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Webinar Slides - Accelerated Development Learning Session
Applying Lean Principles in Health Care Gary Kaplan Virginia Mason Health System Craig Samitt Dean Health System Joe McCannon Centers for Medicare and Medicaid Services Henry Bachofer and Michael Trisolini RTI International We will start shortly after 12:00 PM EST Please mute your phone except when asking a question. Do not put your telephone on hold during the webinar. DISCLAIMER. The views expressed in this presentation are the views of the speaker and do not necessarily reflect the views or policies of the Centers for Medicare and Medicaid Services. The materials provided are intended for educational use and the information contained within has no bearing on participation in any CMS program. WebEx Instructions DISCLAIMER. The views expressed in this presentation are the views of the speaker and do not necessarily reflect the views or policies of the Centers for Medicare and Medicaid Services. The materials provided are intended for educational use and the information contained within has no bearing on participation in any CMS program. How to Ask Questions • When the webinar is open for questions, the audience will be unmuted in the WebEx system. • To avoid background noise, please mute your phones unless you are asking a question. • You can also submit questions through the chat function 3 DISCLAIMER. The views expressed in this presentation are the views of the speaker and do not necessarily reflect the views or policies of the Centers for Medicare and Medicaid Services. The materials provided are intended for educational use and the information contained within has no bearing on participation in any CMS program. Overview of the Virginia Mason Production System Accountable Care Organizations Accelerated Development Learning Session Webinar January 13, 2012 Gary S. Kaplan, MD Chairman and CEO Virginia Mason Medical Center Patient Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Production System © 2009 Virginia Mason Medical Center Virginia Mason Foundation © 2011 Virginia Mason Medical Center “If you are dreaming about it… you can do it.” Sensei Chihiro Nakao Virginia Mason Medical Center •Integrated health care system •501(c)3 not-for-profit •336-bed hospital •Eight locations •500 physicians •5,000 employees •Graduate Medical Education •Research Institute •Foundation •Virginia Mason Institute Patient Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Production System © 2009 Virginia Mason Medical Center Virginia Mason Foundation A Shared Vision Clash Of “Promise” And Imperatives Traditional “Promise” Legacy Expectations Imperatives • Improve safety/quality • Autonomy • Implement EHR • Protection • Create service experience • Entitlement • Be patient-focused • Improve access • Improve efficiency • Recruit/retain quality staff Patient Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Production System © 2009 Virginia Mason Medical Center Virginia Mason Foundation Compact Aligns with Vision Patient Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Production System © 2009 Virginia Mason Medical Center Virginia Mason Foundation Finding a New Method “You should submit wisdom to the company. If you don’t have any wisdom to contribute, submit sweat. If nothing else, work hard and don’t sleep. Or resign.” Taiichi Ohno Seeing with our Eyes Japan 2002 Virginia Mason Production System 1. 2. 3. 4. 5. Patient is always first Focus on highest quality & safety Engage all employees Strive for highest satisfaction levels Maintain a successful economic enterprise Patient Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Production System © 2009 Virginia Mason Medical Center Virginia Mason Foundation ©2011 Virginia Mason Medical Center Start by Removing Waste • • • • • • • Waste of time Waste of making defective products or poor quality Waste of overproduction Waste of motion Waste of inventory Waste of over processing Waste of transportation Patient Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Production System © 2009 Virginia Mason Medical Center Virginia Mason Foundation ©2011 Virginia Mason Medical Center Think Different • ½ the human effort • ½ the space • ½ the equipment • ½ the inventory • ½ the investment • ½ the engineering hours • ½ the new product development time The Methods & Tools that Transform Work • Value Stream Development • 5S (Sort, simplify, standardize, sweep, self-discipline) • Standard Work • Flow • Mistake Proofing • RPIW (Rapid Process Improvement Workshop) Patient Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Production