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When Lean Events or Kaizen projects are not enough… Using lean training to embed lean practice throughout the organization. Denver Health Lean Initiative Who is Denver Health? Why we chose Lean? Lessons learned in the early years Training of DH black belts Realignment of purpose

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when lean events or kaizen projects are not enough

When Lean Events or Kaizen projects are not enough…

Using lean training to embed lean practice throughout the organization.

denver health lean initiative
Denver Health Lean Initiative
  • Who is Denver Health?
  • Why we chose Lean?
  • Lessons learned in the early years
  • Training of DH black belts
  • Realignment of purpose
  • 2009 case studies and ROI

Denver Health

Denver Health Medical Center

Rky Mtn Regional Trauma Ctr

Rocky Mtn Center for Medical Response to Terrorism


Public Health

Regional Poison Center & Nurse Advice Line

Community Health Clinics

Denver Health Medical Plan

School-based Health Clinics

Correctional Care

Denver Cares

denver health medical center
400 bed safety net hospital

Integrated outpatient clinics

140,000 unique users

300 employee physicians

5332 employees

Teaching hospital

Level I trauma center

3800 deliveries per year

$1.1 billion per year in gross charges

Uncompensated care $350 million (2009)

Operating in the black for 18 years

Meeting and exceeding UHC benchmarking data in 60%+ categories

Denver Health Medical Center
decision june 2005
Decision, June 2005
  • Health Care is being delivered in much the same way as it was 40 years ago
  • Health care is full of waste and inefficiencies
  • Other industries have successfully transformed the way they do business
  • Denver Health, a community safety net hospital, expects public financial reimbursement to shrink
  • Demand for services are up
  • We (as an industry or institution) have no cohesive approach to quality and productivity improvement

Getting It Right

  • Transforming Denver Health
  • Getting it Right = Perfecting the Patient Experience
  • Patricia Gabow, MD




Right Process

Right Communication

Right Environment

Right Reward

choosing a methodology
Choosing a Methodology
  • Consulted with industry leaders
  • Chose Lean methodology and Toyota Production System to transform delivery of health care
  • Simple, intuitive
    • Drives culture change
    • Quality and financial ROI

“Saving lives, saving money, saving jobs!”

lean is a people driven process at toyota we build people before we build cars toyota
Lean is a people driven process, …”At Toyota we build people before we build cars.”Toyota
invest in people
Invest in People
  • Best and the brightest people to lead not manage the transformation…
  • Characteristics
    • Work well in teams
    • Identify and solve problems
    • Love to learn
    • Are innovative, early adopters
    • Excel at communication
the launch
The Launch
  • MAMTC: Mid-America Manufacturing Technology Center®
  • Training of 50 Denver Health managers, supervisors, physicians, and other organizational leaders completed by spring, 2005
  • DH Black Belts (BBs) utilize lean for daily improvements and to conduct Rapid Improvement Events
performing kaizen events the early days
Performing Kaizen Events:The Early Days
  • Coordinated by Director of Health Services Research
  • Utilized DH Black Belts as facilitators, team leads, and process owners
  • Realized some success but difficulty with event preparation and follow-up
step off the edge
Step off the edge…
  • 5S everywhere
  • VSA the operative services (this would be our model value stream)
  • 5 rapid improvement events (RIE) in the OR… the same week! (What were we thinking?)
early lean victories
Early Lean Victories
  • Organization-wide 5S…Sort, Set in Order, Shine, Standardize, Sustain
  • 5S of medical offices, clinics, nursing units, engineering, respiratory therapy, and the lab, ambulances, storage areas…pretty much everywhere!
  • Immediate positive feedback
black belts phase i
Black Belts Phase I
  • Train “leaders” in the organization
  • 50 the first year
  • Monthly reports
  • $$ value of efforts
  • Independent of value streams and lean events
  • Expectation to be a team lead on two rapid improvement events
black belt projects big and small
Black Belt Projects: Big and Small
  • Engineering: $448,275. in supply expenses
  • Acute Care: 657 cans of tube feeding (approx $2,000./year) returned
  • Address discrepancies in billing patient bed types in SICU for trauma and isolation patients $381,790.

Frank format picture size

To 3.63” h and 4.84”w


Unit 1, Basement, Bedroom, Plumbing (BEFORE)

Frank Ortega 4/19/06

Unit 1, Basement, Bedroom, Plumbing (AFTER)

Frank Ortega 5/2/06

results year one

Results: Year One +

40 rapid improvement events

$3.5 million saved or new revenue identified

236 employees engaged

50 black belts trained

sample events rie
Sample Events RIE
  • Surgical infection rate (quality)
  • Clinic flow (increased productivity)
  • Financial agreements (improved revenue)
  • Room turnover ophthalmology (efficient use of resources)
rethinking phase ii
Rethinking, Phase II
  • Many successful RIE events, good ROI
  • New Lean Systems Improvement Department with Senior Facilitator and Simpler Business Systems sensei
  • Expanded from 5 to 14 value streams
  • Full time facilitators (7)
  • However…Black Belt projects $$ROI flat!
bringing black belt training in house
Bringing Black Belt Training In-House
  • Spring 2007
  • Training organized into three categories:

II. Tools Used to Eliminate Waste:

Standard Work, 5/6S, Visual Management, Mistake Proofing, Kan Ban-Pull Systems, Flow Cells, Level Loading, Quick Changeover, Production Control Board

I. Tools Used to Identify Waste:

Process Map, Spaghetti Diagram, Communication Circle, Waste-Walk,, Time Observation, Takt Time, Bar Charts, Fishbone Analysis

