Wednesday was the first day of the 6th annual Lean Healthcare Transformation Summit, being held this year in Addison (Dallas), Texas. I'm here and this year my colleagues Dr. Greg Jacobson and Jeff Roussel from KaiNexus are attending, so please say hi if you are here.
Tuesday, I taught a workshop on daily continuous improvement (Kaizen) and I'll be moderating the CEO panel on Thursday. Follow hashtag #HCsummit15 for highlights along the way or see just my tweets from the Summit.
This post will be updated through Day 1 and Day 2.
Check out my posts about past Summits.
You can also read my preview of the Summit via the KaiNexus blog.
I'll posting some highlights from Day 1 keynotes here on this post as the day progresses.
Dr. John Toussaint
John shared his experiences and research from a number of hospitals that are relatively far along in their “Lean journey.”
Listening to the great Dr. John Toussaint's opening keynote at #HCsummit15 @HCValue @LeanDotOrg #lean pic.twitter.com/0O515Iqda2
— Michael Lombard (@MikeLombard) June 3, 2015
Toussaint: True North should be clear and measurable… such as "we're not going to kill patients anymore at the hospital" #HCSummit15
— Mark Graban (@MarkGraban) June 3, 2015
Toussaint on #lean leadership styles at #hcsummit15 pic.twitter.com/RzJ7x0O4ui
— Mark Graban (@MarkGraban) June 3, 2015
An MD and MA having a daily huddle to plan the work day,
Collaborate. #lean #hcsummit15 pic.twitter.com/AkZ4L4DU3b— Mark Graban (@MarkGraban) June 3, 2015
#hcsummit15 – Toussaint: We can't have 222 "top priority" projects if we're going to be effective. Take stuff off your plate.
— Mark Graban (@MarkGraban) June 3, 2015
#hcsummit15 "the problem with 'tell and sell' is that you get compliance and nothing else… that's not in the spirit of #Lean" (Hereford)
— Mark Graban (@MarkGraban) June 3, 2015
https://twitter.com/crockdaddy/status/606095741904261120
Biggest applause line from Dr. Toussaint at #hcsummit15: "Budgeting sucks." #Lean #BeyondBudgeting
— Mark Graban (@MarkGraban) June 3, 2015
I asked a question… if “budgeting sucks,” does he agreed that “annual performance appraisals” also “suck” and are harmful and waste time…
Toussaint asks why we can't have real-time performance appraisal & real-time coaching, instead of typical annual process #HCSummit15 #Deming
— Mark Graban (@MarkGraban) June 3, 2015
Beth Daley Ullem
Beth shared her story of her newborn son dying due to a preventable medical error in 2003… lack of compliance with fetal monitoring standards led to brain damage and death. Failure to detect uterine rupture caused four other deaths in that hospital over a short period of time. $40M in lawsuits paid out… “this could be any hospital,” she says.
https://twitter.com/MikeStoecklein/status/606116711318749185
Ullem's baby was victim of medical error, not listened to… she asks, as many do, "why didn't I do more to protect my baby?" #HCsummit15
— Mark Graban (@MarkGraban) June 3, 2015
Ullem wanted the hospital, in 2003, to learn from her baby's death. She listed improvement opportunities, tried to help. #HCSummit15
— Mark Graban (@MarkGraban) June 3, 2015
Beth Daley Ullem tried to offer learning from son's death but got only defend & denial & refusal to learn #valuecapture #HCsummit15
— Ken Segel (@ktsegel) June 3, 2015
'Almost worse than the (preventable) loss of my child was the disrespect of the hospital not trying to learn from it' #hcsummit15 #Lidznl
— Marc Rouppe vd Voort (@leandenkenzorg) June 3, 2015
Hospital shouldn't react to preventable medical error death by saying, "Well, sometimes bad things just happen." #HCSummit15 #patientsafety
— Mark Graban (@MarkGraban) June 3, 2015
She was also told, “Well now you have a little angel in heaven.” That wasn't reassuring. That's not what she wanted.
Somethings wrong when I know more about my plumber then my surgeon. We NEED transparent healthcare performance data #HCsummit15
— Isaac B. Mitchell (@IsaacMitchell) June 3, 2015
Beth was able to get pregnant again, but her baby required heart surgery. A hospital can do amazing things with procedures like this, but then nearly blew it with multiple preventable errors.
https://app.hubspot.com/contacts/326641/lists/contact/70687
Beth now works with boards — see her website. She also shared stories from the Solutions for Patient Safety Network.
