Using Hoshin Kanri & Baldrige to Improve Performance · o Hoshin means “compass needle” or...
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Using Hoshin Kanri & Baldrige to Improve Performance
Transcript of Using Hoshin Kanri & Baldrige to Improve Performance · o Hoshin means “compass needle” or...
Using Hoshin Kanri & Baldrige to
Improve Performance
Excellence Award 2013
Notable Strengths
Use of Hoshin
Management by Fact
Culture of Problem
Solving and CSI
Our VisionWinona Health will be a recognized leader in the
revolutionary transformation of community healthcare.
Our MissionDevoted to improving the health and well-being of
our family, friends, and neighbors.
Our Aims
Enhance the patient/resident experience
Improve health/outcomes
Reduce/control costs
Our ValuesIntegrity – We do no harm.
Service – We serve with compassion, dignity, and respect.
Loyalty – We build relationships that exceed expectations.
Excellence – We improve performance through learning and innovation.
About Winona Health…
o >60 physicians and associate providers
o 13 specialties
o >1,100 employees
o 425 volunteers
o 99 bed Hospital
o 140 bed SNF
o 61 unit assisted living
o 20 unit Memory Care assisted living
o 3 Pharmacies
Cat. 1
Leadership
CSI Process is leadership-driven
Cat. 2
Strategic Planning
Drives the success of CSI initiatives
Cat. 3
Customer Focus
Identifies value in the eyes of the patient & resident
Cat. 4 / 7 Meas.,
Analysis & Knowledge
Mgmt /
Org. Results
Utilizes data to drive improvement
Cat. 5
Workforce Focus
Engages and empowers employees to drive process improvement
Cat. 6
Operations Focus
Improves work systems to achieve better performance & reduce variability
Baldrige Healthcare Criteria and CSI
CSI as a Strategy
Transforming our Culture
Focus on Principles of:
Customer Value
Value Streams
Flow and Pull
Empowered People
Seek Perfection
Principles apply everywhere
Belief this strategy is key to a successful future for continuously
transforming our culture at Winona Health
WH’s Lean Management System
What is Hoshin Kanri?
o Hoshin means “compass needle” or “direction
o Kanri means “management” or “control”
o Hoshin planning aligns an organization toward accomplishing a
set of goals.
o Discipline of Hoshin Kanri:
o Focused on shared goals
o Goals communicated to all leaders
o All leaders involved in planning to achieve the goals
o Accountability to all participants for achieving their part of the plan
Walk the walk and talk the talk………
Hoshin Kanri = Strategy Deployment
• Statement is the
CONSTANT GUIDE
for the Team
o Hoshin Kanri – Leadership Driven
o Level 1- Organization – True North/3 year
Strategic Goals
o Level 2 – Service Line or Support Area
o Level 3 – Value Streams/Departments
o Linkage from Level 1 to Level 2 to Level 3
o Catchball between all levels
o FOCUS Board Daily Metrics
Hoshin Kanri – Level 1
“Catchball” Processo BOD/CEO/Service Line Leaders/Directors/Mgrs Group
o Discussions between Leadership levels
o Need to limit the “How”/# of Tactics
o Level 3 catchball includes frontline staff
o Improves ownership/engagement at all levels
o Integrated goals/metrics cascade from Level 1 - Level 3 and then to
FOCUS Boards
o Alignment and focus
Hoshin Kanri Cascade
Linkage Validation
Level 1 Box Score Forecasting
Box
Score
Triple
Aim
Measure Baseline
9.13
Qtr 1
12.13
Qtr 2
3.14
Qtr 3
6.14
Qtr 4 9.14 2015 2016 3 Year
Forecast
Long Term
Forecast
Stretch Goal
WH engages with patients/residents to build relationships that help them understand, improve, and manage their health status.
