Simplifying Process Improvement/Lean/Six Sigma Programs for Healthcare

Simplifying Process Improvement/Lean/Six Sigma Programs for Healthcare IIE Engineering Lean and Six Sigma Conference 2013 September 23-25, 2013 Crowne Plaza at Ravinia Atlanta

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craigastevens@westbrookstevens.com

The Most Efficient Doctor Visit What does excellent look like?

Doctor Lucy Treatments

5 C

Agenda Creating a Team Focused Improvement Program

✓

1

Our Foundations of CPI

2

TQM, Lean, Six-Sigma, Strategic Project Management

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This an example text. Go Phases ahead and replace it Threeis Easy To Understand

4

Levels of Resources

5

Training Levels, Tools, and Big Rocks

6

Summary of PI Program Approach

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People and Team Building

Westbrook Stevens, Seven Attributes of Excellent Management Model, 1990 Š

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Our Foundations of CPI The Seven Attributes of Excellent Management

1. Excellent Leadership = Leadership Throughout the Organization, Everyone is Empowered to Lead Their Own Work – What Does Excellent Leadership Look Like?

– What Does Our Leadership Look Like?

• Are Leaders On Board and Do we have a Leader for the CPI Project?

– Where are the Gaps?

– Fix the Gaps!

1/7/2013

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Adapted from Palma Buttles-Valdez, Carnegie Mellon ,Process improvement Briefing to Software Engineering Institute, 2008 – who adapted it from and Dr. Mary Lippitt, Enterprise Management, LTD., 1987, ttp://www.jcse.org.za/upload/events/37/organisational_culture_and_people_issues_in_process_improvementdrpalma_ buttlesvaldez.pdf 2/13 2013

Improvement Efforts and Missing Elements of Change Vision

Resources

Capable Workforce

Capable Processes

Organizational Culture

Incentives

Action Plan

Change

Resources

Capable Workforce

Capable Processes

Organizational Culture

Incentives

Action Plan

Confusion

Capable Workforce

Capable Processes

Organizational Culture

Incentives

Action Plan

Anxiety and Frustration

Capable Processes

Organizational Culture

Incentives

Action Plan

Slow or Little Progress

Organizational Culture

Incentives

Action Plan Action Plan

Reinventing the Wheel

Vision Vision

Resources

Vision

Resources

Vision

Resources

Vision

Resources

Vision

Leadership

Capable Workforce Capable Workforce Capable Workforce

Capable Processes Capable Processes

Organizational Culture

Resources

Capable Workforce

Capable Processes

Organizational Culture

Systems and People

Problem Solving / Skills

Systems and Processes

Incentives

Culture

Action Plan

Incentives

People

Barriers to Change Sporadic Change

False Starts Problem Solving/Skills Tools

Our Foundations of CPI The Seven Attributes of Excellent Management

2. Excellent Culture = The Culture of the Organization, The Culture of the Group – What Does Excellent Organizational Culture Look Like?

– What Does Our Culture Look Like?

• Are All Stakeholders On Board and Do we have a Willing Culture for the CPI Project?

– Where are the Gaps?

– Fix the Gaps!

1/7/2013

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Adapted from Palma Buttles-Valdez, Carnegie Mellon ,Process improvement Briefing to Software Engineering Institute, 2008 – who adapted it from and Dr. Mary Lippitt, Enterprise Management, LTD., 1987, ttp://www.jcse.org.za/upload/events/37/organisational_culture_and_people_issues_in_process_improvementdrpalma_ buttlesvaldez.pdf 2/13 2013

Improvement Efforts and Missing Elements of Change Vision

Resources

Capable Workforce

Capable Processes

Organizational Culture

Incentives

Action Plan

Change

Resources

Capable Workforce

Capable Processes

Organizational Culture

Incentives

Action Plan

Confusion

Capable Workforce

Capable Processes

Organizational Culture

Incentives

Action Plan

Anxiety and Frustration

Capable Processes

Organizational Culture

Incentives

Action Plan

Slow or Little Progress

Organizational Culture

Incentives

Action Plan Action Plan

Reinventing the Wheel

Vision Vision

Resources

Vision

Resources

Vision

Resources

Vision

Resources

Vision

Leadership

Capable Workforce Capable Workforce Capable Workforce

Capable Processes Capable Processes

Organizational Culture

Resources

Capable Workforce

Capable Processes

Organizational Culture

Systems and People

Problem Solving / Skills

Systems and Processes

Incentives

Culture

Action Plan

Incentives

People

Barriers to Change Sporadic Change

False Starts Problem Solving/Skills Tools

Our Foundations of CPI The Seven Attributes of Excellent Management

3. Excellent Customer Focus – – – –

What Does Excellent Customer Focus Look Like?

