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Project Selection Process:Project Selection Process:What Makes a Good ProjectWhat Makes a Good Project

Greg Stock, CEOGreg Stock, CEODarcy Prejeant, Black BeltDarcy Prejeant, Black Belt

Thibodaux Regional Medical CenterThibodaux Regional Medical Center March 3, 2005March 3, 2005

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Achieving ExcellenceAchieving Excellence

• Vision & Strategic Vision & Strategic AlignmentAlignment

• Project Selection ProcessProject Selection Process

• Results Through Results Through AccountabilityAccountability

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Why are we here?(Heart)

Where are we going?

(Brain)

How do we get there?(Courage)

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Initiate Initiate BreakthroughBreakthrough StrategiesStrategies

Mgmt ActionMgmt Action Plans & BudgetPlans & Budget

SelectSelect BreakthroughBreakthrough StrategiesStrategies

DefineDefine “ “Best in Class”Best in Class” Est. Five PillarsEst. Five Pillars

““Close Close

the Loop”the Loop”AccountabilityAccountability

Est. Long Est. Long Range GoalsRange Goals (3-5 Year Plan)(3-5 Year Plan)

Create Vision,Create Vision,AlignAlign

Mission & ValuesMission & Values

Agree on KeyAgree on KeyPerformancePerformance

MeasuresMeasures

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Ordinary PeopleOrdinary People

Extraordinary ResultsExtraordinary ResultsExtraordinary ResultsExtraordinary Results

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Project Selection ProcessProject Selection Process

• Idea GenerationIdea Generation

• Methodology Methodology SelectionSelection

• Resource AllocationResource Allocation

• Project ScopingProject Scoping

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Idea Idea GeneratioGeneratio

nn

• Bottom UpBottom Up– Voice of the CustomerVoice of the Customer– Voice of the EmployeeVoice of the Employee– Voice of the PhysicianVoice of the Physician

• Top DownTop Down– Strategic PlanStrategic Plan– Aligned with PillarsAligned with Pillars– Industry ChallengesIndustry Challenges

• ExternalExternal– Regulatory Regulatory

RequirementsRequirements– Market Place DynamicsMarket Place Dynamics

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Voice of Voice of the the

EmployeeEmployee• Employee ForumsEmployee Forums

– Bi-monthly Bi-monthly – IntradepartmentalIntradepartmental– Conducted by CEOConducted by CEO– QRM & BB presentQRM & BB present– Ideas brought to Ideas brought to

Executive TeamExecutive Team– Close loop by Close loop by

notifying notifying employee of employee of outcomesoutcomes

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ChoicesChoices

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Methodology SelectionMethodology Selection• Six SigmaSix Sigma

– Reduces variationReduces variation– Financial gainsFinancial gains– 4 to 6 month duration4 to 6 month duration– Problem focusedProblem focused

• LeanLean– Elimination of wasteElimination of waste– 3 to 5 day duration3 to 5 day duration– Flow focusedFlow focused

• DIGDIG– Addresses Addresses

departmental issuesdepartmental issues– 4 to 8 hour duration4 to 8 hour duration

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Peo

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Pat

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Pro

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30 20 20 15 15 X

Project Idea or Opportunity

Sponsor Project LeaderProcess Owner

TotalLVF Assessment DIG 0 0 9 1 1 1 210ACEI for LVSD DIG 0 0 9 1 1 1 210AMI - Aspirin and beta blocker at arrival DIG 0 0 9 1 1 1 210AMI - Aspirin and Beta Blocker Discharge DIG 0 0 9 1 1 1 210Specimen To Obtain Order Entry Brenda A DIG Katie Kristi 0 0 3 3 0 1 105Trash Collection Process Mickie R DIG David Eric 0 0 0 3 3 1 90Surgical Instruments in Linen Brenda A DIG Helen Sharon 0 1 0 3 0 1 65Executive Team Rounding DIG 0 0 0 3 0 1 45Lights Off / Thermostat DIG 0 1 0 0 0 1 20Core Measure Data Analysis (for 3 dx) Dana DIG Bonnie Brenda A 0 1 9 1 1 1 230OR Scheduling Brenda A DMAIC Darcy Sharon 9 9 3 9 3 1 690Nosocomial Decubitus Brenda A DMAIC Sheri Cheryl 0 3 9 3 9 1 420ER Door to Discharge Time DMAIC Renee Layne 3 3 3 3 9 1 390Insurance Verification DMAIC 0 9 0 9 3 1 360Improving Demographic Info Upon Admission Dana DMAIC Mickie Dilly 0 9 3 3 3 1 330Contractual Allowances with Payors Steve DMAIC Brenda H Bonnie 3 9 0 0 3 1 315Appropriate Antibiotic Therapy DMAIC 0 3 9 1 3 1 300Claim Denial Reduction DMAIC 0 9 0 3 3 1 270Discharge Room Cleanup Time (Inpatient) Brenda H Lean Bonnie 3 0 3 9 9 1 420OR Turn Around Time Brenda A Lean Darcy 3 3 0 9 1 1 300Radiology Transcription Flow Dana Lean Monica Amie 1 1 3 9 3 1 290Discharge Process Allison Lean Renee 0 0 1 9 9 1 290Antibiotic Timing Brenda A Lean Sheri 0 1 9 1 3 1 260

