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*6 Mute your Line *7 Un-mute your line Please do not put your phone on hold. 1-800-504-8071, code 8422006

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Kaizen Model for Continuous Improvement July 23, 2010 1-800-504-8071, code 8422006

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Minnesota Enterprise Lean

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Enterprise Lean A coordinated state government initiative for improving organizational performance and results in Minnesota's state government agencies

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Approach Lean/Kaizen events Six Sigma tools TQM philosophy Tools and training to help state government work better for its customers and employees.

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What is LEAN? Maximize customer value Minimize waste Empower workers Derived from Toyota Production System

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Foundational Elements of Lean 7 wastes 5S Standard work

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7 Wastes Overproduction Waiting Transportation Processing Inventory Motion Defects

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5s Method for organizing work space Sort Shine Set in order Standardize Sustain

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Before 5S

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After 5S

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Standard Work A simple written description of the safest, highest quality, and most efficient way known to perform a process or task. The only acceptable way to do the process it describes. Expected to be continually improved

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Kaizen = change for the better Identify the current state Develop the future state Implement improvements immediately Standardize the process Train on the new process Track sustainment

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Selecting a Kaizen project Affects many stakeholders/customers Consumes a lot of resources Is highly visible to stakeholders/ customers Is clearly not working well Is a core business process Has leadership support Has worker support

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A Kaizen team Facilitator Sponsor Team leader Members No rank all members have equal voice

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Kaizen process Day 1 current state swim lane map Day 2 future state swim lane map Day 3 make and document changes Day 4 document and train on standard work Day 5 present results

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Swim Lane Map

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Define the scope Walk the process Document the process Characterize the process Include time, people, tasks

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Swim lane tips Move chronologically left to right Use post-it notes Hand-offs indicate a lane change Hand-off usually indicates wait time Assign average times to tasks and waits

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Sustain Improvement Overall improvement plan Visible and engaged management Clear roles and responsibilities Accountability for work Communication about improvement A system to support standard work

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Newborn Screening Kaizen Event Ensure that infants who screen positive for metabolic, genetic, or hearing disorders are referred for diagnostic confirmation receive appropriate intervention and receive long-term follow-up services. It will start at the point that the lab provides a presumptive positive.

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Current state Dried Blood Spot Process CurrentFuture QtyTimeQtyTime Tasks6112.75 hrs Waits2151 days Handoffs36 Decisions11 File/stores26 Total time52.5 days

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Early hearing detection and intervention process CurrentFuture QtyTimeQtyTime Tasks8514.5 hrs Waits2256.5 days Handoffs35 Decisions12 File/stores32 Total time58.3 days

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Observations of Current State Lots of handoffs Lots of double storage Lots of re-entry of data Redundancy some good, some bad We are contacting the same people There are necessary waits in the process We are waiting on people outside our agency It is hard to completely map these processes There is a lack of trust in the data systems

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Recommendations Set up tools (Quickplace, sharefolders, case conferences) to promote better communication Redesign the process, train staff in LIMS, and document standard work Develop Access database. Long-term create a functional, child-based, interoperable system for MDH and its stakeholders. Clarify roles in the process and share key information Institute case conferences

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Future State Dried Blood Screening Process CurrentFuture QtyTimeQtyTime Tasks6112.75 hrs255.60 hrs Waits2151 days723 days Handoffs3615 Decisions112 File/stores268 Total time52.5 days23.65 days

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Improvements from new process 59% reduction in tasks 66% reduction in waits 58% reduction in handoffs 81% reduction in decisions 69% reduction in file/stores 56% reduction in cycle time

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Future state hearing detection/intervention CurrentFuture QtyTimeQtyTime Tasks8514.5 hrs438.60 hrs Waits2256.5 days1021.5 days Handoffs3523 Decisions126 File/stores3211 Total time58.3 days22.7 days

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Improvements from new process 49% reduction in tasks 54% reduction in waits 34% reduction in handoffs 50% reduction in decisions 65% reduction in file/stores 61% reduction in cycle time

