4 Dave Munch HASA Lean Final

Lean Applied in Healthcare in the USA
2013 HASA Conference
David Munch M.D.
IHI Faculty
Chief Clinical Officer
Healthcare Performance Partners
Develop “True North” and align the organization
to that pursuit
Strategy development and deployment
Develop systems and structures
Eliminate waste
and make the
right work easier
to do
Engage staff in
surfacing and
solving
problems
Leadership Standard
Work
Visual Management
Kaizen
5S
A3 Problem Solving
Safety Culture
Develop and support all staff in continuous
improvement
Developing Lean Leaders
A3 Deployment
Organizational Development and Learning
How we measure improvement within the
System: The Value Diamond
Quality
Core Measures, Quality Goals,
Service Issues, 1st Time 100%
Accurate
`
Financial
Materials,
Capital,
Revenue Cycle
Our services:
INCREASE Revenue
DECREASE Costs
IMPROVE Quality,
Satisfaction,
and Safety
Time
Capacity, Wait
Times, LOS, TAT
Satisfaction
Patient, Staff,
Physician
4
Disciplined Problem Solving
A3 Process
Follows
Scientific
Method
Problem
Cause
Solution
Action
Measurement
Similar To
Healthcare
Familiar
PDCA
The 8 Wastes
Everything the organization
does needs to be treated as a
process that serves the patient/
customer.
Steps that don’t directly provide better
care to the patient/customer
must be considered Non-Value added or
WASTE!
l 
l 
l 
l 
RN Time Distribution
Direct Patient
Care 19%
l 
Indirect Patient
Care 24%
l 
Regulatory 12%
Waste45%
l 
l 
Defects
Over-Production
Waiting
Not Clear
(Confusion)
Transporting
Inventory
Motion
Excess Processing
Insanity
7
What you can do in a short amount of time
8
The Problem: Unnecessary COPD Hospitalizations
Patient is
discharged
without training
in use of inhaler
MD gives patient
prescription for
inhaler, but no
training
Patient gets
inhaler from
pharmacy, but
no training
Patient is treated
with nebulizer
during hospital
stay
Patient fails to
use inhaler
properly,
leading to
hospitalization
9
Improving Quality Metrics
PA Urban Medical Center (NFP)
48%
decrease in
readmissions
(sustained and
improving)
The concept of built in reliability
Lean is about knowing normal from abnormal
right now and responding right now
High Probability Harm or Damage Determining Cause Low Defect: E.g.. Adverse Event Time Adapted from slide by John Shook: U. Michigan The Power of Coaching
JCAHO Transforming Care
Understanding The Problem 12 Manager Coach Training Manager Coaching Weekly Hand Hygiene Rates
October 2008-December 2010
100%
90%
Rate of Compliance
80%
70%
60%
50%
40%
30%
20%
10%
0%
P
UCL
Average
LCL
13 1/
1
2/ /08
1
3/ /08
1
4/ /08
8
5/ /08
8
6/ /08
8
7/ /08
8
8/ /08
8
9/ /08
10 8/0
/ 8
11 8/0
/ 8
12 8/0
/8 8
1/ /08
1
2/ /09
1
3/ /09
1
4/ /09
1
5/ /09
1
6/ /09
1
7/ /09
1
8/ /09
1
9/ /09
10 1/0
/ 9
11 1/0
/ 9
12 1/0
/1 9
1/ /09
1
2/ /10
1
3/ /10
1
4/ /10
1
5/ /10
1
6/ /10
1
7/ /10
1
8/ /10
1
9/ /10
10 1/1
/ 0
11 1/1
/ 0
12 1/1
/1 0
/1
0
HAI Prevalence
3.00
120
2.50
100
2.00
80
1.50
60
1.00
40
0.50
20
0.00
0
HAI Prevelance per 1,000 pt days
Hand hygiene percent compliance
Hand Hygiene Compliance
Outcome Measures
Does all this washing make a difference?
HAI Prevalence Correlated with Hand Hygiene Compliance
Case Example:
A3 Deployment
Winona Healthcare
A3 Problem Solving Deployment Schedule
1. 
Train 22 A3 Problem Solving Coaches
November – December 2012
2. 
Train 75 A3 Problem Solvers
January – February 2013
3. 
A3 Coaching Skills Transfer
November 2012 – May 2013
4. 
Begin integrating problem solving A3
March 2013
selection with 2013 Hoshin Planning
5. 
Implement Improvement Tracking
January 2013
System
6. 
Implement systematic Improvement
April 2013
Recognition System
7. 
Implement systematic Value Realization
practices
April 2013
A3 Problem Solving Deployment – A3
Volumes
2013 YTD Completed A3s
A3 Volume
Total Completed A3s
61
A3 Strategically Alignment
•  Satisfaction
•  Safety
•  Quality
•  Financial
•  Time
26
16
26
29
6
Financial and Staffing Impact
Projected First Year Value
Completed A3s - 2013
Hard Dollar
Revenue
Enhancement
Access – Eliminate Text Messages
$396,000
Ortho Clinic Therapy Referrals
$141,192
Screening Mammogram Access
$110,000
Access – Scanning Referral Notes
$98,000
Access – Provider Mail Processing
$79,200
Access – No Shows
$26,100
Charge Write Offs/Denials PR-227
$9,000
Podiatry Lost Charges
$4,800
Access – Prior Authorizations
$4,800
Medication Ordering
Hard
Dollar
Savings
Soft
Dollar
Savings
Time Saved
Hours/Year
$23,651
Specialty Clinic Sterilization
$2,340
Blanket Warmers in Imaging
259
Registration Errors Client Accounts
162
Lab and Client Billing
96
Tracking Dialysis Adequacy Values
50
Total
$869,092
$23,651
$2,340
567
David Munch M.D.
Faculty IHI
Chief Clinical Officer
Healthcare Performance Partners