LEAN Enterprise Methods in Healthcare:
VA Boston Mental Health
Jordan Peck
LAI Annual Conference
March 25, 2010
VA Mental Health – Boston
ESD.62J/16.852J: Integrating the Lean Enterprise
Ellen Czaika
Clayton Kopp
Orietta Verdugo
Zakiya Tomlinson
Jordan Peck, Facilitator
http://lean.mit.edu
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
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Agenda
 Project Overview
 Enterprise Description
 X-Matrix
 Process Waste
http://lean.mit.edu
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
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Project Overview
 Collect Data
– 11 individuals interviews
Project
Approach
– Phone and site interviews—Brockton, Bedford, Jamaica Plains
– Metrics, process and procedure, organizational charts, financial statements
 Conduct Analysis
 Validate Findings
 Formulate Recommendations
 Present Recommendations
Project
Goals
 Analyze the VA BMHS through a Lean assessment and suggest strategy for a Lean
transformation
http://lean.mit.edu
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
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Enterprise Description
 To serve the veteran through the delivery of timely quality care by staff who
demonstrate outstanding customer service, the advancement of health care
through research, and the education of tomorrow's health care providers.
Mission &
Vision
Strategic Goals







Overview
http://lean.mit.edu
Serve Boston Health Services
Team-oriented and Integrated Care
Quality Improvement
Compliance
Evidence-based Care through Educational Residencies
Become World Class Research Hospital System
Accessible Care
 Boston Mental Health Service is largest within VA New England region
 Locations – Brockton, Jamaica Plains, West Roxbury + CBOCs
 Services – Inpatient, Outpatient, Residential Programs
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
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Organization Chart
Veteran
Affairs Office
VA New
England
Director
Boston Health
Mental Health
Clinical Associate
Dir. of Impatient &
Director of
Dir. of Residential &
Transitional
Outpatient Service
Vocational Programs
Chief Psychology
Associate Director of
Director of
Mental Health
Residency Training
Services
Program
Programs
Associate Director of
Program Support
Outpatient Service
Assistant
Key Insights
 Funding and strategic planning is driven from the top down
 Programming and research is volatile and dependant on politicians
 Communication channels between each enterprise
http://lean.mit.edu
Psychiatrist
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
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Financials
Key Insights
 Budgets are based on previous years number of patients and number of
complex patients
 Support processes and research is managed by VA Boston Health Services
http://lean.mit.edu
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
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Stakeholder Value Comparison
VA BMHS
Enterprise Value Delivery to Stakeholder
High
Low
Patients
Doctors
Community
Employees
Hospital Management
Universities & Residents
Politicians
Pharmacy
Supply Chain
VA Leadership
Volunteers
Tax Payers
Partner Hospitals
Homeless Shelters
Finance
Stakeholder Relative Importance to Enterprise
High
Lean Insights
 Mapping the relationship with stakeholders offers insights for enterprise operations
http://lean.mit.edu
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
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Stakeholder Templates
http://lean.mit.edu
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
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Enterprise Metrics
http://lean.mit.edu
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
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X-Matrix
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Enterprise
Metrics
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areas in service, care, &
research
0 0 0
Metrics vs. Processes
 Strong alignment with
outpatient treatment and
clinic wait times
 Missing metrics for key
processes
– Transfers to inpatient
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values such as:
– Operating within budget
– Well-documented
monetary transactions
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least stakeholder values
are primarily patient
movement
http://lean.mit.edu
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Methadone Clinic
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Correctness of diagnosis and treatment
2 2 2 2 2 2
4 4 4 4 4 4
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Strategic
Goals
Metrics vs. Objectives
 Strong Alignment
 Weak Alignment
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
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Research Hospital
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Purchasing (Supplies &
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Inpatient
Transfer from Urgent Care
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Serve Boston Healthcare
System
s
Team Oriented - Integrated
Care
s
s
12 012
Vocational Industry Program
Waiting Times - Clinic
Impatient Service
Mental Health Outpatient
01313s
2
5
7
Strategic
Objectives
Mental Health Measure
s
Tobacco Measure
s
Mental Health Access
s
2 2 2 2 2 2
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Methadone Clinic
MHICM Program - Day Program
Residential Program (REACH)
Substance Abuse Intensive
Outpaitent Program
6
Substance Abuse Outpatient
Program
5
Vocational Industry Program
0
s
s
Upstanding member of local community
s
Efficient Resource Management
Accurate and well-documented monetary
transactions
s
Reasonable expectations and respectful
treatment of employees
Research Advancement
Knowledge Transfer
Communication and Implementation of VA
