OAHHS LEAN WEBINAR OCTOBER 14 TH,2014. Purdue Research Foundation

Transcription

1 OAHHS LEAN WEBINAR OCTOBER 14 TH,2014 1

2 Overview A3 Analyze Key Components Analyze Visual Presentation of TIPs Multi-Level Pareto Analysis Questions? 2

3 A3 Analyze Key Components 3

4 Project Title and Area: Date: Organization: Authors: Pre- Define Measure Select Project 4 Hoshin Kanri VOCS VSM Define the problem Project Y Project charter SIPOCS VOCS (SWOT; Affinity; CTS; Kano) Communication Plan Quantifying the waste & variation Visual display of current process Data collection plan Gemba MSA Process flow charts Spaghetti diagrams Scatter plots Set Goal SMART Team Selection Exec sponsor Process owner Gantt Chart Pie charts; Bar graphs Control Charts Pareto Process capability (DPMO; Sigma score) Takt time; cycle time Understanding the waste & variation Y = f(x) Future State Map Hypothesis Testing Correlation Regression Gap analysis (current/future) Root cause why gaps exist Tools Removing the waste & variation Target state Prioritize solutions Impact/Effort Affinity Multi-voting List Reduction Fishbone; 5 Why Opportunity prioritization Risk/Frequency Affinity diagram Multi-voting/List Reduction families of variation Analyze Gantt chart Kaizen newspaper Small tests of change PDCA Quick change-over Cellular layout 5-S Preventing recurrence of the waste and variation Control Plan Standard Work Visual controls Kan ban 2 bin systems Poke yoke Analyze Improve Control

5 What is Analysis? Analysis is a process of inspecting, cleaning, transforming, and modeling data with the goal of highlighting useful information, suggesting conclusions, and supporting decision making. Analysis has multiple facets and approaches, encompassing diverse techniques under a variety of names. If you can t measure it, you can t manage it - Peter Drucker 5

6 Two families of charts Quantitative Qualitative / Conceptual Pie Bar Column Line Dot Flow Structure Interrelationship Action plan Map Text visual Text table 6

7 Analyze Visual Tips Highlight The So What 7

8 City Hospital Medical Clinical Documentation Requests Current Trends 30 Complete Medical Record Other Grand Total Trend (Complete Medical Record) Trend (Other) Trend (Overall) Overall documentation requests trending downward, complete medical record requests flat 8

9 City Hospital Medical Records Volume by Type % 90.00% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% Improvement Opportunity 20.00% 10.00% 0.00% OT CM HP MN RR DN OR DM LR Other (15 Percent of Total Cumulative Percent codes)

10 Focus the Viewer on The Key Aspects of The Data Percentage of late Patient Accounts Receivables Over 26% of all receivable dollars linked to accounts that are more than 365 late (6.4% of receivables) year late 0-30 days late days late days late days late days late 1-2 years late 2-3 years late 3+ years late Percentage of Accounts Count in 2010, by Claim Age year late 0-30 days late days late days late days late days late 1-2 years late 2-3 years late 3+ years late

11 ED Analyze: Initial Cause and Effect Analysis Frankford Hospital Patient Flow Cause and Effect Diagram Env ironment Needs to mor e Pat ient Focused Bed Design Sub-opt imal RN D/C Not ifi cation No D ischarge notice from MD Sub-opt imal Unit Cl er k D/C Not ifi cation Personnel Priori ty& Timl iness of MD Rounding Patient Traportation Delay's Patient Assignment During Holding Sub-optimal ED registration Staff Strechers Dept.Territorial Organizational Culture Oxygen Tanks Sub-optimal organizational Communication Care Mgt. not Visable on Floors Excessive Mangement Spans of control Sub-optimal number of Phones in ED Sub-Optimal ED Work Stations No of Bed Board MD /RN Communication No Discharge not ificat ion MD/RN/Case Mgt Com munication Delays in Discharge Process Communication Break Downs Variations ED MD/RN Staffing Ratios Lack flexibility Housekeeping staffing Lack of set discharge time Sub-optimal discharge Communication No Organizational status Limited Ancillary testing on Weekends Ancillary Order Issues Emergency Department/ Patient Flow Delay s Beds Equipment Inadequate Patient Equipment Inadequate Number of CT Scans Process No Bed Tracking System Speciman Rejections Ineffective Pt. Transportatin Process Untimely MD Orders ED/Unit Top Root Causes Patient assignment Span of Control Patient Transportation Communication

12 Pareto Analysis Key Considerations 12

13 Pareto Charts Before and After Improvement Confirm the change really improved the process Pre POST 13

14 It May take two or more pareto charts to narrow the focus to an actionable level 14

15 Level 1 Pareto St.Stanton HF Patients Re-admitted W/N 30 days Reason Number of Patients Reason for Re-admission No IPT Prot ocol as Inpatient MED non-compliance No D/C Inst ructions Weight Loss Missed follow-up appointments Percent Count Percent Cum %

16 Level 2 Pareto St. Stanton Heart Failure Patients with No Inpatient Protocol Number of Patients Percent Inpatient Unit 3 East ICU 2 South 4 North 4 South Count Percent Cum %

17 Level 3 Pareto St. Stanton Heart Failure Patients with W/No Inpt protocol MD Drill Down Number of Patients Percent Inpatient MD Dr. Weamer Dr.Veasey Dr.Gorman Dr. Brown Count Percent Cum %

18 Level 1 Pareto Number Comment Type PHCC 4th Quarter Opportunity Comments Room Nursing Meals Skill IV Attitude/Behavior Wait Time Delay Discharge Discharge Instruction Communication Family Other Count Percent Cum % Percent 18

