Lean at Tenet
Hurley Smith
Trinity HCAD Class of 2012
Thursday, November 5th 2015
True North
“Where do I fit in?”
True North
Why do we exist, really?........
For Our
Customers
Who Have
These Needs
We Provide
~Generic Mission~
Unlike Our
Competitors
We Are
Better in
These Ways
~Generic Vision~
True North: Mission & Vision
Mission: Develop souls and propagate the faith.
Vision: To do so by focusing on education, speed, and
adaptability.
St. Ingatius Loyola, SJ
“Loyola Jettisoned whatever traditional religious practices stood in the way…
…like praying...
…more accurately, praying according to the monastic tradition”
True North
Why do hospitals exist, really?........
~ Generic Hospital Mission Statement ~
For Our
Customers
Who Have
These Needs
We Provide
Patients
Emergent
Healthcare
Medical
Surgical
Women's
Diagnostics
So… Are we any good?
So… Are we any good?
ServiceLine Level
Business
Indicators
Process-Level
Business
Indicators
VTE-1
Hospital Name
TARGET
TENET
California
Central
Detroit
Florida
Northeast
PHOENIX MARKET
Southern
Texas
3 West
Readmits
Safety
BSC Metrics
Outcome
CLABSI
Readmis
Falls with Infecti
STK-4
sions
Injury
on
Rate
Rate
96%
95%
93%
99%
99%
95%
98%
98%
97%
93%
92%
85%
59%
100%
100%
97%
71%
100%
100%
86%
0.023
0.041
0.043
0.000
0.000
0.000
0.186
0.000
0.741
0.056
0.500
0.900
1.097
0.395
2.675
0.855
0.513
0.422
1.422
0.299
14.0%
13.4%
14.7%
12.7%
19.9%
14.5%
13.1%
7.5%
12.2%
12.4%
ICU
ER
CLABSI
Sepsis
Value
Sepsis
Excess
Days
Rate
29%
29%
26%
36%
35%
37%
32%
29%
25%
24%
Service
Blood PSMS
Exparel
Utilizat Actual
Usage
ion
Score
1.6
3.4
3.7
5.2
0.0
4.2
0.0
1.9
2.0
6.5
40%
44%
32%
59%
63%
39%
45%
29%
34%
46%
72
72.0
71.9
69.9
72.3
70.4
71.1
67.2
72.0
75.0
LDM
Process
2 North
CAUTI
7
Management System
High Level
Business
Indicators
Requires leadership.
Complicated vs. Complex
Requires lots of
schooling.
Complex Systems: Why Hospitals Are Hard
1840 – Textile Mills
“Of more serious consequence to the workers... Company production innovations”
The “Stretch Out”
Increase in the number of machines for which a worker is responsible
The “Speed Up”
Running the machines at a faster pace
The “Premium System”
Reward the most productive workers with cash
Source: There is Power in a Union, Philip Dray
Why did early managers do that?
Quality
Service
Cost
“Volume cures all ills”
“Work faster”
“More market share”
“Cut costs!”
“Physicians are our number 1 customer!”
“EBITDA!!!!!”
People
Growth
W. Edwards Deming on Leadership
1. Lack of constancy of purpose to plan product and service that will have a market
and keep the company in business, and provide jobs.
No True North. No Economic sense of purpose.
2. Emphasis on short-term profits: short-term thinking (just the opposite from
constancy of purpose to stay in business), fed by fear of unfriendly takeover, and by
push from bankers and owners for dividends.
Emphasis on Cost and Growth (discounting the other 3 pillars)
3. Evaluation of performance, merit rating, or annual review.
Sub optimization (constraint theory)
Visual Management
Consensus
Is
Golden
“Quiet at Night”
Lean Daily Management
The evolution of a management system…
January, 2013 - “lais·sez-faire” Gemba
April, 2013 - Leader x-ray vision
Vanguard
November, 2013 - Look to the Glass Wall!
2014 – Propagate the faith
Spring, 2015 – Trail of tiers
Fall, 2015 – High Reliability
Tenet
High Reliability
Strategy
Deployment
People
Development
Performance
Improvement
Management
System