System © 2009 Virginia Mason Medical Center Virginia Mason Foundation ©2011 Virginia Mason Medical Center Value Stream Map Patient Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Production System © 2009 Virginia Mason Medical Center Virginia Mason Foundation Organize the Workplace 5S Self Discipline: Sort: •Maintain standards through training, empowerment, commitment and discipline •Separate necessary from unnecessary Standardize: Simplify: • Create common agreements • Communicate to the team •A place for everything needed and everything needed in its place and ready to use. Sweep: •Inspection that everything is where it belongs. •Visual confirmation that 5S agreements are being followed Patient Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Production System © 2009 Virginia Mason Medical Center Virginia Mason Foundation Start with 5S 5S Anesthesia - Before 5S Creates Safety 5S Anesthesia “Shadow Board” –After Adopt Standard Work Variation STANDARDIZATION Improvement “Without Standards There can be no Improvement” Patient Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Production System © 2009 Virginia Mason Medical Center Virginia Mason Foundation Central Line Insertion Standard Work Before Dry: 30 sec scrub 30 sec dry Wet: 2 min scrub 1 min dry Paws Maximum Barrier Protection OR AND Thyroid Angio Drapes During Transducer Kit in Top Drawer of Cart OR Transducer Method Manometer Method After Patient “Approved to use Date/Initial Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Production System © 2009 Virginia Mason Medical Center Yellow – top of cart Complete Paperwork Strategies People We attract and develop the best team ” Virginia Mason Foundation – in chart progress notes White Make it Flow Flow of Patients Flow of Family and Relationships Flow of Providers Flow of Information Flow of Medications Flow of Supplies Flow of Equipment Flow of Process Engineering Patient Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Production System © 2009 Virginia Mason Medical Center Virginia Mason Foundation Flow Stations URGENT Flow Station Inbox (e.g. labs) Non-urgent Electronic Flow Station MESSAGE Inbox (e.g. mail) CERNERTE ST RESULT REPORT, RTE, Sign & Review CHARGESLIP MD MA $ DOCUMENT VISIT Patient Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Production System © 2009 Virginia Mason Medical Center Virginia Mason Foundation Build safety into the process Zero Defects Pokayoke Self-Check Successive Check Patient Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Production System © 2009 Virginia Mason Medical Center Virginia Mason Foundation Stopping the line Patient Safety Alert Process Created August 2002 • Leadership from the top • “Drop and run” commitment • 24/7 policy, procedure, staffing • Legal and reporting safeguards 20,000th PSA Reported July 2005 March 2008 February 2011 # of PSAs reported monthly 20,000th 10,000th 1000th Patient Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Production System © 2009 Virginia Mason Medical Center Virginia Mason Foundation “Stopping the Line” Organization-wide Involvement # of PSA's • 400 350 • 300 250 200 150 • 100 50 0 2002 2003 2004 2005 2006 2007 2008 2009 2010 Patient Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Production System © 2009 Virginia Mason Medical Center Virginia Mason Foundation Staff identify and report issues and concerns using the Patient Safety Alert System Leadership involvement with investigation and resolution Board Quality Committee review and approve closure of high-severity issues (Red PSA’s) Reduced Cost of Poor Quality Patient Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Production System © 2009 Virginia Mason Medical Center Virginia Mason Foundation © 2011, Virginia Mason Medical Prevalence of Hospital-Acquired Pressure Ulcers 10% 9% 8% 7% 7% 6% 6% 5% 5% 4% 3% 3% 2% 2% 2% 1% 1% 0% Q1 08 Patient Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Production System © 2009 Virginia Mason Medical Center Virginia Mason Foundation Q2 08 Q3 08 Q4 08 Q1 09 Q2 09 Q3 09 Falls and Falls with Injury / 1000 Patient Days Overall VMMC 10.00 9.00 8.00 Falls / 1000 Patient Days 7.00 Falls University Begins 6.00 TWI Hourly Rounding Begins 5.00 3.74 4.00 3.33 3.41 3.04 3.10 2.88 2.74 3.00 2.92 2.91 2.56 2.18 2.35 1.73 2.00 2.30 2.13 1.68 1.67 1.79 1.65 1.33 1.04 0.77 1.00 0.99 0.81 0.75 1.29 1.02 0.96 0.43 0.44 0.44 0.73 0.61 0.71 0.45 0.30 0.46 0.17 0.30 0.29 0.00 Avg Avg Avg Avg Jan-09Feb-09Mar-09Apr-09 May- Jun-09 Jul-09 AugY2006 Y2007 Y2008 Y2009 09 09 Patient Time Frame Vision To be the Quality