What Does Our Customer Focus Look Like?

Where are the Gaps?

Fix the Gaps!

1/7/2013

9

Our Foundations of CPI The Seven Attributes of Excellent Management

4. Excellent Team Building = All Things People, Team Issues, and Motivational Theories – – – –

What Does Excellent People Management Look Like?

What Does Our People Management Look Like?

Where are the Gaps?

Fix the Gaps!

1/7/2013

10

Adapted from Palma Buttles-Valdez, Carnegie Mellon ,Process improvement Briefing to Software Engineering Institute, 2008 – who adapted it from and Dr. Mary Lippitt, Enterprise Management, LTD., 1987, ttp://www.jcse.org.za/upload/events/37/organisational_culture_and_people_issues_in_process_improvementdrpalma_ buttlesvaldez.pdf 2/13 2013

Improvement Efforts and Missing Elements of Change Vision

Resources

Capable Workforce

Capable Processes

Organizational Culture

Incentives

Action Plan

Change

Resources

Capable Workforce

Capable Processes

Organizational Culture

Incentives

Action Plan

Confusion

Capable Workforce

Capable Processes

Organizational Culture

Incentives

Action Plan

Anxiety and Frustration

Capable Processes

Organizational Culture

Incentives

Action Plan

Slow or Little Progress

Organizational Culture

Incentives

Action Plan Action Plan

Reinventing the Wheel

Vision Vision

Resources

Vision

Resources

Vision

Resources

Vision

Resources

Vision

Leadership

Capable Workforce Capable Workforce Capable Workforce

Capable Processes Capable Processes

Organizational Culture

Resources

Capable Workforce

Capable Processes

Organizational Culture

Systems and People

Problem Solving / Skills

Systems and Processes

Incentives

Culture

Action Plan

Incentives

People

Barriers to Change Sporadic Change

False Starts Problem Solving/Skills Tools

Our Foundations of CPI The Seven Attributes of Excellent Management

5. Excellent Problem Solving = All Things Skills, Core Competencies, and Problem Solving Tools (Project Management, Six Sigma, Lean, Accounting, Etc.) – – – –

What Does Excellent Skills and Tools Look Like?

What Does Our Skills and Tools Look Like?

Where are the Gaps?

Fix the Gaps!

1/7/2013

12

Adapted from Palma Buttles-Valdez, Carnegie Mellon ,Process improvement Briefing to Software Engineering Institute, 2008 – who adapted it from and Dr. Mary Lippitt, Enterprise Management, LTD., 1987, ttp://www.jcse.org.za/upload/events/37/organisational_culture_and_people_issues_in_process_improvementdrpalma_ buttlesvaldez.pdf 2/13 2013

Improvement Efforts and Missing Elements of Change Vision

Resources

Capable Workforce

Capable Processes

Organizational Culture

Incentives

Action Plan

Change

Resources

Capable Workforce

Capable Processes

Organizational Culture

Incentives

Action Plan

Confusion

Capable Workforce

Capable Processes

Organizational Culture

Incentives

Action Plan

Anxiety and Frustration

Capable Processes

Organizational Culture

Incentives

Action Plan

Slow or Little Progress

Organizational Culture

Incentives

Action Plan Action Plan

Reinventing the Wheel

Vision Vision

Resources

Vision

Resources

Vision

Resources

Vision

Resources

Vision

Leadership

Capable Workforce Capable Workforce Capable Workforce

Capable Processes Capable Processes

Organizational Culture

Resources

Capable Workforce

Capable Processes

Organizational Culture

Systems and People

Problem Solving / Skills

Systems and Processes

Incentives

Culture

Action Plan

Incentives

People

Barriers to Change Sporadic Change

False Starts Problem Solving/Skills Tools

Our Foundations of CPI The Seven Attributes of Excellent Management

6. Excellent Continuous Improvement = All Things Change Related, Continuous Improvement, Systems, and Processes (Systems Thinking, CPI) – What Does Excellent Change Management (Systems and Process Improvement) Look Like?

