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How will Healthcare Reform Impact Reengineering Strategies to Transform Healthcare Delivery?

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Title: How will Healthcare Reform Impact Reengineering Strategies to Transform Healthcare Delivery?


1
How will Healthcare Reform Impact Reengineering
Strategies to Transform Healthcare Delivery?
  • Learning from Experience Presents
  • David Belson, PhD, Editor-in-Chief, Journal
    Society of Healthcare Improvement Professionals
  • Imran Chaudhry, FACHE, Regional Executive,
    Operational Excellence, Providence Health
    Services

2
Speakers Profile
  • Imran Chaudhry
  • Imran Chaudhry is the Regional Director of
    the Operational Excellence and Project Management
    Offices for Providence Health and Services,
    southern California. He is responsible for
    providing the overall leadership for the
    deployment and execution of the Lean, Six Sigma,
    Change Management and Project Management
    methodologies across the Providence southern
    California hospitals.
  • Dr. David Belson
  • David Belson, Ph.D. has helped dozens of
    hospitals and clinics improve their productivity.
    He applies his background of over 30 years as a
    professor in Industrial Engineering. He has
    developed classes on improving healthcare
    operations and written articles regarding Lean
    and other methods for radiology, surgery,
    emergency departments and other hospital
    functions. He has initiated research projects
    funded by the California HealthCare Foundation as
    well as the federal and California governments.

3
Insanity is continuing to do things the way
youve always done them and expecting the results
to be different.Albert Einstein
4
About Providence Health and Services
  • Not-for-Profit faith based healthcare
    organization
  • 2nd largest healthcare provider in the Los
    Angeles County
  • 9th largest employer in Los Angeles County
  • 700 licensed beds in the region
  • 12000 Employees and Medical Staff Members
  • 2.7 Million Uninsured people in the county

5
History of Six Sigma and Lean
1986 Bill Smith originated Six Sigma as a metric
1990s GE and AlliedSignal (Radical changes in
products and services)
2003 Providence California
1970s Toyota Production SystemLean
Lean Six Sigma
2002 Providence Health System
1980s Rolled out in Motorola
1988 Malcolm Baldridge National Quality Award
6
Commitment and Involvement of the Senior
Leadership!!
7
OE Growth
2006 6 Resources 2011 120 Resources
8
Linking Business Ys to Process Ys
9
Levels Of A Process
10
Prioritize Opportunities
11
Why Define a Standard Metric
  • What is the Definition of
  • ED Door to Doc
  • OR First Case Start Time
  • Patient Discharge Time

12
PROJECT SCOPING
Define Understanding the Scope
Out of Scope
As Necessary
In Scope
What will not be assessed or reviewed in this
project
Whats in the scope of the project
What may be looked at
Make Sure all team members are on the same page
13
Discuss Resources and Time Commitment Upfront!A
project SHOULD NOT TAKE more than 4 5 months to
complete (few exceptions)
14
Methodologies
Design for Six Sigma
H
Change in Paradigm/Futuristic
Variation and Defect Rate Reduction
Six Sigma/ Lean Six Sigma
High Complexity
CAP (the glue)
Data-driven
Lean
M
Waste Elimination
Flow/ Cycle Time Reduction
Medium Complexity
Work-OutTM
Expert-driven
All tools/processes are used synergistically
15
Dont Silo the Methodologies, its all about
Continuous Improvement!!
16
Change Acceleration Process
Quality x Adoption Result
  • Q x A R
  • x 4 28
  • x 4 32
  • 7 x 7 49

Focus on Q
Instead focus on A
Big Impact
Its All About the Acceptance
17
Change Acceleration Process
Leading Change
Creating A Shared Need
Shaping A Vision
Mobilizing Commitment
Current State
Transition State
Improved State
Making Change Last
Monitoring Progress
Changing Systems Structures
18
Lean vs. Six Sigma
19
Health Care Operations Improvement Work
  • David Belson, Ph.D.
  • USC Department of Industrial and Systems
    Engineering

20
How do we improve healthcare performance?
  • Example projects
  • Emergency Department, Lean
  • Mammography clinic, simulation
  • Surgery patient flow, mapping
  • Primary care, doctors office, redesign
  • Technology solutions, RFID, EMR

21
Fixing the Emergency Departmentwith Lean
22
The most popular tool is LeanToyota method,
Lean-Six Sigma,
  • Hospitals, clinics, suppliers, hospital systems
  • California Hospitals
  • Providers nationally

23
Maximizes participation, reality (Kaizen)
23
24
LEAN Tools
  • Standardize simplify
  • Visual Controls
  • Standard work
  • Kanban
  • Level continuous flow
  • A-3
  • PDSA / DMAIC
  • more
  • Kaizen, participation
  • Waste reduction
  • Mapping
  • 5 S
  • Value Stream mapping
  • 5 Whys
  • Cause effect
  • Pull

24
25
  • Lean event
  • ED department
  • Lean triage
  • Eliminated waste
  • Results
  • lower cost and less waiting

26
Ideas from hands-on staff
27
Results
  • EDs Triage now
  • Fewer forms used
  • Quicker handling of patient visit
  • Less waiting time
  • Fewer patients who left without being seen (the
    original objective)

28
Fixing the Patient Flowwith computer Simulation
29
Simulation
30
Computer Simulation
31
Input Data
  • Observation timing
  • Following patients and staff, interview
  • Hospital data

32
Analysis showed how mammography department could
serve 50 more cases with no increase in staff or
equipment.
33
Fixing Surgerywith Mapping
34
(No Transcript)
35
Lean Value Stream Map from Focus Group Kaizen
36
Value Stream Map Hospital Discharge
37
Spaghetti Diagram
38
Basic Surgery Flow
Q
Q
Q
Q
Q
Q
Q
Q
Improve with pull
39
USC
40
Surgery Operational Problem AreasIssues are
similar among hospitals.
41
Fixing the Primary Care Doctors Office with
Redesign
42
Old Process
43
New Process
44
Fixing Patient Waiting with Technology
45
Patient wristband with RFID chip
46
Staff can see what patient is where and how long
they have been there.
47
Who does Healthcare improvement?
  • External consultants
  • Designated internal department
  • Responsibility of managers
  • Certified or uncertified
  • Corporate vision (or not)

48
Results are significant
  • Time for a given activity reduced by over 50
  • Amount of human effort needed reduced by gt 50
    percent.
  • Defects reduced by gt 90
  • Injuries and sick days reduced by over 50
  • Cost of a given activity reduced by 30 50
  • Work force dissatisfaction and turnover reduced
    dramatically.

49
  • David Belson, Ph.D.
  • USC Department of Industrial and Systems
    Engineering

http//www.jship.org/home/
http//healthcareengineering.usc.edu
belson_at_usc.edu
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