lean thinking: applications for patient safety goals

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Lean Thinking: Applications for Patient Safety Goals

Southern California Patient Safety Collaborative

David Munch M.D. SVP, Chief Clinical Officer

Healthcare Performance Partners

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Lean can help you with:

Providing Value to the

Customer (Patient)

Improving Reliability and Safety

Eliminating Waste

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Driving Incentives to Focus on Patient Safety

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Improving Patient Safety

Designing Reliable Process – The Reliability Design Triad

Establishing Management Systems to support and sustain them – Visual Management – Development of People

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Pyramid for Quality, Safety, Reliability, -

Process: 1. Prevent 2. Mitigate 3. Redesign

Clinical Technology: Work Flow Ideal Use

Safety Culture: 5 Subcultures +

Elements of HROs

People: Management

Systems, People

Development

Process 1. Prevent

1. Standard Work 2. Simplify 3. Total Productive Maintenance

2. Identify and Mitigation 1. Visual Management 2. Mistake Proofing 3. Identify and Respond Immediately

3. Redesign 1. Ideal design, 2. Root Cause problem-solving, 3. By those doing the work, using Scientific

Method, with a Coach

Safety Culture -A Just Culture -Mindfulness -Communication & teamwork

People -Development -Management systems -Leadership standard work

Clinical Technology Work Flow-technology interface

• 3P, Skills and Fit • Appropriate IT application

Presenter

Presentation Notes

Ries, std deck,

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Unnecessary Variation is the Enemy

Creates Waste Hides Problems Counter to Professional

Culture

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Fundamental to Safety and Reliability: Prevention, Detection and Response based upon Understood Standards

You cannot see the abnormal until you have established the normal.

Time

Harm or Damage

Determining Cause

High

Low

Defect: E.g.. Adverse Event

Prob

abili

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Adapted from slide by John Shook: U. Michigan

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Qualities of High Reliability Weick and Sutcliffe: Managing the Unexpected

Preoccupation with Failure Reluctance to (Over) Simplify Sensitivity to Operations Commitment to Resilience Deference to Expertise

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Preoccupation with Failure: Root Cause Problem Solving: “A3” Thinking

This image cannot currently be displayed.This image cannot currently be displayed.

Problem Cause Solution Action Measurement

A3 Process Follows

Scientific Method

Similar To Healthcare

Familiar PDCA

Presenter

Presentation Notes

The A3 process is based upon scientific method. (PCSAM). The form supports this method in its organization and flow. Problem Cause Solution Action Measurement This is very consistant with the PDCA cycle most hospitals are familiar with and use in some form.

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Sensitivity to Operations

Status at a

Glance

Standards or Norms

Observation

Data & Analysis

Visual Mgmt. & Coaching

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Visual Management: The Andon Board

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What Does this Look Like in a Hospital?

Imaging Department

Andon Board – “I need help”

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Visual Controls

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Patient Status at a glance

Pt + Dr name Sched time

Presenter

Presentation Notes

Purpose Show a healthcare application of a visual control board that show status on a unit. (Public knowledge as relates to the previous slide.) Key Points By looking at this board we can see: How many rooms are used Which rooms have been setup for Inpatient or patients to be admitted. Pt & Dr name and scheduled procedure time (First Initial and 3 letters of Last name to meet HIPAA requirements.) At a glance you can see what patients are In procedure (Red arrow) Prepped (Blue dot) Being Prepped (No symbol by name) Add-on procedures are also shown in pink How many more procedures there are for the day. (above line) Floor is currently caught up. There are patients prepped and ready to go to each active procedure block. Note: In this unit a “BLOCK” is a procedure room and crew. Not a block of time as in “block scheduling.”

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History/Pareto/Problem Solving

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WeekHistory Pareto Principle

Problem Solving

Extra Pt Lift keeps coming back to this floor 1 2 Clean Pain pump not available from Central Equipment 3 Weekend shift not putting equipment back

Presenter

Presentation Notes

Purpose: Show an example of History/ Pareto/ Problem Solving on a data wall. Key Points: The data wall is a communication tool. Continuous Improvement flows from What is the Current State (History) What are your biggest problems (Pareto) What are you going to do about it? (Problem Solving)

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Visual Management Example: Backdrop for Dialogue

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Helping People Through Change: The First I.T. Coaching Session

The Development of People

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Time for Video 2

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Cascading Team Structure: Extensive Support and Coaching at the Front Line

Director

Manager

Team Lead

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Coaching Example 410 Bed Hospital in the Denver Area

The Problem: Could not get hand washing compliance above 70% despite DMAIC and effort

The Countermeasure: Coaching – Who are the Coaches? – What are the barriers and support needed?

The Objective: – Wash or gel in and out of patient room, everyone, every time. – Barriers, support and accountability: The Red Rule

The Presence: Within the flow of your other work every day

Timeliness: Immediate intervention The Interaction: Understanding and Action

– “What prevented you from washing your hands this time?” – “What will you do such that this doesn’t happen again?”

The Follow-up: Visual management, ongoing conversations

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Stop when there is a Quality problem Hand Washing

Understanding The Problem

Manager Coach Training

Manager Coaching

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Weekly Hand Hygiene Rates October 2008-December 2010

P UCL Average LCL

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Outcome Measures Does all this washing make a difference?

HAI Prevalence Correlated with Hand Hygiene Compliance

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HAI Prevelance per 1,000 pt days Hand hygiene percent compliance

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The Management System for Patient Safety

• Do the Standard Work • Surface and Solve Problems • Improve the Standard Work

Staff

• Observe, Measure, Analyze, Action

• Immediate Response to Errors • Develop and Coach the Front

Line • Support and Lead the

Improvements

Management • Align to Strategy: Safety as the

Highest Priority • System and Structures • Develop the Middle • Deeply Understand your

Organization: Go See

Executive

Performance Improvement, Decision Support, HR, I.T. Facilities

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“We are Leaders in an industry that we are not sure we understand” Timothy Porter O’Grady

Healthcare has become so complex that “command and control” no longer works.

We have the most educated staff of all industry yet we do not take advantage of their wisdom. – Timothy Porter-O’Grady

Leaders must develop those for whom they are responsible so that the organizational capacity to be self-correcting, self-improving, and self-innovating is distributed and practiced widely and consistently – Steven Spear

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The Method 3 attributes of lean leadership at every level:

Go see: Visit the point where value is actually being created; verify the situation

Ask why: What is the problem? What are possible solutions?

Show respect: Assign clear responsibility for every process and problem; ask questions about people’s work.

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James Womack: Lean Enterprise Institute

lean thinking: applications for patient safety goals

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