– What Does Our Change Management (Systems and Process Improvement) Look Like?

– Where are the Gaps?

– Fix the Gaps!

1/7/2013 14

Adapted from Palma Buttles-Valdez, Carnegie Mellon ,Process improvement Briefing to Software Engineering Institute, 2008 – who adapted it from and Dr. Mary Lippitt, Enterprise Management, LTD., 1987, ttp://www.jcse.org.za/upload/events/37/organisational_culture_and_people_issues_in_process_improvementdrpalma_ buttlesvaldez.pdf 2/13 2013

Improvement Efforts and Missing Elements of Change Vision

Resources

Capable Workforce

Capable Processes

Organizational Culture

Incentives

Action Plan

Change

Resources

Capable Workforce

Capable Processes

Organizational Culture

Incentives

Action Plan

Confusion

Capable Workforce

Capable Processes

Organizational Culture

Incentives

Action Plan

Anxiety and Frustration

Capable Processes

Organizational Culture

Incentives

Action Plan

Slow or Little Progress

Organizational Culture

Incentives

Action Plan Action Plan

Reinventing the Wheel

Vision Vision

Resources

Vision

Resources

Vision

Resources

Vision

Resources

Vision

Leadership

Capable Workforce Capable Workforce Capable Workforce

Capable Processes Capable Processes

Organizational Culture

Resources

Capable Workforce

Capable Processes

Organizational Culture

Systems and People

Problem Solving / Skills

Systems and Processes

Incentives

Culture

Action Plan

Incentives

People

Barriers to Change Sporadic Change

False Starts Problem Solving/Skills Tools

Our Foundations of CPI The Seven Attributes of Excellent Management

7. Excellent Performance Measures – What Do Excellent Performance Measures Look Like?

• Seven Steps (1. Know the Rules, 2. Know the Goals, 3. Know the Criterion for the Goals, 4. Know the Indicators of the Criterion, 5. Collect the Data, 6. Analyze the Data, and 7. Use the Data)

– What Does Our Performance Measures Look Like?

– Where are the Gaps?

– Fix the Gaps!

16

1/7/2013

Agenda Creating a Team Focused Improvement Program

✓

1

Our Foundations of CPI

✓

2

TQM, Lean, Six-Sigma, Strategic Project Management

3

This an example text. Go Phases ahead and replace it Threeis Easy To Understand

4

Levels of Resources

5

Training Levels, Tools, and Big Rocks

6

Summary of PI Program Approach

7

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Lean Improvement Focused Teams

Lean Focuses on reducing waste and improving cycle time through continuous quality improvement Impact – Improves process flow and efficiency

Six Sigma Improvement Focused Teams

Six Sigma Focuses on reducing errors through rigorous data analysis and statistical controls  Impact – Improves quality and reduces process variation Example From the HCA PI Teams

craigastevens@westbrookstevens.com

1st Order Changes or Continuous Improvement Adapt

1st

Some Order Changes become 2nd Order Changes

Adapt

Adapt

Start

1/7/2013 1/7/2013

Copyright Š 2007, www.WestbrookStevens.Com 20 20

craigastevens@westbrookstevens.com

Project Management is Required for 2nd Order Changes (or A Major Step Change)

Before the Change

1/7/2013 1/7/2013

During the Change

After the Change

21 Copyright Š 2007, www.WestbrookStevens.Com

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Project Management Improvement Focused Teams

Project Management ďƒ˜Major Changes Require Mastering Project Management

Example From the HCA PI Teams

Strategic Project Management

Strategic Project Management ďƒ˜Considers the overall value of the project related to desired strategic and tactical results