Leader and transform health care Mission Sep- Oct-09 Nov09 09 Dec- Jan-10Feb-10Mar-10Apr-10 09 Overall VMMC Average Falls / 1000 PT days To improve the health and well -being of the patients we serve Overall VMMC Average Falls with Injury / 1000 PT days Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Production System © 2009 Virginia Mason Medical Center Virginia Mason Foundation 2011 Mary McClinton Safety Award Medication Reconciliation Percent of Reconciled Medications on Discharge 100% 90% November 2010: PowerChart Phase II: 80% 70% 60% 50% 40% 30% 20% 10% 0% % Patient Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Production System © 2009 Virginia Mason Medical Center Virginia Mason Foundation VM Target UCL LCL Let those who do the work improve the work RPIW: A team of people who do the work, fully engaged in a rigorous and disciplined five-day process, using the tools of VMPS to achieve immediate results in the elimination of waste Kaizen Event: A team of people who do the work, fully engaged in a rigorous and disciplined two- day process, using the tools of VMPS to achieve immediate results in the elimination of waste Patient Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Production System © 2009 Virginia Mason Medical Center Virginia Mason Foundation Ideas that Transform Patient Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Production System © 2009 Virginia Mason Medical Center Virginia Mason Foundation Patient Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Production System © 2009 Virginia Mason Medical Center Virginia Mason Foundation Move Across Silos Clinic Experience Inpatient Care Patient Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Production System © 2009 Virginia Mason Medical Center Virginia Mason Foundation Orthopedic Model Line Periop Flow Follow Up Care Support the Effort Kaizen Promotion Office (KPO) • 1-5% of all VMMC staff as KPO • KPO aligned with operational executive leadership • Executive sponsorship with accountability for sustained results • Education Patient Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Production System © 2009 Virginia Mason Medical Center Virginia Mason Foundation Educate the Staff and Leaders All Staff • Introduction to VMPS • VMPS General Education (tools and methods) • Everyday Lean Ideas Supervisors and Managers • VMPS for Leaders • Standard Work for Leaders Directors, Executives, and Physician Leaders • VMPS Certification • Standard Work for Leaders Patient Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Foundation Virginia Mason Production System © 2009 Virginia Mason Medical Center © 2011 Virginia Mason Medical Center Align the Vision with Resource Patient Long Term Vision Vision To be the Quality Leader and transform health care Mission To improve the health and well-being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Service We relentlessly pursue the highest quality outcomes of care We create an extraordinary patient experience 5 Year Plans Innovation We foster a culture of learning and innovation Virginia Mason Team Medicine Foundational Elements SM Strong Economics Responsible Governance Integrated Information Systems Education Research Virginia Mason Production System Virginia Mason Foundation Annual Goals Quality and Safety 1. Ambulatory Prevention Bundles 2. Optimize Care Transitions 3. Zero Nosocomial Injuries Fall Prevention Health-care Acquired Infections 4. Patient Safety Curriculum 5. Innovative Clinical Value Streams Patient Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Production System © 2009 Virginia Mason Medical Center Virginia Mason Foundation KPO Priorities Connect the Dots PeopleLink Tier 3 Reporting: Managers report to department staff and Administrative Directors “Stand Up” Tier 2 Reporting: Vice Presidents, KPO and Administrative Directors report updates on key metrics to the Chief Executive Officer Tier 1 Reporting: Senior Executive Leadership reports updates on key metrics to the Board of Directors Patient Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Production System © 2009 Virginia Mason Medical Center Virginia Mason Foundation Leaders Sustain the Rigor Tuesday Stand up Friday Report Out Standard Work for Leaders “Go and See” Go and See Big Ears, Big Eyes, Small Mouth Patient Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Production System © 2009 Virginia Mason Medical Center Virginia Mason Foundation Capture Wisdom Everyday Lean Idea Form Strive for the Highest Satisfaction 100 90 80 70 60 50 40 30 20 10 0 2007 Patient Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Virginia Mason