Tools to Achieve Performance Excellence
Winona Health’s Continuous
Systems Improvement (CSI)
Lean 2.0 -Activities to Results!
Linda Wadewitz
Director of Continuous Systems
Improvement
Winona Health
Activity to Results
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Strategy not aligned
Sustainment issues
Lack of Standard Work
Discipline/Accountability
Leaders Std Work
RCA-Frontline
• ……thus LEAN 2.0
CSI as a Strategy
• Focus on Principles of:
• Belief this strategy is key to a successful future for
transforming our culture at Winona Health
Winona Health Golden Circle
CSI Goals
• Deployment of Lean 2.0
• Integration of the LMS enterprise wide
• A3 (PDCA) Thinking
• Strategy cascaded to Frontline
• Patient focused – outcomes and results
• Coaching and Mentoring
What is Lean 2.0?
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Strategy Deployment/Enterprise Obeya
Visual Management/PDCA/FB
Cascading metrics
Daily Management – Leadership Discipline
Standard Work - 80/20
Leaders Standard Work
Frontline A3 Problem Solving
Coaching and Mentoring
Results Driven – Course Corrections
Thus…Activity to RESULTS with lean 2.0
WH’s Lean Management System
Customer Value
• Patient/Resident Satisfaction - True North
– Principle 1
– True North drives - Hoshin
– Value Stream mapping – starts with patient flow
– Process mapping – Kaizen, CIP’s
– A3 Problem solving
– Visual Management
• FOCUS Boards
• PDCA Boards
Hoshin Management = Strategy Deployment
Hoshin
Direction/Needle
Kanri
Management
Hoshin Kanri
– Leadership Driven
•• Statement
is the
– Level 1- Organization
CONSTANT
GUIDE for– True North/3 year Strategic Goals
– Level
2 – Service Line or Support
the
Team
– Level 3 – Value Streams/Departments
– Linkage from Level 1 to Level 2 to Level 3
– Catchball between all levels
Hoshin Kanri
Hoshin Kanri Cascade
“Catchball” Process
• CEO/Service Line Leaders/Directors
• Discussions between Leadership levels
– Need to limit the “How”/# of Tactics
• Level 3 catchball includes frontline
• Improves ownership/engagement at all levels
• Integrated goals cascade from Level 1 - Level 3
• Alignment and focus
Level-1
2
1
#1 lags everything
#2 is leading to #1 but lagging to #3
#3 is leading to #2 but lagging to #4
#4 is leads everything
Metrics
Level-2
3
Proposal
A3’s
Level-3
4
Rotation in Hoshin
Linkage Validation
Value Stream Mapping
Evaluate
and
Improve
Map
Current
State
Std Work
Sustaining
Results
Review
Inputs SFP/
Patient
Kaizen CIP
3P A3’s
JDI’s
Determine
Ideal State
Prioritize
Gaps and
Events
Map
Future
State
RCA and
Identify
Barriers
Forecasting –
Ties to Level 1 Hoshin
Forecasting - What We Did
• Eliminated Annual Budget Process
• Implemented Quarterly Forecasting
–Designed overall process
–Operationalize software
–Initiated Quarterly Senior Leader
meeting
Forecasting - Why We Did It
• Agility – annual
budget process is out
of synch
– Pace of change in
the industry
– Winona Health
management
system
– Lead Time too long
– 17 months
Forecasting - Why We Did It
• Noise – Budget becomes noise that gets
in the way of real-time continuous
performance improvement
Forecasting – Why We Did It
• Waste –
time and resources
Observations/Impact/Lessons Learned
• Start with Long-Term Financial Forecast to
determine targets
• Use Quarterly Forecasting to evaluate
progress on Long-Term targets
• Close the Loop on gaps between Quarterly
Forecast and LT Targets
• This is primarily a top-down exercise, resist
creating a quarterly budget process
Observations/Impact/Lessons Learned
• Quarterly Forecasting meeting has created
enhanced dialogue among Senior Leaders
• Preparation for the quarterly meeting has
triggered a more meaningful interaction
between finance and operations
• Operating leaders are asking more and better
questions
• You have to learn to walk again
Observations/Impact/Lessons
Learned
• Quarterly Forecasting:
– Is about performance improvement
– Is not about precision or paper clips
• The point of forecasting is not creating
numbers to “hit”. It’s about designing
operations to deliver better performance.