culture and values
s
Operating within budget
s
Fair Wages for services
Sufficient Inpatient and Outpatient Capacity
s
Clean, High Quality Facility
s
Accurate Patient Records
Availability of medications, supplies, and
equipment
s
X-Matrix
2
4
7
Safety/Security of premises
s
2
5
7
Timely and accurate information flow
0 13 13
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4
4
Timeliness of diagnosis and treatment
Quality of patient experience (minimal
discomfort respectful etc )
2
4
6
Correctness of diagnosis and treatment
1
5
6
Waiting Times - Clinic
2
5
7
MH: SMI - MHICM Capacity
2
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7
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Impatient Service
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4
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Substance Abuse Intensive Outpaitent
Program
2
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2
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2
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2
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© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
12
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Serve Boston Healthcare
System
s
Team Oriented - Integrated
Care
s
Quality Improvement
Complience -VA Code of
Patient Concern & JCAHO
Evidence Based Care (inc.
Through Educational
Residencies)
Become World Class
Research Hospital
Accessible Care
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Transfer from Inpatient to
Residential
Key Processes
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811s
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0 0
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s
Transfer from VA ER to
Inpatient
Transfer from Urgent Care
to Inpatient
Transfer from Outside ER
to Inpatient
0 0 0
0 1 1
0 1 1
w
w
Stakeholder
Values
0 0 0
0 0 0
w
s
Strategic
Objectives
Mental Health Outpatient
Impatient Service
Residential Program (REACH)
MHICM Program - Day Program
Methadone Clinic
Vocational Industry Program
w
s s
w
Metrics
0 0 0
w
Substance Abuse Outpatient Program
Substance Abuse Intensive Outpaitent
Program
s
w
0 0 0
0
0
3
0
0
0
0
1
Mental Health Measure
Mental Health Access
MH: SMI - MHICM Capacity
Tobacco Measure
Waiting Times - Clinic
Impatient Service
Mental Health Outpatient
Methadone Clinic
MHICM Program - Day Program
Residential Program (REACH)
Substance Abuse Intensive
Outpaitent Program
Substance Abuse Outpatient
Program
Vocational Industry Program
0 5 6
w w
s
s
Mental Health Measure
w
Tobacco Measure
w
Mental Health Access
w
Waiting Times - Clinic
w
MH: SMI - MHICM Capacity
w
s
s
Upstanding member of local community
s
Efficient Resource Management
Accurate and well-documented monetary
transactions
s
s s
12 2 3 1 5
23 1 1 0 1
35 3 4 1 6
Reasonable expectations and respectful
treatment of employees
Research Advancement
Knowledge Transfer
Communication and Implementation of VA
culture and values
s s
ss
Operating within budget
ss
s
1
3
4
Fair Wages for services
Sufficient Inpatient and Outpatient Capacity
s
s
Clean, High Quality Facility
s
s
Accurate Patient Records
Availability of medications, supplies, and
equipment
s
s
Safety/Security of premises
s
01212s
Timely and accurate information flow
01313s
2 1 1 1 4 4 2 2 2 1 3
5 6 4 3 0 1 5 3 0 2 1
7 7 5 4 4 5 7 5 2 3 4
Timeliness of diagnosis and treatment
Quality of patient experience (minimal
discomfort respectful etc )
2
5
7
Correctness of diagnosis and treatment
2 2 2 2 2 2
4 4 4 4 4 4
6 6 6 6 6 6
9
10
10
9
5
7
6
5
7
5
2
5
3
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3
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Residential Treatment
Transfer from Residential to Inpatient
Discharge from Residential
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3
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0
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0
0
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0
1
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0
0
0
Purchasing (Supplies & Services)
0
0
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Patient Data Management
0
0
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Research
0
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Facilities and Maintance
0
0
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0
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0
0
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http://lean.mit.edu
1
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© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
13
Transfer from VA ER to Inpatient
s
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Upstanding member of local
community
Accurate and well-documented
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Efficient Resource Management
Communication and Implementation
of VA culture and values
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Sufficient Inpatient and Outpatient
Capacity
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Operating within budget
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Transfer from Urgent Care to Inpatient
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Availability of medications, supplies,
and equipment
Accurate Patient Records
Clean, High Quality Facility
Safety/Security of premises
Key Processes
Timely and accurate information flow
Stakeholder
Values
Quality of patient experience
(minimal discomfort, respectful, etc.)
Metrics
Timeliness of diagnosis and
treatment
Strategic
Objectives
Correctness of diagnosis and
treatment
X-Matrix
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21
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Patient Concern & JCAHO
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Accessible Care
12 012
Mental Health Measure
Tobacco Measure
