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Developing a Culture of Continuous Improvement: Growing Leaders at Rochester General Health System
May 13th, 2010
Behavioral Health Network
Newark-Wayne Community Hospital
Hill Haven Nursing Home
DeMay Living Center Independent Living for Seniors
Rochester GeneralMedical Group
RGH
Rochester General Health System
Rochester General Hospital Statistics
• 528 beds• 1,200 medical and dental staff• 5,000 employees• 31,500 inpatient discharges• 87,000 emergency room visits• 20,165 surgical procedures• 1,050,000 outpatient encounters
Rochester General Health System…5th largest employer in Rochester
• Named 9 times as a Solucient Top 100 Cardiac Hospital• Money Magazine Best 25 Hospitals in the Nation for Heart Attack Care and Hip
Fractures – 2003• Only area Teaching Hospital Cancer Program accredited
by the American College of Surgeons• American College of Surgeons Outstanding Cancer Program – 2006• Department of Health and Human Services – Innovation in Prevention Award –
2006• Nurse Magnet Designation – 2004, 2009• Named 2 times as Solucient Top 100 Performance Improvement Hospital• Healthcare Association of New York State
� Pinnacle Award for Quality – 2002 and 2005� Community Health Improvement Award – 2007
• Premier Award for Quality – 2007, 2006, 2005, 2004• Designated Stroke Center by the New York State Department of Health – 2005 –
and the Joint Commission Accredited – 2007, 2004• Baby Friendly designation by the World Health Organization• Diabetes Program recognized by the Diabetes Association• Nationally recognized Hemophilia Center
RGHS Recognition
Mission, Vision, and Values
Our Mission• To improve the health of the people served by providing high quality care,
a comprehensive range of services, convenient and timely access with exceptional service and compassion.
Our Vision• Rochester General Hospital and its affiliates will be the healthcare provider
of choice for physicians and patients - delivering the healthcare we expect for our own family - recognized for:� Exceptional quality � Unparalleled service and patient experience � Great place to work and practice � Academic programs and research that support core clinical missions � Clinically integrated affiliates � Our Values
Mission, Vision, and ValuesEvery Customer - Every Encounter - Every Time
Service• To serve our community is a privilege and an obligation. We excel in our sensitivity to the
needs of those we serve. Everyday we live our mission through serving our community.Teamwork• Together we can do great things for people in need. One team, with one goal - to be one Great
Health System, Always!Attitude• We are a "can do" team. We are grateful for the opportunities that are presented each and
every day. Through positive energy we can, and we will, meet the needs of those we serve.Respect• We are here to better the lives of others and we are profoundly aware of the value of each
human being.Standards• We pledge to our community the highest standards of respect, patient safety and clinical
excellence. We will do no harm. We are extraordinary people called to do extraordinary work.
Lean-Sigma at RGHS
Background:
� Rochester Business Alliance – identify need for continuous improvement thinking in region’s health systems
� Pull expertise from local manufacturing
� Kodak – extensive training with Shingijutsu, leverage experience into local health systems for greater benefit of community
� Lean Sigma at RGH – introduced July 2006
� Small Team – 35+ years Lean-Sigma experience (manufacturing), 1 Nurse Leader with 17+ years clinical leadership experience
Our Lean-Sigma Thinking
• Everything we do must create customer value
• Everything can and should be improved
• We must pursue & destroy wastes
• Defect free service to our customers is our goal
• Eliminate Variation!
• Do More with Less
• Creativity before $$
• Less human effort, time…
• All Work is a Process
� Optimize the Flow of Our Process
� Tough on the process, not on the person
Office Purpose
• Enable the highest levels of organization effectiveness
• Directly support the transformation of our culture
• Support and accelerate the development of our leaders
• Invest in our people’s personal development
Lean-Sigma Office Operating Model
Time12 to 18 months
TRANSITION ROLES• Develop individual
contributors into future leaders
• Prepare current leaders for broader leadership responsibilities
Transition member(1/Year)
Transition Member (1)
Core Team:3 Members
Rotation ofTransition Member
CORE TEAM•Ensure continuity and efficient transfer of knowledge •Ensures training, and core competencies are continuously developed to be at the leading edge. •Helps to break barriers, resolve key issues, and serves as a strong process improvement resource (Change Agents)
Lean-Sigma at RGHS
Background Continued:� Integrated with HR in 2007
� Lean-Sigma Practitioner Program – first class 2008
� Lean-Sigma Transition Members growing into broader leadership responsibilities:
� Director, Radiology
� Manager, Organizational Development
� Nurse Manager, Anesthesiology
� Finance
� Lean-Sigma Practitioner Program – second class 2009
Transforming our Culture
• Build a foundation of highly talented, motivated, diverse and engaged employees
� Create a community of 7,000 “scientists” continuously solving problems
• Create a customer centric focus
Growing Leaders – the Toyota Way
• Toyota Expression – “we do not just build cars, we build people.”� Are you born with talent, or is it developed?
� “Give us the seeds of talent and we will plant them, tend the soil, water and nurture the seedlings, and eventually harvest the fruits of labor.”
