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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
Con
tin
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pro
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Res
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eop
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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
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%
Month
% O
R P
atie
nts
Rec
eivi
ng A
bx
Pro
phyl
axis
With
in 6
0 M
inut
es o
f Fir
st C
ut RIE June, 2005
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
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!