2 years of Lean at SFGH

Lean Update to the JCC

February 24, 2014

Reflection

2 years

(SFGH)

• 5 active Value Streams

• Tier 1 Report

• Tier 2 Reports

• 30 leaders completed Lean Certification

• 35 more are in Certification

5-7 years

(San Mateo Medical Center)

• All departments, clinics, units have undergone 5S

• Established robust Standard Work auditing

• Accountability and responsibility

10-15 years

(Virginia Mason, Theda Care)

• All leaders in the organization have learned, and practice the fundamental principles of Lean

• All departments, clinics, units have developed and validated Standard Work for their processes

Lean Journey in Healthcare

Continuous Daily Improvement

Lean is a rigorous, disciplined approach to improvement work, where continuous daily improvement IS the work

P

C

D A

SFGH’s Mission: To provide quality health care and trauma services with compassion and respect

Teamwork Respect Learning to

See Continuous

Improvement Challenge

Lean Values and the SFGH Mission

Accomplishments – 3M

Morning Huddle Collecting Co-pays on-site

Sponsor: Sue Currin Process Owners: Dana Nelson

Accomplishments – Urgent Care

Standard Work for the Discharge Process On-site Radiology

Sponsor: Roland Pickens/Iman Nazeeri-Simmons Process Owners: Ron Labuguen, Ricardo Ballin

Accomplishments – OR/PACU

5S – Back Hallway 5S – Sterile Core

Sponsor: Todd May Process Owners: Patty Coggan, Jerry Padilla

Accomplishments – 4D Med/Surg

Before – Hallway Storage After – Nurse Workstations

Sponsor: Terry Dentoni Process Owners: Andre Campbell, Mike Daly, Nela Ponferrada

Accomplishments - Radiology

Before – MRI Waiting Area After – MRI Dressing Room

Sponsor: Shermineh Jafarieh Process Owners: David Sostarich, Mark Wilson

Accomplishments

• 8 Lean Black Belts Dennise Rosas

Michael Pfeffer

Brandi Frazier

Aiyana Johnson

• Partnering with DET, Facilities, EVS, Materials Management

Iman Nazeeri-Simmons Alice Chen Will Huen Joe Clement

Accomplishments

• 8 Patient Advisors

Preparing for the Future

New Hospital Workflow

Vision for Bldg 25: To be the best hospital by

exceeding patient expectations and advancing

community wellness in a patient centered, healing

environment.

Optimal use of Resources

Integrated Information

Systems

Data to support decision making

Technology

Clear Communication:

Staff Department W/ Patients

Service Excellence

Healing Physical

Environment

Comprehensive Integrated Care

Model

Lean Improvement Methodology

SFGH Mission: To provide quality healthcare

and trauma services with compassion and respect.

Future State: Building 25

San Francisco General Hospital A3 – 3P

Patient Centered Care

HCAHPS Scores Safe, secure environment (AWOL, AMA)

Patient engagement Individual care plan (Audit results, LOS)

Pt access (Lead Time, defects)Communication Among Care Providers

Maximizing value Staff training for EOC

(ROK: Cost, Triple Aim) Halogen% Survey results

culture of safety survey

Quality Measurements

Community Wellness Fall Rates Core Measure Outcomes

Patient education teachback HAC's (Ulcer, UTI, ADR's)

Hospital Re-admission rates

Smoking Cessation rate Healing Environment

Primary care linkage % HCAHPS Scores:

Community engagement Food choices

Clean bathrooms & environment

Noise levels

ACTIVITY DATE:

WSL Ann Kernan - RCG Tim Greer

TL Steve Mattson - RCG Gillian Otway

Lawrence Nichols

Sponsor Elena Tinloy

Grobal

process

Elaine Lee

Alice ChenKathy Jung

Juliana Oronos Rachael Kagan Bill Kim

Jason Zook Tristan Cook

Dennise RosasKPO

Participants

Sue Currin, CEO Shermineh Jafarieh

James Alexander Valerie Inouye

Baljeet Sangha Terry DentoniLeadership

David Woods

Todd MayIman Nazeeri-Simmons

Cathryn Thurow William Huen

Facilitators

Sue Carlisle

Terry Saltz

Current state

Key features of Improvement Request (Top 12) Business Requirements (Business impact, strategic requirement)

TARGET STATEMENT

Mission & Vision:

Integration: Seamless, Alignment,

Communication, Patient Centered

Data: Actionable, Integrity, Informative,

Timely

Comprehensive Care: Holistic, Timely,

Appropriate, Safe Reliable

Technology: Cost effective, Integrated,

Visionary

2. 3P Emergency Department: Flow in the ED incuding triage, staffing, signaling,

communications, admissions to the floor as well as flexing to meet changes in

demand and acuity.

