Hospital Plan

Hospital System Improvement Process

2 Year High-Level Plan


  1. Phase 1: *** Management Engagement, Staffing, and Set-up ***,
  2. Educate the Management Team on the System Improvement Process,
  3. Management Commitment. Benefit: Executive Buy-In and Commitment,
  4. Start a Hospital Office of Operational Excellence,
  5. Staff up with 3 Black and 2 Green Belts. Start this early because this will take time and is a Critical Success Factor,
  6. Start the build of your Hospital System “Guiding Principles”. This includes goals, and responsibilities designed to create an agile and robust company, if not currently existing. Start with Toyota as a guide.
  7. Phase 2: *** Review Single Payer Advantages and Investigate Single Payer Hospitals ***,
  8. Education and Staffing. Benefit: If the Future is Single Payer, Investigate, and Bring in the Enabling Staff,
  9. Review Single-Payer Hospital goals and strategies. This is where excellence starts,
  10. 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,
  11. (Optional) Travel to Sweden to investigate Single-Payer hospital operations,
  12. Phase 3: *** Value Stream Mapping ***,
  13. Agree on Success Metrics,
  14. Improve the performance of each Value Stream. For example, value Streams include every process between customer order and customer delivery. Value Stream performance is important, not Process performance. Value Streams move your hospital to create a focal point for Value Delivery.
  15. Use Value Stream Maps to Initiate Improvement Efforts. Benefit: Generate and Promote Measurable Benefits with Profound Knowledge of your Processes,
  16. Select Improvement Projects: (Your System is comprised of Value Streams). Map Value Streams on critical hospital systems as well as poor-performing systems. Benefits include:
    1. Profound Knowledge of each process in the Value Stream and then your system,
    2. Built-in performance metrics
      1. Increase Value Stream and Process velocity,
      2. Decrease costs, and
      3. Increase quality.
  17. Build Project Charters. This provides much-needed direction and project management guidance,
  18. Educate employees on Waste, or activities a customer would not willingly pay for. Use the Lean Six Sigma acronym DOWNTIMES.
  19. Phase 4: *** Initiate Value Stream Improvement Efforts ***,
  20. Initiate the Mapping of Value Streams,
  21. Document and Promote the successes of targeting Value delivered and building project inertia,
  22. Initiate an Education and Instruction Program to increase improvement velocity,
  23. Select the target Value Streams to improve
  24. Start the Project Charter Build for each Value Stream. This provides much-needed direction and project management guidance,
  25. Investigate the usefulness of crucial Lean Six Sigma tools,
  26. Consider building an Operational Excellence Website containing:
    1. Toyota Production System (TPS) overview,
    2. TPS’s competitive advantages,
    3. Lean Six Sigma tools,
    4. Current Projects,
    5. The checkbox of Future Projects planned.
  27. Phase 5: *** Major Strategic Phase ***,
  28. Phase 6: *** SDD – Standardize, Document, and Display. Standardize on Best Practices ***,
  29. Establish success metrics,
  30. Initiate a system-wide standardization effort,
  31. Phase 7: *** Investigate Production Leveling Options ***. This may or may not work for you,
  32. Phase 8: *** Determine areas of Flow potential ***. Start the process of rearranging activities,
  33. Establish success metrics,
  34. Phase 9: *** Start efforts to implement Kanban Pull around areas of Flow ***,
  35. Investigate andon solutions. andon means that you stop to fix a defect in a process or product when detected. Toyota still averages 800 a year. This helps create a Learning Organization,
  36. Above all, Establish the Metrics that demonstrate System Success,
  37. Phase 10: *** Introduce a shadowbox concept ***, to minimize operational equipment shortages,
  38. Phase 11: *** Initiate the Strategic Kata Continuous Improvement Effort, Educate Employees, & Select Value Stream Managers ***,
  39. Build the Kata structure for your system. One Black Belt,
  40. Educate management on the process,
  41. Initiate build of Continuous Improvement Program by SelectingYour Improvement bogey, Toyota uses 6ms,
  42. Select a Business VP who benefits and cares about improving a Value Stream,
  43. Select Value Stream Managers. It’s essential for 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 responsibilities,
  44. Select starting target Value Streams,
  45. Publish success results,
  46. Phase 12: *** Validate Milestones, Improve Supply Chain Relationships ***,
  47. Therefore an Estimated Progress Milestone: At the end of the first quarter, you will have put in place all the parts needed to optimize the implementation of your Production System. Value Streams are Mapped and Improved. The next steps accelerate your march forward,
  48. Supply Chain. Benefit: Bring them closer to meeting your requirements whether lower prices or Just-in-Time
  49. Align your Supply Chain into 6 tiers of partners,
    1. Tier 1: Critical and Just-in-Time,
    2. Tier 2: Critical and Just-in-Time possible,
    3. Tier 3: Critical but no Just-in-Time,
    4. Tier 4: Other suppliers that deliver Just-in-Time,
    5. Tier 5: Other suppliers Just-in-Time possible, and
    6. Tier 6: Other non-critical suppliers.
  50. Explore enhanced relationships with Tier 1,
  51. Include in contracts a constant demand for increased Sigma performance,
  52. Determine which Tier 2 Suppliers could move to Just-in-Time,
  53. Phase 13: *** Implement a Two-Tier Supply System ***. Always have access to medical supplies and limit excess inventory.
  54. Toyota uses 2 hours of inventory as their Just-in-Time requirement. Determine your optimal Just-in-Time requirements,
  55. Phase 14: *** Hospital Patient Safety Improvement Program ***,
  56. Improve Patient Safety. Benefit: Decrease HAIs, Litigation Costs, and Insurance Costs. Protect Patients,
  57. Continue the Standardization of all Processes Affecting Patient Safety, institute best practices, and create a 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 an HAI. This is an opportunity for improvement. HAIs are defects,
  58. Phase 15: *** investigate a revolutionary new Emergency Room Design ***, designed to decrease cost and increase service,
  59. Phase 16: *** Future Actions***
  60. Apply for a Baldrige Performance Excellence Award for Process Excellence,
  61. Phase n: *** Continue the path toward Greatness ***,
  62. (Optional, based on aggressiveness) Hire more Black and Green Belts. This will ramp up the improvement effort through your company, and
  63. Select additional critical and less critical Value Streams to map

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

In conclusion

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.