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http://lean.mit.edu
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to Inpatient
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to Inpatient
0 0 0
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Strategic
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s
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s
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s
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s s
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s
Waiting Times - Clinic
0 5 6
4
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s
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s s
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(minimal discomfort, respectful, etc.)
ss
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s
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treatment
s
s
2
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Accurate and well-documented monetary
transactions
s
s
2
4
7
Reasonable expectations and respectful
treatment of employees
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culture and values
s
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2
5
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01313s
0
4
4
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2
4
6
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2 1
5 5
7 6
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2
5
7
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Availability of medications, supplies, and
equipment
2 2
4 4
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w
s
w
1
0
1
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community
s
s
3
1
4
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monetary transactions
s
w
2
1
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Concern & JCAHO
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Educational Residencies)
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Hospital
s
w
2
3
5
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of VA culture and values
w
1
2
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s
1
3
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s
3
1
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s
s
1
2
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s
w
2
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w
2
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w
2
5
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and equipment
w
4
1
5
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s
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2
4
6
4
0
4
s
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discomfort respectful etc )
2
4
6
1
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s
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2
4
6
1
4
5
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Accessible Care
2
4
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1
6
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Clean, High Quality Facility
2
5
7
9
10
10
9
5
7
6
5
7
5
2
5
3
5
3
4
3
2
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
15
Stakeholder Value Comparison
X-Matrix Version
Enterprise Value Delivery to Stakeholder
High
VA Leadership
Patients
Doctors
Community
Tax Payers
Universities & Residents
Politicians
Hospital Management
Patients
Partner Hospitals
Employees
Doctors
Hospital Management
Employees
Pharmacy
Supply Chain
VA Leadership
Finance
Volunteers
Tax Payers
Partner Hospitals
Homeless Shelters
Community
Supply Chain
Politicians
Volunteers
Pharmacy
Finance
Universities & Residents
Low
Stakeholder Relative Importance to Enterprise
High
Methodology
 Inferred Stakeholder Importance from Strategic Objects & Value Delivery from the
Key Processes
 Used
weighting algorithm to calculate positions
http://lean.mit.edu
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
 More research & data needed on weights, and to validate results.
16
LESAT Gap Analysis
LESAT Section Level X.X
Current State and Gap
High interest in Lean
4
3
Gap
Current State
2
Low Lean awareness
1
III.B
III.A
II.F
II.E
II.D
II.C
II.B
II.A
I.G
I.F
I.E
I.D
I.C
I.B
0
I.A
Average LESAT Practice Maturity in
Section X.X
5
LESAT Section X.X
Lean Transformation Leadership
Highest
HighestScores
Scores
 Developing
DevelopingLean
Leanstructure
structureand
and
behavior
behavior
Adopting
AdoptingLean
Leanparadigm
paradigm&&value
value
stream
streamfocus
focus
Lowest
LowestScores
Scores
 Creating
Creating&&implementing
implementingLean
Lean
initiatives
initiativesplan
plan
Enterprise
Enterprisestrategic
strategicplanning
planning
http://lean.mit.edu
Life Cycle Processes
High
HighScores
Scores
 Developing
Developingproduct
product&&process
process
Producing
Producingthe
theproduct
product
Low
LowScores
Scores
 Business
Businessacquisition
acquisitionand
and
program
management
program management
Business
Businessacquisition
acquisitionand
and
program
programmanagement
management
Enabling Infrastructure
Equal
Equal Scores
Scores
 Lean
Leanorganizational
organizationalenablers
enablers
Lean
process
enablers
Lean process enablers
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
17
Enterprise Processes
Emergency Services
Non-VA ER Transfer
Non-Emergency
Walk-In to Outpatient
VA ER Transfer
Referral from Primary Care
VA Urgent Care Transfer
Enabling Infrastructure
Purchasing
Residential Programs
Substance Abuse
Inpatient Treatment
Acute Care
Chronic Care
PTSD
Women
General Mental Health
Outpatient Treatment
Scheduling
Treatment
Bedford Stabilization
Program
Brockton
http://lean.mit.edu
Jamaica Plain
West Roxbury
Research
Quality Assurance
Community Residential
Domiciliary
Patient Data Mgmt
Payroll
Human Resources
Outpatient Clinics
Outside the Enterprise
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
18
Enterprise Waste


