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Hotel-Dieu Grace Hospital
End to End Patient Flow
Nicki Schmidt RN
Senior Lean Facilitator
Hotel-Dieu Grace
Virus?Our Journey to Date
Oct. 2005-06 ED VSA
Mental Health VSA
Joint Replacements VSA
Clinical Teaching Unit
VSA
Central Sterilizing VSA
General Radiology
VSA
Lab Pathology VSA
Pharmacy RIE
TPOC
Medical VSA
Surgical VSA
Supply VSA
ICU VSA
D.I. 6S
26 RIEs
1 Transformational
Leadership Event
1 2P
Information Services.
VSA
Oct. 06- May
08
May 08-
current
Why End to End?
A New Beginning
A New Beginning
Reality Sets In
Reality Sets In
2005: The Burning Platform
2005: Learning to See
Building On Success
Departments and Value Streams
Challenges
Enterprise Approach
End to End: AH HA’s
Who knows the Plan?
Do We All Know?
Discharge a Priority??
Chaos!! Can We Coordinate?
Sustaining?
Challenges
“Do not assign responsibility without
accepting the responsibility to Mentor”
HDGH Core Team
Lead By Example
Inspiring Others
Enabling the Value Creating Work
RESULTS
GUIDING PRINCIPLES SUPPORTING PRINCIPLES
Measure what matters
Align behaviors with
performance
Identify cause and effect
relationships
STEWARDSHIPSee reality
Focus on long term
Align systems
Align strategy
CONTINUOUS PROCESS IMPROVEMENT
Stablize process
Rely on data
Standardize process
Insist on direct observation
Focus on the Value Stream
Keep it simple and visual
Identify and eliminate waste
Integrate improvement with work
CULTURAL ENABLERSNurture long term relationships
Empower and involve everyone
Develop people
Assure a safe environment
Create value for
the customer
Create constancy of
purpose
Think Systemically
Focus on process
Embrace scientific
thinking
Flow and pull value
Assure quality at the
source
Seek perfection
Lead with humility
Respect every individual
STEWARDSHIP
TEAM WORK
CONTINUOUS IMPROVEMENT
RESPECT COMPASSION
SUPPLY MANAGEMENT
OPERATIONS
PRODUCT &
SERVICE
DEVELOPMENT
CUSTOMER
RELATIONS
SASH BOARD
STRATEGY DEPLOYMENT
VALUE ENABLING SYSTEM
ENSURING FISCAL
RESPONSIBILITY
VALUE
STREAM
MANAGEMENT
DAILY
MANAGEMENT
SYSTEM
SAFETY SYSTEM
PEOPLE SYSTEMS
TALENT
RECRUITMENT &
MANAGEMENT
PERFORMANCE
MEASUREMENT
SYSTEM
SYSTEMSOUR VISION
Building A New Culture
Page 2
Hotel-Dieu Grace CultureWednesday, October 27, 2010
VALUES
Compassion
Respect
Stewardship
Teamwork
Continuous
Improvement
Tells the truth
Keeps promises
Keeps confidences
Maintains privacy
Maintains confidentiality
HONESTY and
INTEGRITY
Speaks with candor in a
respectful manner
Encourages truthfulness
Is transparent to process
and to content
Says hello to all they pass
Shows up on time to
meetings
Attentive and focused in
meetings
Looks to ensure that people
aren’t in need of help, lost or
in distress
Promotes a clean, profes-
sional and safe environment
Does not spread gossip
Asks for clarification if they
do not understand
Listens to others without
interrupting.
Repeats what was heard to
clarify as necessary when
communicator is done.
Sensitive to the spiritual
and emotional needs of
every individual
Demonstrates patience
SEEK TO
UNDERSTAND
VOICE OF THE
CUSTOMER
Asks the patient “Have your
needs been met?”
Acknowledges requests for
help
Explains why – especially if
needs cannot be met
Voice of the Customer is
used to identify and
develop change
Sensitive to the needs of
the patient and responds to
them
Understands the patient is
our focal customer
Encourages self-
determination
SYNERGIZE
Works together with others to
problem solve
Thinks ’Win Win” in support of
a consensus agreement
Recognizes other’s efforts
daily
Coachs and mentors, never
blames
Uses the patient as the focus
of all teamwork
Looks for input from team
members that have been silent
Being flexible when presented
with alternate ideas/timing
Owns up to mistakes
ACCOUNTABLE
Accepts accountability
for tasks
Accepts accountability
for his/her behaviour
Meets deadlines and
communicates action
plans
Seeks help when
needed
Completes work on time
Completes work on
budget
ELIMINATE
WASTE
Identifies waste in work
processes
Removes process steps
that are unnecessary
Collaborates with other
departments to ensure
smooth transitions in
the work
Uses just what is
needed and doesn’t
hoard
TRUSTING AND
TRUSTED
Does what he/she says
Doesn’t take what does not belong
to them
Takes pride in our organization and
speaks highly of its people
Takes pride in their work and the
work of others
Does their share of the workload.
Does not leave work undone for
others to do
Values the competence of
colleagues
Trusts coworkers work and clarifies
if a problem is identified
HUMILITY
Recognizes other people for
their role in a success
attributed to them
Talks about team effort not
individual effort
Works at their highest
capability and not boastful
Having an understanding for
inadvertent mistakes
COURTESY and
HOSPITALITY
SEEK
PERFECTION
SEEKS
FEEDBACK
Asks for feedback
Asks questions to gain
other’s views
Shares information openly
with the understanding that
others will do the same.
Open to the ideas of others
USE
RESOURCES
WISELY
Offers suggestions to
improve use of
resources
Open to changing work
to improve utilization of
resources
Responsible for
resources utilized
Protects the hospital’s
assets
UTILIZE
SCIENTIFIC
THINKING
ASSURE
QUALITY
Creates value in work
processes
Stabilizes processes
Shortens the length of
time to complete work
processes
Continually improve the
work process
Implements PLAN, DO,
CHECK, ACT cycles
Uses data and direct
observation to make
changes
Follows standard work
Make work visual
Uses systems thinking
Simplifys processes
Stops and fix problems
Reports all defects,
problems and near misses
Designs work to eliminate
harm and promote safety
Speaks slowly and clearly
Asks if there are any
questions or comments
Repeats what they said for
clarity
SEEK TO BE
UNDERSTOOD
So What!
# of PATIENTS DISCHARGED with ALC DAYS per MONTH
0
10
20
30
40
50
60
70
80
90
APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR
#
2010-20112009-20102008-20092007-2008
Results
OVERALL OCCUPANCY RATE
75.0
85.0
95.0
1 2 3 4 5 6 7 8 9 10 11 12 13
Percenta
ge
2010-2011 2009-2010 2008-2009 2007-2008 TARGET
Questions
?
