Lake Health’s
Lean Journey
Innovative Improvement for Independence
A little bit about us
Cleveland
Ohio
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Team Members = 3,000
Inpatient Beds = 270
Adult Admits = 17,000
Births = 1,900
Surgical Cases = 14,000
ER Visits = 76,000
Presentation Roadmap
1. Reason for Action: Why did we decide to embark on this journey?
2. Initial State: Where were we when we started?
3. Target State: Where do we want to be in 3…5…10 years down the road?
4. Identifying Gaps: What are the major barriers that must be overcome?
5. Solutions: What needed to be done to overcome those barriers?
6. Rapid Experiments: Early successes/failures along the way?
7. Completion Plan: Getting started on our journey!
8. Confirmed State: Have we moved the dial?
9. Insights: Lessons learned
1. Reason for Action
What is LEAN?
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Toyota Business System

The practice and process of identifying and removing waste

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Waiting
Unnecessary Motion
Defects

The concept and practice of continuous improvement
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The power of respect for people (Front line decisions)
1. Reason for Action
Organizations Practicing LEAN?
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3M

Boeing

Avery Dennison

Dow Chemical

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Virginia Mason

Mayo Clinic

ThedaCare
General Electric

Denver Health

Ford Motor Company

Stanford Hospital & Clinics

Sears

Lake Health!!
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GlaxoSmithKline

GEICO

US Army, Navy, Air Force and Marines
1. Reason for Action
Why did we decide to embark upon this journey?
 Desire to remain an independent, community-based health system
 Recognition that the status quo or incremental changes in quality, cost
and patient experience would not be sufficient to achieve goals
 Require a shared disciplined approach to innovative improvement,
that will transform the way we do business
 Success of the transformation will ultimately depend on the participation
of all team members, volunteers and physicians
1. Reason for Action
May 14-16, 2012 Leadership Retreat
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2. Initial State
Where were we when we started?
 Operating in a dynamic/competitive market
 Desiring to improve clinical quality and patient experience.
 Needing to extend focus beyond acute episodic care to continuum of care
 Reimbursement not keeping pace with increasing expenses
 Mediocre team member engagement
 Average community perceptions
3. Target State
Where do we want to be in 3…5…10 years down the road?
 Improved patient and family value through:
 higher quality
 lower cost
 improved safety
 Waste eliminated from processes
 Instill a culture of continuous improvement
4. Identifying Gaps
What are the major barriers that must be overcome?
Availability of space
Staff Support
Budget
Structure
“Program of the
Month”
Conflicting Priorities
5. Solutions
Deciding where to begin…
 Identify potential areas to begin
 Identify the criteria for areas selected
 Number of patients touched
 Opportunities for improvement
 Highest impact on the organization
 Select ones that complement each other
5. Solutions
What needed to be done to overcome those barriers?
If We:
Then We:
Identify and harvest value streams
#7, #8, Metrics will improve
Utilize A3 thinking
#1, #2, We will hardwire PI
Develop a lean office
#1, #3, #6, #7
Track results to True North metrics
#1, #8, What gets measured gets results
Create steering teams for guidance
(enterprise, value streams)
#2, #4, #6, #7, #8
Provide coaching to leadership team
#1, #2, #6, #7
Have leaders participate on RIE’s, every year
#1, #5
Communication Plan
#1, #2, #5, #7, #8
Physician engagement
#1, #2, #5, #7, #8
Develop common terms/language
#1, #2, #3, #4, #5, #6, #7, #8
5. Solutions
Addressing Space/Staffing
5. Solutions
Addressing Structure
Define
Measure
Pre-work
Analyze Improve
Sustain
RIE
Follow-up
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Lean overview
Review Pre-work
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Educate
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Observations
Validate observations
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Tweak final changes

Stakeholder analysis
Brainstorm solutions
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Sustain new process
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RIE planning
Try-storm solutions

