Laguna Honda Lean Transformation Laguna Honda Strategic Performance Management November 2017
Background MAKE IT BETTER 4. 1. Performance Improvement FIX IT Do the work and make it happen 3. Create best work flow Remove wastes Create standard work Respect people Identify problem and value 2. Map out all steps in the process SEE IT Quality Assurance SAY IT 2
2017 Staff Satisfaction Survey Responses Offer more opportunities for professional development. Create a culture to value the input of line staff for problem solving by increasing participation. Improve communication between depts continuous improvement by way of lean methodology. Involve frontline staff in improvement projects/work. Balance the changes from lean culture. Everybody is talking about it but we don t know what it is. Better communication between lean staff (Administration) and frontline staff. Get more input. Continue w/ lean transformation. Continue with lean transformation as this gives structure and organization to enhance good working environment. Spreading lean continuous improvement principles. 3
Objectives Align Improve Support strategic goals by aligning initiatives, projects and metrics at all levels Facilitate Lean initiatives that focus on improving flow, quality, safety, resident experience & setting standards Enable Provide training, coaching, and support for Lean systems & tools. Develop lean leaders around data driven performance As an organization, we need to move from a culture of compliance, to a culture of improvement. 4
Challenges Developing a Lean culture is a slow process Exposure of Lean initiatives Teaching Lean methods and tools to all departments and shifts Engagement at all levels Sustaining improvement efforts 5
Our Tools Value Stream Mapping(VSM) A technique used to illustrate, analyze and improve the steps required to deliver a product or service Kaizen Workshops Workshop attended by owners & operators with intent of improving a specific process Gemba Walks Personal observation of the work A3 Thinking Root cause analysis; a systematic approach to problem solving 5S Workplace Management Standardize workspaces to eliminate unnecessary items and improve organization 6
Our Lean Journey Jul-16 Intro to Lean Rollout Nov-16 VSM #1- New Admissions Feb-17 VSM #1-Kaizen 1: Pre-Admission Apr-17 VSM #1- Kaizen 2: Clinical Assessments Jun-17 VSM #1- Kaizen 3: Room Readiness Jul-17 VSM #2: Discharge Sep-17 VSM #2- Kaizen 1: Care Planning Oct 2016 Jan 2017 Apr 2017 Jul 2017 Jul 2016 Oct 2017 Aug-16 LHH Leadership & Rona Plan Lean Transformation Sep-16 3-Day Executive Education Nov-16 Intro to A3 Thinking Jan-17 Start of A3 Workshops Mar-17 Pharmacy 5S Jun-17 Apr-17 Monthly DMS Nursing 5S- Phase 1 Training Sep-17 Lean EHR Prep Workshop- Cohort 1 Training & Coaching Kaizen Workshops Jul-17 Nursing 5S- Phase 2 Aug-17 Nursing 5S- Hospital Wide Rollout VSM s & Hoshin Kanri 5S 7
The Start of Our Lean Journey June 2016 Strategic Performance Management Team developed a plan to introduce lean methodologies to all departments at Laguna Honda July 2016 Laguna Honda leadership received formal introductory training on the basic principles of lean August 2016 LHH Executive Team met with Rona Consulting to discuss approach for the organization s lean transformation Projects were selected based on the needs of the San Francisco Health Network September 2016 3-Day Executive Education Jul 2016 Oct 2016 Jan 2017 Apr 2017 Jul 2017 Oct 2017 8
Value Stream Map (VSM) #1: New Admissions Problem The existing admission process was flawed causing many delays and creating a long waitlist for approved patients. Actions Improved Resident Care Team notification & communication Mapped new PASRR workflow to eliminate waste Set standards for timely completion of H&P documentation for coding Results 3 Kaizen/Rapid Improvements: (1) Preadmission, (2) Clinical Assessments and, (3) Room Readiness Jul 2016 Oct 2016 Jan 2017 Apr 2017 Jul 2017 Oct 2017 9
VSM #1 Kaizen Workshop 1: Pre-Admission Problem The pre-admission and screening process was very inefficient and community partners had expressed their concerns to our organization. Actions Developed guidelines for SNF requirements in the new standard Laguna Honda admission application Developed standard work for screening, reviewing and responding to applications. Results # of Incomplete Applications Received per month Time for Clinical Decision of New Apps. # of Apps. reviewed by Screening Committee per Month 71% to 3.3% 5.5 days to 2.6 days 134 to 27 Jul 2016 Oct 2016 Jan 2017 Apr 2017 Jul 2017 Oct 2017 10
