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Leadership for Reliable Systems August 21, 2006. The Quality Colloquium. Stephen R. Mayfield Senior Vice President [email protected] Visualize Success:. We Don’t all SEE the Same Thing. Seeing Differently. De Kalb, Illinois DeKalb, Georgia. Leaders Create the Vision and Set Direction.

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slide1
Leadership for Reliable SystemsAugust 21, 2006

The Quality Colloquium

Stephen R. Mayfield

Senior Vice President

[email protected]

visualize success
Visualize Success:

We Don’t all SEEthe Same Thing

seeing differently
Seeing Differently
  • De Kalb, Illinois
  • DeKalb, Georgia
leaders create the vision and set direction
Leaders Create the Vision and Set Direction

“Would you tell me please which way I ought to go from here?” asked Alice.

“That depends a good deal on where you want to get to,” said the cat.

“I don’t much care,” said Alice.

“Then it doesn’t matter which way you go,” said the cat.

leaders create expectations
Leaders Create Expectations
  • Leaders ->

Values ->

Behaviors ->

Culture ->

Performance

Courtesy of Ann Rhoades

leaders must
Leaders Must
  • Eliminate Preventable Harm
  • Develop Highly Reliable Systems
  • Improve Outcomes Year-to-Year
  • Reduce Costs of Care Year-to-Year
unceasing efforts to
Unceasing Efforts to :
  • Remove Waste
  • Eliminate Defects
  • Reduce Variability

“All work is a system, every system has processes and every process has waste and variability.”

relentless pursuit of waste
Relentless Pursuit of Waste
  • Public perception, the Camry Effect and Community Contribution
other approaches exist
Other Approaches Exist
  • Juran: “There is 30% waste in most healthcare processes”
  • Dartmouth study: “Providers in Salt Lake are number one, if all providers emulated their efficiency CMS could save 30% in expenditures”.
reliability and the four components of care delivery
Reliability and the Four Components of Care Delivery

Patient Information

Clinical Decision

Care Process

Patient Flow

visualize success14
Visualize Success:

We Need to SEEour Processes

our approach to date is not yielding desired rate of change
Our Approach to Date is not Yielding Desired Rate of Change
  • We have believed that –
  • If we have enough of the right data –
  • Analysis will indicate compelling need to change –
  • Change will therefore occur
reliability and the four components of care delivery17
Reliability and the Four Components of Care Delivery

Patient Information

Clinical Decision

Care Process

Patient Flow

systems of care and simple metrics information clinical decisions care processes patient flow
CD

CD

CD

Systems of Care and Simple MetricsInformation -> Clinical Decisions -> Care Processes -> Patient Flow

Evidenced Based

Medicine

Clinical Information System

Outcome

Indicators

(LOS, Mortality, Infection, Readmits)

Financial System

Clinical Best

Practices

Charges

Cp1 + Cp2 + Cp3….

Cp1 + Cp2 + Cp3….

Cp1 + Cp2 + Cp3….

Process Measures

(Waste, SMR, Cycle Time Variances, etc.)

Patient

Patient

Patient

Patient

Patient Flow

innovation in reliable care
CD

CD

CD

Innovation in Reliable Care

Evidenced Based

Medicine

EMR & Orders

Free of Preventable Harm

CPOE

Clinical Information System

Outcome

Indicators

(LOS, Mortality, Infection, Readmits)

Financial System

Clinical Best

Practices

Charges

Timely Resulting

RFID

Sponges

I.D. and Match

Cp1 + Cp2 + Cp3….

Cp1 + Cp2 + Cp3….

Cp1 + Cp2 + Cp3….

Process Measures

(SMR, Cycle Time Variances, etc.)

