safety, quality and productivity at the joint commission

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WCBF Global SummitOrlando 2008

Anne Marie Benedicto, Executive Vice President and Chief of Staff, Certified Green Belt

Rick Morrow, Director, Business Excellence, Certified MBB

Safety, Quality and Productivity at The Joint Commission

WCBF Global Summit - 2

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The Joint Commission

�Founded in 1951, The Joint Commission

seeks to continuously improve the safety and

quality of care provided to the public through

the provision of health care accreditation and

related services that support performance

improvement in health care organizations.

�The Joint Commission is the nation's oldest

and largest standards-setting and accrediting

body in health care.


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Vision forThe Joint Commission Enterprise

To lead the transformation of

health care into a high-reliability

industry, with rates of adverse

events and safety process

breakdowns comparable to air

travel safety.


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Past Success Enables this Next Generation of Improvement

�The Joint Commission and JCR have created state of the art measures, programs, products and services to enhance safety and quality

�Positive impact has been enormous

�Without this solid foundation, we couldn’t even think of taking these next steps

�Standing still is not an option

�Joint Commission = continuous improvement


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Robust Process Improvement ™

The Joint Commission is adopting a systematic

methodology for improving our business processes

that will continuously increase our efficiency and the

quality of our products and services.

Our aim: Consistent excellence in our work

processes and consistently exceptional customer

service, resulting in recognition by the field of The

Joint Commission as a model practitioner of highly

effective process improvement.


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Even after the unidentified patient noted what knee needed surgery, the surgical team still

performed the operation on the wrong side…

In what officials are calling a In what officials are calling a In what officials are calling a In what officials are calling a ““““Tragic medical Tragic medical Tragic medical Tragic medical error,error,error,error,”””” a surgical team removed the wrong a surgical team removed the wrong a surgical team removed the wrong a surgical team removed the wrong kidney from a patient with kidney cancerkidney from a patient with kidney cancerkidney from a patient with kidney cancerkidney from a patient with kidney cancer…………....

Why Robust Process Improvement™?


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What is RPI?

�A set of strategies, tools, methods, and training programs proven in other sectors to greatly improve work processes

� focus on customers and all stakeholders

� drastically decrease failure rates

� simplify and increase speed of processes

�Broadly applicable, not just manufacturing

�Just beginning to be applied in health care, so far usually not in safety and quality


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How Will The Joint Commission Pursue the Vision?

Coordinated, enterprise-wide effort.

Two key, interrelated components:

1. Internal RPI initiative

� Increase our capacity for improvement

2. Continue and enhance current efforts to improve standards, sentinel events, measures, survey process and other products


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How Often Does This Happen?

�Most common sentinel event

�Since 1995: 651 reviewed

�Extrapolating these figures…….

� 6 wrong site surgical procedures in US every day---365 days per year


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Benchmark, Apply and Innovate for New Thresholds of Quality

More hospitals are borrowing safety protocol from the airline

industry to prevent surgical errors such as checklists and x-rays as part of its pre-surgical safety.


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Using RPI at The Joint Commission

�Will increase our capacity for improvement

�Make our work processes more efficient and less

prone to error---reduce rework

�Decrease cost pressure for fee increases

� Improve customer service and retention

� Increase our capacity to handle volume

� Increase resources for new opportunities


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Robust Process Improvement

�These tools and principles are important to us as a way to improve our work processes throughout The Joint Commission enterprise

�RPI is an important new way for health care organizations to achieve unprecedented excellence in safety and quality

�Empowerment � Efficiency � Excellence

�It will be fun!


