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What Matters Most? Integrating a Culture of Improvement with a long-standing
Culture of Excellence at the Cleveland Clinic
Tim Pettry Process Improvement Specialist
Cleveland Clinic
Local Name, Worldwide reach
• 44,000 Caregivers
• Main Campus – Cleveland
• 27 Institutes
• 8 Regional Hospitals
• 18 Family Health Centers
• Weston, Florida
• Lou Ruvo Center for Brain Health, Las Vegas
• Toronto, Ontario, Canada
• Abu Dhabi, UAE
Top 5 U.S. Hospitals U.S. News and World Report
Continuous Improvement Department
• 34 People • Medical Director • Senior Director • Hybrid Structure
– Embedded Institute Resources – Central Team – Process Improvement Specialists
• Focus shifting from – Tools Principles – Discrete projects model areas
Set Goals Review
Performance Improve
Reward /
Recognize
Culture To Sustain
• Goal Setting • Scorecards/
Dashboards • Q-Boards • Plan Initiatives • Benchmarking • Interviews
• Bus. Rvw. Process • Perf. Mgt. Reviews • Follow-up Action Plans • Resource Action Plans • Initiatives Reviews • Solutions ID & Share
• Project Mgmt tools • Problem Solving
- FasTrac - Productivity Mgmt - Lean - Solutions Website - IDEAS - Others
• Recognition • Development Plans • Growth Opportunity
…Structure, Tools, and Creating a Culture for Execution
Equip and Coach Institutes/Hospitals, How to Execute using…
Continuous Improvement Cycle
Methodology Copyright Orion Advisory, LLC 1997-2009
2007-2012
Time
Val
ue
Base Camp
CI Journey / Progress
• Sponsors
• Acceptance (Improvement work)
• Reliable Demand
• Value: $ Impact, Skills & Behaviors
• Disposition: Reactive
• Team to Department
• Leadership: Unilateral to multiple inputs
Next Milestone
2012
Tools based Principle Based
Internal Shingo Assessment Feedback reports
• Digestive Disease Institute – Organizational Alignment – Strategy developed – not deployed – Visual Management – Nothing in place – opportunity – Problem-solving – sporadic – Standardization - sporadic
• Decision Support Services – Organizational Alignment – Good start
– VISUAL management -
– Problem-Solving – Strength – Standardization - opportunity
• Taussig Cancer Institute – Strong systems in place – Organizational Alignment – Visual Management – Problem-solving – Standardization
Simplify the assessment process
Clarify the message
Shift from Assessment to Aspiration
Organizational Alignment
Identify and communicate what matters
most
Visual Management
Manage what matters most
Problem Solving
Improve what matters most
Standardization
Sustain what matters most
Right Systems Right Behaviors Right Results
b
Guiding Principles that helped shape the COI program
DIRECT OBSERVATION (Gemba)
STA
ND
AR
DIZ
E A
ND
SH
AR
E (
Yo
kate
n)
REFLECTION (Hansei)
CO
NT
INU
OU
S IM
PR
OV
EM
EN
T (K
aizen)
Respect for every Individual
Flow and Pull
Value
Seek Perfection
Assure Quality At the Source
Think Systemically
Lead With
Humility
Focus On
Process
Embrace Scientific Thinking
Constancy Of Purpose
The Importance of Thinking of Ourselves as "One Cleveland Clinic“ Dr. Toby Cosgrove, Toby’s Blog, 3/11/2010
Cleveland Clinic Improvement model
Create
Value
for the
Customer
Caregiver Engagement
Value for the Patient
Surgical Supply
A Case Study in implementing a Culture of Improvement Program
Start with Leadership support and Employee engagement
• Can we have 2-4 hrs. week?
• Can we have 30 minutes a day?
• 18 chairs and 4 tables?
• A projector and screen?
• A place to meet?
• Let’s do it!
Lean Simulation using Scrabble
• Introduce systems:
– Organizational Alignment
– Visual Management
– Problem-Solving
– Standardization
Ask What Matters Most?
Inventory Accuracy
Introduce Visual Management – Manage What Matters Most
1. First iteration • Inventory accuracy %
by item count • Standard Huddle
agenda 2. Second iteration
• Directional Arrows • Back Orders
3. Third Iteration • Inventory accuracy by
% absolute $ variance 4. Fourth Iteration
• Absolute $ Variance • Standards for not
taking weekly cycle counts
Problem-Solving Improve What Matters Most
Standardization Sustain What Matters Most
Standard team huddle process allows for rotating huddle leaders
Self Assessment
Developing standard process to find root cause of inventory variance
What have we learned? 1. Communication /
Engagement 2. Teamwork 3. How hospital works –working
smarter, not harder 4. Flow 5. Importance of metrics 6. Didn’t take a lot of work to
get better results 7. Data can be our friend 8. Communication of the data,
understanding what it means
Measuring Engagement
Chagrin Falls Family Medical Center
60.9% 63.6%
77.6%
87.5%
76.5% 75.0%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
8/2
8
9/4
9/1
1
9/1
8
9/2
5
10
/2
10
/9
10
/16
10
/23
10
/30
The time spent on the Culture of Improvement initiative this week was value-added to me. % to Goal
% to goal
Employee Engagement Survey Results
What matters most?
TRUST
Definition of Trust
• Working together
• Having each other’s back
• Mistakes are viewed as learning opportunities
• Our best interests are kept in mind
Pete can not be trusted because… He talks
down about everyone
He has been caught in lies
He looks shady
He does not keep us
updated on any changes
He has no face
He spreads rumors He shows up
late
Owes me money!
He does not know my
area
He can’t doesn’t
communicate with someone
He wants me to fail
He is forgetful
He does not follow up or
follow through
I can not depend on
him
He shares information told to him
in confidence He told things
to others that were shared in
confidence with him
He talks too much
Bill can be trusted because… He has good work ethics
He helps job go smooth
He does what he says
he will do
His words match his
actions
He keeps you updated
on any changes
He has not done
anything to lead me to
not trust him yet
Of his knowledge
Shakes hands
He has worked my
area and knows my
items
Helps others out
He wants me to fail
He shows leadership
Fixes issues of mine on their own
Keeps you updated on any changes and makes
job go smooth
I can depend on him
He has my back
I know he is detail
oriented and will follow through. I
can count on him.
Tracking Question of the Week
There is a climate of trust within my work group.
Completely Agree
Somewhat Agree
Somewhat Disagree
Completely Disagree
Trust Survey results
Results
Results after the first year
• Reduction of absolute inventory variance $395,620 $42,987
• Reduction in net variance $136,000 $5,184
• Overtime reduction > $20,000 • Zero employee turnover since we
started the program in July, 2014 • CEO, Toby Cosgrove visits the team
to share their story with the rest of the Clinic on his bi-monthly Connections webcast. Employees arrange a thank-you
celebration for their Director
Connections - Sharing our Success
“I LOVE hearing the success stories of this team! Without Surgical Supply, our ORs would not be running! You all have done a wonderful job making your work efficient and effective!! GREAT JOB!!!” Coord Research Nurse, Lou Ruvo Center for Brain Health, Las Vegas
Recognition
Questions?
Thank You! Please complete the session survey at:
www.ame.org/survey
Session: ThP/53
What Matters Most? Integrating a Culture of Improvement with a
long-standing Culture of Excellence at the Cleveland Clinic
Tim Pettry
Cleveland Clinic
