06 lipp haussen pdca presentation

8/13/2019 06 Lipp Haussen PDCA Presentation

1/44

Continuous Improvement

Methodology- PDCA

October 2012

Advocate Research and Innovation Forum 2012


2/44

Operations Improvement Vision

1

Commitment to simplify our process

Learning to work more effectively

Learning to see things differently

All Advocate associates become passionate aboutprocess improvement, embracing equality, excellence,

partnership, and stewardship.


3/44

Objectives

Introduce the PDCA cycle

Present tools and concepts to facilitate problem solving,which can be applied to any problem in any setting

Illustrate the concepts with a healthcare application ofPDCA

2


4/44

Continuous Improvement

Continuous improvement is an ongoing effort to improveproducts, services, or processes.

Continuous and incremental improvements remove

unnecessary activities and variations providing increasedcapability, reduced costs, improved efficiency and qualityover time.

A complete transformation process takes time, butcontinuous improvement allows teams to change theorganization one problem at a time.

3


5/44

A Method to Promote Continuous Improvement

The Plan-Do-Check-Act(PDCA) Cycle is an iterativefour-step problem solving model to promote continuousimprovement.

Brief History: Walter A. Shewhart first discussed the concept of PDCA in 1939

when he introduced the notion that constant evaluation ofmanagement practices is key to the evolution of a successfulenterprise.

In the 1950s, W. Edwards Deming promoted PDCA as a primarymeans of achieving continuous process improvement. He alsoreferred to the PDCA cycle as the PDSA cycle ("S" for study).

4


6/44

Action plan andexecution

Progress, targetvs. actual

Alignment,identify problem,

determine goal,cause analysis.

Standardize if itworked, adjust if

it didnt work.

Act Plan

DoCheck

PDCA

5


7/44

Strategy: Leader:

Strategic Initiative: Department/Branch:

Stakeholders (people involved/impacted by the initiative):

PLAN DO

Background Information:

Problem Statement:

Goal (think SMART):

Cause Analysis:

See Action Plan: (add action plan title here!)

CHECK

ACT

PDCA - Template

6


8/44

PDCA Is Not New: Clinical Thought ProcessPLAN DO


Gather History and Physical information. Patient short

of breath and swelling of lower extremities over last

several weeks.

Problem Statement:

Patient is short of breath, elevated heart rate and

swollen legs.

Goal:

Upon confirmation of heart failure diagnosis, treat

patient until swelling in legs diminished and shortness

of breath subsides. Achieve over next ~4 days.

Cause Analysis:

CMP Lab test drawn identified electrolytes level.

Chest X-Ray showed enlarged heart, supporting

diagnosis of congestive heart failure.

Administer IV diuretics and electrolyte replacements

Administer O2 and monitor intake and output

Weigh patient daily

Perform Echocardiogram

CHECK

Electrolytes in balanceIntake and Output balanced

Weaning off O2

Chest X-ray demonstrates improvement in patients

enlarged heart

ACTEnsure handoff to patients primary care physician

7


9/44

Strategy: Leader:

Strategic Initiative: Department/Branch:

Stakeholders (people involved/impacted by the initiative):

PLAN DO


Problem Statement:

Goal (think SMART):

Cause Analysis:

See Action Plan: (add action plan title here!)

CHECK

ACT

Key Tools and Concepts to Help You Problem Solve

= Tool = Concept

Go see visit the

Gemba

Process mapping

Root cause

analysis:

5 whys

Brainstorming

Action Plan

What worked/

what didnt work

Goals:

Specific

Measurable

Achievable

Relevant

Timely

Check

against

goal

Problem Statement

Data analysis


10/44


11/44

Visit the Gemba (the real place)

10

What disrupts the work?

Where could mistakes be made?What keeps those mistakes from being made?Is it just vigilance?Or is there some mechanism to prevent mistake?

Is there any backtracking, rework, looping around?Are things where they are actually needed?Do people have to look around for things?

How do they know what they should be doing?What is their source of information?

Do they have to hunt it down, or worse, guess atwhat should be done?Or is the right thing and the right way crystal clear

to even the casual observer (that would be you).

Work

Flow

Errors

Rework

VisualMgmt

What is it?