Sat 1 Satisfaction: Top Decile 100%
HCAHPS 64.9 65.7 66.5 67.3 68.1 70.15 70.2 >95
CGCAHPS 87.4 88.03 88.6 89.3 89.9 91.5 93.1 >95
Resident 86.8 85 86 87 88 90 90 >95
WH’s standard evidence based processes lead to superior P/R outcomes and improved community health status.
Safety 2 Adverse Events 1 0 0 0 0 0 0 0 0 0
Quality 2 Quality Ranking: Top Decile Top Decile
Hospital 89.9% 89.9% 91.1% 92.3% 93.5% 93.5% >95
WSS 63.2% 63.2% 66% 68.8% 71.6% 71.5% >80
Clinics 44% 44% 49.6% 55.2% 61% 61% >70
Quality 2 % Use CPOE 78% 78% 78% 80% 80% 80% 85% >85% >90% >90%
% Use Care Plans 0 0 0 >40% >50% >60% >75% >80%
We work as a system to eliminate waste and provide value to our customers using A3 problem solving.
Prod 1,2,3 Revenue/FTE
Prod 3 %Labor/Rev
Prod 3 1% Improvement
Prod 1,3 Ambulatory Market
Share
WH is a successful community health system providing competitive Total Cost of Care to our patients, employers and community.
Cost 3 Net Revenue 2.5% annual
inc
Cost 3 Operating Margin 3.53% 1.9% 2.29% 2.3% 1.87% 3.0% 4% 4% 5% Sustain
Fin 3 Days Cash 180 181 182 184 186 192 200 200+ 200+ Sustain
Fin 3 A/R Days 48 48 47 46 45 44 42 42 40 Sustain
Fin 3 Generosity Inspires Sustain Sustain
ENTERPRISE OPERATIONAL AND FINANCIAL TARGETS AND FORECASTS 2014
Box scoresSupport/Service Line: Community Engagement Date/Period: Q2 2014
MetricsAnnual Target
Quarterly Target
Previous Quarter
Performance
Current Quarter Forecast
Current Quarter Actual
Current Quarter Performance by Month Current Full
Year ForecastJanuary February March
QUALITYAdherence to Generosity Map* 100% TBD - - TBD
SATISFACTIONWould you recommend?Primary Care Clinic 90.63% 88.30% 87.20% 89% 89.30% 88.50% 89% 89.30% 91%Speciality Care Clinic 90.88% 87.52% 87.80% 88.63% 89.40% 87.90% 86.50% 89..4%
TIME/PRODUCTIVITYIncrease # of Volunteers by 10% 386 3 359 362 377 362 365 377 386Increase # of Donors by 25% 295 15 251 266 430 403 423 430 295
FINANCIALNet Revenue per FTEMinimum ContributionTargeted ImprovementYear To Date Progress
Mgmt by fact.....what is missing?
Proposal A3’so Proposal A3’s-all levels of Hoshin – “HOW”
o What tactics we use to accomplish breakthrough objectives and
how do you measure for success
o Started by leader /
finished by area
o Burning platform
o Also used for CPR’s
presented to CEO/CFO
Proposal A3
Business Case
Current State/Gap
Future State
Action Plan
Measurement/Results
Visual Management Enterpriseo PDCA Enterprise Level
o Plan
o Hoshin Level 1 and Level 2’s
o Proposal A3’s from level 1 Hoshin
o Long term goals and forecast
o Do
o Proposal A3’s from all level 2 Hoshin
o Check
o Std Box Scores with Charts/Graphs not meeting target
o Act
o Follow-up – Course Corrections
Enterprise Obeya
PDCA
Visual Management- SL and Dept
PDCA Boards – Level 2 and 3
o Hoshin
o Proposal A3’s
o Box Score
o Course correction based on fact
o Reviewed weekly, monthly - transparent
PDCA Board Weekly/Monthly
Visual Management FOCUS Boards
o FOCUS Boards- daily/every shift- every dept.
