systemcpi jumpstart

8/7/2019 SystemCPI Jumpstart

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SsmCPISM JmpS:

119 HealtHCare IMProveMent oPPortunItIeS IdentIfIed In two weekS

CaSe Study



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About the Organization

Te healthcare organization discussed in this case study is an integrated not-or-prothealthcare system ounded in 1981. It provides comprehensive healthcare services

to several communities in upstate NY and northern Pennsylvania. In addition to a

community-based university-aliated teaching hospital, the system includes three acute-

care community hospitals. Primary and specialty care services are provided in twelve

amily health centers. Te system includes home health, nursing home and long-term

care, and other community health services and agencies. Te system has a combined

medical sta o more than 500 physicians, is licensed to provide more than 800 inpatient

beds, and is one o the region’s primary employers with more than 4,500 employees.

IntroductionIn late 2008, the hospital system was looking to move orward with an implementation o Lean

Six Sigma. However, the leadership team knew that they did not have a deployment strategy

in place to get the results they were looking or. Tey turned to NOVACES to help orm astrategy or Lean Six Sigma deployment and build the inrastructure or a sel-sucient

program. o accomplish this, NOVACES used the company’s SystemCPI, an integrated

roadmap to plan and manage the deployment o process improvement best practices, and to

guide the hospital system along its journey to process improvement excellence.

SystemCPI JumpstartTe JumpStart assists organizations to quickly realize benets rom the deployment. Te

SystemCPI JumpStart program compresses the timeline rom kicko through development

o the deployment plan to two weeks and completes all o the steps in the Assess Phase and

initial steps in the Plan Phase, setting the path or the rst wave o training.

During the JumpStart workshops, the SystemCPI approach addresses two common reasonsor ailures o process improvement deployments: poor project selection and lack o leadership

engagement. o improve the project selection process and ensure that strategically aligned

improvement opportunities are identied, SystemCPI employs three tools:

nSystemVSASM: A system-level value stream analysis o the hospital

nSystem Constraint Identication: an analysis o the constraints that prevent the

organization rom attaining its goals

nStrategic Gap Analysis: a benchmark comparison o hospital perormance against strategic goals

Te deployment strategy developed during JumpStart is designed to drive executive

leadership engagement. Successul CPI deployments must start at the top and ow down

through the organization. Te hospital system’s leadership participated in each o the

Figure 1. SystemCPI Roadmap

At a GlanceOrganizationIntegrated not-or-prothealthcare system

IndustryHealthcare

Business IssueCPI Deployment

Methodology AppliedSystemCPI

Business ImpactnCPI Deployment PlannBusiness Strategy Alignment

n119 Improvement OpportunitiesIdentied in Less Tan 2 Weeks

Financial ResultsnValidated savings o $296K in less

than 90 days

Process ImprovementsAchieved During Initial 90 Days

nReduction o CMS Core MeasureFailures or CHF rom 30% to zero

nEliminatation o 28 minutes romED LOS, a 44% improvement

nReduction o SA Laboratory cycle time by removing 7,300miles per year o travel rom thephlebotomists’ process



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JumpStart sessions. One advantage o JumpStart is that, although the two-week agenda is

aggressive, the team is able to make adjustments to the schedule to allow or the executiveteam to deal with emerging issues that arise on a daily basis in a hospital and still participate

in the planning process.

Te deployment strategy developed during JumpStart is designed to ensure executive

leadership engagement. Successul CPI deployments must start at the top and ow down

through the organization. Te organization’s leadership participated in each o the JumpStart

sessions. One advantage o JumpStart is that, although the two-week agenda is aggressive,

the team is able to make adjustments to the schedule to allow or the deployment team to

deal with emerging issues that arise on a daily basis in a hospital and still participate in the

planning process. Te deployment team included:

nSenior Director, Clinical Operations

nManager o Quality Management

nAdministrator o Public Relations

nDirector o Nursing Operations

nPerormance Improvement Facilitator/Lean Engineer

nEducation and raining Specialist

Leadership Training

Te Executive Leadership eam (EL) participated in a kicko presentation addressing

the SystemCPI approach and the path orward. Te EL attended Champion raining

along with mid-level leaders, who will become Champions. Te training was two days

and covered topics included the undamentals o Lean, Six Sigma, and Constraints

Management, roles and responsibilities, project selection, prioritization, and project

chartering. During course workshops, the EL and Champions jointly developed the

project prioritization system that will be used to select projects. Tus, this initial cadreo Champions became responsible or initiating the rst wave o improvement eorts.