III. Using Tools in Focused Manner:

RIEs, Value Stream Analysis, 2P/3P

dh black belts
DH Black Belts?
  • All BB nominees come from the executive staff
  • All black belt trainees are selected by the CEO
  • 50+ BB train each year
  • 60 hours of training
  • Advanced BB training 24 hours
  • All departments represented
  • Middle management level and above
current state
Current State
  • 172 BB trained
  • 150 remain in organization
  • January 2009 accountable for ROI for projects of $30,000. each for year
  • Do bi-monthly reports
  • Financials vetted by budget analysts
  • Reports and results reported on SharePoint site
  • Additional financial incentives if BB exceeds financial goals
denver health black belts
Denver Health Black Belts

Abrams, Lisa; Adams, Cheri L; Albert, Rick ; Alexander, Wendy; Anderson, Mark; Andis, Ann; Askenazi, Morris; Balshaw, Donna; Barrow, Bobbi; Batal, Holly;Beauchamp. Kathy; Beauchamp, Louis; Beckmann, Catherine; Benedict, Mike; Bjork, Andrew; Blair, Patti; Bliss, Heide; Boyle, Kathy; Brewis, Patty; Brandt, Jeffrey; Branigan, Timothy; Brown, Jennifer; Browne, Margaret; Callahan, Annette; Campbell, Margie; Cannon, Ingrid; Carey, J. Chris; Carpenter, Debra; Carroll, Kim; Chu, Eugene; Clark, Jonathan; Colwell, Chris; Crawford,Debbie;Dingley, Catherine; Doherty, Niall; Donovan, LeAnn; Duke,James; Eisert, Sheri; Ellis, Andrea; Entwistle, Julie; Fluent, Jay; Fox, Rebecca; French, Richard; Geninger, Mark; Gerardi, Joseph; Gomez, Victor; Goodman, Philip; Gorsegner, Scott; Greenstone, Naomi; Gutierrez, Pete; Haenel, James; Hak, David;Hambidge, Simon;Hanley, Michael; Harding, Mario; Hess, RCraig; Higgins, Nancy; Holzwart, Jean; Hoye, Scott; Humphress, Marcia; Jackamore, Stephen; Johnson, Eliza; Kane, Lee Ann; Kashuk, Jeffrey; Kassatly, Carmen; Kaufman, Linda; Keller, Pat; Keniston, Angela; Kilfoyle, Mary; Kim, Esther; Klock, Nancy; Kukolja, Teresa; Lamberis, Paul; Lamont-Anich, Diane; Lanius, Patricia; Lee, Jay; Leeret, Rob; Leger, Vickie; Limberis, Paul; Lindroos, Beth; Linehan, Deborah; Lockrem, John, M.D.; Lee, Long, Jeremy; Loomis, Lucy; Lovseth, Carol; Mabb, Jodi; MacKenzie, Thomas; Magee, Mary; Markson, Deb; Masi, Joseph; McCloskey, Tom; McDonald, Nancy; McEwen, Dean; Mestas, Tricia; Metropulos, Peter; Miller,Howard; Milton, Brian; Moldenhauer, Kendra; Morgan, Steven; Muchow, Trish; Mucklow, Sheila; Mulhern, Ellen, R.N.; Nagy, Robyn ; Nelson, Kim; Nugent, Michael; O’Brien, Kelly; O'Malley, Mike; Ogle, John; Parnigoni, Kelly; Paulson, Pam; Pelot, Jeffrey; Pettigrew, Philip; Pinkney, Mary; Potocnik, Julie; Proudfoot, Susan; Quintana, Tina; Reid, Mark; Robinson, James; Rossman, Greg; Ryan, Mimi; Ryder, Elizabeth; Sangster, Tom; Sawyer, Michael; Scherger, Deb; Schneider, Bettina; Shecter, Barbara; Shockley, Lee; Stephenson, Cheryl; Stiglich, Norma; Szceapanski, Jen; Tann, Sheila; Thompson, John; Thress, Greg; Townsend, Ron; Ullrich, Shawn; Uran, Kathryn; Van Dyk, Susan; Vance, Anna; Vincent, Audrey; Walker, LaVonna; Ward, Rachel; Wolken, Bob; Wright, Mark; Wruk, Kathleen

phase iii what s working
Phase III, What’s Working?
  • Created an alignment of purpose
  • BB have accountability to $$ metric
  • Value streams have accountability to a $$ metric
  • Organization is accountable for

$30 Million from Lean efforts (2009)

lab savings
Lab Savings
  • Savings:
    • Reagent and Supply Savings: $88,000/5yr
    • Maintenance Contract Savings: $5,500/yr
    • SpecTrak Software at no cost: $25,000/1X
    • FTE:
      • Maintenance on multiple platforms: 257 hrs/yr
      • Decreased QC Prep and Runs: 888 hrs/yr
      • Auto-verification of Normal Results: 893 hrs/yr
        • Bring more testing in-house to decrease referral testing costs (HCV, Vitamin B12) $31,000 in 2008
        • In progress: Flow Cytometry, BNP, HIV Gene Prove ID, PCR for Infectious Disease
black belt projects good to the last puff
Black Belt Projects: Good to the Last Puff!
  • Black belts need to question establish processes to determine if there is a better way.
  • Combining with peers creates results
  • $200,000 + predicted savings

The Wastes this project eliminates:

Overproduction, Inventory, Over-processing

  • Contact Information: nancy.mcdonald@dhha.org
  • Lean Systems Improvement Department

777 Bannock St, MC 8702

Denver, CO 80204-4507

303 602 7030