• Every manager at Toyota is a teacher
• Add value to the organization by developing your people
• Developing exceptional people - #1 priority
• Must become embedded as a cultural value throughout the company
Growing Leaders – the Toyota Way
• Principle 9 - “Grow leaders who thoroughly understand the work, live the philosophy, and teach it to others.”� Teaching is the most highly valued skill of leaders – must deeply
understand the work to coach
• Principle 10 – “Develop exceptional people and teams who follow your company’s philosophy.”� Teams depend on well-trained people and part of individual
development is learning to work in teams
RGHS Lean-Sigma Practitioner Program
• “Give a man a fish and he’ll eat for a day. Teach him how to fish, and he’ll eat forever.”
• Practitioners develop “eyes for waste”� Understand the philosophy, principles, and tools
• Most importantly - gain confidence to teach principles to team members
• Create a culture of continuous improvement
RGHS Lean-Sigma Practitioner Program
Must demonstrate ability to:1. Understand2. Practice3. Teach
Key Outcomes:� Develop internal expertise and capabilities to lead process
improvement initiatives� Increase team member engagement and commitment to the
organization� Develop and leverage best practices� Opportunity for personal growth and development� Foster culture of continuous improvement
Development of course
12 month certification program
Allow information to be digested� Go to gemba� Practice� Fail� Teach to others� Personal guidance from lean-sigma coach throughout the course
• Without constant attention, the principles will fade. • Must be engrained in the way one thinks• Maintain a learning organization
Structure
• Lecture – every 2-3 weeks• Practitioner / L-S Coach One-on-One sessions every 2 weeks• Case Studies – White paper readings• Activities
� Walk the flow – see other practitioner’s areas� Hands-on exercises� Table top simulation – demonstrate pull� Establish visual controls� See standard work in action
• Capstone project – lead a kaizen team� Teach the team � Establish standard work� Round for sustainability
Practitioner Key Responsibilities
• Champion of change
• Lead process improvement activities & follow up
• Develop a measurement and tracking process
• Deliver Lean-Sigma training to their departments
• Coach leaders and team members to adopt Lean-Sigma principles & practices
• Lead a ‘Capstone Project’
System Support
• Executive Support� Senior leaders to sponsor participants
� Course kick-off with CEO, VPs
• Responsibilities of the Sponsor� Communicate certification initiative, and practitioner’s role
to home department� Facilitate monthly review sessions with practitioner� Review work plans; confirm priorities; provide needed
resources; confirm progress� Aid with breaking through barriers to success
Course Outline
1. History – Toyota / Motorola
2. Introduction / Understanding of the Value Stream
3. Elements of Project Management
4. 5S and visual controls
5. Key components of standard work
6. Takt time, cycle time
Course Outline
7. Kaizen circle and process
8. Importance of Capstone
9. Six Sigma tools and methodology
10. Statistical Analysis – Basics
11. Statistical Tools for problem solving
12. Review of Capstone
Course Outline
13. Leaders role in Lean-Sigma culture / Tips for training
14. 3P and Design for Flow
15. Setup and Changeover Optimization
16. Poke Yoke – HC applications
17. Success / Challenges with Capstone
18. Celebration - Certification
Competency Certification LevelsL1
L2
L3
L4
Trained
Trained; able to practice with Guidance
Trained; able to practice with out Guidance, & can teach w/ support
Master Practitioner;Fully Proficient;Master Trainer
TargetedLevel
Selecting participants
• Class of 10-15 participants
• Leaders
• Change Agents
• Live the values
• Encourage team member engagement
• Show interest in process improvement
• Multidisciplinary / Affiliate locations
• Vocal senior-level sponsorship
Multidisciplinary Focus
Practitioners exposed to other applications and affiliate locations
• Labs
• Medical Groups
• Foundation
• HR
• Support Services
• Patient Financial Services
• Volunteer Services
• Environmental Services
• Information Technology
• Radiology…
Class #1 – 200814 Practitioners
• Program Manager• Manager of HIM Operations• Billing Manager• Director of Adult Day Health Care• Program Manager• Nurse Manager• Director, Non-Clinical Operations• Operations Manager• Director of Patient Access• Educator/Clinical Nurse Specialist• Practice Manager• Quality Improvement Coordinator• Recruiter• Director of Admissions & Social Work Services
Class #1 Projects and Results
Decrease access time to services at BHN
Improve admissions
Streamline processes to allow for 32% volume growth in endoscopy
Streamline processes at registration to allow for 4% volume growth in radiology
Streamline workflow for follow up on insurance claims
Increase accuracy of deficiency
Workload rebalance of access associates
- Increased # of intakes- Revenue
Behavioral Health Network
Newark-Wayne Community Hospital
25% volume growth50% reduction in patients
rescheduled
Wayne County Rural Health Network