Long wait times in admitting, transferring, and discharging processes

Need to spread knowledge of service lines among staff and overcome
training siloing

Opportunity for improvement with patient teams
Infrastructure


Inefficiencies in resources by providing treatments at multiple sites
Information Flow


Little accesses to patient records from the Department of Defense

Emergency and non-emergency hospitals sending ineligible veterans
to Mental Health
Processes
People
Supplier
http://lean.mit.edu
Need more knowledge sharing among programs and departments
Transportation waste: moving people among sites
Lack of documentation from transfers and referrals
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
19
Enterprise Waste
Veterans
Customer

Patient opting not to conform to treatment and developing
dependency on system for support and shelter



Multiple visits for complete evaluation
Commuting home to site and site to site
Resource limitations with beds and program capacity
Physicians
Leadership
http://lean.mit.edu

Redundant testing from patients who are referred from the military
and other institutions


Resource limitations with beds and program capacity



Strategic goal and objectives are not published
Commuting home to site and site to site
Strategic goals not fully aligned among parent-child enterprises
Inadequate communication channels between VA New England and
VA Boston Mental Health Services and between VA BMHS and VA
BHS
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
20
Enterprise Architecting
http://lean.mit.edu
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
21
Veteran Affairs
Boston Mental Health
Enterprise Architecting
May 13, 2009
Team:
Oladapo Bakare
Jordan Peck
Orietta Verdugo
http://lean.mit.edu
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
22
Agenda
•
•
•
•
•
http://lean.mit.edu
Current Architecture
Enterprise Vision
Candidate Architectures
Architecture Evaluation
Transformation Plan
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
23
Current Architecture
http://lean.mit.edu
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
24
Current Architecture
http://lean.mit.edu
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
25
View Interrelations
Needs more integrated understanding of
the process flow; Build artifacts of
standard processes and documentation
across all sites
Main driver of business strategy and services;
Government and policy driven; Public
Relations plays a factor as well.
Policy / External Factors
Process
Lacks strategy within the organization,
only top levels have input to strategy.
Main focus of the enterprise as its mission
is servicing the veterans and their needs
Organization
Products /
A
Services
Strategy
Knowledge
Lacks clear organizational direction from leadership; Needs
an employee feedback loop and more collaboration between
sites, departments, and networks
IT/Infrastructure
IT system that links VA documentation and procedures across the
enterprise
(IT ahead in national health care); Infrastructure has
26
http://lean.mit.edu
various
locations
Clear knowledge exchange is
needed; Meetings and emails are
primarily communications; Not
enough knowledge sharing between
leadership within VISN
26
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
Ability to adapt to changes
& process requirements
Ability for a system to
readily expand capacity
Scalability
Meeting VA national &
accreditation board
requirements
Ability to measure
performance
Survivability
Ability to reduce defect
& optimize service
Accessibility
Demonstrability
Veteran’s ability to access
& afford services
The Ilities
Responsiveness Ability to quickly respond
Ability to treat a
Customizability
patient based on their
particular needs
to changes or needs in the
system
Serviceability
Ability to treat a
patient based on their
particular needs
http://lean.mit.edu
Quality
Safety
Ability to reduce defect
