Daily Continuous Improvement Program:Safety Culture at the Front Line

Trey CoffeyMedical Safety Officer

Associate Director, U of T C-QuIPS

2011: Lean-based ED Performance Improvement Program

We Finally Improved Door-to-

Floor times!

Reality sets in… Again.

• Early adopter of Lean in Appleton, Wisconsin.

• ThedaCare addresses sustainability by developing culture of DAILY continuous improvement FIRST

2012: Learning Partnership with ThedaCare

Different Levels of Process Improvement

Adapted from: “The Toyota Way Fieldbook” by Liker and Meier

Large issues

Medium issues

Small issues

LargeProjects

LeanEvent

Focus of Daily CIP

Six Sigma

Manager Daily Status Sheet

Unit Scorecard: Driver & Watch metrics

24% of unit scorecard

metrics related to

safety

Daily Improvement huddle: MWF 1:15-1:30

Daily Improvement Board

Just do its

More challenging

problem solving (PDSA3)

Collect Improvement

Cards

Prioritize Issues

Completed

Daily Improvement Huddle Board

Daily CIP’s Goal:Develop people to solve problems and improve

performance

Early success: hand hygiene compliance

Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar0.0

20.0

40.0

60.0

80.0

100.0

57.0

75.0

93.0

78.0

100.0

2011-2012 2012-2013 actual Target

Falls, Entrapment, Strangulation, Entanglement documentation

7B 7C 7D0%

20%

40%

60%

80%

100%

120%

24%

44%

23%

35%

43%

30%

51%

39%50%

57%50%

54%

0.670000000000002

0.680000000000001

52%48%

97%100%

72%

83%89%

77%

90%Aug

Sept

Oct

Nov

Dec

Jan-13

Feb

March

April

16% 20%

54%

71%

Sample performance gains realized by individual units

Perc

en

tag

e I

mp

rovem

en

t

Maturing the ProgramRelationship to Safety Culture

• Reporting Culture +• Just Culture ?• Informed Culture ?• Learning Culture ?

Acknowledgments

SickKids nursing and operational leaders: Kate Langrish, RN, Lynn Mack, RN, Linette Margallo, RN, Dinarte Viveiros, RN

SickKids Office of Process Improvement: Shiraz Bhajwa, MBA, Travis Beamish, MBA, Ali Shahzada, MBA

Executive sponsor: Jeff Mainland, EVP Strategy, Performance, Quality and Communication