6% volume growthDeMay Living Center
5% increase in accounts worked per dayCentral Business Office
- Expected: 75% Improve accuracy
Behavioral Health Network
Average Denial Turnaround time reduction of > 75%
VMG Medical Groups
Affiliate /Dept Capstone Project Demonstrated Results
Class #1 Projects and Results
-Reduced from 7 stops to 2 stops-Employee Retention
Improve on-boarding Process for new employees
Human Resources
Decrease time from patient presentation in ED to EKG
Rebalance Workload of Access Associates to improve access to registration
Being Decided after Magnet accreditation
Eliminate Discharge Delays in Rehab. Unit due to Facility Errors
Redesign work processes to enable electronic scheduling
Develop work processes to accompany Lithotripsy service
-Revenue-Patient Satisfaction
Patient Access
Expected 50% reduction in Turnaround time
RGH Quality Improvement
Expected: -Patient Satisfaction
Women’s Center & Genesee OB / Gyn
Medicine-Surgery Nursing
-0 delays > 24 hours-Patient Satisfaction-Revenue
Hill Haven
Expected: - 10 additional cases per day
RGH Department of Diagnostic Imaging,
Affiliate / Dept Capstone Project Demonstrated Results
Class #1 – 2010 Status
• Continued communication/collaboration with coaches
• Move into larger system roles
• System Recognition – Axe Award
• Mentors to current practitioners
• Extension of Lean-Sigma office� Requests for coaching � Manage process improvement initiatives at affiliates
• ILS, Medical Groups
Class of 2009• 11 Practitioners
� Writer/Director, Donor Stewardship� Manager, Laboratory Services� Manager, Patient Access� Practice Manager� Volunteer Services� Manager, Environmental Health and Safety� Compensation Analyst� Manager, Environmental Services� Senior Manager, Laboratory Services� Call Center System Specialist � Student (Industrial and Systems Engineering), RIT
Class #2 – Projects
Reduce Rework and Patient Wait Time for Direct Admissions
5S Specimen Courier Drop-off
Charge Capture Standards for Physicians
- Standard work for Special Events- Mailing Data Analysis
On-Call Physician System Roll-out and Standards
Cytology Work Redesign
Improve Bed Turn-Around
Reduce internal waiting by 25%Patient Financial Services
25% reduction WIPLaboratory Services
5% Revenue IncreaseMedical Groups
- Reduction in expedited costs- Identify effectiveness of mailing
strategies – Increase donations
Foundation
Improve Physician SatisfactionInformation Technology
3% Productivity ImprovementLaboratory Services
95% of Dirty Bed triggers within 10 minutes of patient discharge
Environmental Services
Affiliate /Dept Capstone Project Targeted Results
Organizational Fit – Ideation
• DO-IT Groups a.k.a. DIGs� Four, one hour meetings
� 1) Define the Problem
� 2) Outline Causes and Identify Solutions
� 3) Implementation Plan (Action Plan)
� 4) Test Changes / Track Results
• Just DO-ITs a.k.a JDIs� Ideas immediately implemented
• All ideas go triaged to appropriate leader
Organizational Fit – Ideation
• Ideation - DIGs, JDIs• Team member engagement• Culture shift – ‘authority to act’• Lean-Sigma leaders and practitioners
� Sensei � Coach on waste identification� 5 Whys� Guide groups on system implications� Focus on the customer� PDCA cycle – round for sustainability
Culture Shift
• Language changing� “We need to map the value stream”� Lean terms becoming commonplace� Individuals bringing kaizen experience to DIGs
• Focus on the process� Two major health system initiatives
• Patient Flow� Process Focus and Standards from Admission to Discharge… and beyond
• Patient Safety� Patient Safety Summit – “Focus on the process, not the person.”
� Guidance from Lean-Sigma office and practitioners
• Waiting list for next practitioner course
Sustaining the Gains
• Roles of Practitioner� Leaders that “get it”
� Drive sustainability of improvements
� Understand importance of adherence to standard work
� Support standard work as a living document
� Track metrics to identify process shifts, changes in variability
� Encourage team member ideation• Identify wastes
• 5 Whys
• Establish a process
• Focus on the customer
• Tie back to values
Challenges• Time Commitment
� ~ 6 hours per month
• Need strong senior level sponsorship
• Establishing metrics
• Statistics / Excel
• Making data driven decisions
• Confronting silo mentalities
• Transition from “manager” to “teacher”
• Perseverance to break through common set-backs
RGHS / RIT Alliance
• Strategic Alliance - 2009� Advances in research, education, technology
� Biomedicine and Health Sciences• Health Sciences Engineering, Patient Safety / Quality, etc.
• IOM Call
• Tomorrow’s health care leaders� Process Thinking
� Change Management
� High Reliability Organizations
� Complex Systems Theory
Path Forward
• Integrate past and current practitioners in patient safety and flow initiatives
• Rounding with leaders to encourage:� Problem Solving� Use of Standard Work� Focus on Process� Teaching Others
• Plant new seeds – Practitioner Class #3
• Continue to build culture of continuous improvement
Contact Info:
Roop Hazarie (585) 922-2988
Robert Agness (585) 922-4245
Sarah Bonzo (585) 922-4378
Questions?