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Benefits of Future State Save some trees and staff sanity Families are better and more efficiently served Will be able to move forward with more initiatives Will have more time to be proactive instead of reactive Laid the groundwork for future changes Staff will be used more effectively, and less frustrated

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30 - 60 day Action Plan ActionwhowhenComplete Provide LTFU access to Update Registry Chris3-12-09X Training in LIMS for LTFUAmy3-19-09X Assure LTFU staff have access to LIMS Barb3-22-09X Update and/or create audio-related forms Kirsten3-23-09X Create LTFU Access databaseMaggi e 5-6-09X Aug 09 Create standards for data itemsAllison3-31-09X Determine if GCs can track in RegistryAmy3-26-09X

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30 - 60 day Action Plan, Continued Actionwhowhencomplete Create Work Space rooms for blood spot transfers/hearing QA /H & V Amy3-13-09X hearing not possible Write a SOP for the HPRs for Blood Spot Julie3-23-09X Update SOP for the HPRs for Hearing Chris3-23-09X Write script for HPRs to find PCPAmy3-12-09X Finish SOP for LTFU hearingNicole Yaoli 3-24-09X Standardize availability/location of procedures Chris/Bar b 5-1-09X Case conference/set up schedule for future Amy3-13-09X -ongoing Implement new processChris/Bar b 5-18-09X - ongoing

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What must we and the agency do to implement and sustain this effort? We need to have follow-up meetings of this group through implementation and evaluation of the new process Maintain respectful and open communications at all levels We need management and staff support We need some IT resources to implement new process

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Service Contracting Kaizen Event Erin Barkema Iowa Department of Public Health Presented July 23, 2010 34 Quality Improvement in Iowa

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Why a Kaizen event? 35 Customer concerns about the service contracting process Grant application process Issuance of contracts Reimbursement of expenses

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Pre-event activities 36 Identified a facilitator Identified participants Developed a charter Scope Objectives Goals Gathered data

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The Event - November 2-6, 2009 37 Agenda Overview of Kaizen Flow charting Brainstorming Identifying a new process Results Assigning homework Gaining buy-in from leadership

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Flowcharting 38

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Brainstorming 39 7 ideas for improvement 7 different ways to implement main idea

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Brainstorming 40 Small groups Discuss options Identify solutions Prioritize solutions IIII IIIV IMPACTIMPACT DIFFICULTY

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New Process 41

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Homework 42 Twenty-three steps identified on a variety of topics Training curriculum Policies and procedures Standardized forms Use of technology Communication plan Measures to determine change or improvement Assigned to members of the team Due dates established

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Buy-in 43 Report outs to Deputy Director throughout the week. Presented the results of the week to the IDPH Executive Team. Developed a newsletter to keep people informed of the progress.

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Post-event activities 44 HOMEWORK, HOMEWORK, HOMEWORK!!! Follow-up meetings 30 day* 60 day* 90 day* 120 day 150 day 6 month* Communication C ELEBRATION !

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Accomplishments & Lessons Learned 45 Accomplishments Implemented an electronic document library Provided training to over 101 IDPH staff on the new service contracting process Completed 90% of homework assignments to date Lessons learned Kaizen was a great team building experience. Large scale quality improvement work takes time. Improved processes and increased satisfaction will be worth all of the hard work!

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Questions 46

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Information 47 Service Contracting Process http://www.idph.state.ia.us/mphi/quality_improvement.asp Contact Information: Erin Barkema Iowa Department of Public Health ebarkema@idph.state.ia.us (515) 242-5524

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Reflections and Questions

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Announcements from NNPHI

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Site Visits and Final Learning Congresses Schedule is posted on MLC page of website Please let us know the dates of final sessions/learning congresses 2010 Open Forum September 15-17 th Washington, DC Please register/reserve your room. Spots still available for the workshops on Sept. 14 th ! More information regarding presentations/display space is coming soon. Thank you for your patience!

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Storyboard Call (June 18 th ) Foiled by technology! Slides are on MLC page and notes will be available soon. Stories from the MLC http://www.nnphi.org/mlcstories http://www.nnphi.org/mlcstories

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More information www.nnphi.org/mlc