2. Staff, using sticky notes (one process per sticky note), identify individual work processes (tasks performed

on a daily/weekly/monthly/quarterly/annual basis). There is no wrong answer. 3. Director, Supervisor, Manager consolidate staff feedback4. Staff provide final approval/changes5. Send to print

Big Dot Goals Key Performance Measures 2.2a(5) and 4.1a(1)

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0102030405060708090

1.11.2

2.1

2.2

3.1

3.2

4.1

4.2

5.15.2

6.1

6.2

7.1

7.2

7.3

7.4

7.5

2015MBNQA 2016MBNQA (BSVE) 2017 MBNQA

Leadership

Strategy

Customers


Workforce

Operations






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Category 3 Best Practice

Brian R. DieterPresident & CEO

Mary Greeley Medical Center

Listening &Learning Approaches

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Patient & Family Advisory CouncilListening to Patients and Other Customers 3.1a

Received the 2019 CMS Challenge Coin from the Quality Improvement & Innovation Group

Inpatient Experience Rating approaching top decile performance across all NRC clients

Inpatient Experience Overall RatingPatient Satisfaction 3.1b(1)

81.0%

82.3%81.7%

82.8%83.3%

74.0%

76.0%

78.0%

80.0%

82.0%

84.0%

86.0%

FY15 FY16 FY17 FY18 FY19ytd

% O

vera

ll Ra

ting

9 or

10

Fiscal Year

Inpatient NRC Top 25% NRC Top 10%

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Employee Goal CardsCreating a Focus on Action 1.1c(2)

Tiered Daily Safety HuddlesWorkforce Engagement 5.2a

Tier 1 7:00am-8:00amBedside Shift Report – identify issues/Shift Safety Report Tier 2 8:00am-8:30amDepartment Huddle – complete Shift Safety Report & PostTier 3 8:45am Organizational Huddle – report last/current/future shift safety concerns

Priorities to report at the Daily Organizational Safety Huddle at 8:45am:Focus is on SAFETY – only report if you have a ‘safety concern’ in your department

1. Days since last fall, pressure injury, SSI, needle stick, musculoskeletal injuries, lost time injury

2. A3’s to be done and action taken3. Complete A3 resolution in 72 hours

When safety portion of huddle is concluded, report successes/recognitions or other updates

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0102030405060708090

1.11.2

2.1

2.2

3.1

3.2

4.1

4.2

5.15.2

6.1

6.2

7.1

7.2

7.3

7.4

7.5

2015MBNQA 2016MBNQA (BSVE) 2017MBNQA 2018MBNQA

Leadership

Strategy

Customers


Workforce

Operations






Keys to Success at Mary Greeley Medical Center

• Senior Leader engagement and discipline • Baldrige criteria provides a Framework for

Excellence– Annual application submission provides rigorous self-

assessment.– Feedback report supports annual action planning.

• Our work and the Mission, Vision and Values of the organization align with the Baldrige Core Values.

• The Baldrige process becomes part of the work we do everyday.

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Questions?

Contact InformationRon SmithManager, Performance Improvement and Lean FacilitationMary Greeley Medical Center1111 Duff Ave. Ames, IA [email protected]

mailto:[email protected]

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