When Lean Events or Kaizen projects are not enough

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When Lean Events or Kaizen projects are not
enough

• Using lean training to embed lean practice
  throughout the organization.

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Denver Health Lean Initiative

• Who is Denver Health?
• Why we chose Lean?
• Lessons learned in the early years
• Training of DH black belts
• Realignment of purpose
• 2009 case studies and ROI

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Denver Health
Denver Health Medical Center
Rky Mtn Regional Trauma Ctr
Rocky Mtn Center for Medical Response to Terrorism
911
Public Health
Regional Poison Center Nurse Advice Line
Community Health Clinics
Denver Health Medical Plan
School-based Health Clinics
Denver Cares
Correctional Care
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Denver Health Medical Center

• 400 bed safety net hospital
• Integrated outpatient clinics
• 140,000 unique users
• 300 employee physicians
• 5332 employees
• Teaching hospital
• Level I trauma center

• 3800 deliveries per year
• 1.1 billion per year in gross charges
• Uncompensated care 350 million (2009)
• Operating in the black for 18 years
• Meeting and exceeding UHC benchmarking data in
  60 categories

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Decision, June 2005

• Health Care is being delivered in much the same
  way as it was 40 years ago
• Health care is full of waste and inefficiencies
• Other industries have successfully transformed
  the way they do business
• Denver Health, a community safety net hospital,
  expects public financial reimbursement to shrink
• Demand for services are up
• We (as an industry or institution) have no
  cohesive approach to quality and productivity
  improvement

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Getting It Right

• Transforming Denver Health
• Getting it Right Perfecting the Patient
  Experience
• Patricia Gabow, MD

I.T
Right People
Right Process
Right Communication
Right Environment
Right Reward
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Choosing a Methodology

• Consulted with industry leaders
• Chose Lean methodology and Toyota Production
  System to transform delivery of health care
• Simple, intuitive
• Drives culture change
• Quality and financial ROI
• Saving lives, saving money, saving jobs!

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Lean is a people driven process, At Toyota we
build people before we build cars.Toyota
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Invest in People

• Best and the brightest people to lead not manage
  the transformation
• Characteristics
• Work well in teams
• Identify and solve problems
• Love to learn
• Are innovative, early adopters
• Excel at communication

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The Launch

• MAMTC Mid-America Manufacturing Technology
  Center
• Training of 50 Denver Health managers,
  supervisors, physicians, and other organizational
  leaders completed by spring, 2005
• DH Black Belts (BBs) utilize lean for daily
  improvements and to conduct Rapid Improvement
  Events

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Performing Kaizen EventsThe Early Days

• Coordinated by Director of Health Services
  Research
• Utilized DH Black Belts as facilitators, team
  leads, and process owners
• Realized some success but difficulty with event
  preparation and follow-up

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Step off the edge

• 5S everywhere
• VSA the operative services (this would be our
  model value stream)
• 5 rapid improvement events (RIE) in the OR the
  same week! (What were we thinking?)

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Early Lean Victories

• Organization-wide 5SSort, Set in Order, Shine,
  Standardize, Sustain
• 5S of medical offices, clinics, nursing units,
  engineering, respiratory therapy, and the lab,
  ambulances, storage areaspretty much everywhere!
• Immediate positive feedback

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Black Belts Phase I

• Train leaders in the organization
• 50 the first year
• Monthly reports
• value of efforts
• Independent of value streams and lean events
• Expectation to be a team lead on two rapid
  improvement events

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Black Belt Projects Big and Small

• Engineering 448,275. in supply expenses
• Acute Care 657 cans of tube feeding (approx
  2,000./year) returned
• Address discrepancies in billing patient bed
  types in SICU for trauma and isolation patients
  381,790.

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Engineering Supplies
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Frank format picture size To 3.63 h and 4.84w
Unit 1, Basement, Bedroom, Plumbing
(BEFORE) Frank Ortega 4/19/06
5S
Unit 1, Basement, Bedroom, Plumbing
(AFTER) Frank Ortega 5/2/06
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Results Year One

• 40 rapid improvement events
• 3.5 million saved or new revenue identified
• 236 employees engaged
• 50 black belts trained

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Sample Events RIE

• Surgical infection rate (quality)
• Clinic flow (increased productivity)
• Financial agreements (improved revenue)
• Room turnover ophthalmology (efficient use of
  resources)

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Surgical Site Infection RIE June 2005
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Provider Flow CellRIE September, 2006
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Ophthalmology Room Turn
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Rethinking, Phase II

• Many successful RIE events, good ROI
• New Lean Systems Improvement Department with
  Senior Facilitator and Simpler Business Systems
  sensei
• Expanded from 5 to 14 value streams
• Full time facilitators (7)
• HoweverBlack Belt projects ROI flat!

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Bringing Black Belt Training In-House

• Spring 2007
• Training organized into three categories

II. Tools Used to Eliminate Waste Standard
Work, 5/6S, Visual Management, Mistake Proofing,
Kan Ban-Pull Systems, Flow Cells, Level Loading,
Quick Changeover, Production Control Board
I. Tools Used to Identify Waste Process Map,
Spaghetti Diagram, Communication Circle,
Waste-Walk,, Time Observation, Takt Time, Bar
Charts, Fishbone Analysis
III. Using Tools in Focused Manner RIEs, Value
Stream Analysis, 2P/3P
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DH Black Belts?