Beth Daley Ullem – Powerful case for Transparency, Safety, Partnership with Patients, deserved the standing ovation she received #HCsummit15
— Paul DeChant, MD/MBA (@PaulDeChantMD) June 3, 2015
Michael Erikson
Michael is COO of the Palo Alto Medical Foundation, a medical practice in Silicon Valley.
Title: “Reimagining, Realigning, Restructuring Your Organization to Bring Greater Value to Your Patients.”
PAMF is a high-growth organization, adding a lot of patients. Lean journey started in 2010.
The @paloaltomedical "true north" = "an exceptional experience — every patient, every time" #hcsummit15 #lean
— Mark Graban (@MarkGraban) June 3, 2015
The foundation of their “Lean house” = “Our people — daily engagement system”
Three primary paths to unlocking value”
- Eliminate waste
- Integrate across the supply chain (optimize e the flow of materials & information)
- Reconfigure to create new value (create new capabilities)
With all of the consolidations… “is bigger better? We'll see.”
Out of pocket cost now the leading factor in choosing clinical services.HDHP turning patients into consumers. How do we choose? #HCSummit15
— Isaac B. Mitchell (@IsaacMitchell) June 3, 2015
There's lots of disruption and opportunity – new competitors, including Walgreens, Minute Clinic, etc.
New technologies and telemedicine will help make that happen.
Erikson: Why is venture capital flooding into HC? 40% waste creates lots of opportunity to capture value #HCSummit15 #ValueCapture
— Ken Segel (@ktsegel) June 3, 2015
“If your leaders are not in the gemba at least once a week, go back to the basics and figure out what's in their way.”
“This is indeed a heavy lift in change management” (“realigning an organization is disruptive”).
Erikson: Don't realign to support value until you have @least 50% of top leaders aligned & capable w/lean #HCSummit15 #ValueCapture
— Ken Segel (@ktsegel) June 3, 2015
“Daily engagement system” is their translation of a “daily management system”
- Linked checking
- Showing people how to make improvements that matter
- Leaders are able to round and ask questions: 1) What's the gap between expected and actual? 2) What are you doing to improve?
Day 2 – Doug McKeever
Doug is speaking from the payer perspective. He is Chief of the Health Policy Research Division at the California Public Employees' Retirement System (CalPERS).
They spend $8 BILLION a year on health benefits for their 1.4 million members each year. They're the second largest purchaser of healthcare in the U.S., after the federal government. They have many initiatives around “influencing healthcare delivery, improving health outcomes, and delivering sustainable programs.”
https://twitter.com/MikeStoecklein/status/606449829070258176
2-4% of their dependents, when they first did an audit to verify eligibility, were NOT really eligible. They saved $100 million by getting ineligible dependents off of their plan.
Calpers 21 health strategies #HCSummit15 #valuecapture pic.twitter.com/WCcRGWn5JK
— Ken Segel (@ktsegel) June 4, 2015
Value Based Purchasing = “Reference Based Pricing” in their terminology.
They discovered that, for elective knee replacement — hospital costs varied from $15,000 to $110,000 “with no difference in quality or outcome.” And they were paying $55 million a year on that. They established a payment threshold of $30,000. Promoting access to higher value providers, treatments, and services to reduce costs while maintaining quality.
If somebody wanted to choose a hospital with a $60,000 price, the member would have to pay $30,000 – the amount above and beyond the reference price. They had to do a lot of outreach to let members know about the price variation, to make sure people had the info to choose a reference price hospital.
“We're not going to send our members to a facility that's going to give them poor care. That's not going to happen.” “Please do not leave quality out of the equation.”
The program saved $5.5M over two years and it sent a message to the provider community that they're keeping an eye on costs. Lower general complication rates and lower 30-day general infection rates. Similar follow-up admission rates. They are still surveying patients on the patient experience.
