Value Summary 2.0 Overview

Value Summary 2.0

Standardized Improvement Framework

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Improvement Design& Implement

Goals

Baseline Analysis& Investigation

Team & Project Vision

Monitoring

Use Improvement Science

Why Use the Value Summary

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Concise – avoids death by PowerPoint

Methodology – promote improvement that works

Measurement – track work at project & enterprise level

Transparency – self-service visibility to value work

Communication – standardize review of value work from director to staff

Lean

6s

PDSA

Project Definition

Baseline Analysis

Investigation

Improvement Design

Implement

Monitoring

Value Improvement Framework

UUHC Value Methodology

Project Definition + Goals

Baseline Analysis

Investigation

Improvement Design

Implement

Monitoring

Value Improvement Framework

UUHC Value Methodology in Value Summary

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2

3 4

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5 Sections of the Value Summary

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1 2 3 4 5

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1

Project Definition

Team & Project Vision

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Project Definition

Engage the People – Team Elements

Ask often: “Do we have the right team”?

Representation of all roles

Upstream / Downstream

Experts who do the work

Team Member Roles

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are not only a great way to

identify individual roles

within a project, they are

also key to creating reliable

reporting of project work to

appropriate department

leaders.

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Project Definition

Why & How Elements

Why is this an important issue?

Why are you working on this now?

Internal / external drivers

How does this benefit the patient/customer?

How does this benefit the team?

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Problem & Goals

Specific, Measurable, Attainable, Relevant, & Time-bound

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G O A L S

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Specific - How specific is based on your judgment. “Poor communication” and “inefficiency” are not specific. “Readmission rates for ileostomy

patients” is specific enough.

Measureable - Define with an actual number. Some, more, many are not numbers. “20% increase,” is a number you can track concretely.

Attainable - Is your goal realistic? Chasing unrealistic goals is demoralizing.

Relevant - This area is another judgment call.

Time-bound – Set the date when you want the goal met.

Problem & Goals

SMART Goals

Source: http://healthsciences.utah.edu/accelerate/blog/2017/01/the-smart-way-to-keep-your-new-years-resolutions.php

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14

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Problem & Goals

Goal Type

Process

Action to get to

the outcome

e.g. removed the Foley

before 48 hours

e.g. performed preventive

maintenance within

96 hours

Outcome

Output from the

process

e.g. urinary tract infection

rate

e.g. equipment failure rate

Balancing

Unintended

Consequences

e.g. Reducing length of

stay but increasing

readmissions is not

an acceptable trade-

off.

Strive for a mix. Implementation of a solution is not a goal type

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Problem & Goals

Measure Elements

Numerator & Denominator

Local

Meaningful

Transparent

When measurement is used effectively, teams can design,

implement, and sustain improvements. Elements of effective and

actionable measures are:

Source: Becoming a Value Driven Organization. Value Collaboration October 2015.

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Baseline Analysis &

Investigation

3

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Baseline Analysis & Investigation

Methods / Tools

Examine & Document Baseline Process

BenchmarkTo Peers

Analyze Data

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Baseline Analysis & Investigation

Tools to Examine + Document Process

What does the

process tell you?

Describe your major

findings from each tool.

Attach related Documents.

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Baseline Analysis & Investigation

Tools to Analyze Data

What does the data

tell you?

Describe major findings

from each analysis.

Data collection can be:

Manual e.g. tally sheet, survey

Automated e.g. data warehouse

Attach related documents

(no VDO/cost data).

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Baseline Analysis & Investigation

Tools to Benchmark

What did you learn

from others?

Describe what best

practices you learned

from peers.

Attach any related

documents.

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Baseline Analysis & Investigation

Summary

ROOT CAUSE

What did you learn?

Synthesize the information you’ve collected to target & prioritize opportunities for

improvement.

One method to identify the root cause is to ask ‘why’ 5 times. The reason a

problem exists usually goes deeper; keep going until you feel comfortable

you’ve identified the real reason(s).