Gembawalk, is an activity

that takes management to

the front lines to look for

waste and opportunities.

How to do it?

While at the place where

the work is happening

(Gemba), ask the questions

to the right.

Results:

Understanding of what is

really happening


12/44

Process

Step

RN Gets

Gown for

Patient

Yes

No

Short, Simple, Specific

Noun-Verb

Process Mapping Basics

11

Yes, No

It Depends

Patient

Available?Decision

Point

What is it?

Visual step-by-step process flow

outlining how work is done

One Post-it note per process step

to depict main activities, information

flows, and interconnections

Apply 80/20 Rule80% stays inmain path or flow

Overlay Data, Value Added, and

Waste Identification

Results:Allows an observer to walk-

through the whole process and see

it in its entirety.

Start & End Points = clearly

define scope of the process


13/44

Data Analysis

12

What is it:

Baseline data analysis provides a view of how big

the current problem is, where there is opportunity

to improve.

Re-measure data analysis demonstrates if the

solution has improved the problem and is sustained.How to do it:

Investigate various available reports, understand

definitions

Collect manual data if there is not electronic data

available Analyze the data to quantify the problem

Results:

Data driven analysis that cannot be disputed to

quantify the problem and sustain results.De

c/08

Nov/08

Oct/08

Sep/0

8

Aug/0

8Jul/0

8

Jun/0

8

May/08

Apr/0

8

Mar/

08

Feb/0

8

Jan/0

8

Dec/07

Nov/07

Oct/07

Sep/07

Aug/07

Jul/07

Jun/07

May

/07

Apr/07

Mar/

07

Feb/0

7

Jan/07

100

95

90

85

80

75

70

Performance%

_X=85.58

UCL=98.07

LCL=73.09

2

2

2

1

22

SURGICAL CARE IMPROVEMENT PROJECT (SCIP) BUNDLE

2008 Target: 79%

2007 Target: 77%

2/9/09

(January 2007-December 2008)


14/44

PLAN DO


Inconsistent ED work practices create a chaotic and exhausting

work environment.ED LOS metrics are too high, well above benchmark

Problem Statement:

Inconsistent practices contribute to inefficiencies for our EDdischarged home patients with an average LOS of 181 minutes, well

above the national benchmark of 90 minutes.

Goal:

Improve communication and optimize ED process, in order to

provide timely quality care, with ED discharged home patient LOS

of 90min by January 2012.

Cause Analysis:

No Communication Tool to communicate patient readiness

No standard workflow

No Standard Patient Assignment process for Physicians

Chart is placed far away from care site

Chart Flow beginning in patient room

RN, Tech, Physician assess patient together and

share the plan of careDefined Roles and Standard Work

Identify a communication tool with All-Call

feature to communicate a new patients arrival,

and patientsdischarge readiness.

CHECK

Metric Baseline Remeasure Target

LOS Discharge 181min 136min 90min

Door to

Physician

55min 34min 30min

Door to Lab

Received

71min 61min 35min

ACT

Metrics trending positive, continue to implement.

What worked What didnt work

Education before

implementation

Ownership of solutionBuy-In to try

Need more time to

trial process on

various patient days

Pt Arrives Greet Triage Register To Room

InitialCare

Doctor Treat Disp Plan Discharge

13

PDCA Applied to Healthcare Processes

Process Map


15/44

Write a sentence that defines the problem you aretrying to solve.

The problem is the gap between the current stateand the goal.

Select one problem per PDCAAct Plan

DoCheck

14


16/44

What is the gap that you are trying to close?

Goal

Goal

New Goal

GAP

GAP

ORPatientSatisfact

ion

PatientSatisfact

ion

Problem: understanding the gap

15

Process that is declining in

performance and currently not

achieving desired target.

Sustained performance compared

to initial goal. New level of

performance is identified.


17/44

Example Problem Statements

BEST 78% of outpatients have missing/incomplete testing on day of procedure whichresults in 75% of the first cases to be delayed by more than 15 minutes.

38% of patients arriving at the Imaging Department Check-In desk wait longer than 15minutes before being met by Liaison to take them to their CT scan.

AWV reimbursement is new from Medicare in 2011. The Clinic has approximately

44,000 patients that qualify for an AWV. This represents approximately $14.8M Grossand $7.4M Net revenue opportunity.

