“Go Slow to Go Fast” Go Slow to Go...Key Lean Principles Multidisciplinary Team –all voices...
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Transcript of “Go Slow to Go Fast” Go Slow to Go...Key Lean Principles Multidisciplinary Team –all voices...
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“Go Slow to Go Fast”
OCTOBER 18, 2017
P R E S E N T E R S
Dennis Stone, Robert Corson, Leigh Snow & Chee Keong Lin
C A P T U R E A N D L E V E R A G E T H E L E A N A D V A N T A G E
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Robert CorsonExeter Hospital
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Facilities Architect
Dennis StoneTRO
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Engineer
Lean Process Facilitator
Leigh Olson Snow TRO
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Healthcare Planner
Project Manager
Chee Keong LinSmithGroup JJR
─
Principal-in-Charge
Process Leader
Presenters
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Learning Objectives
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This case study will:
▪ Demonstrate the value of “Going Slow To Go Fast” in a project setting
▪ Show how to use the Lean A3 problem-solving process to structure a pre-design exploration and
set the stage for an informed design process.
▪ Show how to use the PDCA cycle and continuous improvement to facilitate a large group
investigation.
▪ Inspire and equip participants to apply these principles and tools in other project settings.
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1. Background: Exeter 2020
2. Inspiration: Go Slow to Go Fast
3. Content: Lean A3 Problem-Solving
4. Process: Plan-Do-Check-Act
Workshops & Tours
5. Next Steps
Agenda
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1. Background: Exeter 2020
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Project Description
Exeter 2020:
▪ Pre-design study
▪ Multidisciplinary team exploration
▪ Inpatient care models and innovations
▪ Spanned 8 months
▪ Team
▪ 17 Exeter Hospital staff members
▪ 5 TRO designers / planners / engineers
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Exeter Hospital Background
▪ Independently-owned Community
Hospital and Health System
▪ 42 acre main campus
▪ Serves 46 communities in NH
▪ 100 inpatient beds in 5 units
▪ 5 years into Lean journey
▪ 3 Operational Excellence practitioners
on staff
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2. Inspiration: Go Slow to Go Fast
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What makes a small community
health system sustainable?
Operational improvements that support
the Triple Aim (+ one)
+ Organizational Sustainability
Inspiration: Why Do this Study?
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Inpatient care is changing……
Current state of Inpatient Units does not support Triple Aim objectives:
▪ Aging infrastructure
▪ Discreet and separate units
▪ Patient rooms below
industry standard
▪ Inadequate support space
▪ Distance from support services
▪ Not conducive to standard work
Inspiration: Why Do this Study?
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STAKEHOLDERS INFLUENCE OVER TIME
Inspiration: Why Do this Study?
Concepts behind Exeter 2020
▪ Sustainable value-added process
▪ Building alignment throughout the team
▪ Common goals & values
▪ Shared knowledge & vocabulary
▪ Change management
▪ “Go Slow to Go Fast”
▪ Stakeholders involved from the start
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C A P T U R E A N D L E V E R A G E T H E L E A N A D V A N T A G EF
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Info
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Le
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Patient E
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Laura
Team of stakeholders: 22
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3. Content: Lean A3 Problem-Solving
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A3 Process
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Mission Statement embodies A3 Process
We’re a multidisciplinary team that is
studying the future of inpatient care delivery
at Exeter Hospital.
We’re starting by understanding the current
state, exploring trends elsewhere and
envisioning our ideal future state.
Together we’ll develop a road map for next
steps towards our vision of optimizing
patient and staff experience.
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4. Process: Plan-Do-Check-Act
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Initial Proposal
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Overlaying the A3 Process
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Engaging Stakeholders Effectively
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WorkshopMultidisciplinary
Team
Current
State
Future State
& Trends Analysis
Next
Steps
1 Process, Scope, Goals • • •
2 Learning to See & Going to Gemba •
3 HealthCare Design Conference •
4 Defining the Problems • •
5 Root Cause Analysis • •
6 Countermeasures; Prep for Tours •Facility Tours •
7 Assimilation & Next Steps • •
Actual Process
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4. Process: Workshops & Tours
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Workshop 1: Process, Scope & Goals
Summary▪ Introductions & team building
▪ Defined scope and process
▪ Rated the ‘Keys to Success’
▪ Discussed current state
▪ Envisioned future state
Key Lean Principles▪ Multidisciplinary Team – all voices
▪ Defining value by the clients’ needs
▪ Outlined process – PDCA and A3
▪ Go slow to go fast – entire day workshop on setting the foundation for the study
Key Takeaways▪ Defined parameters of study
▪ Developed shared conditions of satisfaction – keys to success
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Workshop 2: Learning to See & Going to Gemba
Summary▪ Developed Mission Statement.
