Cancer Treatment Centers of America
The Transformation of
Healthcare Forum
OCHI-CSC
Presented by: Lynn Valz, MBB
Director, Lean Six Sigma
Operations
®
October 22, 2013
Culture of Innovation and Continuous
Improvement
Lean Six Sigma Operations
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© 2013 Rising Tide
CTCA specializes in treating complex
and advanced stage cancers
Our Mission
CTCA is the home of integrative and compassionate cancer care.
We never stop searching for and providing powerful and innovative therapies
to heal the whole person, improve quality of life and restore hope.
Our Vision
To be recognized and trusted by people living with cancer
as the premier center for healing and hope.
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Who We Serve
Cancer Patients In Search Of:
– Personalized attention
– Control over their
healthcare
– Best chance to beat
cancer
– Cutting edge treatments
– Compassion and hope
“Winning the fight against cancer every day”
MOTHER STANDARD ® of CARE
Provision of the same level of care that you would want for
your own mother, father, brother, or sister
© 2013 Rising Tide
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Lean Six Sigma
helps us deliver and continuously improve
the Mother Standard®
“It is always, and only,
about the patient.”
Richard Stephenson,
Chairman and Founder
Mary Brown Stephenson
© 2013 Rising Tide
Patient-Driven Leadership
• Patient testimonial to start each board meeting
• Patient input on hospital renovation or new building
• Patient Empowered CareSM (PEC) model
• Change based on patient feedback – Patient Advisory
Council
• Lean Six Sigma improvement to Patient Experience
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Strategic Deployment
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Lean Six Sigma at CTCA
"I cannot teach anybody anything,
I can only make them think." - Socrates
Embed the expertise
within the hospital….
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Lean Six Sigma at CTCA
The Efficient Translation of Customer Desires into Patient Loyalty
•
Efficient
– Best way not the fastest way
– Identify and eliminate non value add activities
– Total involvement
LSS culture at CTCA fostered through:
•
Lean Daily Management System
•
A3 Process Improvement Program
•
Green Belt Training Program
•
Kaizen Events
•
Strategic Improvement Mapping (SIM) Events
•
Key Performance Indicators (KPI’s)
•
Reward and Recognition Program
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© 2013 Rising Tide
LSS Deployment Tactics
A3 Performance ImprovementSM
• Continuous Incremental Improvement
• High Volume
• Focused on Lean tools
Kaizen Event
• 2-5 day facilitated rapid improvement event
• Breakthrough results
• Focused on key business value streams
LSS Green Belt
• Direct link to strategic plan
• 4 month cycle time
• High Impact
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What is an A3 Project?
A3 Performance ImprovementSM
Foundational Offering
Methodology
• Fosters a culture of Lean
Thinking and “Learning to See”
• Learn by doing, hands on
application
• Lean tool training
• Projects focused on
incremental improvements
• Projects typically stem from
VOC information and pain
points
Problem
statement
Objective
statement
Current
state
Root
cause
analysis
•
•
•
•
8 week course, 2 hours/session
1 hour “homework” per week
Complete 1 project
Graduation ceremony to Senior
Leadership
• Continue Solving
• Coach & Sponsor
Follow-up
Results
Future
state
Implementation
plan
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© 2013 Rising Tide
A3 Project Examples
• Reduced the TAT to process a Rehab order from an average
of 20 minutes to 10 minutes by June 1, 2010.
– (Process an Order = time order is identified to ready to schedule.)
• Reduced the TAT to schedule a patient for an Oncology
Rehab appointment from an average of 19 minutes to 8
minutes by June 1, 2010.
– (Schedule a Patient = having an accurate order and speaking with
patient to collaborate schedule time.)
• Reduced the TAT for trash removal in the Culinary department
from a daily average of 3 hours to less than 1 hour.
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© 2013 Rising Tide
A3 Project Examples
• Reduced the number of Amifostine doses wasted from an
average of 5 per month to 1 or less per month, and improved
the percentage of patients receiving Amifostine within the
optimum window from 82% to 94%.
• Improved the timely identification and prevention of nutrient
deficient patients with a history of GI surgery / resection by
95%.
• Decreased the time for Nursing to complete appropriate care
plans for inpatients from an average of 17 minutes per patient
to less than 10 minutes.
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© 2013 Rising Tide
What is a LSS
Green Belt Project?