Example From the HCA PI Teams

Strategic Planning

Industrial/Systems Engineering

Process Improvement

Lean

Productivity Improvement

Project Selection Portfolio Management

Project Management Program Management

Agenda Creating a Team Focused Improvement Program

✓

1

Our Foundations of CPI

✓

2

TQM, Lean, Six-Sigma, Strategic Project Management

✓

3

Three Easy To Understand Phases

4

Levels of Resources

5

Training Levels, Tools, and Big Rocks

6

Summary of PI Program Approach

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Three Easy to Understand and Use Improvement Phases A= Assessments

P = Problem Solving

I = Implementation Using Project Management Tools/Support

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Assessment Phase

A= Assessments

P = Problem Solving

I = Implementation Using Project Management Tools/Support

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Solve Problems and Apply GFR (Benchmarking) A= Assessments

GFR GFR

GFR P = Problem Solving

I = Implementation Using Project Management Tools/Support

craigastevens@westbrookstevens.com

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Step 6 – Select the Solutions and Build a Project Portfolio A= Assessments

GFR GFR

GFR P = Problem Solving

I = Implementation Using Project Management Tools/Support

29

Agenda Creating a Team Focused Improvement Program

✓

1

Our Foundations of CPI

✓

2

TQM, Lean, Six-Sigma, Strategic Project Management

✓

3

Three Easy To Understand Phases

✓

4

Levels of Resources

5

Training Levels, Tools, and Big Rocks

6

Summary of PI Program Approach

30

Three Types of Assessments Level One - SelfAssessments – – – –

Tool Box Available to All Sites PM Driven PI Supported Operations Follow Up

Level Two - Onsite Assessments – – – –

Only a Few DVP/GVP Chosen Sites PI Driven PM Support (and others) Operations Follow Up

Level Three - Third-Party Supported Assessments Level Three (A) – Third-Party Supported Assessment of Current Practices – – – –

For a Few Highly Complicated or Politically Charged Sites PI Driven Contractor Supported Operations Follow Up

Level Three (B) – Third-Party Assessment of New Acquisition –

– – –

For the Critical New Sites Chosen by DVP/GVPs TM Ops/Contractor Driven PI Supported Operations Follow Up

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Three Types/Levels of Assessments

PM Driven Self-Assessments (Level 1)

PIP Team Onsite Assessments (Level 2) 32

Level One - Self-Assessments •

Materials/Tools – On-line Tool Box • A Menu of Tools • Triggers for When to Use the Tools

– 30 Minutes to an Hour Audios with PowerPoint Presentation – Example Projects (Green Flag Report Lessons Learned) • Scheduling, Staffing/Labor, Patient Flow, Telephones • General Assessing, Problem Solving, and Implementation Tools

•

•

Website, SharePoint Site, Newsletter – Lessons Learned and Materials – Face-to-Face, WebEx, and Online Education and Training Organizational Support Development – “The HCAPS Way” with a Culture of Continuous Improvement – Obtain Resources for Improvement and Sustainability

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Team Room Link: http://teamrooms.hca.corpad.net/sites/hcapsproject/OPSS/Process%20Improvement/Forms/AllItems.aspx

Create the Tools and Teach How to Find and Use Them

Activity Tiers For Level Two Week 1 = Off-Site Kickoff, Surveys, and Data Gathering Week 2 = Off-Site Data Gathering, Interviews, and Analysis

A= Assessments

Week 3 = Managed Assessment and Problem Solving

Week 4 + = PMs Continue Problem Solving and Implementation Using Project Management

P = Problem Solving

I = Implementation Using Project Management Tools/Support

35

Build a Assessment Candidate Portfolio

Agenda Creating a Team Focused Improvement Program

✓

1

Our Foundations of CPI

✓

2

TQM, Lean, Six-Sigma, Strategic Project Management

✓

3

Three Easy To Understand Phases

✓

4

Levels of Resources

✓

5

Training Levels, Tools, and Big Rocks

6

Summary of PI Program Approach

37

CPI Training Modules

Suggested and Optional Modules Training Modules

Description

Leaders

Tools Only

Master

CPIP Team

Introduction and Orientation T.001.1234 - O.10.S - PI Training Introduction 20130208

This is a 30 Minute orientation to summarize the program.

O

X

X

X

T.001.1234 - O.10.L - PI Training Introduction - Hour 20130313 (one or the other)

More detailed Orientation - This is a 60 Minute summarization of the program for those whom will not take other training.