Team Strong Economics Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Production System © 2009 Virginia Mason Medical Center Staff Satisfaction Hospital Clinic Virginia Mason Foundation 2008 2009 2010 Maintain a Successful Economic Enterprise $ (Millions) 50 45 40 35 30 25 20 15 10 5 0 47.6 40.9 Shared Success Program 28 18.4 12 0.7 3.2 2000 2005 2006 2007 2008 2009 2010 Patient Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Production System © 2009 Virginia Mason Medical Center Virginia Mason Foundation During 2007 – 2009 VM and Boeing collaborated to implement an “ambulatory ICU” program Aim: reduce Boeing’s healthcare cost for employees with the most expensive health conditions by 15% while improving their health status The Boeing Company: Connect and protect people globally Patient Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Production System © 2009 Virginia Mason Medical Center Virginia Mason Foundation VM’s cost/utilization metrics were outstanding -100% -80% -60% Costs (standardized) Prescriptions (day supply) Prescriptions Out-patient (other) Home Health Visits Dental Lab Radiology Outpatient Visits Office Visits ER Visits Hospital Days (acute) Patient Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Foundation Admits (acute) Virginia Mason Production System © 2009 Virginia Mason Medical Center -40% -20% 0% 20% Requirements for Transformation Improvement Method Applied to ALL Processes Critical mass feels urgency for change Executives address technical AND human dimensions of change Visible and committed leadership Broad and deep commitment to shared vision New compact aligns expectations with vision Don’t Let Up Patient Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Production System © 2009 Virginia Mason Medical Center Virginia Mason Foundation December 2010 Change the Paradigm FROM • • • • • • • • • TO Provider First Waiting is Good Errors are to be Expected Diffuse Accountability Add Resources Reduce Cost Retrospective Quality Assurance Management Oversight We Have Time • • • • • • • • • Patient First Waiting is Bad Defect-free Medicine Rigorous Accountability No New Resources Reduce Waste Real-time Quality Assurance Management On Site We Have No Time © 2011 Virginia Mason Medical Center “In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists.” Eric Hoffer Patient Vision To be the Quality Leader and transform health care Mission To improve the health and well -being of the patients we serve Values Teamwork | Integrity | Excellence | Service Strategies People We attract and develop the best team Quality Virginia Mason Team Strong Economics Responsible Governance Service We relentlessly pursue the highest quality outcomes of care Medicine Integrated Information Systems We create an extraordinary patient experience Innovation We foster a culture of learning and innovation SMFoundational Elements Education Research Virginia Mason Production System © 2009 Virginia Mason Medical Center Virginia Mason Foundation Copyright © 2009 Virginia Mason Medical Center. All Rights Reserved. Lean@Dean: Applying Lean Principles in the Journey to Accountable Care Craig E. Samtt, MD, MBA President & CEO, Dean Clinic January 13, 2012 ACO Accelerated Development Learning Program Webinar Series Our Focus Today • Our Story: Introducing Dean Clinic and our vision for transforming healthcare • Our Journey: Using Lean as a key component of our transformation strategy • Our Results: “Better Care at a Lower Cost” through Lean • Our Next Steps: Our new innovations and fine-tuning our approach Page 53 Our Story Page 54 Our Heritage: Partners who Care for over 100 years … Page 55 Our Structure: A Virtually Integrated System Dean Health Systems (MD Shareholders) SSM Health Care Dean Clinic Rural Network ASC System Page 56 Dean Health Plan WIITTS (Technology Company) Navitus Health Solutions (PBM) Our Destiny: Accountability Page 57 Our Vision: Transformation in all we do Let the rest of our industry focus on Volume. We’re focusing on Value. Page 58 Our Strategy: Value through Integration Page 59 Our Approach: Change from within “We must become the change we want to see” Mahatma Gandhi Page 60 Our Tactics: Applying Business Tools to Transform Healthcare Delivery Incentives Building an Effective Team Data Reliance Service Innovation: Lean@Dean The Art of Influence Becoming Virtual Avoiding Obsolescence Page 61 Optimal Use of Technology Standardization Business Development Our Tactics: Applying Business Tools to Transform Healthcare Delivery Incentives Building an Effective Team Data Reliance Service Innovation: Optimal Use