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Four Critical Success Factors for

Breakthroughs with RPI

1. Leadership commitment and action

2. The right work

3. The right people

4. The infrastructure


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The Joint Commission’s Total Value

Stream forRobust Process Improvement

Conceive Develop Procure Provide Maintain Prevent Conceive Develop Procure Provide Maintain Prevent ReceiveReceive


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Robust Process Improvement

Using Lean Six Sigma DMAICDMAIC

PhaseDefine Measure Analyze Improve Control

RPI

Principles

Specify

what

customers

value

Identify all

steps and

inputs in the

value

stream

Eliminate

waste and

variation at

the root

cause

Stabilize,

reduce

variation

and defects

and create

flow letting

the

customer

pull

Standardize,

level flow

sustain and

continuously

improve

What are the

opportunities for

improvement

that will achieve

the strategy and

goals?

What is our

current

performance

level?

What are the

wastes and root

causes for gaps

or problems in

performance?

What are the

possible

solutions and

how do we

implement the

best solution?

How do we

maintain the

gains we have

achieved and

standardize?

Is the organization prepared for change?

Questions we

answer


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Path to Robust Continuous Improvement

StabilizeCreate Flow

StandardizeLevel Incrementally

Stabilize

Create FlowStandardize

Level Incrementally

Stabilize

Create Flow

StandardizeLevel Incrementally

RPI creates and sustains stable capable processes


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Results-Driven Versus Activity-Centered

Robust Process Improvement Approaches

Activity-Centered Programs

1. Every manager is involved in an action

2. “Don’t look for results this year – it is a long term process.”

3. Staff experts and consultants train everyone first because otherwise it will be a Tower of Babel

4. First year training, 2nd year diagnose, third year consultant survey customers….

Results-Driven Programs

1. “Get a team together to solve this issue”

2. “We should strive to eliminate half of the cost disadvantage in 3 months”

3. RPI experts help managers achieve results and discover customer-centric metrics

4. “Let’s get started trying to increase sales and if it does, scroll and replicate in other areas.”

Adapted from Successful Change Programs Begin with Results, Schaffer, Thomson, HBR J-F 1992

A fallacy

The RPI Way


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Learning TJC's Robust Process

Improvement Methodology

�We want the best Belts in the World

Best = Achieving breakthrough results

�TJC's Belts are trained by doing – not just

learning

�Using proven, powerful and productive tools

�Trained, mentored and coached by TJC's

experienced Black Belts and MBB’s

�With relevant examples repetitively


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The Joint Commission RPI Roadmap


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Renaissance Blvd and the Avenues, Butterfield and 22nd

� Renaissance Blvd is always where we start.

� Renaissance Blvd gets us a quick consistent start and towards our destination consistently and with the fewest diversions.

� Belts and teams will start on Renaissance Blvd and take the Avenues based on the project’s needs.

� The Belts and teams will end on Renaissance Blvd arriving successfully and as quickly as possible

� Renaissance Blvd has the core tools needed in any project and the common tools regardless of project.

� Avenues represent specific tools driven by project/metric type


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Mentoring in Problem Solving is Easy with The Joint

Commission's Lean Six Sigma Roadmap

� Guide the Belt starting with the module on The Joint Commission's Lean Six Sigma Roadmap

� Key Points:

1. All problems are best solved using our roadmap

2. Start on Renaissance Blvd. and ensure all tools are completed well

3. The Mentor and Belt assure Tollgates are performed with the Champion and Sponsor

4. Tollgates are simply the validation that the questions are answered sufficiently with the tools prior to the Tollgates

5. The Tollgate marker on the Roadmap lists the key deliverables

6. The Mentor should have been directing the Belt at least weekly through the Roadmap

7. Not all tools on the Blue and Yellow Avenues are necessary


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What one should expect after use of the toolKey Outputs

Necessary for using the toolKey Inputs

This is a good tool to use in answering theKey Decisions

RPI Tools

Answer these questions to improve the

Quality of your project work and choose the

right Avenue and best tool

Key Decisions

Key Decisions, RPI Tools, Key Inputs and Key Outputs

& Deliverables help us progress along the Roadmap


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Our Primary Metric is cycle time – a Productivity

Metric. We choose the Avenue for Productivity

and start at the Key Decision once again……


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Choose the tools that add value on the Avenues and always return to Renaissance Blvd and to Your Final Destination = Success!