X

O

O

O

X

X

X

White Belt Training (2 hours) T.002.1234 - W-20-X1 - PI White 20 Minutes - General Introduction to Lean/6 Sigma/TQM/Change Management/Project Belt Training 20130208 Management

O

T.002.1234 - W-20-X2 - PI White 20 Minutes - Leadership - Situational Leadership Belt Training 20130208

O

X

X

T.002.1234 - W-20-X3 - PI White 20 Minutes - Leadership - Understanding Empowerment and how to get results Belt Training 20130208

O

X

X

T.002.1234 - W-20-X4 - PI White 30 Minutes - Culture – Understanding culture.

Belt Training 20130212

O

O

X

X

T.002.1234 - W-20-X5 - PI White 30 Minutes - General Introduction to Customer Focus, People, Skills/Problem Belt Training 20130214 Solving Tools, Change/Improvement, and Performance Measures

O

O

X

X

Training by Levels of Expertise

120 Min.

For Leaders

Create an Understanding with a focus on Leadership and Empowerment (White Belt)

For Supervisors

1 Day – Mainly Lean Tools with some Culture, Teams, and Motivation

Be Able to Manage and Contribute to Improvements (Yellow Belt)

For Practitioners 2 Weeks Worth of Training, Projects and Tools For CPI Mentors and Facilitators 3 Months Worth of Implementation – Mentoring and Implementation Study

Be Able to Perform Improvement Projects Independently (Green Belt)

Be able to Teach and Facilitate Improvement Projects for Others (Black Belt) 39

White Belt – 120 Minutes of Building Leaders

Element 1 -Leadership 2 - Culture 3 - Customer Focus

% of Introduction Time 50 25 5

Minutes of a 120 Minutes Presentation 60 30 6

Goal: To Create an Understanding

1 -Leadership 2 - Culture

4 - People and Teams 5 - Skills and Tools

5 5

6 6

6 - Processes and Systems

5

6

7 - Performance Measures

5

6

3 - Customer Focus

4 - People and Teams 5 - Skills and Tools 6 - Processes and Systems 7 - Performance Measures

40

Leadership Training - (50% of Time) • Situational Leadership – When and how much to lead

• Incubation of Leaders – About people, Empowerment and – how to motivate and lead people to get results 1/7/2013

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Organizational Culture Training – (25% of Time) • What is Culture • How to Assess the Culture • How to Create a Cultural Desire to Improve 1/7/2013

42

Training by Levels of Expertise

120 Min.

For Leaders

Create an Understanding with a focus on Leadership and Empowerment (White Belt)

For Supervisors

1 Day – Mainly Lean Tools with some Culture, Teams, and Motivation

Be Able to Manage and Contribute to Improvements (Yellow Belt)

For Practitioners 2 Weeks Worth of Training, Projects and Tools For CPI Mentors and Facilitators 3 Months Worth of Implementation – Mentoring and Implementation Study

Be Able to Perform Improvement Projects Independently (Green Belt)

Be able to Teach and Facilitate Improvement Projects for Others (Black Belt) 43

Yellow Belt – 1 Day – Building Direct Supervisors

Element 1 -Leadership 2 - Culture 3 - Customer Focus

% of Leaders’ Minutes of 1 Time Day 2 10 2 10 4

20

Goal: To Be Able to Manage and Contribute to Improvements

1 -Leadership 2 - Culture

4 - People and Teams

4

20

3 - Customer Focus 4 - People and Teams

5 - Skills and Tools

63

300

5 - Skills and Tools

6 - Processes and Systems

6 - Processes and Systems

13

60

7 - Performance Measures

13

60

7 - Performance Measures

44

Yellow Belt – Problem Solving (Skills and Core Competiveness) (63%of time)

• Highest Impact Tools and Solutions – Doctor Schedule Templates – Patient Throughput – Phones – Room Utilization – Staffing

• Green Flag Reports 1/7/2013

45

craigastevens@westbrookstevens.com

Yellow Belt – Problem Solving (Skills and Core Competiveness) (63%of time)

• Introduce Lean Tools – – – – – – –

In addition to the Big Rocks & GFRs Observations Value Stream Mapping Flow Charting A3 Processing and Reporting Spaghetti Diagram 5 S Events