• All BB nominees come from the executive staff
• All black belt trainees are selected by the CEO
• 50 BB train each year
• 60 hours of training
• Advanced BB training 24 hours
• All departments represented
• Middle management level and above

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RIE Black Belt Savings Trend
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Current State

• 172 BB trained
• 150 remain in organization
• January 2009 accountable for ROI for projects of
  30,000. each for year
• Do bi-monthly reports
• Financials vetted by budget analysts
• Reports and results reported on SharePoint site
• Additional financial incentives if BB exceeds
  financial goals

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Denver Health Black Belts

• Abrams, Lisa Adams, Cheri L Albert, Rick
  Alexander, Wendy Anderson, Mark Andis, Ann
  Askenazi, Morris Balshaw, Donna Barrow, Bobbi
  Batal, Holly Beauchamp. Kathy Beauchamp, Louis
  Beckmann, Catherine Benedict, Mike Bjork,
  Andrew Blair, Patti Bliss, Heide Boyle, Kathy
  Brewis, Patty Brandt, Jeffrey Branigan,
  Timothy Brown, Jennifer Browne, Margaret
  Callahan, Annette Campbell, Margie Cannon,
  Ingrid Carey, J. Chris Carpenter, Debra
  Carroll, Kim Chu, Eugene Clark, Jonathan
  Colwell, Chris Crawford, Debbie Dingley,
  Catherine Doherty, Niall Donovan, LeAnn Duke,
  James Eisert, Sheri Ellis, Andrea Entwistle,
  Julie Fluent, Jay Fox, Rebecca French,
  Richard Geninger, Mark Gerardi, Joseph Gomez,
  Victor Goodman, Philip Gorsegner, Scott
  Greenstone, Naomi Gutierrez, Pete Haenel,
  James Hak, David Hambidge, Simon Hanley,
  Michael Harding, Mario Hess, RCraig Higgins,
  Nancy Holzwart, Jean Hoye, Scott Humphress,
  Marcia Jackamore, Stephen Johnson, Eliza Kane,
  Lee Ann Kashuk, Jeffrey Kassatly, Carmen
  Kaufman, Linda Keller, Pat Keniston, Angela
  Kilfoyle, Mary Kim, Esther Klock, Nancy
  Kukolja, Teresa Lamberis, Paul Lamont-Anich,
  Diane Lanius, Patricia Lee, Jay Leeret, Rob
  Leger, Vickie Limberis, Paul Lindroos, Beth
  Linehan, Deborah Lockrem, John, M.D. Lee,
  Long, Jeremy Loomis, Lucy Lovseth, Carol Mabb,
  Jodi MacKenzie, Thomas Magee, Mary Markson,
  Deb Masi, Joseph McCloskey, Tom McDonald,
  Nancy McEwen, Dean Mestas, Tricia Metropulos,
  Peter Miller, Howard Milton, Brian
  Moldenhauer, Kendra Morgan, Steven Muchow,
  Trish Mucklow, Sheila Mulhern, Ellen, R.N.
  Nagy, Robyn Nelson, Kim Nugent, Michael
  OBrien, Kelly O'Malley, Mike Ogle, John
  Parnigoni, Kelly Paulson, Pam Pelot, Jeffrey
  Pettigrew, Philip Pinkney, Mary Potocnik,
  Julie Proudfoot, Susan Quintana, Tina Reid,
  Mark Robinson, James Rossman, Greg Ryan, Mimi
  Ryder, Elizabeth Sangster, Tom Sawyer, Michael
  Scherger, Deb Schneider, Bettina Shecter,
  Barbara Shockley, Lee Stephenson, Cheryl
  Stiglich, Norma Szceapanski, Jen Tann, Sheila
  Thompson, John Thress, Greg Townsend, Ron
  Ullrich, Shawn Uran, Kathryn Van Dyk, Susan
  Vance, Anna Vincent, Audrey Walker, LaVonna
  Ward, Rachel Wolken, Bob Wright, Mark Wruk,
  Kathleen

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Phase III, Whats Working?

• Created an alignment of purpose
• BB have accountability to metric
• Value streams have accountability to a metric
• Organization is accountable for
• 30 Million from Lean efforts (2009)

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Case Studies2006-2009
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Lab Savings

• Savings
• Reagent and Supply Savings 88,000/5yr
• Maintenance Contract Savings 5,500/yr
• SpecTrak Software at no cost 25,000/1X
• FTE
• Maintenance on multiple platforms 257
  hrs/yr
• Decreased QC Prep and Runs 888
  hrs/yr
• Auto-verification of Normal Results 893
  hrs/yr
• Bring more testing in-house to decrease referral
  testing costs (HCV, Vitamin B12)
  31,000 in 2008
• In progress Flow Cytometry, BNP, HIV Gene Prove
  ID, PCR for Infectious Disease

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Black Belt Projects Good to the Last Puff!

• Black belts need to question establish processes
  to determine if there is a better way.
• Combining with peers creates results
• 200,000 predicted savings

The Wastes this project eliminates
Overproduction, Inventory, Over-processing
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Questions?

• Contact Information nancy.mcdonald_at_dhha.org
• Lean Systems Improvement Department
• 777 Bannock St, MC 8702
• Denver, CO 80204-4507
• 303 602 7030