TRMC PROJECT PRIORITIZATION MATRIX

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Resource AllocationResource Allocation

• CEO commitmentCEO commitment

• ET supportET support

• Allocate resourcesAllocate resources

– Trained staff Trained staff

– Multidisciplinary teams (all levels)Multidisciplinary teams (all levels)

– Appropriate meeting timeAppropriate meeting time

– BudgetBudget

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DeploymentDeployment

Six Sigma - (9/year) Lean - (30/year) Digs - (30/year)

1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd 4th

Six Sigma

Six Sigma

Six Sigma

Lean

Lean

Lean

Lean

Lean

Dig

Dig

Dig

Dig

Dig

April MayDecember January February March

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• ManageableManageable

• MeaningfulMeaningful

• MappingMapping

Project Project ScopingScoping

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Project Project ScopingScoping

• Medication MgtMedication Mgt– Large processLarge process– Multiple sub-Multiple sub-

processesprocesses– Phased projectsPhased projects– Now using Lean for Now using Lean for

sub-processessub-processes• OR ScheduleOR Schedule

– ““When OM calls to When OM calls to schedule to when schedule to when patient is scheduled”patient is scheduled”

ExamplesExamples

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Example of Six Sigma Example of Six Sigma Project Project

• AR DaysAR Days– Not at best performanceNot at best performance– Data available in HISData available in HIS– Direct alignment with PillarDirect alignment with Pillar– Start = 71.08; Goal = 56 Start = 71.08; Goal = 56

Project Results = 62.3 Project Results = 62.3 Current = 50.1Current = 50.1

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Example of Lean ProjectsExample of Lean Projects

• Excellent selectionExcellent selection– Discharged patient left room until room Discharged patient left room until room

cleanedcleaned– Started at 108 minutes, now 32 minutesStarted at 108 minutes, now 32 minutes

• Not the best selectionNot the best selection– OR Turn around timeOR Turn around time– Difficult to establish a metricDifficult to establish a metric

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So what makes a good So what makes a good project?project?

• Ideas generated from Ideas generated from

organization’s prioritiesorganization’s priorities

• Correct assignment to Correct assignment to

proper methodologyproper methodology

• Allocation of resourcesAllocation of resources

• Proper scopingProper scoping

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Closing the LoopClosing the Loop

• CEO, ET Sponsor, & MBB attend Lean report CEO, ET Sponsor, & MBB attend Lean report

outs outs

• Continuous reports from Process Owners to MBBContinuous reports from Process Owners to MBB

• Process Owner to present at Leadership SessionProcess Owner to present at Leadership Session

• MBB documents summaries for ET, Medical MBB documents summaries for ET, Medical

Executive Committee and Board Executive Committee and Board

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Achieving Achieving ExcellenceExcellence

• Patient SatisfactionPatient Satisfaction – Top 1% for 18 quarters Top 1% for 18 quarters

• PeoplePeople– Low turn over & vacancy rateLow turn over & vacancy rate– 1% contract labor1% contract labor– 97 percentile employee satisfaction97 percentile employee satisfaction

• FinancialFinancial– No debtNo debt– $77 million expansion project$77 million expansion project– Double digit marginsDouble digit margins

• QualityQuality– Clinical indicatorsClinical indicators

• UTI, Pressure Ulcers, Medication ErrorsUTI, Pressure Ulcers, Medication Errors• GrowthGrowth

– 70% Inpatient volumes70% Inpatient volumes– No population growth market placeNo population growth market place– $30 million of new technology$30 million of new technology

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SuccessSuccess Success is believing that what you are Success is believing that what you are

doing is worthwhile and that doing it doing is worthwhile and that doing it well is what really matters.well is what really matters.

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Question & AnswersQuestion & Answers