Things are underway at the 2013 Lean Healthcare Transformation Summit. We have 600 attendees from 39 states and 8 countries.
I will be tweeting, as will others, at the hashtag #HCsummit13.
John Toussaint, MD will be doing his keynote at 8:30 AM EDT. I will be taking notes live in this public google document (also see completed notes below).
Notes
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We need to revitalize this industry
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The people in this room are trying to transform the industry
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3 pillars for this summit and transformation
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Care redesign (including Lean)
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Paying for value
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Transparency
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Tish's story (80 year old patient)
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Many, many errors and problems in her care
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“Her morning meds were given at night and her night meds were given in the morning… but they [the nurses] ignored her.”
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Surgery to correct a hospital-acquired infection
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Waiting, waiting, waiting
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Cultured specimens were lost by the lab
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“Tish noticed nobody who entered the room washed their hands other than the phlebotomist. The antiseptic dispenser was empty.”
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“It takes guts to tattle on your nurse.” Nothing changed.
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Her wishes and concerns were ignored
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A major hospital well known for good safety
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“Is this your health system??” – rhetorical Q
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“After two weeks in the system, she was WORSE then when she started.”
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After three weeks, she was finally better.
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“It doesn't have to be this way.”
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Tish is John's mother in law
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What's the problem? Unfortunately, this is going on a lot in patient care… harming patients.
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What are some of the root causes?
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The overall value stream of cancer care is not viewed as an overall system
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Even though we claim to be highly integrated, we are not
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Lack of an operating system to help fix things – see article
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We've got a problem with our management system – the most important critical factor missing in healthcare is a management system that supports improvement.
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Need to shift from the top-down command and control model to a lean management system
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What can we do about it?
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Shows a ThedaCare cancer value stream map for the entire care process
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Lean management system – connects people and process working for a purpose
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“Management by process” – not “management by objective”
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A3 thinking
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Daily status sheet
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Daily performance and defect review huddle
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Unit-based leadership teams
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Standardized work for leaders and supervisors
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Standardized work audits
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Visual process tracking
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Andons
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“No meeting zones”
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2 hours each morning – so what happens?
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People leading in the gemba, leading by asking questions
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One Iowa org implemented 12,000 staff ideas
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Video of a team “defect huddle”
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Lab orders remaining on care plans – RNs don't know if they've been done or not – why do they remain there?
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Do we have a timeline for when we can come up with a suggestion?
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Asking employees to help solve the problems and improve the process
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Our job as leaders is to help them unravel the giant hairball of problems
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Standardized work for leaders – daily stat sheet (status sheet)
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Asking questions, going off a guide of what to ask and investigate
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As a CEO, are you going to the gemba for 15 minutes every day? (at least?)
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Examine your management system – can it actually support the continuous improvement your staff are trying to make happen?
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Good (in Mark's opinion): staff tracking metrics by pencil at the gema
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Bad (in Mark's opinion): simplistic “red/green” analysis around an (arbitrary?) target. Need better SPC analysis to avoid overreacting to every up and down in the data (see here)
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John talks about the mentoring from Paul O'Neill (he is speaking later today)
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3 questions – can you say yes every day?
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Is everybody treated with dignity and respect by everyone?
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Does everybody had the tools, training, and encouragement to do the work that gives their life meaning?
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Have people received recognition?
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Results
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NYC HHC has saved nearly $250M over 5 years, for example
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It's management by process so we can get results
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Reduced cardiac mortality through use of Lean methods (2.5% lower… not much, but it's lower)
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“This operating system is critical for delivering results.” But we need more than the management system too. Also requires:
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Transparency of patient outcomes:
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Study – MDs that report quality of care measures improve more quickly (Health Affairs)
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The systems that would create this transparency are a mess – no standards, information is locked up for experts to get out
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Much of Tish's story could have been improved by having better information flow
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Need more “Business Intelligence” applied to healthcare
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See CBIN effort
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Payment reform
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Has anybody put it all together?
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HealthPartners in MN – web and mobile transparency… rating the MD clinics on cost and quality, star rating
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Paying differently based on results
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Withhold payment portion and then pay if they hit metrics
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Bonus and public recognition for top 1%
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Triple Aim savings (cost, quality, etc.) – shared savings
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Trying to “pay for value” in MN and WI
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Involving the patient to redesign care
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Wisconsin Statewide Value Committee
(end of talk)
Q&A comments:
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Most organizations haven't mapped out their existing state. They don't know how they are performing.
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Reimbursement is a challenge and a problem in every country
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How many of Tish's problems could have been avoided? 90-95%? One or both hospitalizations could have been avoided?
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Q: How do we get MDs to follow standardized work?
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John says we need to look at the system… the system is designed for people to not follow SW
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(Mark's commentary… we can't force anybody to do anything)
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- don't just Plan and Do and Run – focus on Study and Adjust!
Photo below by Bobby Gladd. See his blog post about the Summit here.
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