3. 3P Operating Room/ PACU/ Procedural Services: Shared processes, patient flow and staffing.

3.1 Post 3P KW: Basement 2 flow: Diagnostic Imaging, Pulmonary &

Cardiology - shared processes and patient flow.

1. 3P Inpatient Services March 17-21

Visioning Workshop participants

Cost Effective: No Waste,

Just In Time, Strategic,

Accountable, Informed

Environment: Safe, Healing,

Easy to navigate

Lean: Discipline, Structure,

Continuous Improvement,

Innovative, Engagement

Service Excellence:

Satisfaction, Respectful,

Patient Centered

A3-3PTEAM CHARTER Date: 3-Feb-14

PROPOSED ACTIONFuture state

May 5 - 92. 3P Emergency Department

SFGH Mission: To provide quality healthcare and trauma services with compassion and

respect.

Bldg 25 Vision: To be the best hospital by exceeding patient expectations and advancing

community wellness in a patient centered, healing environment.

ACTION PLAN

© 2009 rona consult ing group

Patient Expectations

Customer Requirements (desirable characteristics)

Product /service name : Building 25

San Francisco General Hospital is a world

class hospital and trauma center in the

elementary stages of adopting new

systems of financial and operational

accountability. As such in our current

state we have silos of excellence

composed of well intentioned, mission

driven staff, hampered by aging

infrastructure, lack of integrated and

optimized technology, and disparate flows

of communiation.

Major barriers include:

Lack of integrated EMR

Lean culture is not universal throughout the

organization

Lack of accountability / alignment at all levels

No universal culture of service excellence

Multiple priorities and scope

Bureaucratic systems

Lack of time

Cumbersome IT systems and access to data

Limited resources, staffing and infrastructure

Partnering with unions

Accountable care act considerations

Goal: To design processes that coordinate the 7

flows of medicine where:

Patient care needs are visual to all care team

members

Patient care goals are understood, and

expectations are communicated early in the

process

There are no waits / delays in care

Care is delivered by respectful , high functioning,

cohesive care teams

Decision making is guided by transparent

information

The EMR, data systems and business intelligence

are integrated

Processes are built around the patient, and

services are brought to the patient whenever

possible

Staffing and support models expand and contract

according to fluctuations in demand and acuity

Reliable processes utilize mistake proofing

concepts to eliminate defects

Our staff has exactly what they need to do their

job

The environment is safe, clean, comfortable and

quiet

RESOURCES

1. 3P Inpatient Services: Optimizing patient flow and quality outcomes, looking at staffing models,

flexing to meet changes in demand and acuity.

1.1. Post 3P KW: L&D: Patient flow, staffing and communications.

1.2 Post 3P KW: Med/Surg: Patient flow, acuity changes, staffing, collaborative teams,

documentation and communication.

Detail action items for 3P workshops (Explanation of and deliverables for each 3P workshop)

Boundaries:

• Sterile processing

• Pulmonary

• GI / Endoscopy

• OR / Pre-op / PACU

• Emergency Department

• Med Surg (Peds, ACE)

• ICU / CCU / Stepdown

• IT Requirements

• Support services that will expand their scope

into the new building: Messengers, Patient

Transport, EVS, etc

Monitor implementation of Kaizen improvements weekly and workshop targets with completion of 30,

60 and 90 day reports as well as daily audits of standard work. Weekly review with executive team.

Develop a visual workplace and methods for communication.

Excluded:

• Unaffected departments not moving into the new facility

Included:

• Cardiology

• Cath Lab

• Diagnostic Imaging

• Interventional Radiology

• Dietary

• NICU

• Labor and Delivery

• Pharmacy

• Clinical Lab/Blood bank

CHECK AND ACT

3. 3P OR & Procedural Services June 23 - 27

On the Horizon

SFGH Management System – KPO Development

– State of the Union for Lean implementation

– Return on Kaizen (ROK) analysis

1 More Value Stream:

Outpatient Pharmacy Kick-Off in March 2014