GOOD

Average OR room turnover is 32 minutes which is higher than the national

average of 20 minutes.

There are 200-300 calls on average requesting information, distracting the desk

operators from their duties. OR staff and surgeon frustration with process breakdowns leading to performance for

OR turn-around time, On-Time Starts, and associate satisfaction that does not meetnational best practice

BAD

Associate and physician satisfaction is low.

16


18/44

PLAN DO



work environment.

ED LOS metrics are too high, well above benchmark

Problem Statement:

Inconsistent practices contribute to inefficiencies for our ED

discharged home patients with an average LOS of 181 minutes, well


Goal:

To achieve timely and quality care for our ED discharged home

patient with a LOS of 90min by January 2012.

Cause Analysis:







share the plan of care

Defined Roles and Standard Work



and patients discharge readiness.

CHECK



Door to

Physician

55min 34min 30min

Door to Lab

Received

71min 61min 35min

ACT



Education before

implementation


Need more time to

trial process on



Initial

CareDoctor Treat Disp Plan Discharge

17



19/44

How will you measure success?

KRA goal or other goal that you are tryingto impact.

Think SMART!Act Plan

DoCheck

18


20/44

Goal How will we know if we are achieving the

future state?

How will we know if we are successful?

Metrics must be SMART

Specific

Measurable

Achievable

Relevant

Timely

Metric Baseline Goal By When ActualPerformance

Patient WaitTime

50 minutes 30 minutes 12/31/2012

Room Turn-Around Time

45 minutes 20 minutes 12/01/2012

Example Metric Chart

19


21/44

PLAN DO



work environment.

ED LOS metrics are too high, well above benchmark

Problem Statement:




Goal:



Cause Analysis:












CHECK



Door to

Physician

55min 34min 30min

Door to Lab

Received

71min 61min 35min

ACT



Education before

implementation


Need more time to

trial process on



Initial


20



22/44

What is causing the problem?

What prevents us from achieving the goal?

Why does the cause exist?

Is there a highest priority cause?Act Plan

DoCheck

21


23/44

Root Cause Analysis

22

What is it?

An identified reason for the

source or origin of an event

or defect.

How to do it?

An iterative, question-asking method used to

explore the cause/effect

relationships underlying a

particular problem.

Be sure to not stop at anartificial reason.

Results:

Ultimate goal is to

determine a root cause of a

defect or problem.


24/44

Five Whys - Example

Thomas Jefferson Memorial preservation:

The National Park Service noticed the ThomasJefferson Memorial in Washington, D.C., was

deteriorating faster than other monuments. Parkservice rangers investigated the problem withthe five whys technique, which keeps asking"Why?" for five or more times, and formed thefollowing chain of causation:


25/44

Five Whys - Example Whydoes the memorial deteriorate faster?

Because it gets washed more frequently.

Whyis it washed more frequently?

Because it receives more bird droppings.

Whyare there more bird droppings?

Because more birds are attracted to the monument. Whyare more birds attracted to the monument?

Because there are more fat spiders in and around themonument.

Whyare there more spiders in and around the monument?

Because there are more tiny insects flying in and aroundthe monument during evening hours.

Whymore insects?

Because the monument illumination attracts more insects.


26/44

PLAN DO




Problem Statement:




Goal:



Cause Analysis:












CHECK



Door to

Physician

55min 34min 30min

Door to Lab

Received

71min 61min 35min

ACT



Education before

implementation


Need more time to

trial process on



Initial


25


5 Whys:

Why? Time is wasted looking for charts

Why? Charts never in central designated location

Why? Care givers would take chart to see patients by bedsideWhy? Chart information is needed for patient care

Why? Chart is placed far away from care site


27/44

What are the solutions to addressthe root cause?

What activities need to take place?

Who will be responsible? When?

Document in the action plan!

Create the WIIFM

Act Plan

DoCheck

26


28/44

Brainstorming

27

What is it:

Group technique for generating many ideas in a short period of time

An invitation to think outside of the box

How to do it:

Clearly state the topic and brainstorming guidelines

Give people plenty of time on their ownat the start of the session to generate asmany ideas as possible.

Collect ideas on Post-Its or Flipchart.

Encourage people to develop other people's ideas.