Box Scores – Tie to Hoshin
Boxscore Graphs/Charts
PCC % Use of CPOE
PCC Pt Sat Raw Score
Goal
90
90
90
Actual
90
Actual
Linear (Actual)
90
90
90
90
90
100
89.3
Goal
Linear (Actual)
100
100
100
80
80
80
100
100
100
65.5
88.5
88.4
88.4
88.4
88.1
1-Jun 1-Jul 1-Aug 1-Sep 1-Oct 1-Nov 1-Dec
Proposal A3’s
• Proposal A3’s-all levels of Hoshin – “HOW”
– What tactics we use to accomplish breakthrough
objectives and how do you measure for success
– Started by leader /
finished by area
– Burning platform
– Also used for CPR’s
presented to CEO/CFO
Proposal A3
Business Case
Future State
Action Plan
Current State/Gap
Measurement/Results
Visual Management Enterprise
• PDCA Enterprise Level
– Plan wall
• Hoshin Level 1 and Level 2’s
• Proposal A3’s from level 1 Hoshin
• Long term goals and forecast
– Do wall
• Proposal A3’s from all level 2 Hoshin
– Check wall
• Std Boxscores from every Service/Support Line
• Charts/Graphs not meeting target
• Results tracking to forecasting
– Act wall
• Follow-up – Course Corrections
Enterprise Obeya
Visual Management-PDCA Boards
PDCA Boards – Level 2 and 3 (SL/Dept)
–New format with Standard Work
–Box Score – Vital few – Level 2 and 3
–Reviewed weekly, monthly and
quarterly
PDCA Board Weekly/Monthly
Visual Management FOCUS Boards
• FOCUS Boards- Daily- every dept
–New format with Standard Work
–A3 Problem solving at frontline
–More meaningful than old version
FOCUS Boards - DAILY
Standard Work
• Standard work at the frontline-goal 20%
– Based on risk and volume
– Critical to quality steps on a scorecard audit
– Improves outcomes and quality
– Process stable prior to improvement
– Decreases variability
• Standard work for Leadership
– Standard set of tasks all leaders or managers perform
– Same expectations/outcomes-quality
– Accountability
– Staff see the same process in all leaders
Leaders Standard Work
• Leaders Standard Work cascaded up from
frontline to the CEO
• Daily, weekly and monthly audits
• Done with a score card
• Gemba walks/Rounding
• Coaching and Mentoring- 4-Patterns
• Visual Board Rounding
Standard Work / LSW
Scorecard Requirements
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Cascaded frontline to CEO
Vital few – one on/one off
Discipline at all levels
Reviewed at 1:1 leaders mtg
Follow-up to issues and
commitment from either party
• 4- Patterns guides actions
• Live tool-changes as needed
Frontline Daily Problem Solving
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22 Coaches trained
75 Frontline Problem Solvers trained
6 additional groups trained
> 200 A3’s since January 2013
> 140 A3’s closed out of the 200
New A3 Format
Healthcare sensei December 2012
In addition to FB and JDI’s
Problem Solving A3
Problem Statement
Background
Target Condition
Current State
Countermeasures
Implementation Plan
Problem Analysis
Gap
Follow-up Actions and Metrics
Cost Benefit Analysis
Recognition Program
• New-previously not done well, if at all
• Access Data Base to track results
–Hard dollars saved
–Revenue enhancement
–Hours saved
–Satisfaction – lagging
–Reports
Recognition Reports
• Executive Summary – Financial and time
• Weekly Recognition-report detailing
closed A3’s
–teams are recognized at the FOCUS
Boards by the Service Line Leaders.
• Monthly Recognition – CEO highlights
monthly and tells the story….
Executive Summary Report
A3 Revenue Enhancement and Hard Dollar Savings
Value Realization
Hours saved
Reassigned to “new” work
A3 Problem solvers/Coaches
Have a “no lay off” policy related to “CSI”
Attrition
Forecasting adjusted if appropriate
Hard Dollar Savings
75% adjustment in forecasting
Validation required in intervals
Forecasting adjusted if appropriate
Leadership Academy
Why Leadership Academy?
• Developing out people
• Respect for our people
• Use of talent
• Grown your bench
• Staff Satisfaction = Increased
Patient Satisfaction
Results
• Strategy patient focused, aligned and integrated
from Hoshin to the frontline
• Sustainment with Results using Std Wk/LSW
• Improved visual management
• Engagement at all levels with A3 problem solving
(critical thinking) and FOCUS/PDCA boards
• Enterprise results monitored and addressed by
the CEO and Senior Leadership Team with course
correction and follow-up when needed
• Results reflected in measurement and metrics
Questions?
• is the CONSTANT GUIDE for the Team