• Six Sigma Projects are directed toward reducing defects
and variation to improve processes and quality of patient
care
• Use of data and statistical analysis to drive improvement
• Multidisciplinary involvement and collaboration
• 4-8 months to complete
• Include ~80 hours of instructor led training
• Completion of 1 project demonstrating breakthrough
improvement of metrics
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© 2013 Rising Tide
Lean Six Sigma Green Belt Framework
Stabilize
Process2-3 months
4 weeks
4 -8 weeks
4 weeks
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Lean Six Sigma Green Belt Project
Examples
• Decreased chemotherapy waste by 57% and enhanced
patient safety
• Reduced patient wait time from clinic visit to medical
support treatment by 20 min and travel distance by 600
feet per patient
• Decreased “missed” pulmonary consults and procedures
from 25% to <10%
• Decreases hospital acquired pressure ulcer rate by 60%
• Decreased pyxis discrepancies in Surgery by 63%
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© 2013 Rising Tide
Lean Six Sigma Green Belt Project
Examples
• Goal: Decrease patient wait time to receive
Chemotherapy, from appointment time to first medication
administered, by 25%
28 minutes to 20 minutes
29% Improvement
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© 2013 Rising Tide
What about Variation with each patient
experience?
CTCA Southwestern - Infusion
13 M onth Rolling A v erage
200
Minutes
150
100
50
30(M ) G oal
0
S -12
O -12
N -12
D -12
J-13
F -13
M -13
A -13
M -13
J-13
J-13
A -13
S -13
Sep12
Oct-12
Nov12
Dec12
Jan-13
Feb-13
Mar-13
Apr-13
May13
Jun-13
Jul- 13
Aug-13
Sep-13
Average
TAT
21.5
(M)
20.5
(M)
21.4
(M)
24.0
(M)
24.7
(M)
20.5
(M)
22.0
(M)
16.8
(M)
19.3
(M)
19.7
(M)
18.5
(M)
18..5
(M)
17.8
(M)
% within
30 min
79.4%
81.2%
81.2%
72.8%
76.6%
84.4%
76.6%
89.9%
86.0%
85.0%
89.6%
88.1%
87.3%
N=
Total
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© 2013 Rising Tide
Waste
How did we do this?
Transportation
Inventory
Motion
Excess processing
1.
Define the
Problem or
Opportunity
 Pilot changes
 Change Management
 Full Implementation
5.
Monitor and
Control
 Real Time schedule
 One piece flow
 “Just-In-Time” per
schedule
 Schedule guidelines
 Nurse work flow and
partnership
 Checks & Balances
to “Error Proof”
 Communication &
Education
Defects
Overproduction
Waiting
Underutilization
4.
Implement
Improvements
Reduce/ Reorder/ Revise
2.
Go to GEMBA
document
process &
collect data
28 minutes to 20 minutes
29% Improvement
3.
Root Cause
Analysis
 Order not available at
time of appointment
 Chemo not ready at time
of appointment
 There is not an available
chair
 There is not an available
nurse
 Nurse work flow
 Patient showed up early
or late
 Scheduling Practices and lack of
real-time visibility
 Physician work flow, batching
 Pharmacist work flow, batching /
schedule
 Patient expectations
 Nurse work flow
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© 2013 Rising Tide
Lean Six Sigma Green Belt Project
Examples
• Goal: Drive a 50% turnaround time reduction from
Imaging procedure to result available to the patient
11.1 hours to 6.4 hours
42% Improvement
6.4 hours to 3.7 hours
42% Improvement
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What is Kaizen?
• Kaizen = “Good Change”
• Hospital strategic plan
• Top down
• Creates breakthrough and rapid change (3-5 day event)
• Short term intensive concentrated effort by a cross-functional
team
• 4-6 week preplanning
• 50% of improvements are made during the event
• Follow-up @ 30-60 days for additional actions implementation
• 2-6 month follow-up to Monitor and Sustain
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Kaizen Framework
After Event
Event
Up to 5 days
Planning
2-3 weeks
Initiation
Stabilize &
Monitor
Process2-6 months
Timeline for
implementing
add’l solutions30-60 days
4-6 weeks
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© 2013 Rising Tide
Kaizen Event Examples
• Reduced Scheduling complaints by over 60%
• Reduced the turn around time for new patients from
scheduling to treatment date by 20%
• Reduced denial rate for PET scans by 20%
• Designed a Survivorship program, including definition,
guidelines, and process to capture 100% of patients at
the appropriate point of their experience
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Celebration
• Executive Leadership
Report out
• Certifications
• Rewards and Recognition
program
• Hospital Wide sharing
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© 2013 Rising Tide
Thank You!
Questions?
Lynn Valz, MBB
Director of Lean Six Sigma Operations
Cancer Treatment Centers of America® at
Southwestern Regional Medical Center
Tulsa, OK
Lynn.Valz@ctca-hope.com
918-286-5210
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© 2013 Rising Tide