Congratulations!


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Our Mission

Key Drivers

Patient Safety and Healthcare QualityPatient Safety and Healthcare Quality

Quality and

ProductivityQuality and

Productivity

Customer

SatisfactionCustomer

Satisfaction

Financial PerformanceFinancial

Performance

Cycle time in the

development of

standards

Cycle time in the

development of

standards

Revenue below

target in new

products

Revenue below

target in new

products

Schedule

changes in

survey process

Schedule

changes in

survey process

The First RPI Green Belt Projects

Inconsistency

perceived in surveysInconsistency

perceived in surveys

Long cycle times and

variability in standards

roll-out

Long cycle times and

variability in standards

roll-out


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Master Black Belts

Black BeltsLeaders dedicated

to strategic projects, experts in TJC's

LSS, CAP & Mentor/Trainers

Green BeltsLeaders of vital projects.

Skilled in TJC's Lean Six Sigma

Methodology and Change Acceleration Process & Work-out

Robust Process Improvement Belts and Teams

Skilled in PPS and empowered to continuously improve processes.

Tools include: histograms, pareto, SPC, “5 Why’s”, C&E diagram, checksheets, 5S, standard work, flow, pull, VSM

Mentor, Trainer and Coach of Leadership and Belts

Cham

pio

ns

and S

ponso

rs

Support

RPI P

roje

ct S

elec

tion a

nd B

elts

Robust Process Improvement Learning and Roles Pyramid


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Practical Problem Solving - Foundation Tools

Check Sheet

Systems Manual Entry

Up time Compliance

Stratification

Poor Quality

System

Environment

Methods

Personnel

School

Inexperience

Manual entries

No Poka-Yoke

No quality training

Statutory

S-Ox

GAAP

Not integrated

Too many

Cause and Effect Diagram

Cause and Effect Diagram

Sales

Frequency

136132128124120

4

3

2

1

0

Mean 125.8

StDev 3.621

N 12

Histogram of SalesNormal

Histogram

Scatter Diagram

Advertising

Sales

373635343332

136

134

132

130

128

126

124

122

120

Scatterplot of Sales vs Advertising

Observa tion

Individual Value

121110987654321

140

135

130

125

120

115

_X=125.75

UCL=137.84

LCL=113.66

I Chart of Sales

Control Charts

Statistical Process Control

Pareto Chart

Count 431 231 100 15

Percent 55.5 29.7 12.9 1.9

Cum % 55.5 85.2 98.1 100.0

Count

Percent

Day OtherWedTueMon

800

700

600

500

400

300

200

100

0

100

80

60

40

20

0

Pareto Chart of Day

Pull from CustomersContinuous Flow Process

Fist to Five Consensus

Brainstorming

5 Why’s Value Stream Mapping


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Thanks to:

�The RPI Team

�Teena Wilson, Connie Neven ,Caron Wong, Dawn Allbee, John Cullinan, Diane Kohler-Rausch

�And

�Bill Bullerman, Patty Chappell, Kathy Wood, Tracy Robinson, Sharon Sheehan, Andy Trippi, Brian Nosek, Bill Kent

�The Joint Commission's Print Services


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Summary

� Our Vision is: To lead the transformation of health care into a high-reliability industry, with rates of adverse events and safety process breakdowns comparable to air travel safety.

� RPI is:A set of strategies, tools, methods, and training programs proven in other sectors to greatly improve work processes� focus on customers and all stakeholders� drastically decrease failure rates� simplify and increase speed of processes

� Leadership for Robust Process Improvement’s Four Critical Success Factors:

1. Leadership commitment and action

2. Right work

3. Right people

4. Right Infrastructure

� RPI creates and sustains stable capable processes for continuous improvement

safety, quality and productivity at the joint commission

Education

joint commissionerror

joint commissionmeasures

joint commissionservice

joint commissionstanding

joint commissionwill

joint commissionjust

joint commission enterpriserpi

joint commissiontravel