Mr. Potato Head: A LEAN, Mean Quality Improvement Teaching Machine! Beth Murphy, MD Ambulatory Block QI Session #2 2013-2014
Mr. Potato Head: A LEAN,
Mean Quality
Improvement Teaching
Machine!
Beth Murphy, MD
Ambulatory Block
QI Session #2
2013-2014
Mr. Potato Head Facts
• Created by George Lerner in Brooklyn, NY
– Jumble of accessories meant to pierce a real potato
– Sold idea for $5000 to a cereal maker in 1951
• 1952- Rights acquired by “Hasbro”
• 1952-First toy advertised on TV and the first marketed directly to kids
• 1987-“Spokes spud” for ACS Great American Smokeout
• Resurgence in 1990’s with Toy Story Movies/Disney
• 2000-RI State Family Travel Ambassador & License Plate
• > 100 million have sold over past 60 years
Source: Yankee Magazine, Dec 2012
Mr. Potato Head
LEAN Simulation Exercise • A fun, interactive, innovative way to demonstrate:
– Quality Improvement concepts
– Patient Safety/Medical Errors
– LEAN Process Management
– Teamwork
– Communication
• Can do with 4 to >100 learners
• Can do with learners of all levels and disciplines
Mr. Potato Head has Traveled
California Adventure
Anaheim, CA
Downtown Disney
Orlando, FLA
Mr. Potato Head
• Created by Eric Dickson, MD
• UMMHC President and CEO
• ER physician
• Professor of Emergency Medicine
• Institute for Healthcare Improvement
Lean Process Management
• Derived from Toyota Production System
• Efficiency and Quality are both important
• Every step in process should add “VALUE”
• Eliminate all “WASTE” from the system
• EVERY member of the team is valued for
their contributions to the process AND their
ideas for improving the system/insuring
safety
“At Toyota we get brilliant results from
average people managing a brilliant
process. Others get average results from
brilliant people managing broken
processes.”
--The Toyota Motor Company
Even Mr. Potato Head has Gone
“Lean”
BEFORE A Slimmed Down Spud
LEAN BELT PROGRESSION
YELLOW BELT=SOME TRAINING
GREEN BELT=USES TOOLS
BLACK BELT=PROJECT LEADER
WHITE BELT=AWARENESS
• What do your patients value?
• What do you value as an employee?
Value
TYPES OF WORK
Work/Service the patient cares about and is willing to pay for
Face time, Diagnosis, Treatment Non-Value Added
(Required)
Non –Value Added
PURE WASTE
Value Added
Value-Added Work
No value in the patient’s eyes, but can’t be avoided
o Billing, Regulatory tasks
Consumes resources but doesn’t add value.
o Looking for supplies
o Patient/Staff waiting
o Re-work, redundant paperwork
Required Non-Value Added Work
Pure WASTE – Non-Value Added Work
Forms of Waste: DOWNTIME
• Defects • Overproduction • Waiting • Not Utilizing the Creativity of all Employees • Transport • Inventory • Motion • Extra-processing
There’s been a terrible accident!
The Situation…
• A bus filled with 16 Potato Head family
members is in a terrible crash!
• EMS arrives at the scene to find only
potato body parts scattered about.
• Luckily, there is an electronic medical
record showing what each family member
looks like.
The Game
• Your “team” is the Trauma Team in the ER
• The goal of the game is to accurately assemble as many “patients” as possible in 7 minutes
The Rules 1. Only 2 people from each team can
physically implant the Potato Head body parts (”Implantation Specialists”)
2. Completed “patients” must be inspected.
3. There are no other rules.
Before we start…
We need 3 brave volunteers
System 1 System 2 System 3
Systems & “Waste”
First Lessons Learned
• Quality is influenced more often by the SYSTEM than the individual players
• How much “waste” is actually in “the system”
• Think LEAN!!
ASSEMBLE YOUR TEAMS
• Choose your 2 “Implantation Specialists”
• Patient photos in the bag
• Bring assembled patients to
Check Out
• You have 2 minutes to plan
your team’s “system”
• You have 7 minutes to
process all 16 patients.
TAKE A FEW MINUTES..
Take 2 Minutes to
plan your team’s
system.
Inspection Stations
Bring completed
patient AND
photo to your
designated
inspection
station
• http://www.online-stopwatch.com/full-screen-stopwatch/
• Why did we pick 7 minutes?
