Target condition for today:

Transcription

1 James Hereford President and CEO Target condition for today: Challenge us as a community to further our understanding of why lean works This is critical if we want to transform health care organizations. 1

2 First let me state that I believe health care is the most complex operating environment there is. 1. We are capital intensive, with expensive buildings and expensive equipment. 2. We are labor intensive. Unlike other industries that deploy a lot of capital, we don t use it to reduce down the size of our labor force, and in fact it often goes up with additional capital being deployed. 3. We are in the service business, delivering our product with our customer being along side of us, and, if we are doing it right, they are highly involved in the process of care. 4. We are in the knowledge management business, working in a network of information flow, with complex information development and communication as a key predictor of our ability to deliver high quality care. Related to that, unlike many industries, the people with the highest level of training and expertise are at the point of service, not in management. 5. Ours is a highly regulated and litigious environment at the local, state and federal level. 6. Our mistakes can have immediate life and death consequences. Fairview Operating System Improvement System Value & Outcomes Patients and other Customers Management System Principles Mission, Vision, Values 2

3 The Fairview Management System is a management system designed to support an organization that wants to drive systematic and continuous improvement and believes that they can achieve strategic differentiation through superior operational performance. The management system is designed to: Align the goals and improvement work of the organization Focus on the patient and optimize performance across functions Support continuous improvement at scale Sustain gains from improvement work Support engagement from everyone in the enterprise 3

4 Delivery System Operations Dashboard: FY 2015 (Stanford Health Care) Patient Safety CLABSI CAUTI Pressure Ulcers Population Health Readmissions Quality ED OR Ambulatory IP Discharges Cost/Adj Discharge Growth Efficiency 2.42 ED LTR Cancer LTR Inpatient LTR Ambulatory LTR Hereford area of responsibilities. Source: June FPM Report Net Revenue (after bad debt) Patient Satisfaction Financial Hereford area of responsibilities. Source: June FPM Report Access Specialty Care Access Primary Care Access Discharge by Noon People Employee Safety Employee Engagement 74 (2014) 68 (2013) Organization Wide Source: Advisory Board Survey Other Value Streams and Projects: Value Stream Initiatives: FY15 (Stanford Health Care) Value Streams in Progress: GI 3P Using lean 3P method (Production Preparation Process) a team of physicians, clinical staff and managers have come together to design a the space for the Digestive Health Center at Redwood City Pavilion D to significantly improve the patient and clinical experience, and also improve throughput. PC 2.0 a cross disciplinary team has come together to reinvent the way that prmary care works. Maximizing the use of virtual care, leveraging technology and designing the space to optimize utility and minimize square footage. Cancer Center Transformation A broad based transformation that includes a patient centered approach to complex care and operational transformation to support efficient qnd effective care. Interventional Home A value stream effort to emphasize the content and experience of the preintra- and post-operative processes. Other Projects: UHA Operational Integration Operational integration between SHC and UHA processes to better support UHA practices. Blood Center Acquisitionm transfer of ownership of the Stanford Blood Center from the University to Stanford Health Care, including the formation of an LLC and transfer of employee status. Genomics Clinical Service building operational structure and processes to establish a robust genomics clinical service. South Bay Cancer Center Completion and opening of the SBCC. Neuroscience Center Programming, integrated planning for the Hoover comprehensive Neuroscience Center. Emeryville Programming and planning for a new multi-specialty clinic, interventional and ancillaries of a new facility. Pavilion D Programming and planning for converting the Redwood City pavilion D from administrative to clinical space. Team Staffing and Development New VP s hired and team building conducted. Inpatient Volume Management managing all components of supply and demand to maximize the limited and largely fixed inpatient space for the hospital. 500P Planning and execution of transition activities for the new hospital. 300P Planning for the redevelopment of the new hospital 4

5 FY16 Delivery System Operations Dashboard (June 2016 YTD) (Stanford Health Care) Qualit y Patient Safety Sepsis Mortality Population Health Readmissions 0 0 ED Ambulatory Primary Visits Inpatient Surgical Visits Patient Days Financial Net Revenue (After Bad Debt) 12.3 Hereford area of responsibilities Source: June FPM Report Growt h ,776 Patient Experience Operational Excellence Inpatient LTR Primary Care Access Cancer LTR ED Access Non-Labor Expense Reduction Prior (FY15) of Goal ($12M) People Hereford area of responsibilities Source: June FPM Report Employee Safety Employee Engagement Organization Wide Source: Advisory Board Survey 9 FY16 Delivery System Value Streams Initiatives Summary (FY16 Quarter 3) (Stanford Health Care) Additional Highlights Completed successful Joint Commission & Magnet Surveys. Obtained Magnet re-designation with zero identified opportunities for improvement. Value Stream Improvements Cancer Transformation: The percentage of patients scheduled to be seen within 7 days in the Hematology Clinic continues to exceed 90, which is a significant increase from baseline of 50 Patient Flow: In addition to increasing discharges before noon, the Orthopedic Joint service has also realized an 8 hour reduction in length of stay Primary Care 2.0: We launched our first Primary Care 2.0 Clinic at Santa Clara in June. The 30-day check confirmed the implemented interventions (team-based care with the support of an extended care team, the use of open-scheduling template, pre-visit planning, and 5s) have sustained and will continue to monitor the improvements at the 60 and 90-day check ins. 5

6 You have shown good results, do you understand why? H 0 : Problem Solving is a Better Forcing Function 6

7 H 0 : Managing in Real Time H 0 : Incremental Continuous Improvement At Scale 7

8 H 0 : Enhanced People Development H 0 : Relational Coordination is Enhanced 8

9 H 0 : Cross Functional Problems Are Addressed H 0 : Quality at the Point of Design 9

10 H 0 : A Better System of Management Conclusion These hypotheses are not necessarily right or exhaustive. If we want lean to be driving force in transforming health care and not another fad, it needs to be studied and understood more deeply Understanding cause and effect in such complex environments will require sophisticated and varied approaches to study methods and designs. As health care researchers and academic institutions, we are uniquely positioned to collaboratively study our efforts and share what we learn, but it will require us to disciplined and systematic about how we do it. 10

11 Thank You 11