2 years of Lean at SFGH. Lean Update to the JCC February 24, 2014

Transcription

1 2 years of Lean at SFGH Lean Update to the JCC February 24, 2014

2 Reflection Lean Journey in Healthcare 2 years (SFGH) 5 active Value Streams Tier 1 Report Tier 2 Reports 30 leaders completed Lean Certification 35 more are in Certification 5-7 years (San Mateo Medical Center) All departments, clinics, units have undergone 5S Established robust Standard Work auditing Accountability and responsibility years (Virginia Mason, Theda Care) All leaders in the organization have learned, and practice the fundamental principles of Lean All departments, clinics, units have developed and validated Standard Work for their processes

3 Continuous Daily Improvement Lean is a rigorous, disciplined approach to improvement work, where continuous daily improvement IS the work P A D C

4 Lean Values and the SFGH Mission Challenge Continuous Improvement Learning to See Respect Teamwork SFGH s Mission: To provide quality health care and trauma services with compassion and respect

5 Accomplishments 3M Sponsor: Sue Currin Process Owners: Dana Nelson Morning Huddle Collecting Co-pays on-site

6 Accomplishments Urgent Care Sponsor: Roland Pickens/Iman Nazeeri-Simmons Process Owners: Ron Labuguen, Ricardo Ballin On-site Radiology Standard Work for the Discharge Process

7 Accomplishments OR/PACU Sponsor: Todd May Process Owners: Patty Coggan, Jerry Padilla 5S Back Hallway 5S Sterile Core

8 Accomplishments 4D Med/Surg Sponsor: Terry Dentoni Process Owners: Andre Campbell, Mike Daly, Nela Ponferrada Before Hallway Storage After Nurse Workstations

9 Accomplishments - Radiology Sponsor: Shermineh Jafarieh Process Owners: David Sostarich, Mark Wilson Before MRI Waiting Area After MRI Dressing Room

10 Accomplishments 8 Lean Black Belts Dennise Rosas Michael Pfeffer Brandi Frazier Aiyana Johnson Iman Nazeeri-Simmons Alice Chen Will Huen Joe Clement Partnering with DET, Facilities, EVS, Materials Management

11 8 Patient Advisors Accomplishments

12 Preparing for the Future

13 New Hospital Workflow

14 Future State: Building 25 Optimal use of Resources Lean Improvement Methodology Integrated Information Systems Data to support decision making Comprehensive Integrated Care Model SFGH Mission: To provide quality healthcare and trauma services with compassion and respect. Vision for Bldg 25: To be the best hospital by exceeding patient expectations and advancing community wellness in a patient centered, healing environment. Healing Physical Environment Service Excellence Clear Communication: Staff Department W/ Patients Technology