Importantly, the Champions lef the training with project charters in hand.

System Constraint Analysis

Te System Constraint Analysis identies and links critical success actors and conditions

necessary to attain the overarching organizational goal. It provides leaders with visual

map o specic policy and market constraints that can prevent reaching the goal. It also

identies the key leverage points o the organization so that scarce resources are ocusing

on the right opportunities. Constraints are like the weakest link in chain – and the weak

links are where the most impact can be made. For the hospital system, the ocus point

becaime Operational Perormace.

Strategic Gap AnalysisTe Strategic Gap Analysis identies gaps in current perormance by comparing

perormance against established criteria. Te deployment team reviewed numerous

sources to identiy perormance gaps and translated them into improvement opportunities.

NOVACES uses the ollowing data sources or gap analysis:

nPress Ganey Patient Satisaction Survey

nCulture o Saety Survey

nreo Resource Management: LOS, Cost and Charges

nJoint Commission Periodic Perormance Review

nJoint Commission / Centers or Medicare & Medicaid Services (CMS) Core Measures

nQuality Indicators (including HEDIS)

Tools AppliednStrategic Gap AnalysisnSystemVSAnSystem Constraint AnalysisnChange Readiness AssessmentnCPI Maturity AssessmentnProcessVSAnRapid Improvement Workshops



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nNY Dept o Health (National Database o Nursing Quality Indicators)

nUnited Health Services Hospitals (USHS) DashboardnBlue Cross Blue Shield Scorecard

nInternal Clinical Excellence Measures

SystemVSA

Te SystemVSA maps core business processes and

transitions the organization rom a collection

o unctions to a system o interdependent

processes. Te healthcare organization has our

core processes: Inpatient Care, Outpatient Care,

Community Health Services, and Provide/Assure

Healthcare Services (the latter included medical

education, community and government relations,

as well as internal recruitment and retention). Tecore processes are drilled down into component

processes until key perormance metrics and

perormance gaps could be identied.

Synergy of the Triadic Approach

Te combined outcomes o the three event described

above resulted in the identication o 119 strategically

aligned improvement opportunities. Te opportunities

were linked to specic organizational strategies as

well as their level o impact on the core problem area.

Additionally, the most appropriate improvement

methodology was identied to assist in scheduling,

training needs, and resource allocation. Te breakouts

by unction and methodology are shown below.

CPI Maturity Assessment

CPI Maturity Assessment is administered to the

executive leadership team early in the deployment,

typically during JumpStart to provide a baseline or

the organization. It is also administered periodically to

validate progress.Figure 2. Excerpt o SystemVSA or core

process “Provide Outpatient Care”

Figure 3. Breakdown o improvement opportunities by

unction and CPI methodology



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For this healthcare system, the

maturity assessment indicatedthat the organization was actively

pursuing process improvement

throughout the organization.

It also revealed that the work

constituted multiple, localized

eorts but was not yet ocused on

strategic alignment or long term

sustainability.

Change Readiness Assessment

An organization’s willingness to change determines how quickly and thoroughly

the deployment can proceed. By assessing change readiness, dierent drivers or

the deployment are emphasized to produce the best outcomes. Te change readinessassessment measures ve dierent readiness dimensions: communications, culture,

leadership, organization, and skills.