Frontline metrics – Based off Hoshin L3
Problems and Occurrences
A3 Problem solving
Audit and sustaining
Behavioral Standards/Relationships
Std Work – Scorecards
Management by fact….CGCAHP
SNov Dec Jan. Feb. Mar. Apr. May June July August Sept FINAL
OctAll Clinics Combined
Actual 79.95% 80.60% 81.80% 82.80% 81.70% 81.20% 81.30% 81.00% 79.50%
PrimaryForecast
78.96 79.33% 79.70% 80.07% 80.44% 80.83% 81.18% 81.55% 81.95% 82.32% 82.69% 83.08% 83.08%
Actual 78.20% 80.40% 82.00% 84.40% 80.50% 83.00% 82.30% 83.90% 81.50%
SpecialtyForecast
78.16% 78.52% 78.90% 79.28% 79.66% 80.03% 80.41% 80,79% 81.15% 81.53% 81.90% 82.28% 82.28%
Actual 80.90% 82.70% 84.80% 84.40% 83.70% 79.20% 77.80% 79.60% 78.00%
Diabetic 5 Quality Report 2014 criteria
2014 A1c
A1C Goal
<8
state avg
74% LDL
LDL Goal
<100
mg/dL;
state avg
64% Aspirin
Aspirin
Goal-on
Aspirin
state avg
100% BP
BP State
Goal
<140/90;
state avg
84%
No
Smoking
Smoking
Goal- no
smoking
state avg
84%
Monthly
D5 %
Monthly
D5 Avg
39%
January 77% 68% 89% 80% 80%
February 67% 67% 86% 76% 90%
March 85% 68% 86% 85% 87%
Qtr 76% 68% 87% 80% 86%
April 66% 69% 90% 83% 86% 42%
May 62% 68% 87% 77% 87% 27%
June 66% 70% 88% 86% 87% 41%
Qtr 65% 69% 88% 82% 87% 37%
July 68% 67% 89% 86% 87% 41%
Year
Avg
Goal is
39%
Frontline Daily Problem Solving
o Trained coaches and problem solvers
o Frontline FB group A3’s – all staff trained
o Better engagement/empowerment
o All leadership trained in coaching
o >50% of problem solving related to Hoshin
Standard Work
o Standard work at the frontline
o Based on risk, volume and improvements
o Critical to quality steps on a scorecard audit
o Improves outcomes and quality
o Process stable prior to improvement
o Decreases variability
Score cards – 4 – PatternsLSW: Month: Name:
Daily Target 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Target 1 2 3 4 5
Target 1 2 3 4 5
5
Monthly Target 1
10
10
Monthly Target 1
10
10
Passes
Total
Observations
Passes
Total
Observations
2. Response to pain medication
documented.
Target: 10 out of 10 observations
Passes
Total
Observations
Passes
Total
Observations
***All negative findings MUST be addressed immediately with coaching and mentoring.***
4 Patterns to Observe for on the Scorecard:
a) Target observations not completed by assigned - review with staff member
b) An observation item has been positively performing at 100%- Move to lower frequency of
audit
c) 1-2 defects in a measurement is related to specific staff behaviors.- review with staff member
d) Greater defects (i.e. 5 out of 10) suggest a systemic/process issue. Why might the process be
failing? Use the questions below to evaluate process issues:
1. What is the TARGET CONDITION?
2. What is the ACTUAL CONDITION?(use data)
3. What is going well? (celebrate success)
4. What OBSTACLES are now preventing you from reaching the target condition?
(PARETO with data, how did you priortize?)