15 TEAM CHARTER Date: 3-Feb-14 Current state San Francisco General Hospital is a world class hospital and trauma center in the elementary stages of adopting new systems of financial and operational accountability. As such in our current state we have silos of excellence composed of well intentioned, mission driven staff, hampered by aging infrastructure, lack of integrated and optimized technology, and disparate flows of communiation. Major barriers include: Lack of integrated EMR Lean culture is not universal throughout the organization Lack of accountability / alignment at all levels No universal culture of service excellence Multiple priorities and scope Bureaucratic systems Lack of time Cumbersome IT systems and access to data Limited resources, staffing and infrastructure Partnering with unions Accountable care act considerations San Francisco General Hospital A3 3P Future state A3-3P Product /service name : Building 25 Mission & Vision: PROPOSED ACTION 2009 rona consulting group SFGH Mission: To provide quality healthcare and trauma services with compassion and respect. Bldg 25 Vision: To be the best hospital by exceeding patient expectations and advancing community wellness in a patient centered, healing environment. Detail action items for 3P workshops (Explanation of and deliverables for each 3P workshop) 1. 3P Inpatient Services: Optimizing patient flow and quality outcomes, looking at staffing models, flexing to meet changes in demand and acuity Post 3P KW: L&D: Patient flow, staffing and communications. 1.2 Post 3P KW: Med/Surg: Patient flow, acuity changes, staffing, collaborative teams, documentation and communication. 2. 3P Emergency Department: Flow in the ED incuding triage, staffing, signaling, communications, admissions to the floor as well as flexing to meet changes in demand and acuity. 3. 3P Operating Room/ PACU/ Procedural Services: Shared processes, patient flow and staffing. 3.1 Post 3P KW: Basement 2 flow: Diagnostic Imaging, Pulmonary & Cardiology - shared processes and patient flow. Key features of Improvement Request (Top 12) Goal: To design processes that coordinate the 7 flows of medicine where: Patient care needs are visual to all care team members Patient care goals are understood, and expectations are communicated early in the process There are no waits / delays in care Care is delivered by respectful, high functioning, cohesive care teams Decision making is guided by transparent information The EMR, data systems and business intelligence are integrated Processes are built around the patient, and services are brought to the patient whenever possible Staffing and support models expand and contract according to fluctuations in demand and acuity Reliable processes utilize mistake proofing concepts to eliminate defects Our staff has exactly what they need to do their job The environment is safe, clean, comfortable and quiet TARGET STATEMENT Business Requirements (Business impact, strategic requirement) Patient Expectations Patient Centered Care HCAHPS Scores Safe, secure environment (AWOL, AMA) Patient engagement Individual care plan (Audit results, LOS) Pt access (Lead Time, defects Communication Among Care Providers Maximizing value Staff training for EOC (ROK: Cost, Triple Aim) Halogen% Survey results culture of safety survey Quality Measurements Community Wellness Fall Rates Core Measure Outcomes Patient education teachback HAC's (Ulcer, UTI, ADR's) Hospital Re-admission rates Smoking Cessation rate Healing Environment Primary care linkage % HCAHPS Scores: Community engagement Food choices Clean bathrooms & environment Noise levels Customer Requirements (desirable characteristics) Cost Effective: No Waste, Just In Time, Strategic, Accountable, Informed Environment: Safe, Healing, Easy to navigate Lean: Discipline, Structure, Continuous Improvement, Innovative, Engagement Service Excellence: Satisfaction, Respectful, Patient Centered Integration: Seamless, Alignment, Communication, Patient Centered Data: Actionable, Integrity, Informative, Timely Comprehensive Care: Holistic, Timely, Appropriate, Safe Reliable Technology: Cost effective, Integrated, Visionary Boundaries: Included: Cardiology Cath Lab Diagnostic Imaging Interventional Radiology Dietary NICU Labor and Delivery Pharmacy Clinical Lab/Blood bank Excluded: Unaffected departments not moving into the new facility ACTIVITY ACTION PLAN Sterile processing Pulmonary GI / Endoscopy OR / Pre-op / PACU Emergency Department Med Surg (Peds, ACE) ICU / CCU / Stepdown IT Requirements Support services that will expand their scope into the new building: Messengers, Patient Transport, EVS, etc DATE: 1. 3P Inpatient Services March RESOURCES 2. 3P Emergency Department May 5-9 Visioning Workshop participants Participants Facilitators WSL Ann Kernan - RCG Sue Currin, CEO Shermineh Jafarieh Tim Greer TL Steve Mattson - RCG James Alexander Valerie Inouye Gillian Otway Leadership Baljeet Sangha Terry Dentoni Lawrence Nichols Sponsor Iman Nazeeri-Simmons Sue Carlisle Todd May Elena Tinloy Grobal Terry Saltz Cathryn Thurow William Huen Elaine Lee process KPO Dennise Rosas David Woods Kathy Jung Alice Chen Juliana Oronos Rachael Kagan Bill Kim Jason Zook Tristan Cook 3. 3P OR & Procedural Services June CHECK AND ACT Monitor implementation of Kaizen improvements weekly and workshop targets with completion of 30, 60 and 90 day reports as well as daily audits of standard work. Weekly review with executive team. Develop a visual workplace and methods for communication.

16 On the Horizon SFGH Management System KPO Development State of the Union for Lean implementation Return on Kaizen (ROK) analysis 1 More Value Stream: Outpatient Pharmacy Kick-Off in March 2014