Calpers: Reference pricing drops costs w/o loss of quality. Hip/knee costs down 26% w/fewer complications.#HCSummit15 @ValueCapture1
— Ken Segel (@ktsegel) June 4, 2015
The Health Affairs article on reference pricing mentioned by @McKeeverDoug http://t.co/oMooJsJf6j #hcsummit15
— Mark Graban (@MarkGraban) June 4, 2015
Calpers: Those hospitals that insisted on charging the most w/o better quality saw volumes drop to zero. #HCSummit15 @ValueCapture1
— Ken Segel (@ktsegel) June 4, 2015
CEO Panel
I'm thrilled to host the CEO panel, which includes short one-on-one chats with each of the three panelists, and then a group Q&A session.
Howes: key moment=doc saying to a leader: model cell work=I can focus again on work I went to med school to do #HCSummit15 @ValueCapture1
— Ken Segel (@ktsegel) June 4, 2015
David Howes, of Martin's Point Health Care, reminds us that humility and asking questions goes a long way in a long lean journey #HCSummit15
— Monica Garcia Norlander, MPH, MLIS, MA (she/her) (@MonicaBruin) June 4, 2015
https://twitter.com/crockdaddy/status/606468845579042816
https://twitter.com/rbcall/status/606469958977994753
Dr Eric Dickson says its management's role to take care of the people who take care of the patients. #HCSummit15
— Catalysis (@HCValue) June 4, 2015
https://twitter.com/stevenbookman/status/606472555826790400
UMAss CEO Dickson: Get CEO on board by taking exec team & board to see what good looks like, i.e. thedacare. #HCSummit15 #valuecapture
— Ken Segel (@ktsegel) June 4, 2015
Kathy Kruise of St. Joseph's Regional Health Center engages others by saying that through lean, we strengthen what we already do #hcsummit15
— Monica Garcia Norlander, MPH, MLIS, MA (she/her) (@MonicaBruin) June 4, 2015
Impressed by CEO Krusie's focus on middle managers. Leaders must drive alignment of improvement & management. #HCSummit15 #valuecapture
— Ken Segel (@ktsegel) June 4, 2015
Lean thinking became base for St. Joseph Regional HRO efforts. Serious safety events drop from 1 every 30 days to one in 200 #HCSummit15
— Walter Bilgram (@Walter_Bilgram) June 4, 2015
https://twitter.com/brenda4rf/status/606479551883902977
Jim Womack
Title of his talk: “Moving Forward with Mended Management”
Jim Womack closing out #hcsummit15 pic.twitter.com/54doqtJVks
— Mark Graban (@MarkGraban) June 4, 2015
Jim Womack followed Don Berwick's example on doing an RFP for his medical need… #hcsummit15 cc @ePatientDave pic.twitter.com/gT6U5iyrD2
— Mark Graban (@MarkGraban) June 4, 2015
Jim asked his doctor, “Where are your outcomes data?” The reply was, “What? I'm a Harvard-trained doctor”
Jim Womack -"In 2015, it's easier to find data about a used car than about a doctor. We need to fix that!" #HCSummit15
— Jeffrey Roussel (@jeff_roussel) June 4, 2015
Womack "The key to this whole [#Lean] thing is behavioral change for managers." #HCSummit15
— Mark Graban (@MarkGraban) June 4, 2015
Womack: Our human default when we face resistance is to say they are 1) idiots 2) evil. More likely: uninformed, scared, or both #HCSummit15
— Mark Graban (@MarkGraban) June 4, 2015
Jim Womack compliments healthcare for realizing lean is not about tools (it's about mgmt) 20 years faster than other industries #HCSummit15
— IntermountainCI (@IntermtnCI) June 4, 2015
What needs to be done now for #lean healthcare? #hcsummit15 "We will always need more experiments" pic.twitter.com/mb7xQxOxZm
— Mark Graban (@MarkGraban) June 4, 2015
You can't spread something you do not understand – Womack. You can't understand what you don't do. @KaiNexus #HCSummit15
— Gregory Jacobson (@GregHJacobson) June 4, 2015
Tweet of the Day
From the workshop I taught Tuesday…
Batching tasks is an indicator of a poorly designed system. [Paraphrasing @MarkGraban ] #lean #pkflow
— Jim Benson (@ourfounder) June 2, 2015
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Check out my latest book, The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation:
Here is Bobby Gladd’s summary of Day 1, with some photos:
http://regionalextensioncenter.blogspot.com/2015/06/there-is-no-prescription-for-lean.html
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