Lean At Denver Health:
Saving Lives, Saving Money, Saving Jobs
Phil Goodman
Director
Lean Systems Improvement
What is LEAN?
LEAN can be defined as a systematic approach
of continuous improvement, based on the
Toyota Production System (TPS) of lean
principles and lean tools, used for the
identification and elimination of waste.
LEAN Pillars of Transformation
Continuous
Improvement
Respect for
People
Two Pillars
LEAN Values
• Waste is disrespectful of
Society because it wastes
scarce resources
•Waste is disrespectful to
• Waste is disrespectful of
individuals because it asks
them to do work with no value
- President of Toyota
•Waste is disrespectful to
patients by asking them
to endure processes with
no value
taxpayers for asking
them to financially
support processes with
no value
Two-Pronged Approach of
Deploying Lean at
Denver Health
• 247 DH Black Belts
(BBs):
• 48 hours lean training
• Day to day lean
• RIE team leads
• Quarterly reports
• BBs embedded
throughout clinical and
non-clinical areas
• 36 Master BB’s
• Rapid Improvement
Events (RIEs)
• RIE is 4.5 day team event
• 7-9 team members
• RIEs are based on Value
Stream Analysis
• 16 Value Streams
• Each Value Stream will
conduct 8 RIEs per year
• Each value stream is
assigned to an executive
staff member
Black Belt Projects
Creative, Innovative, and Productive!
DH Black Belts are using lean everyday, in every
way….here’s an example:
Engineering: $457,000 reduction in supply expenses
Black Belt Project Example:
Common Canister
Inhalers for Asthma and COPD:
Combivent, Albeterol, Atrovent, and Flovent
Pharmacy/Respiratory Therapy
“Common Canister”
Black Belt Project:
Pre Lean: 6,624 canisters/year
Post Lean:
2,381 Canisters/year
Savings in Acquisition Costs:
$363,000!
(75% Reduction)
Rapid Improvement Event (RIE)
–Using Lean Tools in Focused Manner
Day 1
Mon
• Examine a process/function or area
• Identify areas of waste, non-value added steps
• Identify metrics
Day 2
Tues
• Develop new process, standard work and
communication to eliminate identified waste and
increase value
• Design rapid experiments
Day 3
Weds
• Implement the new processes, standard work
• Monitor production board and communicate
standards
• Observe new process and any change in metrics
Day 4
Thurs
• Adjust and fine tune new standard work
Day 5
Friday
• Celebrate!
• 10 minute team reports
RIE Employee Engagement
YTD August 24, 2012
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415 Rapid Improvement Events
2,055Employees participated on RIEs
16 Value Streams
247 Black Belts
2012 Value Streams
Revenue Cycle
1st Floor
Managed Care
Nursing
RMPDC- Patient
Access
RMPDC- Drug &
Product Safety
Specialty Clinic
OB/Gyn
Community Health Services II
Clinical Process
Behavioral Health
Pharmacy
Perioperative Services
Education
Human Resources
Community Health Services I
Examples of Clinical and
Non-Clinical Lean Events
• Facility Bill Clean
• DVT Prophylaxis
Claim Rate
• Cancer Screening
• Improve Internal
• Chronic Opiate
Processing
Therapy
Turnaround Time
• Surgical Site Infection
• Reduce # of accounts
• Rehab Utilization
on front end work lists
• Provider Flow Cells
• Problematic Rx
Surgical Site RIE Case Study
1.Reason for Action
SCIP II requires abx
within 60 minutes of
“first cut”
2. Initial Condition
Prophylactic abx in
OR within 60 mins
< 80% of cases
3.Target Condition
Prophylactic abx in
OR within 60 mins in
100% of cases
4.Gap Analysis
Abx given “OCTOR”
Variable abx
APC Frustration
OR Frustration
5.Solution Approach
Conduct waste walk
Map process
RIE to include IC
Chart review
6.Rapid Experiment
Change OCTOR to
“Abx delivered in OR
by anesthesiologist”
Abx guidelines
7.Completion Plans
Change order forms
Monitor data
8.Confirmed State
Per Dr Lockrem:
“We’ve changed our
practice”
9.Insights
The problem was
definitely the process,
not the people!
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Clinical RIE Case Study Results
Surgical Site Infection RIE Results
RIE Date: June 6-10, 2005
120%
100%
80%
60%
40%
20%
0%
RIE June, 2005
Month
Enterprise Transformation
Alignment
Aligning System Metrics with
Value Stream Metrics
and RIE Metrics
Enterprise Metric Alignment:
System Level Metrics
Quality
Delivery
(Access)
Productivity
Financial
Human
Development
Nosocomial
Infections
ED Divert
Visits per
Session
Expense per
D/C or
Encounter
Employee
Engagement
Value Stream Level Metrics
OB
ED/
AU
CC
Spec
Clinic
Rev
HR
Cycle
MC
Rx
BHS
RM
PD
C
Para
medi
cs
NSG
CP
Med
D/C
CHS
RIE Level Metrics
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Achieved with no layoffs and no reductions in patient services!
Standard Work:
Metric Monitoring
RIE Team Lead/Process Owner
Lean Facilitator
Sr. Financial Analyst
Associate CFO Review
CFO Review
CEO Review
Transparency At Denver Health
Example: Human Resources (HR) Value Stream
HR RIE Level Metrics Posted
“In the Gemba”
HR Value Stream Level Metrics Near
Greg Rossman’s Office
HR Metrics Posted at the Enterprise Level in Sabin
Summary
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Lean is a philosophy and tool set that fits for healthcare
Eliminating waste improves quality of care
Lean tools are intuitive
Frontline staff must be respected because they
understand where the waste exists and how best to
eliminate it
• Lean has the power to change culture because it truly
empowers employees to break down silos, rapidly
implement change and own the process!