Hospital Excellence System Improvement Process
- Phase 1: Management Commitment. Benefit: Executive Buy-In and Commitment – Week 1
- Start an Office of Hospital Excellence.
- Educate the Management Team on the System Improvement Process.
- Start of Project Charter Build. This provides much-needed direction and project management guidance. (Single Payer Hospitals goals are focussed on Patient Experience and Operational Excellence through focusing on process improvement).
- Phase 2: Education and Staffing. Benefit: If the Future is Single Payer, Investigate, and Bring in the Enabling Staff – Week 2 – 4
- Review Single Payer Hospital goals and strategies. This is where excellence starts.
- Investigate a Single Payer Hospital online. Single Payer hospitals have a different focus on patients, which leads to Operational Excellence and a Patients First mentality.
- (Optional) Travel to Sweden to investigate Single Payer hospital operations.
- Start the project off by bringing in 3 Black and 2 Green Belts. Start this early because this will take time and is a Critical Success Factor. Each Black Belt averages $1 million of cost savings.
- Initiate build of Continuous Improvement Program materials with 1 Green Belt. Initiate Monthly Reporting
- Phase 3: Final Pre-Work. Benefit: Stage Set, Ownership Established – Week 5
- Select the top five or more Value Streams to improve (Your System is comprised of Value Streams and Overhead functions). Map Value Streams on critical Hospital systems and poor performing Hospital systems. Lean Six Sigma Project Selection by using ROI as the method.
- Start the build of your Hospital Guiding Principles. This includes goals, and responsibilities designed to create an agile and robust Hospital.
- Establish the Metrics that demonstrate System Success.
- Execute two important Lean Six Sigma tools. A “House of Quality” and a FMEA. A House of Quality aggregates information from customers, engineers, innovators, and competition to assist in product or service design. A FMEA (or Failure Modes and Effects Analysis) helps define and diminutize project risk.
- Educate employees on Waste, or activities a patient would not willingly pay for. Use the Lean Six Sigma acronym DOWNTIMES. Setup an internal web page. *** 101 documented Wastes in Hospitals ***
- Phase 4: Initiate Improvement Effort. Benefit: Generate and Promote Measurable Benefits – Week 6 – 10
- Select Value Stream Managers. It’s important to future improvement that Value Streams have ownership. A Value Stream Manager would have additional time to perform other job functions such as managing other Value Streams or operational responsibility. Initiate Monthly Reporting.
- Investigate areas for Flow and Pull. The Toyota Production System focuses on a unit of one, just like a unique patient.
- Map and Improve the performance of each Value Stream. Value Streams, as an example, would include every process between a patient entering and leaving a Hospital. Value Stream performance is important, Process performance may not be. Value Streams move your Hospital to create a focal point on Patient Value Delivery. A Value Stream gives Hospitals:
- – Profound Knowledge of Value Stream processes,
- – Built-in performance metrics,
- – Value Stream velocity improvement,
- – Decreased Value Stream cost, and
- – Increased Value Stream output quality.
- Document and Promote the successes of targeting Value delivered, building project inertia.
- Estimated Progress Milestone: At the end of Week 10 you will have put in place all the parts needed to optimize the implementation of your Hospital Production System and completed the Mapping and Improvement of 2 Value Streams. The next steps accelerate the march forward.
- Phase 5: Patient Safety. Benefit: Decrease HAIs, Litigation Costs, and Insurance Costs. Protect Patients – Week 11
- Initiate the Standardization of all Processes Affecting Patient Safety, institute best practices, create human andon system that stops a process when there is a deviation from best practices thereby mitigating HAIs. 1/31 (which is 32,000 times out of 1,000,000 opportunities) patients leaving with a HAI. This is an opportunity for improvement. HAIs are defects.
- Phase 6: Layer on the Powerful Continuous Improvement Program. Benefit: Strive for Greatness – Week 12
- Seek Perfection. Start a Kata Continuous Improvement Program (11 CI ideas per person per year) on each Value Stream Mapped. This is a secret of Toyota’s Production System. It is a program, not a bolt-on. Toyota uses this to continue its march towards perfection. Note: Toyota will not expand their business if it risks this program.
- Phase n: Future Steps Towards Your Production System
- Initiate an Education and Instruction Program to increase improvement velocity.
- (Optional, based on aggressiveness) Hire additional Black and Green Belts. This will ramp up the improvement effort through your company.
- Select additional critical Value Streams to Map, and so on throughout the whole hospital. The company now has a focal point on the Value it creates for patients.
Estimated Progress Milestones:
At the rate of 5 Values Streams Mapped and Improved every 4 weeks you will have:
- First Quarter: 6 Value Streams
- Second Quarter: 21 Value Streams
- Third Quarter: 36 Value Streams
- Fourth Quarter: 51 Value Streams
- Second Year: 111 Value Streams (or more if you continue to staff up)
Benefits of your new Hospital System:
- Profound Knowledge of your Hospital System
- Operational Excellence (a competitive advantage)
- Increased Value Stream velocity
- Decreased costs
- Increased product/service quality
- Continued improvement with a quest for Perfection
This is a big effort but unlike other projects, measurable benefits start within the second month. This effort will move your hospital to constantly change, create an improvement culture, and comes with Performance Metrics. Your Hospital is now on its way to excellence.