of Technology Lean@Dean The Art of Influence Becoming Virtual Avoiding Obsolescence Page 62 Standardization Business Development Our Journey Page 63 The Dean Clinic Improvement System Lean@Dean Page 64 We’re just getting started Page 65 We’ve learned from others Page 66 The journey has been colorful Page 67 We Looked for Needles in Haystacks… and found low-hanging fruit Page 68 We found waste administratively And we found waste clinically Medical Flow Waste: • • • • • • • • F I X I T N O W finding/searching (motion) imperfections (defects) xtra process steps inventory transportation non used human potential over production waiting (time) Page 69 •Flow of patients •Flow of providers •Flow of medications •Flow of supplies •Flow of information •Flow of equipment •Flow of process We solidly but prudently built our infrastructure Page 70 We involved the whole team. Page 71 We started with standouts Page 72 We focused on our five goals. Financial Growth People Quality Service Page 73 Then concentrated on broad value streams ACCESS •Phone triage •Walk-in triage •MyChart activation protocols •Standardized schedules •E-visits COORDINATED CARE •Care coordination initiative in development •Referral tracking •After-visit planning Primary Care Re-Design Value Stream Page 74 TEAM BASED CARE •Pre-visit summary at check-in (meds, allergies, demographics) •Medication Refill protocols •Panel size management with ideal provider mix QUALITY CARE •Quality metric monthly reports •Population management using Reporting Workbench •Pre-visit workflows (labs and health maintenance) COMPREHENSIVE CARE •Pre-visit planning •Quality, service and access incentives and then moved to more targeted hot spots Page 75 Blood Pressure Process Improvement Success Story And spent most time Focuses: on specific Rapid Improvement Events Process Owner: Jane Klann, Clinic Manager Medical Champion: Danielle Gindlesberger, MD Project Sponsor: Charles DeShazer, MD • Zero Defects in the BP reading process & standard workflow for the Provider. • Providing the patient with Hypertension educational materials at the visit if BP is above target. • BP check and adjustments made every two weeks until BP is in control. BP Control Percentage 90.0 85.0 Percentage 80.0 80.4 Corporate Goal 78% 75.0 75.8 77.6 78.7 73.4 70.0 69.9 Initiated 68.4 65.0 Spread Rapid Improvement Event 60.0 April 2011 May 2011 June 2011 July 2011 Aug 2011 Sept 2011 Dean - Deerfield/Sun Prairie Family Medicine PageClinic 76 Oct 2011 Last updated: 12/07/11 We followed a formal approach, and improved upon it over time 12 weeks before – Sponsors & PI Team create plans – Select teams and collect data 3 Weeks before – RIE prep work begins 2 Weeks before – Pre work continues 1 Week before – Finalize data, goals & plans Day 1 – Training, study current conditions Day 2 – Apply tools, make changes, experiment Day 3 – Apply tools, make changes, experiment Day 4 - Standard work Day 5 - Presentation 1st week after – leadership audit, problem solving 2nd week after – measure, measure, measure 3rd week after – daily management and sustain Page 77 We’ve applied Lean broadly Page 78 We’ve held ourselves accountable for our True-North Metrics. Page 79 Our Results Page 80 We were hoping Lean@Dean would “raise all boats” from a goals perspective… and it has. Page 81 Improvements in Patient Satisfaction Average Improvement in Overall Provider Rating “Overall Rating of Doctor” 80.20% (Shadowed vs. Non-Shadowed, variable baseline to Dec. '10) 7.00% 79.20% 78.20% 77.20% 76.20% "9 or 10" 75.20% 74.20% 73.20% Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 '09 '09 '10 '10 '10 '10 '11 '11 Page 82 % Improvement from Baseline TARGET 5.70% 6.00% 5.00% 4.00% Shadowed Non-Shadowed 3.00% 2.00% 0.70% 1.00% 0.00% Shadowed Non-Shadowed 82 Improvements in Medical Staff Satisfaction Page 83 Improvements in Employee Satisfaction Page 84 Improvements in Clinical QualityPart 1 Page 85 Improvements in Clinical QualityPart 2 Page 86 Improvements in Clinical QualityPart 3 Page 87 Our Next Steps Page 88 We’re seeking our Waste in new and different ways: Introducing The WASTEbasket Page 89 We’re using lean principles to optimize our use of technology. Page 90 We’re utilizing “Dean Listens”, our online patient focus group, to include patients in our Lean work Page 91 We’re focusing on implementing a strategy for spread Page 92 And a standard changemanagement model And all-the-while becoming more sophisticated in our use of Lean Page 93 Questions? Page 94 Thank You Craig E. Samitt, MD, MBA President & CEO, Dean Clinic [email protected] (608) 215-6300 Page 95