– If it takes 20-30 seconds to correctly assemble one Potato Head with no waste in the system, it should take maximum of 8 minutes to assemble all 16 if only 1 assembler. You have an entire team!
• Guinness Book of World Records’ fastest assembly of a Mr. Potato Head: Samet Durmaz of Turkey.
7 Minutes!
6.62 seconds!
Tracking Your Data/Progress
PDSA 1 # built # errors # started Time to 1st
assembly
Team 1
Team 2
Team 3
PDSA Cycle #1
• How many patients did you treat correctly during this cycle?
• How many errors did your team make?
• How long did it take you to complete first one?
• What changes will your team make for next cycle to eliminate waste and improve both quality and efficiency?
Sharing Best Practices
• Team with Most # Patients Seen
• Team with Least # Errors
PDSA CYCLE
TYPES OF WORK
Work/Service the patient cares about and is willing to pay for
Face time, Diagnosis, Treatment Non-Value Added
(Required)
Non –Value Added
PURE WASTE
Value Added
Value-Added Work
No value in the patient’s eyes, but can’t be avoided
o Billing, Regulatory tasks
Consumes resources but doesn’t add value.
o Looking for supplies
o Patient/Staff waiting
o Re-work, redundant paperwork
Required Non-Value Added Work
Pure WASTE – Non-Value Added Work
Forms of Waste: DOWNTIME
• Defects (Medical Errors) • Overproduction (Unnecessary testing) • Waiting (Patients and Employees) • Not Utilizing the Creativity of all Employees • Transport (Moving patients) • Inventory (Equipment, Discharge delays) • Motion (Physical Plant/Flow) • Extra-processing (Retesting, Readmissions)
BACK TO YOUR TEAMS
Take 2 Minutes to
discuss how your
team will improve
the quality and
efficiency of your
patient care.
Start PDSA CYCLE #2
• Switch Bags!
– You don’t see the same patients every day!
• Notice there are many differences in each
body part (i.e. ears, eyes, mouths)
– Demonstrates how each patient is unique!
• You have 7 Minutes!
• http://www.online-stopwatch.com/full-
screen-stopwatch/
7 Minutes!
PDSA Cycle #2 • How many patients did you treat
correctly during this cycle?
• How many errors did your team make?
• How long did it take you to complete your first patient?
• How would you plot your data?
• What changes will your team make for next cycle to eliminate waste and improve both quality & efficiency?
Tracking Your Data/Progress
PDSA 2 # built # errors # started Time to 1st
assembly
Team 1
Team 2
Team 3
RUN CHART: Plotting Your Data/Progress
0
2
4
6
8
10
12
14
16
PDSA 1 PDSA 2 PDSA 3
Team 1
Team 2
# P
atie
nts A
sse
mb
le
d
For PDSA Cycle #3 • There’s been a change at work.
• Your Implantation Specialists have decided to work for your competing medical system across town and you now have Locum Tenens MDs filling in.
• Implantation Specialists must switch tables!
BACK TO YOUR TEAMS
Take 2 Minutes to
discuss how your
team will improve the
quality and efficiency
of your patient care
with NEW TEAM
MEMBERS!
Start CYCLE #3
• Switch Bags Again!
• You Have 7 Minutes!
• http://www.online-stopwatch.com/full-screen-
stopwatch/
Review PDSA Cycle #3
• How did your new team do?
• How did having new team members effect your quality and/or efficiency?
• Did you change your system?
If we did PDSA Cycle #4… • Unfortunately, Federal Budget
cuts continue and reimbursements from Medicare and Medicaid are down substantially.
• We have to lay off one team member from each team…
• The tallest person on the team has to step away from the table and observe
Team Outcome Review
What I learned from Mr. Potato Head:
1. The system is the critical determinant of performance.
2. Good communication is essential for a high-functioning team.
3. Good ideas for improvement can come from anyone on the team.
4. Data is essential to drive improvement efforts.
5. Repeating PDSA cycles is a valuable process.
6. Efficiency is enhanced when value-added work is increased and waste is reduced. (LEAN)
7. With very simple changes in system, you can improve quality, efficiency, and safety!
8. QUALITY IMPROVEMENT CAN BE FUN!
MEDICINE IS A TEAM SPORT!
Remember…There are “Different” ways
to achieve the same goals…
Suitcase of Tools
Thank you for participating!
Be sure to take these tools
back with you to your clinics,
wards, ward/ICU teams!
With very small changes, you
can make BIG differences in
both safety and efficiency!
Questions/Comments?