Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids...

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Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality Improvement and Patient Safety

Transcript of Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids...

Page 1: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

Daily Continuous Improvement Program

Trey Coffey MD FAAP FRCPC

Medical Safety Officer, SickKidsAssociate Director, University of Toronto Centre for

Quality Improvement and Patient Safety

Page 2: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

Disclosures

I have no conflicts of interest to disclose

Page 3: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

Lean Concepts

• Origins in Toyota Production System c. 1930s

• Term coined and applied to western manufacturing c. 1980s

• Processes analyzed from the point of view of customer value

• Focus on eliminating waste of all kinds in the system

• Deference to expertise – executives on the factory floor (“Gemba”)

Page 4: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

Getting to know you

Your prior experience with LEAN is best described as:

A. I am not very familiar with LEAN.

B. My healthcare organization is doing some LEAN things and my reaction is… “meah.”

C. My healthcare organization (or other organizations I am familiar with) did some LEAN and it was an unmitigated disaster.

D. My healthcare organization is completely LEAN

Page 5: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

Different Levels of Process Improvement

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

Very fewLarge issues

FewMedium issues

ManySmall issues

Page 6: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

Objective

To tell a genuinely enthusiastic firsthand account

of a unique Lean Management System, which:

• is new to SickKids

• is not yet fully realized nor perfected

• might be revolutionary…

Page 7: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.
Page 8: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

New Job

Paediatric Medicine Quality Committee c. 2005

Page 9: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

2011: Emergency Department Performance Improvement Program

We used Lean to improve

Door-to-Floor times!

Page 10: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

Reality sets in… Again.

Page 11: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

• ThedaCare group of hospitals and clinics in Appleton, Wisconsin.

• Early adopter of Lean methods 8 years ago

• ThedaCare Business Performance System to address sustainability and to develop a culture of daily continuous improvement

Impact

32% improvement in patient

satisfaction

21% reduction in hospital cost per

case

Feb 2012: Learning Partnership with ThedaCare

Page 12: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

Awaiting my invitation…

• Rapid process improvement workshop?

• Kaizen event?

Page 13: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

Manager Daily Status Sheet

Page 14: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

Manager Daily Status Sheet

Page 15: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

A few weeks later this appears

Page 16: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

Daily Improvement huddle: M,W,F 1:15-1:30

Page 17: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

Daily Improvement Board

Just do its

More challenging

problem solving (PDSA3)

Collect Improvement

Cards

Prioritize Issues

Completed

Page 18: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

Daily Improvement Huddle Board

Page 19: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

Early signs of success: Engagement of frontline nurses on 7B raised 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

100.07B Moment 1

2011-2012 2012-2013 actual Target

Page 20: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

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

performance

Page 21: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

Different Levels of Process Improvement

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

Very fewLarge issues

FewMedium issues

ManySmall issues

LargeProjects

LeanEvent

Focus of Daily CIP

Six Sigma

Page 22: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

Status Sheet: Manager, Director and VP

DAILY

ManagerStatus Sheet

WEEKLY

DirectorStatus Sheet

EVERY 2 WEEKS

VPStatus Sheet

ManagerCharge Nurse Director VP

Page 23: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

Status Sheet: Links Between Levels

DAILY

ManagerStatus Sheet

WEEKLY

DirectorStatus Sheet

ManagerCharge Nurse Director

Page 24: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

A wise man once told me: “Behavior drives culture”

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• Competing priorities for improvement

• Improvement accountability with a few people

• Project teams solve problems periodically

• Ad-hoc use of improvement tools and approaches

Frequent review of improvement priorities

Improvement accountability at all levels

Front line staff solve problems daily

Staff trained in adopting tailored toolkit and approach for problem solving

From: To:

Page 25: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

New and Improved Paediatric Medicine Quality Leadership Team

• We still meet monthly to discuss trends in performance and to prioritize which metrics to improve upon

Except now…• I had to get a much bigger room!• I am currently looking for an even bigger room!• Staff come in on their OFF DAYS!• I look forward to it instead of dreading it

Page 26: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

Monthly Score Card: Driver and Watch indicatorsThis scorecard dictates the unit focus for the month

Page 27: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

Falls, Entrapment, Strangulation, Entanglement documentation scores

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

Page 28: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

Three day Equipment Improvement EventSituation Overview

Finding supplies is difficult

Approach Impact

a place for everything everything in its place

SortSet-in-orderShineStandardizeSustain

5S

Page 29: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.
Page 30: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

RESULTS

Staff-driven problem solving: Over 65 improvement ideas identified and executed since April 2012

Median of 19% Improvement in Engagement Scores

Page 31: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

Key ingredients

1. INTRINSIC MOTIVATION

•Provide opportunity for self-leadership •Provide choices •Help members acquire skills and knowledge •Assign tasks but make connections •Coach 2. DISCIPLINE• Simple behaviors repeated over and over

Autonomy

RelatednessCompetence

Self-Determination Theory

Page 32: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

Enterprise wide picture

• 12/22 units doing Daily CIP• 20 yellow belts trained• 178 green belts trained

• Larger projects/value streams: Ambulatory, Surgical, Procurement, Pharmacy, Administrative. • ~20 Rapid Improvement Events completed to date

Page 33: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

How much does this cost?

• “Lean Promotion Office”

• Office of Process Improvement

• Director, five staff, and an assistant • hired from industry and consulting firms• $1 million/year (approx)

Page 34: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

The Hand Hygiene graph continued….

Apr May` Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar

20.0%

40.0%

60.0%

80.0%

100.0%

7BCD Moment 1

2012-2013 Target

Linear (Target) 2011-2012

Page 35: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

Questions for consideration

1. Are we going to be able to tackle the big stuff?

2. How is this experience going to vary across units?

3. How are we going to substantively engage physicians?

Page 36: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.

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, MBAAli Shahzada, MBA

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

Page 37: Daily Continuous Improvement Program Trey Coffey MD FAAP FRCPC Medical Safety Officer, SickKids Associate Director, University of Toronto Centre for Quality.