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Presented by: Julia S. Finken, BSN, MBA, CPHQ, CSSBB Associate Director, The Joint Commission j
[email protected] e @jo tco ss o o g 630-792-5283
© Copyright, The Joint Commission
How to Become a Lean Organization While Driving Quality Outcomes
Why Should I Lean my Organization? ]To maximize the efficiency of the organization in order to drive down costs while providing value through exceptional quality client outcomes ]To become a High Reliability Organization – Leadership Commitment – Safety Culture – Robust Process Improvement – Lean Six Sigma – Change Management
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Objectives ]Identify 3 performance improvement tools that can be utilized to Lean your organization. ]Describe 3 key tenants for effective change management. ]Determine key drivers to improve quality outcomes.
Performance Improvement
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Performance Improvement Definition ] Measuring the current state and using this data to improve structure, process and or outcomes.
Performance Improvement Focus ]On Systems not People
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Performance Improvement is the Application of Science ]High Performing Organizations (and Health Care Entities) see it as essential to their success and continuing viability ]Organizations want better outcomes, operations, safety and satisfaction
Deming ]Dr. W. Edwards Deming is the father of the Theory of Profound Knowledge Knowledge, that he stated was essential for any organization that desired to be competitive in today's marketplace
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Profound Knowledge ]Knowledge of Systems ]Knowledge of Statistics (Variation) ]Theory of Knowledge (prediction based on past experience) ]Knowledge of Psychology (Cognition, Motivation & Human Factors)
Why Performance Improvement? ]Health Care Performance in the aggregate Exhibits: – Too much variability – High levels of harm – Operational waste ]This results in: – High Costs – Low Quality
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High Performing Collaborations ] The Organization establishes what is important ] Th The O Organization i ti d determines t i expected t d performance f llevels l ffor: – Clinical outcomes – Operational performance – Safety – Satisfaction ] The Organization develops a Balanced Measurement System ] The existing performance is assessed
High Performing Collaborations (cont.) ] The Business Case for Quality is clearly established. ] Departments/functional areas are aligned with the organization’s performance expectations. ] Priorities for process improvement are identified. ] Appropriate A i t tools t l and d methods th d are used d tto b bring i about b t successful change and improved performance.
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What % of the Organization’s Problems are known to…..
4% 9% 74% 100%
Top Management Middle Managers Supervisors Front-Line Employees/ Physicians
Evolution of Performance Improvement in the Health Care Industry
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Knowledge Center > Learn About Quality > Six Sigma Quality Glossary Definition: Six Sigma n process variation lead to defect reduction and improvement in profits, employee morale, and quality of products or services. Six Sigma quality is a term generally used to indicate a process is well controlled (within process limits ±3s
web@asq knowledge Six 1 0 sixSigma Sigma
History to Today ] Florence Nightingale ] Ernest Codman Codman, W W. Edwards Deming Deming, Walter Shewhart, Joseph Juran and others ] TQM – 1987 embraced by Naval Medicine, 1988 all military medicine ] 1992 PDCA and later Focus PDCA adopted by many Hospitals ] 2000’s Lean Six Si Sigma begins to emerge in Health Care ] Then Robust Process Improvement and High Reliability begins to emerge in health care.
The Hidden Factory of Health Care
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Frameworks for PI ] Lean – When need to reduce waste – Tools include Value Stream Mapping and others ] Six Sigma – To remove defects or variations, or develop new product or process – Tools include DMAIC and others ] Lean Six Sigma – Combination C bi ti off L Lean and d Si Six Si Sigma th theory and d methodology ] PDCA/PDSA/Focus-PDCA ] Other
Lean Theory ]"lean", is a production philosophy that considers the expenditure of resources in any aspect other than the direct creation of value for the end customer to be wasteful, and thus a target for elimination. Working from the perspective of the client who consumes a product or service, "value" is any action or process that a customer would be willing to pay for.
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Examples of The seven Deadly Wastes of Lean in Health Care
Six Sigma Theory ]Six Sigma seeks to improve the quality of process outputs by identifying and removing the causes of defects (errors) and minimizing variability in manufacturing and business processes. It uses a set of quality management methods, including statistical methods, and creates a special infrastructure of p people p within the organization g ("Champions", "Black Belts", "Green Belts", "Yellow Belts", etc..) who are experts in these methods.
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Tenants for Effective Change Management
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]Facilitating Change is a set of actions, supported by a tool set set, used to prepare an organization to seek, commit to, and accept change. Facilitating Change tools increase the exposure and participation of staff and leadership in shaping new solutions and interventions. These tools increase the speed in which the proposed change is adapted and accepted and reinforce its effectiveness.
Changing Behavior
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Resistance to Change ]For many people change is uncomfortable ]All change is a new beginning – Every new beginning is the end of something else – Endings g are unsettling g – People may react out of anxiety, fear or self-preservation
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Facilitating Change Model
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Facilitating Change Model
Robust Process Improvement ]Utilization of Lean Six Sigma and Change Theory to attain sustainable improvement.
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Performance Improvement Tool Box to Lean your Organization
Roles in Team Activities
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DMAIC
Define ]Define the problem and identify opportunities for Improvement – Goals – Scope – Business Case
]Specify what customers value
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Key Questions and Key RPI Tools
Critical Path
• • • • • •
Key Questions What is the problem? Why is it important? Who is the customer? h h ? What is the project scope? What does the customer want? What is critical to quality?
• • • • • • • •
What is the goal? What are you going to improve? By how much are you going to improve it? By how much are you going to improve it? By when are you going to improve it? Who are your key stakeholders? Who will be on the project team What is the project time line? What does the current state look like?
RPI Tools 15 Words; Charter Threats and Opportunities; 3D; Ch t Charter Includes/Excludes; Charter Voice of Customer; Critical to Quality; Quality Function Deployment; Survey Design; Kano Model SMART; More Of/Less Of; Charter SMART; Charter
ARMI; Charter WWW; Charter SIPOC Process Map
Tips to Avoid Potential Pitfalls ]Narrow problem/opportunity definition ]Clear C ea p project ojec scope ((includes/excludes) c udes/e c udes) ]Broad definition of customers/stakeholders ]Inclusive project team (
