State of New Hampshire Lean Continuous Process Improvement

Introduction and Overview

Presented by:

Kate McGovern, Department of Administrative Services

and

Heather Barto, Department of Health and Human Services

October 20, 2016

Objectives

� Describe the Bureau of Education and Training’s model for Lean within New Hampshire's public and non-profit sector.

� Report on the use of Lean process improvement techniques in a range of State agencies and non-profit organizations, including the delivery health and human services.

� Discussion � The linkage between Lean training, Lean projects, and

the development of a Lean Network as a community of practice.

� Potential opportunities for joint projects between State agencies and health care organizations?

What Is Lean Continuous Process Improvement?

� Lean is an organizational improvement philosophy and set of tools and methods that originated in manufacturing but has been expanded to government and service sectors.

� Lean enables government agencies to work more effectively and efficiently to serve the citizens, while protecting human health and the environment, by identifying and eliminating waste in government processes.

NH Bureau of Education’s Lean Training Model

� Introduction to Lean and basic overview, typically provided to leadership and management

� Uses a Lean project while learning the tips and formal process of Lean at the same time

� Training for Lean facilitation of events

� Advanced training for Lean Practioners, includes theory and practice, systematic approaches, and culture champions

State of NH’s Lean Secret Lean Formula ☺☺☺☺

� Bureau of Education and Training +

� Supportive agency leadership for practice and

implementation of Lean +

� Lean Executive Committee +

� Lean Network Meetings +

� Lean Practioners “telling the story” +� Mentoring/continuing education & training

= A comprehensive Lean formula

Cumulative Growth of Lean Deployment in NH Government

AgenciesLean Projects

0

50

100

150

2009 2010 2011 2012 2013 2014 2015

5 6 8 11 14 16 16

13 2641

67

96

126148

NH Lean NetworkA Community of Practice – All are

welcome!

� Annual Lean Summit

� Quarterly Network Meetings

� http://Lean.nh.gov

Lean Executive Committee (LEC)

� Lean coordinator of each state agency

� Representative from Governor’s staff

� Collaborative leadership model

� Plans Lean Summits and Lean Network events

� Meets 1st Wednesday of each month

� Identifies opportunities for cross-silo Lean events

John MacPhee, LEC Co-Chair

addressing the 2013 Lean Summit

DoIT Commissioner Denis Goulet provides

opening remarks at Lean 2016 Summit

Governor Maggie Hassan recognizes the Dept. of Revenue for their Lean project at the Lean 2013 Summit

Attendees at the Lean 2014 Summit

Governor John Lynch with

panelists at the Lean 2012

Summit

Showcasing Lean

in State Government

Lean Black Belt Class of 2015

Front row left to right: Danielle Fuller, Sharyn Goddard, Diane Dawson, Heather Barto, Jill Fournier, Michelle Marshall, Mike Moranti (Professor)

Middle row left to right: Roberta Emmons, Angela Linke, Dagmar Vlahos, Tyler Brandow, Paul Raymond

Back row left to right: Thomas Lambert, and Todd Ringelberg

Missing: David Jenkins and Laura Holmes

Lean Works!

�Defects – typos, missing

data, errors

� Overproduction – Extra copies, reviews, signatures

�Waiting – approval cycles, missing information

�Non-utilized/underused

employees – front line employees who are process experts

�Transportation – report

routing for approvals

� Inventory – backlog of work,

emails needing responses

�Motion – trips to copier, file

cabinets, meetings

�Excess processing –

multiple reviews, approvals

Examples of waste identified with Lean methods:

What are the benefits of Lean Continuous Process Improvement?

� By using Lean tools, an organization may:

� Eliminate or dramatically reduce wait times or back logs

� Reduce costly errors

� Improve stakeholder satisfaction

� Streamline business operations; simple and complex

� Save time and reduce frustration from a “broken process”

� Enhance process transparency to internal and external audiences

� Reallocate critical resources for mission supporting work

� Improve staff morale and teamwork

Lean Methods Continued

� A3� On 11x17 piece of paper, this format is used to depict the problem identification and solutions

� Concisely communicates continuous improvement activities in this format.

Background Target Condition/Goal Statement

Describe the problem and indicate how it affects business. Use data whenever possible

Indicate what you are trying to achieve and by when. Predict the expected improvement, specifically and quantitatively

Current Condition/Problem Statement

Indicate the magnitude of the problem on a qualitative scale. Use graphics if possible.

Implementation Plan

List of actions that will be taken and by whom and by when.Root Cause Analysis

Why are we experiencing this problem? Dig deep to find the root cause using Pareto diagram, fishbone diagram or 5 why’s analysis

Follow-Up

How will the effectiveness of the improvement be measured and by whom?

Questions Used in Lean

� What value is added for the customer?

� Does this save us time, money or something else?

� How does this change our current process?

� How can we streamline Lean work into our business?

� What tool is appropriate to use in the Lean analysis?

� What is our baseline data measurement?

� How do we explain this process to someone that is not close to it?

Lean Application in State of NH Gov’t

� Adjutant General

� Administrative Services

� Banking

� Corrections

� Cultural Resources

� Employment Security

� Environmental Services

� Information Technology

� Insurance

� Judicial

� Labor

� Health & Human Services

� Lottery

� Public Utilities Commission

� Resources & Economic Dev.

� Revenue

� Safety

� Transportation

� University of NH

� University System of NH

DHHS Lean Examples:

Women Infants Children Program Management Tool

Infectious Disease Program

Lyme Disease Surveillance System

DHHS Lean Example: Emergency Preparedness

Lean results: an emergency preparedness plan template, clear review structure, group email account, training staff on common terms, protocols, etc.

DHHS Lean Example: Hospital Billing and Reimbursement

Lean Results:Significantly increased reimbursement revenue, by 6% ($800,000) for calendar year 2012,

reduced insurance payment denials, shortened billing & reimbursement time, resolved

prior authorization confusion and delays, added transparency, and employee satisfaction

increased

Final Thoughts on Lean

� Lean works because it’s simple, digestible, and requires group participation

� Lean trained professionals have a unique skill set that is marketable to

employers

� Lean thinking happens every day in every setting; healthcare is using and

has massive potential for Lean application for lowering costs and reducing

medical errors and business challenges

� Lean trained staff get promoted!

For more questions please contact:

Kate McGovern, MPA, Ph.D, Lean Black Belt

Adjunct faculty, Bureau of Education & Training

603-271-1429

Mary.Mcgovern@nh.gov

Heather Barto, MS, Lean Black Belt

Administrator, Medicaid Managed Care

603-271-9788

Heather.Barto@dhhs.nh.gov

Thank you for your time!