Continuously improve
through MDI
Validate improvements
5. Solutions
Addressing Structure
RIE – Change Based on Knowledge of the World’s Greatest Experts
Those doing the work
Monday
Tuesday
Wednesday
Thursday
Friday
Current Condition
Gemba
Waste Observation
Waste Analysis
Map Future State
Generate Solutions
Run Rapid
Experiments
Problem Solving
Run New Process
Document Standard
Work
Report Out
6. Rapid Experiments
Early successes/failures along the way?
Nurse to Nurse Handoff
Initial:
• Average time from ED to inpatient bed 79 minutes and up to 250
• ED staff took patient to inpatient unit then had to find the nurse
Solution:
• Inpatient nurses pull the patients from the ED within 15 minutes
• Developed new clinical summary screen to facilitate face to face handoff
Benefit:
• Reduced time to inpatient bed from 79 minutes to 40
• Improved perception of care from patients
• Improved quality and safety of hand off.
Second Pass improvements Solution:
• Time reduced an additional 20 minutes!
6. Rapid Experiments
Early successes/failures along the way?
Periops
Initial:
• Increasing Cost/UOS
• Different patient types cared for by same staff
• Causing uneven patient flow through SDS
• Need to expand SDS area to support patient volume $3M project
Solution:
• Developed flow/standard work based on procedure
• Identified specific locations in SDS for each patient type
Benefit:
• Improved flow avoided need for additional SDS beds.
• Saved $2.5M in capital.
6. Rapid Experiments
Early successes/failures along the way?
Physician First
Initial:
• Median time Door to Doc was 40 minutes
• Protocol Care creating excessive ordering
• Patient satisfaction for arrival less than desired
Solution:
• Implement Physician first concept at peak volume times
• Triage by physician
• Earlier implementation of care
Benefits:
• Patient satisfaction with arrival improved by 57%
• Door to Doctor time decreased by 48%
7. Completion Plan
Never complete…
 Review the System-wide Transformational Plan of Care
 Integrate into System-wide plan.
 Looking to expand to new areas within the system
 Expanding the number of facilitators
 Implemented Management for Daily Improvement Boards
 Managing for Daily Improvement (MDI) is focused on implementing a
management system that creates, accommodates, and sustains a
culture of continuous improvement
 The MDI System facilitates an ongoing transformation to a data
driven, action oriented, engaged & empowered lean organization
7. Completion Plan
Daily Activities
 Manage “Flow” of process outputs (Visually)
 Identify and prioritize anomalies of performance and make
improvements
 Encourage associates to identify and eliminate waste
 Create an environment where associates are responsible for
identification (and assisting in the elimination) of waste
7. Completion Plan
MDI Goals
 Convert from being a reactive firefighter,
whose attention and priority is focused on
the self- perpetuating, never-ending fires
whenever they occur (always on the edge of
out of control)
TO…
 A proactive Lean thinker who is managing
and controlling his priorities and ultimately
his destiny
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7. Completion Plan
Incremental daily improvement supplemented with Rapid Improvement Events
Improvement
Level
RIE Events
RIE Events
Daily MDI
Activity
Event based improvement
Incremental Daily
Improvement
(coupled with events)
8. Confirmed State
Have we moved the dial?
 20 months into our journey…
 $5.9M in Hard Dollar Savings
 Patient satisfaction with the arrival process
improved by 57%
 Avoided $2.5M in capital expense by
improving patient flow
 Falls reduced by 55%
9. Insights
Lessons Learned?
1. Reason for Action: Leadership focus on the “what” not the “how”
2. Initial State: Must have 100% commitment from all (especially physicians).
3. Target State: Double the good…or…half the bad
4. Identifying Gaps: Focus on the process…not the people
5. Solutions: - Creativity over capital
6. Rapid Experiments: The best laid plans…
7. Completion Plan: A disciplined approach
8. Confirmed State: Hope is not a strategy…countermeasures
9. Insights: Some people will want to get off the bus…let them.
9. Insights
“Committed and trained senior leadership,
without question, is the key component in
successfully transforming an organisation
through lean initiatives”
“Having a great partner, like Simpler, is
essential to guiding an organization
through such a transformative
process.”