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Leading High Reliability Organizations in Healthcare
Richard Morrow, MBA, MBB
Author/Founder
RPM Exec (847) 989-3333
www.rpmexec.com
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Baseline Performance – Healthcare Compared
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Organizations Excelling in Reliability
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Payers are driving value by redistributing* $1.9B in reimbursement through Value-Based Purchasing
Today’s Lesson: How to Become Paul
*CMS FY2018 IPPS Final Rule estimate
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Reimbursement is Shifting to Reliability =Clinical Outcomes and Value
Source: CALHIIN
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How Much Is At Stake for Your Organization?
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Then, Paul can lose it all in readmission and hospital-acquired conditions penalties
The cost of poor reliability comes to healthcare
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Becoming a High Reliability Healthcare Organization
▪ What is reliability?
▪ How bad is it today?
▪ What causes poor reliability?
▪ What improves it?
▪ How do we sustain it?
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HIGH RELIABILITY is:
CAPABILITY IN ACHIEVING THE
EXPECTED OUTCOME
THROUGH TIME
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High Reliability is Not…
▪ Just about safety
▪ Six wrong site surgeries every week
▪ Patient and caregiver satisfaction below national median
▪ Readmissions being big business for you
▪ Entertaining your State Inspectors
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Comparing Complexity and Reliability Skills
INDUSTRY HEALTHCARE
HEALTHCARE INDUSTRY
If this is true, how are you going to compete and win the margins to sustain your mission?
Complexity
Reliability Skills
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Required: Systems Approach to High Reliability
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Step 1: Safety Engineering - Leadership’s Role
“I was absolutely amazed that the NASA people I argued with against the launch…
didn't even mention to other members of the mission management team that there was a concern…”
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High Reliability Healthcare
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Step 2: Reliability Engineering principles taught to leadership and staff (Yellow – Master Level)
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High Reliability Organizations Utilize 3Ms:
1.Measure daily
2.Manage to that measure
3.Make it easy to do the right thing
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Utilize the 3Ms of Performance Reliability
1. Measure the Process - Daily
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Failure Mode and Effects Analysis the Right Way & the Healthcare Way
Healthcare Starts FMEA
Process FMEA
HRO Starts FMEA
Bad Event
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2. Manage to the Measure – Every Day
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Don’t accept failureThe movie, “Lincoln,” Directed by Steven Spielberg
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3. Make it easier for teams to solve problems
The movie, “Lincoln,” Directed by Steven Spielberg
“Circulate among followers consistently,”
Abraham Lincoln
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Favo
rab
le
What Can Be Achieved
Imp
rove
men
ts Begin
85th %
40th %
• Benchmark for clinical outcomes – Center of Excellence• Top 5% in Value-Based Purchasing with Zero Penalties• Leads the market and wins the margins
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How to Build Reliability Skills - Example of a High Reliability Training System
1 2 3 4 5 6 7 8 9 10 11 12
Culture
People
Process (Improvement)
ClinicalTechnology
Reliability and Teamwork Training
Population Health (System Reliability)
Human/Technology Interface
Just CultureReporting
CultureLearning Culture
Informed Culture
Flexible Culture
Workflow that utilizes technology effectively
Leadership’s Four Critical
Success Factors for
High Reliability
Quality fundamentals
Leading High Reliability Organizations
Preoccupation with Failure
Reluctance to Simplify
Sensitivity to Operations
Commitment to Resilience
Deference to Expertise
Mindfulness
Supplier Resource Management
Reliability Principles for Healthcare
Safety Culture
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Get a Roadmap to Improve Reliability in Healthcare
Utilizing3Ms
LeadingChange ExploreTogether Explain Celebrate
KeyQuestions:Whatisour
purpose?
Issue?Defect?
Whoarethe
customers,who
areinvolved?
Whatisthe
Voiceofthe
Customer?
DesignCriteria?
Whatdoes
demandlook
like?
Primarily
improvingquality
orproductivity?
Dataanalysis
potential?
CanImeasure
thedatawell?
Ismyprocess
stable?
Currentprocess
capabilityof
meetingthe
customer'sneeds?
Whatarethe
validatedroot
causes,
contributing
factors?
Bestcounter
measures?
Counter-
measures
successful?
Isthistheright
way?
Willprocess
continue
reliably?
Cadenceof
Accountability
Reinforced
Improvementwith
ourpeopleandin
thevaluestream?
Tools:Charter
template
Stakeholder
Analysiswithplan
toimprove
engagementand
minimize
resistance
Surveys,Quality
Function
Deployment
(QFD),Pugh
Matrix
Demandrate
from
customers.Takt
time.