VSM #1 Kaizen Workshop 2: Clinical Assessments Problem The length of time for all Resident Care Team members to complete their initial clinical assessments could take 7 to 14 days. Actions Implemented Pharmacy chart preparation process Improved Resident Care Team communication Created standard work with expectations to complete initial clinical assessments w/in 48hrs of admission Created Admission Kits for clinical assessments and ADLs kits for residents Results Rx Chart Prep Process Social Services Assessments, n=82 Clinical Nutrition Assessments, n=82 Activity Therapy Assessments, n=82 process time & did not decrease med rec errors 82% compliance rate 72% compliance rate 4% compliance rate Jul 2016 Oct 2016 Jan 2017 Apr 2017 Jul 2017 Oct 2017 11
VSM #1 Kaizen Workshop 3: Room Readiness Problem Vacant rooms are scheduled for a new admission within 24 hours of discharge. However, the process of cleaning & repairing a room can take several days. Actions Facilities, Nursing, and EVS collaborated to create a Room Readiness Checklist Implemented new method to send notifications when discharges are confirmed Created standard work & mapped new workflow with sequencing and time requirements Results July 2017 Aug 2017 Vacant Rooms Prepared w/in 24hrs, n = 24 Sep 2017 Oct 2017 Vacant Rooms Prepared w/in 24hrs, n = 30 50% Compliance Rate 77% Compliance Rate Jul 2016 Oct 2016 Jan 2017 Apr 2017 Jul 2017 Oct 2017 12
Return on Kaizen for VSM #1 Category Kaizen Measure Data % Change Motion Cost Savings Time Savings Defects Pre Admission Clinical Assessments Pre Admission Pre Admission Room Readiness Pre Admission Clinical Assessments Room Readiness # of steps taken to transfer the Admission Application to the clinical screener # of steps taken during Nsg Assessment Salary spent per month on non-value added time for unnecessary screenings & incomplete application follow up Turn around time from receiving application to admission decision Turn around time to prepare a room after discharge Admission Application missing clinical information Initial clinical assessments completed w/in 48 hrs Rooms prepared w/in 24 hrs of discharge Baseline: Result: 500 steps by Admission Cord. 0 steps by Admission Cord. Baseline: 308 steps by Nsg Result: Baseline: $3,515 Result: $0 0 steps by Nsg Baseline: 5.5 days Result: 2.9 days Baseline: 48 hrs Result: 12 hrs Baseline: 71% (n = 52) Result: 3% (n = 30) Baseline: 100% (n = 22) Result: 48% (n = 82) Baseline: 100% (n= 70) Result: 23% (n = 54) 100% 100% 100% 44% 75% 68% 52% 77% 13
Pharmacy 5S Workplace Management 1. Sort 3. Shine 5. Sustain 2. Set in Order 4. Standardize Jul 2016 Oct 2016 Jan 2017 Apr 2017 Jul 2017 Oct 2017 14 14 San Francisco Health Network
Nursing 5S Workplace Management Before After Nursing 5S- Phase 1 Nursing 5S- Phase 2 Jul 2016 Oct 2016 Jan 2017 Apr 2017 Jul 2017 Oct 2017 15
Value Stream Map #2: Discharge Problem Some short stay residents who have housing remain at Laguna Honda beyond their skilled nursing need, which contributes to a waitlist and backup in the network. Actions Created a script for A&E and each discipline to acknowledge short stay Documented reason resident not present in RCC note Discussion with referring sources re: start discharge plan. Results 3 Kaizen/Rapid Improvements: (1) care planning, (2) discharge preparation and, (3) discharge day Jul 2016 Oct 2016 Jan 2017 Apr 2017 Jul 2017 Oct 2017 16
VSM #2 Kaizen Workshop 1 Care Planning Problem There are no estimated discharge dates for Short Stay residents due to unclear ownership in care planning Actions Revised the Resident Care Team meeting notes form Standardized physician work flow for Short Stay referrals to LHH s specialty clinics Created an educational program for staff on short stay goals Results Process Owners will evaluate the outcomes at 30, 60 and 90 days Jul 2016 Oct 2016 Jan 2017 Apr 2017 Jul 2017 Oct 2017 17
Moving Forward Oct-17 Lean EHR Prep Workshop- Cohort 2 Nov-17 Lean EHR Prep Workshop- Cohort 3 Nov-17 Lean Certification Training Nov-17 VSM #2-Kaizen 2: Discharge Prep Jan-18 Jan-18 Hoshin Kanri VSM #2-Kaizen 3: Day of Discharge Mar-18 VSM #3: TBD May-18 VSM #3- Kaizen 1: TBD Jan 2018 Apr 2018 Oct 2017 Jun 2018 Oct-17 Lean Certification Training Oct-17 Monthly DMS Training Dec-17 Lean Certification Training Nov-17 Nursing 5S- Hospital Wide Rollout Jan-18 Lean Certification Training Training & Coaching Kaizen Workshops 5S VSM s & Hoshin Kanri Lean Certification 18
Strategic Performance Management Team/ Kaizen Promotion Office Elizabeth Schindler Health Program Planner Vincent Lee Administrative Analyst Olivia Thanh Jr Administrative Analyst 19