2 years of Lean at SFGH Lean Update to the JCC February 24, 2014
2 years of Lean at SFGH
Lean Update to the JCC
February 24, 2014
Reflection
2 years
(SFGH)
• 5 active Value Streams
• Tier 1 Report
• Tier 2 Reports
• 30 leaders completed Lean Certification
• 35 more are in Certification
5-7 years
(San Mateo Medical Center)
• All departments, clinics, units have undergone 5S
• Established robust Standard Work auditing
• Accountability and responsibility
10-15 years
(Virginia Mason, Theda Care)
• All leaders in the organization have learned, and practice the fundamental principles of Lean
• All departments, clinics, units have developed and validated Standard Work for their processes
Lean Journey in Healthcare
Continuous Daily Improvement
Lean is a rigorous, disciplined approach to improvement work, where continuous daily improvement IS the work
P
C
D A
SFGH’s Mission: To provide quality health care and trauma services with compassion and respect
Teamwork Respect Learning to
See Continuous
Improvement Challenge
Lean Values and the SFGH Mission
Accomplishments – 3M
Morning Huddle Collecting Co-pays on-site
Sponsor: Sue Currin Process Owners: Dana Nelson
Accomplishments – Urgent Care
Standard Work for the Discharge Process On-site Radiology
Sponsor: Roland Pickens/Iman Nazeeri-Simmons Process Owners: Ron Labuguen, Ricardo Ballin
Accomplishments – OR/PACU
5S – Back Hallway 5S – Sterile Core
Sponsor: Todd May Process Owners: Patty Coggan, Jerry Padilla
Accomplishments – 4D Med/Surg
Before – Hallway Storage After – Nurse Workstations
Sponsor: Terry Dentoni Process Owners: Andre Campbell, Mike Daly, Nela Ponferrada
Accomplishments - Radiology
Before – MRI Waiting Area After – MRI Dressing Room
Sponsor: Shermineh Jafarieh Process Owners: David Sostarich, Mark Wilson
Accomplishments
• 8 Lean Black Belts Dennise Rosas
Michael Pfeffer
Brandi Frazier
Aiyana Johnson
• Partnering with DET, Facilities, EVS, Materials Management
Iman Nazeeri-Simmons Alice Chen Will Huen Joe Clement
Accomplishments
• 8 Patient Advisors
Preparing for the Future
New Hospital Workflow
Vision for Bldg 25: To be the best hospital by
exceeding patient expectations and advancing
community wellness in a patient centered, healing
environment.
Optimal use of Resources
Integrated Information
Systems
Data to support decision making
Technology
Clear Communication:
Staff Department W/ Patients
Service Excellence
Healing Physical
Environment
Comprehensive Integrated Care
Model
Lean Improvement Methodology
SFGH Mission: To provide quality healthcare
and trauma services with compassion and respect.
Future State: Building 25
San Francisco General Hospital A3 – 3P
Patient Centered Care
HCAHPS Scores Safe, secure environment (AWOL, AMA)
Patient engagement Individual care plan (Audit results, LOS)
Pt access (Lead Time, defects)Communication Among Care Providers
Maximizing value Staff training for EOC
(ROK: Cost, Triple Aim) Halogen% Survey results
culture of safety survey
Quality Measurements
Community Wellness Fall Rates Core Measure Outcomes
Patient education teachback HAC's (Ulcer, UTI, ADR's)
Hospital Re-admission rates
Smoking Cessation rate Healing Environment
Primary care linkage % HCAHPS Scores:
Community engagement Food choices
Clean bathrooms & environment
Noise levels
ACTIVITY DATE:
WSL Ann Kernan - RCG Tim Greer
TL Steve Mattson - RCG Gillian Otway
Lawrence Nichols
Sponsor Elena Tinloy
Grobal
process
Elaine Lee
Alice ChenKathy Jung
Juliana Oronos Rachael Kagan Bill Kim
Jason Zook Tristan Cook
Dennise RosasKPO
Participants
Sue Currin, CEO Shermineh Jafarieh
James Alexander Valerie Inouye
Baljeet Sangha Terry DentoniLeadership
David Woods
Todd MayIman Nazeeri-Simmons
Cathryn Thurow William Huen
Facilitators
Sue Carlisle
Terry Saltz
Current state
Key features of Improvement Request (Top 12) Business Requirements (Business impact, strategic requirement)
TARGET STATEMENT
Mission & Vision:
Integration: Seamless, Alignment,
Communication, Patient Centered
Data: Actionable, Integrity, Informative,
Timely
Comprehensive Care: Holistic, Timely,
Appropriate, Safe Reliable
Technology: Cost effective, Integrated,
Visionary
2. 3P Emergency Department: Flow in the ED incuding triage, staffing, signaling,
communications, admissions to the floor as well as flexing to meet changes in
demand and acuity.