▪ Learned ways to look at space and healthcare design principles
▪ Addressed how to read drawings
▪ Five hours of observation in existing Exeter inpatient units
Key Lean Principles▪ Looking at flow – process improvement mindset
▪ Going to Gemba
Key Takeaways▪ Deep understanding of Current State
▪ Process improvement mindset
▪ Identified the need to tour more hospitals (more Gemba walks)
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Workshop 3: HealthCare Design Conference
Summary▪ Eighteen team members at national HealthCare Design conference
▪ Attended 216 total, 42 unique learning sessions
▪ Toured a nearby new hospital (Gemba walk #2)
▪ Shared learning amongst the team in a full day session back home
Key Lean Principles▪ Exploring Future State and possible countermeasures
▪ Team building – empowering team
Key Takeaways▪ Focused our future learning on doing tours (rather than more
conferences)
▪ Education built a common understanding of conditions for
satisfaction for the new design.
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Workshop 4: Problem Analysis
Summary▪ Collected elements of Future State
▪ Gap Analysis
▪ Prioritized Problems
Key Lean Principles▪ Gap Analysis: Multidisciplinary team
▪ Plus delta learning
Key Takeaways▪ Established consensus on the problems to focus on solving
▪ Shared perspectives on problems
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Workshop 5: Root Cause Analysis
Summary▪ Chose 5 top problems and did a 5-Why analysis
Key Lean Principles▪ Root cause analysis
Key Takeaways▪ Helped solidify that we should not jump to a solution; study
the problems and the data
▪ All problems are intertwined – root causes are often shared
▪ Multidisciplinary team helped us to understand the root
causes in a much deeper way
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Workshop 6: Countermeasures & Prep for Facility Tours
Summary▪ Deeper study of countermeasures – what are ways we
can approach these problems
▪ Half day preparation for facility tours – study plans and
follow patient paths through them
Key Lean Principles▪ Simulation of patient care process for 4 different
unit layouts
▪ Go Slow to Go Fast – deep study of the buildings we will
tour so we can get more from the experience; prepare
questions
Key Takeaways▪ Assimilation of learning
▪ Preparation for Gemba
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Facility Tours 3 & 4: Gemba Walks
Summary▪ Full day tours of two recent inpatient units:
▪ MaineGeneral Hospital
▪ Lunder Building at Mass General Hospital
Key Lean Principles▪ Going to Gemba (others)
▪ Looking at flow
Key Takeaways▪ Successful projects had good clarity about goals from
the beginning, patient first ideology for everything
▪ Lean was very present; process improvement and
standardization were strong and effective in both units
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Workshop 7– Assimilation & Next Steps
Summary▪ Summarized each workshop
▪ Developed key takeaways
▪ Checked back to initial goals
▪ Discussed Next Steps
Key Lean Principles▪ PDCA
▪ Implementation / Action Plan
Key Takeaways▪ Summary of our progress and accomplishments
▪ Road map for next steps
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5. Next Steps
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Construction
Building the Business Case2017-2018
Organizational
Alignment
Education/
Learning
Strategic
PlanningIP+OP Demand/
Market Analysis
Project Scoping
Feasibility
Programming
Concept
ModelingDesign &
Documentation
Clinical Model
Testing
Future
State
Mapping
Current
State
Mapping
Facilities
Assessment
Ju
ne
20
17
Octo
be
r 2
01
8
Next Steps - Road Map
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• Use lean principles – focus on process and flow
Guiding Principles for the Future Design Project
▪ Develop and sustain a patient & family centered
experience aligned with our community’s needs
▪ Deliver a highly reliable environment that supports
patient and staff safety
▪ Create value, defined as highest quality / total cost over
a period of time
▪ Cultivate a positive culture that promotes staff
engagement and retention
▪ Make decisions based on qualified data and evidence
▪ Eliminate all barriers to collaboration
▪ Use lean principles – focus on process and flow
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Recap
1. Background: Exeter 2020
2. Inspiration: Go Slow to Go Fast
3. Content: Lean A3 Problem-Solving
4. Process: Plan-Do-Check-Act
Workshops & Tours
5. Next Steps
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What would we change / do differently?
▪ Have a second physician on team
▪ Include patient voice early
▪ Make Workshop 4 (Problem Analysis) more digestible
▪ Never take notes of a workshop on hospital computer!
▪ Make logistics of planning sessions and space simpler
▪ Use quantitative data earlier in process
▪ Hard to find places to tour (ie. Acuity Adaptable units)
▪ How translate lessons from large medical centers to community hospital
Lessons from Exeter 2020
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▪ Build multidisciplinary team with shared experiences and vocabulary
▪ Develop deeper understanding of Current State
▪ Analyze key problems to solve
▪ Further define goals for and qualities of Future State
▪ Develop knowledge of countermeasures, models of care, and impact of built
environment on outcomes
▪ Create next steps roadmap
Lessons from Exeter 2020: Steps for a Successful Project
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QUESTIONS
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+ / Δ
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Contact Us
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Chee Keong Lin
Leigh Olson Snow
Robert Corson
Dennis Stone
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