Lean Healthcare Transformation Summit 2013, John Toussaint Keynote

photoThings are underway at the 2013 Lean Healthcare Transformation Summit. We have 600 attendees from 39 states and 8 countries.

I will be tweeting, as will others, at the hashtag #HCsummit13.

John Toussaint, MD will be doing his keynote at 8:30 AM EDT. I will be taking notes live in this public google document  (also see completed notes below).

Notes

  • We need to revitalize this industry

  • The people in this room are trying to transform the industry

  • 3 pillars for this summit and transformation

    • Care redesign (including Lean)

    • Paying for value

    • Transparency

  • Tish’s story (80 year old patient)

    • Many, many errors and problems in her care

    • “Her morning meds were given at night and her night meds were given in the morning… but they [the nurses] ignored her.”

    • Surgery to correct a hospital-acquired infection

    • Waiting, waiting, waiting

    • Cultured specimens were lost by the lab

    • “Tish noticed nobody who entered the room washed their hands other than the phlebotomist. The antiseptic dispenser was empty.”

    • “It takes guts to tattle on your nurse.” Nothing changed.

    • Her wishes and concerns were ignored

    • A major hospital well known for good safety

    • “Is this your health system??” – rhetorical Q

    • “After two weeks in the system, she was WORSE then when she started.”

    • After three weeks, she was finally better.

  • “It doesn’t have to be this way.”

  • Tish is John’s mother in law

  • What’s the problem? Unfortunately, this is going on a lot in patient care… harming patients.

  • What are some of the root causes?

    • The overall value stream of cancer care is not viewed as an overall system

    • Even though we claim to be highly integrated, we are not

    • Lack of an operating system to help fix things – see article

    • We’ve got a problem with our management system – the most important critical factor missing in healthcare is a management system that supports improvement.

    • Need to shift from the top-down command and control model to a lean management system

  • What can we do about it?

    • Shows a ThedaCare cancer value stream map for the entire care process

    • Lean management system – connects people and process working for a purpose

    • “Management by process” – not “management by objective”

      • A3 thinking

      • Daily status sheet

      • Daily performance and defect review huddle

      • Unit-based leadership teams

      • Standardized work for leaders and supervisors

      • Standardized work audits

      • Visual process tracking

      • Andons

  • “No meeting zones”

    • 2 hours each morning – so what happens?

    • People leading in the gemba, leading by asking questions

    • One Iowa org implemented 12,000 staff ideas

  • Video of a team “defect huddle”

    • Lab orders remaining on care plans – RNs don’t know if they’ve been done or not – why do they remain there?

      • Do we have a timeline for when we can come up with a suggestion?

      • Asking employees to help solve the problems and improve the process

    • Our job as leaders is to help them unravel the giant hairball of problems

  • Standardized work for leaders – daily stat sheet (status sheet)

    • Asking questions, going off a guide of what to ask and investigate

    • As a CEO, are you going to the gemba for 15 minutes every day? (at least?)

    • Examine your management system – can it actually support the continuous improvement your staff are trying to make happen?

    • Good (in Mark’s opinion): staff tracking metrics by pencil at the gema

      • Bad (in Mark’s opinion): simplistic “red/green” analysis around an (arbitrary?) target. Need better SPC analysis to avoid overreacting to every up and down in the data (see here)

  • John talks about the mentoring from Paul O’Neill (he is speaking later today)

    • 3 questions – can you say yes every day?

      • Is everybody treated with dignity and respect by everyone?

      • Does everybody had the tools, training, and encouragement to do the work that gives their life meaning?

      • Have people received recognition?

  • Results

    • NYC HHC has saved nearly $250M over 5 years, for example

      • It’s management by process so we can get results

    • Reduced cardiac mortality through use of Lean methods (2.5% lower… not much, but it’s lower)

  • “This operating system is critical for delivering results.” But we need more than the management system too. Also requires:

    • Transparency of patient outcomes:

      • Study – MDs that report quality of care measures improve more quickly (Health Affairs)

      • The systems that would create this transparency are a mess – no standards, information is locked up for experts to get out

      • Much of Tish’s story could have been improved by having better information flow

      • Need more “Business Intelligence” applied to healthcare

    • Payment reform

  • Has anybody put it all together?

    • HealthPartners in MN – web and mobile transparency… rating the MD clinics on cost and quality, star rating

    • Paying differently based on results

      • Withhold payment portion and then pay if they hit metrics

      • Bonus and public recognition for top 1%

      • Triple Aim savings (cost, quality, etc.) – shared savings

      • Trying to “pay for value” in MN and WI

    • Involving the patient to redesign care

  • Wisconsin Statewide Value Committee

(end of talk)

 

Q&A comments:

  • Most organizations haven’t mapped out their existing state. They don’t know how they are performing.

  • Reimbursement is a challenge and a problem in every country

  • How many of Tish’s problems could have been avoided? 90-95%? One or both hospitalizations could have been avoided?

  • Q: How do we get MDs to follow standardized work?

    • John says we need to look at the system… the system is designed for people to not follow SW

    • (Mark’s commentary… we can’t force anybody to do anything)

  • don’t just Plan and Do and Run – focus on Study and Adjust!

Photo below by Bobby Gladd. See his blog post about the Summit here.


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Mark Graban's passion is creating a better, safer, more cost effective healthcare system for patients and better workplaces for all. Mark is a consultant, author, and speaker in the "Lean healthcare" methodology. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. His most recent project is an eBook titled Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also the VP of Improvement & Innovation Services for the technology company KaiNexus.

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