& optimize service
Ensure wellbeing of
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck
patient & employees
06/03/09
27
Enterprise Future Vision
http://lean.mit.edu
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
28
Future Vision
Strategic View
•
•
•
Strategy driven by all levels of the organization, through continuous
improvement methods
Create and maintain strategy document that delineates the actionable strategic
goals at all levels of the organization
Increase strategy visibility and awareness through meetings between
professionals
Process View
•
•
•
•
http://lean.mit.edu
Integrate understanding of the process flow through standard processes and
documentation across all sites
Obtain process measurements that directly align to strategic goals
Transparency throughout the organization of processes and performance
Continuous process improvement;Yearly goal to meet, incentivizing
improvements, educate and give resources for improvement.
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
29
Future Vision
Organizational View
•
•
•
•
•
Clear organizational direction from leadership on all levels to proactively push
agendas
Increase collaboration between sites, departments, and networks
Incentivize employees to take ownership of patient services
Create an employee feedback loop to communicate needs, best practices, and
change
Lean Six Sigma department throughout VA to drive quality and continuous
improvement initiatives
Knowledge View
•
•
•
http://lean.mit.edu
Clear knowledge exchange between employees, programs, and sites
Incorporate knowledge exchange programs with other VA campuses to share
best practices
Increase leadership communication amongst VISN, departments, and
networks
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
30
Future Vision
IT View
•
•
•
•
•
•
Upgrades given to all sites within the same time frame
Ensuring there is a sufficient IT budget each year
Making sure practitioners are able to make changes to the system to facility
processes/procedures
Ability to communicate efficiently with all campuses
Proficiency and acceptance from all staff
Expansion of utility to customers to reduce costs from excess or forgotten
appointments
Policy View
•
•
•
•
http://lean.mit.edu
Making sure practitioners are able to make changes to the system to facility Being
active in driving policy and program initiatives
Increase agility in responding to policy changes
Ability to buffer themselves from extreme political changes
Understand the needs and expectations of veterans, families, and community
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
31
Future Vision
Service/Product View
•
•
•
•
•
•
•
http://lean.mit.edu
Improve service efficiency
Expand services to fit all incoming customer needs
Measure services more carefully
Re-design services for continuum of care approach
Insulate services from outside factors
Make service offerings clearer to potential patients
Integrate services and improve ability to customize based on patient
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
32
Candidate Architectures
http://lean.mit.edu
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
33
Candidate Architectures
Illness Based
Serious MI
Vocational
Sexual Abuse
Residential
Inpatient
Vocational
Outpatient TBI
Residential
Inpatient
Vocational
PTSD & SA
Outpatient
Residential
Pros:
•
•
Continuous care in a given category can be easily tracked and
traced
Flexible if new mental disorders, programs, or illnesses arise in the
future
Cons:
•
•
Many patients fall into more than one category
Wasted resources on programs that have low volume or excess
capacity
Patient Length of Stay
Vocational
Residential
Outpatient
Inpatient
Vocational
Outpatient
Residential
Inpatient
Outpatient
Short Term
Pros:
•
Homeless Prog.
Long Term
Urgent Care
Inpatient
Outpatient
Resources can be maximized through each department
PATH
RISE
REACH
LT Stay
Private Homes
Cons:

Unbalanced system with excess capacity in some units and
overflow in others

Patients currently transition between some or all of the programs

Metrics will be focused on local maximization rather than
focusing on optimal flow across the organization
http://lean.mit.edu
Intermittent
SAARP
WITRP
Programs
Homeless
CWP
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
34
Candidate Architectures
Psychology
Profession Expertise
Pros:
•
•
Allows medical staff to create optimal treatment plans by working within their
specialty
There is a direct connection with leadership team and employees
Cons:
•
•
Difficult to collaborate with other specialties
Supervisors will not be capable of treating specific illnesses
SMI & UC
Psychiatry
Inpatient
SMI & UC
Residential
Nursing
Inpatient
Vocational
Residential
Outpatient
SMI & UC
Administration
Vocational
Inpatient
Outpatient
Residential
SMI & UC
Vocational
Inpatient
Social Worker
Outpatient
Residential
SMI & UC
Vocational
Inpatient
Outpatient
Residential
Vocational
Outpatient
Area Based
Pros:
•
•
Community
CBOCs
Leadership oversight is more direct and site specific
Initiating change in each location is more manageable
Private Homes
Homeless Prog.
Outpatient
Cons:
•
•
Scalability of any one location is limited to capacity constraints
Quality of treatment programs may vary across locations
http://lean.mit.edu
Brockton
Urgent Care
Inpatient
Outpatient
Residential
SAARP
WITRP…
Jamaica Plain
Urgent Care
Inpatient
Outpatient
Residential
SAARP
WITRP…
West Roxbury
Urgent Care
Inpatient
Outpatient
Residential
SAARP
WITRP…
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
35
VA
BM
H
Design Parameters
Functional
Requirements
Maximize Veteran Quality of Life
Identify Patietns with Mental Illness
Treat Cause and Effect of Mental Illness
Integrate Patient Back into Community
Pa
ti
& ent
Co Id
m en
m tif
un ic
ity ati
Re on
Tr
lat
ea
io
tm
ns
en
tP
ro
gr
am
Pa
s
tie
nt
Re
-In
te
gr
at
io
n
Candidate Architectures
X
X
X
X
X
Axiomatic
Pros:
•
•
Director responsibilities are clear and aligned
Connection between leadership and treatment
professionals are more transparent
Cons:
•
•
Departmental imbalance due to program sizes and
patient needs
Requires significant re-organization of the enterprise
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© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
36
Architecture Evaluation
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37
Architectures at a Glance
Illness Based
Short Term
Serious MI
Homeless Prog.
Vocational
Residential
Outpatient
Vocational
Sexual Abuse
Residential
Inpatient
Vocational
Outpatient TBI
Residential
Inpatient
Vocational
PTSD & SA
Outpatient
Residential
Current State
PATH
RISE
REACH
LT Stay
Private Homes
SAARP
WITRP
Private Homes
Homeless Prog.
Outpatient
Brockton
Intermittent
Programs
Homeless
CWP
Urgent Care
Inpatient
Outpatient
Residential
SAARP
WITRP…
Professional
Community
CBOCs
Long Term
Urgent Care
Inpatient
Outpatient
Inpatient
Vocational
Outpatient
Residential
Inpatient
Outpatient
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Area Based
LOS
Jamaica Plain
Urgent Care
Inpatient
Outpatient
Residential
SAARP
WITRP…
West Roxbury
Urgent Care
Inpatient
Outpatient
Residential
SAARP
WITRP…
Psychology
SMI & UC
Psychiatry
Inpatient
SMI & UC
Residential
Nursing
Inpatient
Vocational
Residential
Outpatient
SMI & UC
Administration
Vocational
Inpatient
Outpatient
Residential
SMI & UC
Vocational
Inpatient
Social Worker
Outpatient
Residential
SMI & UC
Vocational
Inpatient
Outpatient
Residential
Vocational
Outpatient
Axiomatic
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
38
Ranking Ilities
Definition
Ranking
Weight
Agility
Ability to adapt to changes in service and process requirements
2
9.00%
Scalability
Ability for system to readily expand capacity
1
3.25%
Quality
Ability to reduce defect and optimize services
3
15.00%
Accessibility
Veteran's ability to access and afford services
2
9.00%
Standards Compliance
Meeting VA National and accreditation board requirements
1
3.25%
Customizability
Ability to treat a patient based on their particular needs
3
15.00%
Demonstrability
Ability to measure performance
3
15.00%
Safety
Ensure wellbeing of patient & employees
1
3.25%
Responsiveness
Ability to quickly respond to changes or needs in the system
3
15.00%
Serviceability
Ability to provide resources required for employee performance