3. 3P Operating Room/ PACU/ Procedural Services: Shared processes, patient flow and staffing.
3.1 Post 3P KW: Basement 2 flow: Diagnostic Imaging, Pulmonary &
Cardiology - shared processes and patient flow.
1. 3P Inpatient Services March 17-21
Visioning Workshop participants
Cost Effective: No Waste,
Just In Time, Strategic,
Accountable, Informed
Environment: Safe, Healing,
Easy to navigate
Lean: Discipline, Structure,
Continuous Improvement,
Innovative, Engagement
Service Excellence:
Satisfaction, Respectful,
Patient Centered
A3-3PTEAM CHARTER Date: 3-Feb-14
PROPOSED ACTIONFuture state
May 5 - 92. 3P Emergency Department
SFGH Mission: To provide quality healthcare and trauma services with compassion and
respect.
Bldg 25 Vision: To be the best hospital by exceeding patient expectations and advancing
community wellness in a patient centered, healing environment.
ACTION PLAN
© 2009 rona consult ing group
Patient Expectations
Customer Requirements (desirable characteristics)
Product /service name : Building 25
San Francisco General Hospital is a world
class hospital and trauma center in the
elementary stages of adopting new
systems of financial and operational
accountability. As such in our current
state we have silos of excellence
composed of well intentioned, mission
driven staff, hampered by aging
infrastructure, lack of integrated and
optimized technology, and disparate flows
of communiation.
Major barriers include:
Lack of integrated EMR
Lean culture is not universal throughout the
organization
Lack of accountability / alignment at all levels
No universal culture of service excellence
Multiple priorities and scope
Bureaucratic systems
Lack of time
Cumbersome IT systems and access to data
Limited resources, staffing and infrastructure
Partnering with unions
Accountable care act considerations
Goal: To design processes that coordinate the 7
flows of medicine where:
Patient care needs are visual to all care team
members
Patient care goals are understood, and
expectations are communicated early in the
process
There are no waits / delays in care
Care is delivered by respectful , high functioning,
cohesive care teams
Decision making is guided by transparent
information
The EMR, data systems and business intelligence
are integrated
Processes are built around the patient, and
services are brought to the patient whenever
possible
Staffing and support models expand and contract
according to fluctuations in demand and acuity
Reliable processes utilize mistake proofing
concepts to eliminate defects
Our staff has exactly what they need to do their
job
The environment is safe, clean, comfortable and
quiet
RESOURCES
1. 3P Inpatient Services: Optimizing patient flow and quality outcomes, looking at staffing models,
flexing to meet changes in demand and acuity.
1.1. Post 3P KW: L&D: Patient flow, staffing and communications.
1.2 Post 3P KW: Med/Surg: Patient flow, acuity changes, staffing, collaborative teams,
documentation and communication.
Detail action items for 3P workshops (Explanation of and deliverables for each 3P workshop)
Boundaries:
• Sterile processing
• Pulmonary
• GI / Endoscopy
• OR / Pre-op / PACU
• Emergency Department
• Med Surg (Peds, ACE)
• ICU / CCU / Stepdown
• IT Requirements
• Support services that will expand their scope
into the new building: Messengers, Patient
Transport, EVS, etc
Monitor implementation of Kaizen improvements weekly and workshop targets with completion of 30,
60 and 90 day reports as well as daily audits of standard work. Weekly review with executive team.
Develop a visual workplace and methods for communication.
Excluded:
• Unaffected departments not moving into the new facility
Included:
• Cardiology
• Cath Lab
• Diagnostic Imaging
• Interventional Radiology
• Dietary
• NICU
• Labor and Delivery
• Pharmacy
• Clinical Lab/Blood bank
CHECK AND ACT
3. 3P OR & Procedural Services June 23 - 27
On the Horizon
SFGH Management System – KPO Development
– State of the Union for Lean implementation
– Return on Kaizen (ROK) analysis
1 More Value Stream:
Outpatient Pharmacy Kick-Off in March 2014