Encourage an enthusiastic, uncritical attitude among members of the group.

Ensure that no one criticizes or evaluates ideas during the session and welcome

creativity!

Results:

A collection of ideas (no idea is too big or too small)


29/44

Brainstorming: Affinity Diagram

Group ideas andcreate solutioncategories/themes

28


30/44

Action Plan

How to do it:

Define the key steps to implement the solution

Who will do each step

When the step should be completed

Identify plan to follow up and review the status of all assigned tasks

Results:

Critical to document and make visually available all action items

planned by the team.

What is it:Tool that specifies the necessary tasks that

must be executed to implement the solution

to your problem. It contains the name(s) of

person(s) responsible and a time frame for

completing the task.

What (Tasks) Who When StatusStart End


31/44

Who(one

person)

What (startwith verbs)

When

30

Action Plan - Example

# What (Tasks) Who When Status Comments

Start End1 Create new Standard Work to include

process change

Gloria 11/1 11/7

2 Begin placing patient charts in ED

patients room

Susan 11/1 11/7

3 Teach ED associates the new process Gloria 11/8 11/144 Implement data tracking log Susan 11/15 Ongoing5 Obtain Walkie Talkies Steve 11/7 11/146 Go-Live with new process ALL 11/15 Ongoing


32/44

PLAN DO




Problem Statement:




Goal:



Cause Analysis:











CHECK



Door to

Physician

55min 34min 30min

Door to Lab

Received

71min 61min 35min

ACT



Education before

implementation

Ownership of solution

Buy-In to try

Need more time to

trial process on



Initial


31


What (Tasks) Who When

Start End

Create new Standard Work to include

process change

Gloria 11/1 11/7

Begin placing patient charts in ED

patients roomSusan 11/1 11/7

Teach ED associates the new process Gloria 11/8 11/14

Implement data tracking log Susan 11/15 Ongoing

Obtain Walkie Talkies Steve 11/7 11/14

Go-Live with new process ALL 11/15 Ongoing


33/44

What is the progress/result in lightof your original goal?

Do the actual results match theplanned results?

Act Plan

DoCheck

32


34/44

Check Make sure you are making progress

Update action plan accordingly

Review metric chart Did you achieve your goal?

Continue for 30/60/90-day sustainment

Metric Baseline Goal By When

Actual

MonthlyPerformance

Patient WaitTime

50 minutes 30 minutes 12/31/2012 55 minutes

Room Turn-Around Time

45 minutes 20 minutes 12/01/2012 19 minutes

33


35/44

PLAN DO




Problem Statement:




Goal:



Cause Analysis:











CHECK



Door to

Physician

55min 34min 30min

Door to Lab

Received

71min 61min 35min

ACT



Education before

implementation


Buy-In to try

Need more time to

trial process on



Initial


34



Start End


process change

Gloria 11/1 11/7








36/44

Adjust if it didnt work, reassess andmake changes.

Standardize if it worked, documentstandard process if solution solved theproblem.

Expand implementation to other areasas appropriate.

Ensure ongoing PDCA to sustainresults.

Celebrate WINS!

Act Plan

DoCheck

35


37/44

What Worked/What Didnt Work

36

What worked What didnt workWhat is it:

A simple tool to capture whatyou learned.

Results:

A list of positive andnegative outcomes of your

attempt to solve theproblem.


38/44

PLAN DO




Problem Statement:




Goal:



Cause Analysis:











CHECK



Door to

Physician

55min 34min 30min

Door to Lab

Received

71min 61min 35min

ACT



Education before

implementation


Buy-In to try

Need more time to

trial process on



Initial


37



Start End


process change

Gloria 11/1 11/7








39/44

PDCA Applied to Key Result Areas

38

PLAN DO


In Press Ganey Q2 2012 report, Home Care Office identified that the

question Family informed regarding progresspresents a low mean score

in the last two quarters. This question is rated as of high importance to

patients in the same report.

Problem Statement:

Patient satisfaction mean score for the question Family informed

regarding progress in Q2 2012 was 87.5. In order to achieve the 75th

percentile goal, the mean score for this question should be 91.7.

Goal (think SMART):

Increase Press Ganey mean score for question Family informed regarding

progressby 4.2 points by the end of 2012.