MainStreetand
Avenuesonthe
Roadmap
Measure-
SystemAnalysis
(MSA).Gage
R&R,Attribute
Agreement
Analysis
Statistical
Process
ControlChart
(SPC)visual
management
CurrentState
Capabilityof
charteredmetrics
andkeyprocess
variables.Value
Quotient,Cpk,Ppk,
Sigmalevel
Validatingroot
causesand
contributing
factorsusing
SPC,
Hypothesis
Tests,
Confidence
Interval
Testing,
Piloting
Comparisonof
ideasusing
importantcriteria
Pilotcounter
measures.Design
ofExperiments
Standard
Work,Job
Instruction
Measure
frequentlyand
stopthe
processif
defects
occurring."Stop
theline"
Recognitionfor
benefits
KeyQuestions:DoIhaveall
ofthe
inputs?
Whatarethefew
keyprocess
inputvariables
(KPIV)tofocus?
Whatarethe
probable
causesforthe
keyinput
variation?
Whichdata
measure
currentstate
andvalidatethe
rootcauses?
Whatdoesthedata
show?
Howcanwe
improvethe
inputs?
Significant
differences?
Statistically
significant?
Tools:SIPOC
map
Cause&Effect
Matrixwith
HumanFactors
Analysis
FMEA
Datacollection
planfor
baseline
androotcause
analysis
Histograms,check
sheets,pareto
chartsfornarrowing
ofrootcauses/
contributingfactors
Countermeasure
experiments.
Designof
Experiments
Beforeandafter
comparisons,
histograms,
paretoanalysis,
scatterplots,
stratification
SPC,Hypothesis
Testing,
Confidence
Intervals
KeyQuestions:
Whatisthe
valuestream
andits
flows?
Areastofocus
wastereduction?
Disorganized
workplace?
Isprocess
equipment
operationalwhen
needed?
Layoutallows
continuous
improvement
Flexibilityamong
workers?
Isprocessfail-
safe?
Processwaste
fromset-ups,
turnaroundsand
change-overs?
Flowinsmall
batches
possible?
Canwereduce
lead-timefor
patientand
customer?
Canwesmooth
demandoratleast
internally?
Replenishonly
onpullfrom
customer?
Canthe
processflex
withdemand?
Inventorywastes
present?
Tools:
Value
StreamMap
(Current
State)by
walkingthe
process
Kaizen,8
Wastes,
Spaghetti
Diagram
5S
TotalProductive
Maintenanceand
Operational
Equipment
Effectiveness
Cellularflow,
"focused
factories"
Multi-skilledstaff Mistake-Proofing
Observation,
TurnaroundTime,
internalvs.
externaltasktime,
spaghettidiagram,
5S
One-pieceor
smallbatch
flow
Lead-time
reduction
Demandand
production
smoothing(Mixed-
Model
Sequencing)
Pull
replenishment
(Just-In-Time,
Point-Of-Use,
Kanban)
Quantity
adaptsto
demandfor
capable
service
Inventory
reductionto
improveservice
andreduce
waste
Define
Phase
Tollgatewith
signed
charterand
currentstate
map
MeasurePhase
Tollgatefor
BaselineCapability
AnalyzePhase
Tollgatefor
validated
contributing
factors
Improve
DesignPhase
Tollgatefor
designor
improvements
andpilot
validation
ControlPhase
Tollgatewith
processcontrol
plan,training,
standardwork
RoadmaptoHighReliability
Corequestionsandcommontools.A
lldecisionson"MainStreet"arereq
uired.
Allrisksmanagedto
sustainthegains?
FMEA,Visual
managementwith
SPC,fail-safes,
TeamSTEPPSand
aControlPlan
Prepareforchange-Train,Envision,Engage,EnableandEmpower Experiment,Explore,whilebuildingconsensuswithstakeholders Train,Enable,Empower,HoldAccountable
Measure Managetothemeasure Makeiteasier
ReinforceCILeanSixSigma ImproveandDesign
Achievecapabilityandstability
Productivitymetrics,employeeengagementan
d
enablemen
t"Avenue"
Wherearethekeyareasoffocus
forPerformanceImprovementand
FutureStatevision?
ValueStreamMapsoftarget
wastes(FutureState)
Qualitymetrics&dataanalysis"Avenue"
Definetheissue
Whatdoesthecustomervalue?
Control
Sponsor/ChampionTollgates ©RickMorrow.Allrightsreserved.
Nottobereproduced.
MeasurecapabilityandcontrolofYandXs
Analyzevalidatingcontributingfactors
AcronymsandMeanings
CI Continuous Improvement
VSM ValueStreamMap
SIPOC Supplier,Input,Process,Output,Customermap
SPC StatisticalProcessControl
JIT Just-In-Time
QFD QualityFunctionDeployment
FMEA FailureMode&EffectsAnalysis
)...,( 21 nxxxfY =),( 31 xxfY=
Available free at www.rpmexec.com
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What is your next step to reliability?