2
9.00%
Survivability
Ensure sustainability throughout political transitions
1
3.25%
Ranking
Definition
Weight
1
Low
3.25%
2
Medium
9%
3
High
15%
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© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
39
Concept Scoring Matrix
Architecture Evaluation
Selection Criteria
Agility
Scalability
Quality
Accessibility
Standards Compliance
Customizability
Demonstrability
Safety
Responsiveness
Serviceability
Survivability
Weights
9.00%
3.25%
15.00%
9.00%
3.25%
15.00%
15.00%
3.25%
15.00%
9.00%
3.25%
Total Score
Rank
Continue
Enterprise Architecture Concepts
Current State
Weighted
Rating
Score
3
0.27
3
0.10
3
0.45
3
0.27
3
0.10
3
0.45
3
0.45
3
0.10
3
0.45
3
0.27
3
0.10
3.00
Expertise
Weighted
Rating
Score
1
0.09
2
0.07
3
0.45
3
0.27
3
0.10
2
0.30
1
0.15
2
0.07
1
0.15
4
0.36
5
0.16
2.16
Used CurrentLOSWeighted
Rating
Score
State as
2
0.18
benchmark
2
0.07
2
3
3
2
3
3
2
3
2
0.30
0.27
0.10
0.30
0.45
0.10
0.30
0.27
0.07
2.40
Illness
Weighted
Rating
Score
1
0.09
2
0.07
4
0.60
3
0.27
3
0.10
2
0.30
3
0.45
4
0.13
2
0.30
3
0.27
1
0.03
2.61
Area
Weighted
Rating
Score
3
0.27
1
0.03
2
0.30
4
0.36
3
0.10
1
0.15
2
0.30
3
0.10
3
0.45
1
0.09
4
0.13
2.28
Axiom
Weighted
Rating
Score
5
0.45
3
0.10
4
0.60
3
0.27
3
0.10
5
0.75
4
0.60
4
0.13
4
0.60
3
0.27
3
0.10
3.96
2
6
4
3
5
1
No
No
No
No
No
Develop
1-5 Success Ranking for Architectures
5=high, 1 = low
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40
Proposed Architecture
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41
Transformation Plan
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42
Three Lens Evaluation
Cultural Lens
• Represents implicit aspects of the
Cultural
Political
architecture such as organizational norms,
behaviors, actions, and processes
Political Lens
• Symbolizes the power struggle and
interactions within a changing architecture
Strategic
Strategic Lens
• Provides insight into the logical interactions
that drive decisions for the enterprise
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© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
43
Three Lens Evaluation
Cultural Lens
•
Cultural
Current State
•
Political
•
Strategic
•
Future State
•
•
http://lean.mit.edu
Limited communication and Knowledge
Transfer between teams, functions, and
programs
Employees do not feel Empowered to
influence change
Interminable Transparency and effective
Feedback Loop between teams,
functions, and programs and
Employees Empowered to make
meaningful changes within the enterprise
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
44
Three Lens Evaluation
Political Lens
•
Cultural
Current
•
Political
•
Strategic
•
Future
•
•
http://lean.mit.edu
Federal government mandates enterprise
Program Initiatives
Teams work in Functional Silos and are
unable to share knowledge for optimal
patient care
Drive Policies and program initiative to
influence policy makers
Enterprise is Patient Centric and
knowledge of patient continuum of care
is shared
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
45
Three Lens Evaluation
Strategic Lens
•
Cultural
Current
•
Political
•
Strategic
•
Future
•
•
http://lean.mit.edu
Employees are constantly ‘fire fighting’
and Reactionary to issues
Current Metrics that are in place are
Insufficient to provide optimal patient
care
System can mitigate unplanned events
through Proactive Care programs
Performance Metrics directly monitor
localized initiatives for optimal patient
care coverage
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
46
Matrix of Change
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© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
47
Transformation Plan
Cultural
Empower workforce - Create a community of connected enabled
professional
Transparency - constantly
evolving
Feedback loop to managers
Political
Create Axiom Structure
Assign Leadership
Strategic
Empowerment for Continuous
improvement
Top-level management can involve govt. and drive policies
Pro-active care focus on continuum of care
Develop strategy
Define Metrics
Training Programs for staff
Period 1
EA views
process
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product/service
strategy
Period 2
external factors/policy
Period 3
knowledge
organization
Period 4
information technology
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
48
Closing Remarks
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49