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Baseline Analysis & Investigation

Check your Goals

Process

Action to get to

the outcome

e.g. removed the Foley

before 48 hours

Outcome

Output from the

process

e.g. urinary tract infection

rate

Balancing

Unintended

Consequences

e.g. Reducing length of

stay but increasing

readmissions

Now that you have a better understanding of your problem and what changes will be made to your process, add/adjust SMART goals.

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Improvement Design

& Implement

4

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Improvement Design & Implementation

How to Improve a Process

Make it Reliable e.g. Standard Work

Make it Simple e.g. Workplace Organization

Make it Visible e.g Visual Management

Make it Flow e.g. Eliminate Waste

There is no one-size-fits-all solution; find what works for your team.

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Improvement Design & Implementation

Elements for Success

Design Changesto Process / Workflow

Communication Plan for improved design

Forcing Functions

to guide use of improved design

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Improvement Design & Implementation

Changes to Process / Workflow

Provide information in the value summary such that others can

understand and potentially replicate.

What are your process change(s), Who (role) is accountable, and

When / Where is it happening in the process?

What major findings does the improvement design address?

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Improvement Design & Implementation

Customer / Patient Elements

Convenient

Empathetic

Coordinated

Reliable

Don’t forget about your customer! Improvements should be:

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Improvement Design & Implementation

Communication plan

Plan to communicate the improved design:

Policy (re)written

Communication campaign

Education, internal

Education, patient/customer

Plan a communication strategy for anyone affected by the process -upstream & downstream. Attach related documents.

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Improvement Design & Implementation

Create a Reliable Process

Tools to ensure the improved design is followed:

MANUAL TOOLS

COMPUTER / AUTOMATION

PHYSICAL MECHANISMS

VISUAL REMINDERS

Person will be expected to fill out and check/ monitor their work.

The step is automatically performed or resides in a trackable system.

The new process or step will happen on it’s own or the error can’t happen because of design.

Person will be expected to notice reminder and take additional steps as needed.

E.g. paper checklist, nursing whiteboard

E.g. EMR order set, telemetry monitor

E.g. barcodes, RFIDE.g. poster, best practice alert

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Improvement Design & Implementation

Forcing Functions

Forcing functions ensure that the right step is done right every time. The more

automated, the more effective it is at preventing errors. Automation (system) is not

always practical; determine your needs by considering the severity, likelihood, and the detectability of the error.

MANUAL TOOLS

E.g. paper checklist, nursing whiteboard

COMPUTER / AUTOMATION

E.g. EMR order set, telemetry monitor

PHYSICAL MECHANISM

E.g. barcodes, RFID

VISUAL REMINDERS

E.g. poster, best practice alert

[-] EFFECTIVE [+]

Source: http://healthsciences.utah.edu/accelerate/blog/2017/01/sepsis-using-emr-as-a-forcing-function.php

PEOPLE FOCUSED SYSTEM FOCUSED

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Monitoring & Impact

5

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Monitoring & Impact

What Gets Measured Gets Managed

Monitor data continuously

Monitor process (Goals/Gemba)

Reflect on effectiveness &

adjust design, if needed.

At least 1 year of monitoring is

recommended; 2-3 years to

ensure sustainability.

Is it working?

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Monitor & Impact

Measure Elements

Numerator & Denominator

Local

Meaningful

Transparent

Providing results to individuals can engage team members in their

ability to contribute to the improvement. This is often done outside of

the Value Summary reporting & monitoring.

Value Summary 2.0

http://pulse.utah.edu/go/valuesummary

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http://healthsciences.utah.edu/accelerate 36

The Smart Way to Keep your New Year's ResolutionsCan improvement science help you keep your new year’s resolutions? Every

year, Chrissy Daniels coaches leaders throughout the system as they set goals.

She knows what works.

Lean Guard Rails: Using the EMR as a Forcing FunctionThis post is about the Sepsis project’s technical achievement using a process

improvement principle. Our system taught Epic, Utah’s electronic medical record

(EMR) how to provide urgent, life-saving information to clinicians.

WHAT IMPROVEMENT (REALLY) LOOKS LIKE

identify problem

JK

START END

AHA! found the real problem

keep going!

set goals

assemble the team

now we have the right team

analysis &

investigation

design improvement

implement