Lean At Denver Health:Lean At Denver Health:Saving Lives, Saving Money, Saving Saving Lives, Saving Money, Saving

JobsJobs

Phil GoodmanPhil GoodmanDirector Director

Lean Systems ImprovementLean Systems Improvement

What is LEAN?What is LEAN?

LEAN can be defined as a systematic approach of continuous improvement, based on the Toyota Production System (TPS) of lean principles and lean tools, used for the identification and elimination of waste.

Two PillarsTwo Pillars

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LEAN Pillars of Transformation

LEAN ValuesLEAN Values

• Waste is disrespectful of Society because it wastes scarce resources

• Waste is disrespectful of individuals because it asks them to do work with no value

- President of Toyota

•Waste is disrespectful to patients by asking them to endure processes with no value

•Waste is disrespectful to taxpayers for asking them to financially support processes with no value

Two-Pronged Approach ofTwo-Pronged Approach ofDeploying Lean at Deploying Lean at

Denver HealthDenver Health

• 247 DH Black Belts (BBs):

• 48 hours lean training• Day to day lean • RIE team leads• Quarterly reports• BBs embedded

throughout clinical and non-clinical areas

• 36 Master BB’s

• Rapid Improvement Events (RIEs)

• RIE is 4.5 day team event• 7-9 team members • RIEs are based on Value

Stream Analysis • 16 Value Streams• Each Value Stream will

conduct 8 RIEs per year • Each value stream is

assigned to an executive staff member

Black Belt ProjectsBlack Belt Projects Creative, Innovative, and Productive!Creative, Innovative, and Productive!

DH Black Belts are using lean everyday, in every way….here’s an example:

Engineering: $457,000 reduction in supply expenses

Black Belt Project Example:Black Belt Project Example:Common Canister Common Canister

Inhalers for Asthma and COPD:Combivent, Albeterol, Atrovent, and Flovent

Pharmacy/Respiratory Therapy “Common Canister” Black Belt Project:Pre Lean: 6,624 canisters/year

Post Lean:2,381 Canisters/year

Savings in Acquisition Costs:$363,000!

(75% Reduction)

Rapid Improvement Event (RIE) Rapid Improvement Event (RIE) –Using Lean Tools in Focused Manner –Using Lean Tools in Focused Manner

Day 1

Mon

• Examine a process/function or area• Identify areas of waste, non-value added steps • Identify metrics

Day 2

Tues

• Develop new process, standard work and communication to eliminate identified waste and increase value

• Design rapid experiments

Day 3

Weds

• Implement the new processes, standard work• Monitor production board and communicate

standards• Observe new process and any change in metrics

Day 4

Thurs

• Adjust and fine tune new standard work

Day 5

Friday

• Celebrate! • 10 minute team reports

RIE Employee Engagement RIE Employee Engagement YTD August 24, 2012YTD August 24, 2012

• 415 Rapid Improvement Events• 2,055Employees participated on RIEs• 16 Value Streams• 247 Black Belts

2012 Value Streams2012 Value StreamsRevenue Cycle 1st Floor

Managed Care Nursing

RMPDC- Patient Access

OB/Gyn

RMPDC- Drug & Product Safety

Community Health Services I

Specialty Clinic Community Health Services II

Clinical Process Behavioral Health

Pharmacy Perioperative Services

Education Human Resources

Examples of Clinical and Examples of Clinical and Non-Clinical Lean EventsNon-Clinical Lean Events

• Facility Bill Clean Claim Rate

• Improve Internal Processing Turnaround Time

• Reduce # of accounts on front end work lists

• DVT Prophylaxis• Cancer Screening• Chronic Opiate

Therapy• Surgical Site Infection• Rehab Utilization• Provider Flow Cells• Problematic Rx

Surgical Site RIE Case StudySurgical Site RIE Case Study1.Reason for Action

SCIP II requires abx within 60 minutes of “first cut”

2. Initial Condition Prophylactic abx in OR within 60 mins

< 80% of cases

3.Target Condition

Prophylactic abx in OR within 60 mins in

100% of cases

4.Gap Analysis

Abx given “OCTOR”

Variable abx

APC Frustration

OR Frustration

5.Solution Approach

Conduct waste walk

Map process

RIE to include IC

Chart review

6.Rapid Experiment

Change OCTOR to “Abx delivered in OR by anesthesiologist”

Abx guidelines

7.Completion Plans

Change order forms

Monitor data

8.Confirmed State

Per Dr Lockrem: “We’ve changed our practice”

9.Insights

The problem was definitely the process, not the people!

Clinical RIE Case Study ResultsClinical RIE Case Study Results

Surgical Site Infection RIE Results RIE Date: June 6-10, 2005

0%20%40%60%80%

100%120%

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Enterprise Transformation Enterprise Transformation

AlignmentAlignmentAligning System Metrics with Aligning System Metrics with

Value Stream MetricsValue Stream Metrics

and RIE Metricsand RIE Metrics

Enterprise Metric Alignment:Enterprise Metric Alignment:

OB ED/AUCC

Spec Clinic

Rev Cycle

HR MC Rx BHS RMPDC

Paramedics

NSG CP Med

D/C

CHS

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Quality Delivery

(Access)

Productivity Financial Human Development

Nosocomial Infections

ED Divert Visits per Session

Expense per D/C or

Encounter

Employee Engagement

System Level Metrics

Value Stream Level Metrics

RIE Level Metrics

Achieved with no layoffs and no reductions in patient services!

Standard Work:Standard Work: Metric Monitoring Metric Monitoring RIE Team Lead/Process Owner

Lean Facilitator

Sr. Financial Analyst

Associate CFO Review

CFO Review

CEO Review

Transparency At Denver HealthTransparency At Denver HealthExample: Human Resources (HR) Value StreamExample: Human Resources (HR) Value Stream

HR RIE Level Metrics Posted“In the Gemba”

HR Value Stream Level Metrics Near Greg Rossman’s Office

HR Metrics Posted at the Enterprise Level in Sabin

SummarySummary

• Lean is a philosophy and tool set that fits for healthcare• Eliminating waste improves quality of care• Lean tools are intuitive• Frontline staff must be respected because they

understand where the waste exists and how best to eliminate it

• Lean has the power to change culture because it truly empowers employees to break down silos, rapidly implement change and own the process!