5. What is your NEXT STEP? (PROBLEM SOLVE using an A3 the obstacle are you addressing now)
6. What can I do to HELP? (Remove barriers, connect to other areas)
Weekly
Passes
Total
Observations
Weekly
Passes
Total
Observations
Passes
Total
Observations
Day of Month
Passes
Total
Observations
Passes
Total
Observations
Coaching to 4 – Patterns
o Audits NOT performed
o 20% rate of adherence
o 80% rate of adherence
o Standard work followed 100%
Leaders Standard Work
o Leaders Standard Work cascaded up from frontline leaders scorecards to the CEO
o Daily, weekly and monthly audits
o Done with a score card/LSW checklist
o Gemba walks/Rounding
o Coaching and Mentoring- 4-Patterns
o Visual Board Rounding
o Accountability
Talent Trainingo Leadership Academy
o Director/SL weekly meeting
o Manager’s Meeting
o Technical vs. Adaptive training
o Problem Solving
o Coaching
o FOCUS Board A3 training
o Started with CSI – WH LMS
o CSI Hoshin
Deployment
True North
3 –Year Strategic
Goal
Breakthrough Objectives
Breakthrough Initiatives
SL Tactics
Process Improvement
FB Daily Metrics
EDUCBreakthrough Initiative:
Drive significant improvement in SL box scores
Tactic:
Implement and audit use of daily standard work/A3 problem solving/results
Metrics:
Improve patient satisfaction from 89.9 to 92.5 by 12/14
Cost Reduction
FOCUS Board:
A3 work – Decision to admit – Quality metric
Track every patient time to admit
Std work after CIP – audited by Gemba Coordinators
< 30 minutes – current rate is 83%
A3 on ED Staffing
Staffing model improvement with transparent tracking of OT
All OT is tracked by individual/shift –reviewed daily at FB
Defects tracked and addressed
Decision to Admit
Q1FY2014 Q2FY2014 Q3FY2014 Q4FY2014 Q1FY2015 Q2FY2015
Decision to Admit 73.67% 77.33% 81.00%
Forecast 85.00% 85.00% 80.00% 80.00% 85.00% 87.00%
Goal 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
% T
ime G
oal A
ch
ieved
Decision to AdmitWH Goal < 30 Minutes
National average time from decision to admit to ED departure = 82 minutes
WH Health average time = 26 minutes
WSSBreakthrough Initiative:
Drive significant improvement in SL box scores
Tactic:
Implement and audit use of daily standard work/A3/results
Metrics:
Reduce Resident falls with injuries
Cost Reduction
FOCUS Board:
A3 work – Falls from injury – Quality metric
Track every resident falls with injuries each shift
RCA on each fall – prioritized work around occurances
A3 on LWM Staffing
Staffing model improvement with transparent tracking
All OT is tracked by individual/shift –reviewed daily at FB
Defects tracked and addressed – A3 or JDI
Quarterly Targets and Goal
Q1FY2014 Q2FY2014 Q3FY2014 Q4FY2014 Q1FY2015 Q2FY2015
% Falls 52.30% 50.93% 52.45%
Forecast 52.80% 52.80% 52.80% 52.00% 50.00% 49.00%
Goal-Nat'l Avg 44.40% 44.40% 44.40% 44.40% 44.40% 44.40%
40.00%
45.00%
50.00%
55.00%
60.00%
% P
ati
en
ts w
ith
Falls
Resident Falls
SSCBreakthrough Initiative:
Drive significant improvement in SL box scores
Tactic:
Reduce supply chain costs by 19% = xxx$
Metrics:
Cost Reduction $$$$ with goal
FOCUS Board:
Track opened unused surgical supplies - waste
Std work after CIP – audited by Gemba Coordinator
Daily defects in process tracked and improvement work based on
priority
Cost savings – dollars saved-cost avoidance
InpatientBreakthrough Initiative:
Drive significant improvement in SL box scores
Tactic:
Drive significant problem solving by frontline staff using Kaizen, 5S,
A3 and 3P
Metrics:
Maintain > 98% compliance in CMS measures (<20000 DMP)
FOCUS Board:
Care Coordination – detailed by pt
Pneumonia, AMI, CHF, SCIP, Outpt AMI Cardiac Care
Reviewed twice a day for adherence/course correction
Care Coordination Nurse – EMR hard stops – Std Wk – Power Plans
Team – Providers/Nurses/Pharmacy/Social Workers/etc.
Process improvement posted on FB with transparent audits
Review every shift
Questions?
• is the CONSTANT GUIDE for the Team