Based on the outcome o the change readiness assessment, the hospital system is well-poised to

move orward with their CPI deployment eorts, but has room or improvement. Tey scored the

highest in communications. For the most part, communications throughout the organization

seemed open and consistent. Te dimension with the weakest score was organization. Tis

is consistent with Peter Drucker’s observation, “Te hospital is altogether the most complex

human organization ever devised.” Te deployment plan included recommendations or them

to adjust current practices that would enhance their adaptability to system-wide change.

Communications Plan

With the active support o their Community Relations Department, the deployment team

produced a very comprehensive communications plan. Te plan identied nine distinct

audiences, sixteen separate communications vehicles and a distinct communications

strategy by audience.

The ResultsO the 119 improvement opportunities identied, the Congestive Heart Failure Discharge,

Patient ranser, and Critical Lab esting/Report ing processes were scheduled or Process

VSAs, in which process-level value streams would be mapped and streamlined. At least

one Rapid Improvement Workshop (RIW) per ProcessVSA was conducted to carry out

improvement actions and get results within the rst 45 days o the deployment kick-o.

Te improvements realized as a result o these eorts were:

nReduction o CMS Core Measure Failures or CHF rom 30% to zeronElimination o 28 minutes rom ED LOS, a 44% improvement

nReduction o SA Laboratory cycle time by removing 7,300 miles per year o travel rom

the phlebotomists’ process

Summary

At the conclusion o the two-week JumpStart, a complete Deployment Plan was

presented to the executive leadership team. Te plan included the results o each o the

three leadership workshops: System Gap Analysis, SystemVSA, and System Constraint

Analysis, both organizational assessments, the communications plan, and the training

plan. As the organization moves into ull-scale deployment, they will begin working on

Figure 4. CPI Maturity Assessment Scorecard

The deployment strategy developed during SystemCPI JumpStart isdesigned to ensureexecutive leadership

engagement.



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Six Sigma projects that will ocus on problem-solving and error reduction. Tere are some

challenges ahead, such as sustainment o an eective project selection system and theneed to standardize a nancial validation process or improvements. Te hospital system

is now in the process o carrying out the training plan to garner Champion support rom

hospital management and utilizing newly trained Lean Six Sigma experts to complete

high-impact improvement projects. About the Author

Dan Chauncey, Director of Deployment Services

Dan is the director o deployment services or NOVACES. He is a

Master Black Belt who has been directly involved in the development

and application o process improvement methodologies or more

than twenty years. He began his career in the U.S. Air Force where,

as a director o strategic planning and quality improvement, he

was responsible or conducting needs analysis and developingthe leadership approach or a variety o service-wide initiatives. Subsequent to his

military service, he joined Humana Inc. where he led a structured approach to process

improvement in the customer service center. At the University Health System in San

Antonio, X he identied improvement opportunities, set the goals and the plan using

the Malcolm Baldrige National Quality Award criteria that resulted in signicant quality

improvements and cost savings. Later during his role as Assistant Vice President at Rath &

Strong, a division o Aon Management Consulting Group, he trained over 850 Green and

Black Belts and mentored over sixty process improvement eorts that realized combined

savings exceeding $6 million. In his role at Grant Tornton, a global accounting, tax and

business advisory, he accomplished the mission o applying Lean principles to achieve a

reduction in cost management reporting cycle times or the U.S. Army. Dan has written

extensively, including Instructional Design or the Corporate rainer: A Handbook onthe Science o raining (Writers Club Press) and he authored the Process Management

chapter in Rath & Strong’s Six Sigma Leadership Handbook (John Wiley & Sons), plus a

variety o articles on the subject o Lean Six Sigma deployment. Dan holds a B.S. degree

in Criminal Justice and Behavioral Science rom Wilmington College, an M.A. in Human

Resource Development and an MBA rom Webster University.



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New OrleaNs, la

red BaNk, NJ

TOll free: 877.577.6888

www.NOvaces.cOm© 2010 NOvaces, llc. a ight

About Us

NOVACES is a leading provider o continuous process improvement (CPI) consulting

and training services. By leveraging over two decades o applied research experience, we

are capable o delivering today’s most eective methods or generating breakthroughs in

operational capabilities and nancial perormance.

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