1/7/2013

46

Training by Levels of Expertise

120 Min.

For Leaders

Create an Understanding with a focus on Leadership and Empowerment (White Belt)

For Supervisors

1/2 Day – Culture, Teams, Motivation

Be Able to Manage and Contribute to Improvements (Yellow Belt)

For Practitioners

2 Weeks Worth of Training, Projects and Tools For CPI Mentors and Facilitators 3 Months Worth of Implementation – Mentoring and Implementation Study

Be Able to Perform Improvement Projects Independently (Green Belt)

Be able to Teach and Facilitate Improvement Projects for Others (Black Belt) 47

Green Belt – 4 Days & Project – Building Practitioners

% of Practitioners’ Time

Hr Training

1 -Leadership

2

1/2

2 - Culture

2

1/2

3 - Customer Focus

6

2

Element

Goal: To Be Able to Perform Improvement Projects Independently

1 -Leadership

4 - People and Teams

10

3

5 - Skills and Tools

60

20

2 - Culture 3 - Customer Focus 4 - People and Teams 5 - Skills and Tools

6 - Processes and Systems

10

3

7 - Performance Measures

10

3

Requires Completion of a Complete Improvement Project

6 - Processes and Systems 7 - Performance Measures

48

craigastevens@westbrookstevens.com

Green Belt – Select a Green Belt Project that Relates to Your Work Area • Use the Three Phases – Assess Using the Seven Attributes • Plant Green and Red Flags • Build Red Flag Portfolio

– Perform Problem Solving On One or More of the Red Flags • Facilitate a Team Problem Solving Effort • Build a Solution Portfolio and Select the Best (May Be a Real Project)

– Implement Solutions • Build a Project Portfolio Based on the Solutions • Implement some Quick Fixes and • Select and Use PM tools to Implement a Real (Larger) Project 1/7/2013

49

Green Belt – Training • Learn the Key Six Sigma Tools – Stats and Use the Lean Tools

• Review and Expand on the Other Subjects • Apply to The Selected Project • Learn Project Management Tools

1/7/2013

50

Training by Levels of Expertise HCAPS Improvement Focused Teams

120 Min.

For Leaders

Create an Understanding with a focus on Leadership and Empowerment (White Belt)

For Supervisors

1/2 Day – Culture, Teams, Motivation

Be Able to Manage and Contribute to Improvements (Yellow Belt)

For Practitioners

2 Weeks Worth of Training, Projects and Tools For CPI Mentors and Facilitators 3 Months Worth of Implementation – Mentoring and Implementation Study

Be Able to Perform Improvement Projects Independently (Green Belt)

Be able to Teach and Facilitate Improvement Projects for Others (Black Belt) 51

Black Belt – 6 Months Experience, Training, & 4 Projects for CPI Facilitators

% of Facilitators' Time

Hours over 6 Months

1 -Leadership

5

2

2 - Culture

5

2

3 - Customer Focus

5

2

Element

Goal: To Be able to Teach and Facilitate Improvement Projects for Others

1 -Leadership 2 - Culture

4 - People and Teams

20

8

5 - Skills and Tools

30

10

3 - Customer Focus 4 - People and Teams 5 - Skills and Tools

6 - Processes and Systems

30

10

7 - Performance Measures

5

2

6 - Processes and Systems

Requires Facilitating the Successful Completion of 4 Complete Improvement Projects for Others

7 - Performance Measures

52

Black Belt – Training • Review and Expand on the Attributes and Tools • Add Systems Thinking Archetypes • Apply to The Selected Projects • Have a Strategic Focus • Focus on Mentoring Others • Focus on Training-the-Trainer

1/7/2013

53

Agenda Creating a Team Focused Improvement Program

✓

1

Our Foundations of CPI

✓

2

TQM, Lean, Six-Sigma, Strategic Project Management

✓

3

Three Easy To Understand Phases

✓

4

Levels of Resources

✓

5

Training Levels, Tools, and Big Rocks

✓

6

Summary of PI Program Approach

54

Results

A= Assessments

GFR GFR

GFR P = Problem Solving

I = Implementation Using Project Management Tools/Support

55