Cause Analysis:(5 whys)

Patients do not perceive that we keep family members informed of

progress

Families are complaining they are not adequately informed of progress

Staffs who care for patients are not informing the families of patients

progress

No standard process for how staff communicates patients progress

with family/friends (root cause)

See Action Plan:

Action plan attached.

CHECK

Awaiting further results to evaluate success.

Question: family informed regarding progress

Baseline (Q2) Q3 Q4 Target

87.5 91.7 (75th

%ile)

ACT


Team based approach to

brainstorm issues and

barriers

Engaging team in the

action plan development.Communication sheet

facilitates the

communication of progress

because it helps summarize

message.

Team perceives

communication

log as busy

work, consider

revising theprocess.


40/44


39

Action Plan

# What (Tactics/Tasks) Who When Status

Start End1 Create draft of communication log. Jenny 8/20/12 8/24/12 Completed

2 Create draft of communication sheet. Jenny 8/20/12 8/24/12 Completed

3 Review communication log and sheet with clinical

staff for feedback.

Jenny 8/20/12 8/31/12 Completed

4 Review with clinical managers and BSS how to

incorporate communication log/sheet into folders.


5 Communicate new tools and how to use to field

staff.Jenny 9/6/12 9/6/12 Completed

6 Educate field staff on communication tools for new

and existing patients.


7 Survey field staff at September staff meeting to

inquire if communications tools are helpful.

Jenny 9/20/12 9/20/12 Started


41/44


40

PLAN DO


In Press Ganey Q2 2012 report, Home Care Office identified that the

question Family informed regarding progresspresents a low mean score

in the last two quarters. This question is rated as of high importance to

patients in the same report.

Problem Statement:

Patient satisfaction mean score for the question Family informed

regarding progress in Q2 2012 was 87.5. In order to achieve the 75th

percentile goal, the mean score for this question should be 91.7.

Goal (think SMART):

Increase Press Ganey mean score for question Family informed regarding

progressby 4.2 points by the end of 2012.

Cause Analysis:(5 whys)

Patients do not perceive that we keep family members informed of

progress

Families are complaining they are not adequately informed of progress

Staffs who care for patients are not informing the families of patients

progress

No standard process for how staff communicates patients progress

with family/friends (root cause)

See Action Plan:

Action plan attached.

CHECK

Awaiting further results to evaluate success.

Question: family informed regarding progress

Baseline (Q2) Q3 Q4 Target

87.5 91.7 (75th

%ile)

ACT


Team based approach to

brainstorm issues and

barriers

Engaging team in the

action plan development.Communication sheet

facilitates the

communication of progress

because it helps summarize

message.

Team perceives

communication

log as busy

work, consider

revising theprocess.


42/44

AdditionalQuestions

Mariana Lipp Haussen,

Operations Improvement

[email protected]

630.990.8114

Rebecca Lechowicz,

Operations [email protected]

630.990.8389

Mike Virgilio

Director Operations [email protected]

630.990.2649

Amy Herbst

Director Operations Improvement

[email protected]

630.990.8389

41

Key Takeaways

Build confidence with the PDCAtools by applying to small

problems.

Different problems require

different tools, you dont have to

use them all.

PDCA is to engage front line

associates.

Dont be afraid to experiment.

There is no failure if you learned

with your PDCA!

Continuous improvement is an

ongoing effort.
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


43/44

Additional Course Information Change Acceleration Process (CAP)

Data Analysis (Excel Basic & Excel Intermediate)

WorkOut (WO)

Effective Meeting Facilitation Statistical Process Control

Project Management 101

Six Sigma

Lean Fundamentals

Search words: Performance Enhancement in ALEXAdvocateOnline>Divisions>Advocate Performance Enhancement>

42
http://advocateonline.advocatehealth.com/homepage.cfm?id=1http://advocateonline.advocatehealth.com/page.cfm?id=5588http://advocateonline.advocatehealth.com/page.cfm?id=13910http://advocateonline.advocatehealth.com/page.cfm?id=13910http://advocateonline.advocatehealth.com/page.cfm?id=5588http://advocateonline.advocatehealth.com/homepage.cfm?id=1


44/44

Questions?

06 lipp haussen pdca presentation

Documents