19 Level 2 Pareto PHCC 4th QTR Opportunity Comments RM Drill Down Number Percent Comment Type TV Malfunction Call Light Cleanliness Temp Count Percent Cum %

20 Project Title and Area: Date: Organization: Authors: Pre- Define Measure Select Project How does this project move the organization to its goals? Define the problem Set Goal SMART Why this problem? 1. Business case has been explained 2. Problem statement in measureable terms 3. Data provided to describe the problem 4. Performance gap is described 5. Metrics are specified Quantifying the waste & variation What x s and processes were measured to understand the stated problem? 1. Current state performance is described 2. Visual representation of process is shown 3. Data describing problem/process is provided 4. Project objectives/goals are specified Understanding the waste & variation 1. Primary obstacles and barriers are specified 2. Root causes are specified 3. Method of identifying root causes is shown 4. Goals regarding root causes are shown Removing the waste & variation 1. Proposed changes are specified 2. Visual representation of Target State is shown 3. Implementation plan is detailed 4. Results of Implementation are specified 5. Spread is in Implementation Plan if applicable Preventing recurrence of the waste and variation 1. Process owner is specified 2. Plans for follow up monitoring is detailed Analyze Improve Control 20

21 Anthony Veasey, MA,CPHQ, LSSBB Senior Advisor Lean Six Sigma (office) (mobile) Purdue Healthcare Advisors Purdue University 21

22 LEAN HEALTHCARE: HAC Project Sky Lakes Medical Center 22

23 About Us. Located in Klamath Falls 300 days of sunshine per year! Licensed for 176 beds Average Daily Census around 62 We serve approx 80,000 people in Klamath and Lake counties in Oregon, and Modoc and Siskiyou counties in California 23 23

24 Our Lean Project Bedside Report.. Is the time when responsibility and accountability for the care of a patient is transferred from one nurse to another. Journal of Perinatal and Neonatal Nursing December

25 Bedside Report Project Team Jeremy Westover RN Quality Claire Jambalos RN front-line Post-Surgical Sarah Freitas RN front-line Post-Surgical Tiffani Boehnen RN front-line Post-Surgical 8 front-line Shannon Mason RN front-line PCU nurses! (even a Karen Wright Doty RN front-line PCU few naysayers) Chantry Forney RN front line Post-Surgical Sabrina De Vall RN front-line Medical Stacey Mathis RN front-line Emergency Department Christie Wiles RN Unit manager PCU/Medical Justin Jannicelli RN Unit manager Post-Surgical Katie Singleton RN Nursing Education Cindy Neubauer RN Director Nursing education 25

26 Sky Lakes Medical Center: Patient and Family Engagement: Bedside Shift Report: May 29 th 2014 Authors: Jeremy Westover, Katie Singleton, Cindy Neubauer, Jodie Grohs, Justin Jannicelli, Christie Wiles Define Background: Bedside report provides an opportunity to improve patient safety and increase patient involvement through collaboration and coordination of the patient s plan of care. It also reassures patients that caregivers work as a team, therefore providing professional transfer of responsibilities. Problem Statement: Sky Lakes Medical Center has a poor shift to shift patient hand-off process. Often, crucial information such as fall risk, pain control, or pressure ulcer concerns are missed because they are not systematically discussed between caregivers at the bedside at shift change. The patient is rarely involved in their own care. Aim: Bedside report Small test of change on 12 bed 2A Post-Surgical Unit, July 7 th After 3 weeks of PDCA, then spread process to each unit for a 3 week period. All inpatient floors utilizing bedside report by October 1 st Daily and nightly audits will be performed for two months and then weekly thereafter. Voice of the Customer (Staff) Survey Scenario #1 Scenario #2 Measure This is a copy of the hand-off tool we will use on our July 7 th Post- Surgical small test of change Improve Analyze Daily BSR audit sheet Project: Bedside Report, Sky Lakes Medical Center Control 26

27 Define Why we chose bedside report The problem: No early interaction with patient No formal introduction of oncoming staff No confirmation of details or concerns from the patient No discussion of goals, discharge plan, tests or procedures with patient No standardization in quality or consistency of report Propagation of bias at the nurses station outside of earshot of the patient ( crazy, drug seeker, etc). 27

28 Our Aim. Define We began with a small test of change on a 12 bed Post-Surgical Unit on July 7 th 2014 with the goal of: Improving patient safety and quality Improving the hand-off communication process Improving time management (reducing OT) Improving accountability between nurses Increasing staff satisfaction with hand-offs 100% compliance with the new process 28

29 Prior to bedside report Measure 29

30 Voice of the Customer (staff) Top Responses Measure BSR: Benefit to the patient BSR: Benefit to the staff Sub-point one content. Sub-point two content. BSR: Staff concerns with old process BSR: Staff concerns with new process 30

31 Measure Analyze 31

32 Analyze 32

33 Improve Main point Sub-point one content. Sub-point two content. 33

34 Going to the Gemba 34

35 Improve Bedside Report skills stations Offered several different dates and times Three patient scenarios each Mandatory attendance Fed them well for attending 35

36 Two weeks of auditing per department, random thereafter 36

37 37

38 Control (Sustainability/Spread) AM and PM weekly random shift audits Bedside Report Team meets weekly 38

39 Advice to Others & Lessons Learned Front-line involvement every step! Go visit a hospital that does it really well Regular updates to staff on successes and opportunities Don t discount your naysayers for the BSR team (they can change and others will follow) Meet regularly (monthly is not enough) Give out lots of food tied to BSR efforts Incorporate a unit huddle just before BSR Random Audits for the rest of your life 39

40 Contact Information Jeremy Westover RN Nursing Quality Coordinator Sky Lakes Medical Center Klamath Falls, Oregon

41 QUESTIONS? 41