Safe Meds

Accurate Labs

Patient

Patient

Patient

Patient

Patient Flow

RFID Location

lean six sigma more value
Lean + Six Sigma = More Value

# Steps + 3σ+ 4σ+ 5σ+ 6σ

1 93.32% 99.379% 99.9767% 99.99997%

7 61.63% 95.733% 99.839% 99.9976%

10 50.08% 93.96% 99.768% 99.9966%

20 25.08% 88.29% 99.536% 99.9932%

40 6.29% 77.94% 99.074% 99.9864%

Lean Reduces non-value add steps

Six Sigma improves quality of value-add steps

leaders must21
Leaders Must
  • Eliminate Preventable Harm
  • Develop Highly Reliable Systems
  • Improve Outcomes Year-to-Year
  • Reduce Costs of Care Year-to-Year
unceasing efforts to22
Unceasing Efforts to :
  • Remove Waste
  • Eliminate Defects
  • Reduce Variability

“All work is a system, every system has processes and every process has waste and variability.”

the 8 deadly wastes
The 8 Deadly Wastes
  • Overproduction
  • Waits/Delays
  • Transport
  • Process
  • Movement
  • Inventory
  • Defects
  • Underutilization
data collection
Data Collection
  • Design instrument
  • Develop plan
  • Collect Information
  • Found 3 Problems: Matching, Batching Attaching
over 40 specific defects identified in 6 classes
Over 40 specific defects identified in 6 classes:
  • Label defects (unlabeled, misplaced, wrong patient labels, misaligned, etc.)
  • Patient ID band defects ( improper matching, no label, wrong label, etc.)
  • Unsuccessful draw (not first stick, second phlebotomist required)
  • Unacceptable specimen/recollect (wrong tube, clotted, hemolyzed, insufficient quantity, contaminated, overfilled, etc.)
slide34
Prevention – Appraisal – Failure:

Visible Defects and

Direct Costs are

The Tip of the Iceberg!

slide38
SIPOC Interventional Scheduling

Suppliers

Inputs

Process

Outputs

Customers

Requirements

Physician

Patient

Radiologist

Pathology/Lab

Nursing/ I.P.

Registration

Convenient

Accurate Results

Timely On Demand

Convenient

Clear expectations

Timely Results

Results

Previous Exam

Good History

Convenient Schedule

H&P

Accurate Scheduling

Completed record

Demographic info

Payer info

ICD 9

See Below

Orders

Patient Information

Schedule Information

Capacity

Staffing

Physicians

Completed Procedure

Specimen Obtained

Results in System

Receive call from Physician for Interventional test

Approve Test

Contact ordering Physician, Schedule test

Patient enters our “system” (“Orders, Labs, H&P)

Administer and complete test

data collection40
Data Collection
  • Data Collection

bserving the Process

min max
MinMax

609 Min

234 Min

62 Min

the 8 deadly wastes48
The 8 Deadly Wastes
  • Overproduction
  • Waits/Delays
  • Transport
  • Process
  • Movement
  • Inventory
  • Defects
  • Underutilization
visualize success52
Visualize Success:

We Need to SEEour Processes

our mission
Our Mission
  • The AHA Quality Center™ is a resource of the AHA designed to help providers accelerate their quality improvement processes to achieve better outcomes for patients and improve organizational performance.  
  • In collaboration with leading quality improvement stakeholders, it provides access to leading practices, tools and resources that support providers to achieve better patient outcomes, improved operational performance, enhanced safety and increased satisfaction. 
increasing pressure on hospitals providers
Need for accurate patient I.D. and Matching.

Increasing numbers of older and more acute patients.

Increased volumes through the E.D.

Increasing incidence of HAI.

Pay for Performance initiatives.

Reduced reimbursements.

Pressure for public reporting.

Medication errors and harm.

Patient falls.

Poor handoffs.

Delays, queues, bottlenecks.

Incomplete information for decisions.

Rework.

Staffing and resources.

Pressure to define and assess “Quality.”

Increasing Pressure on Hospitals & Providers
the quality center will support the continuum of care
The Quality Center will support the continuum of care:
  • Improve throughput and reduce LOS.
  • Reduce readmissions.
  • Improve patient identification and matching.
  • Reduce Healthcare associated infections (HAI).
  • Improve medication safety.
  • Reduce incidence of falls.
  • Improve top clinical processes.
  • Reduce mortality.
  • Improve financial performance

(C/Adj/DC).

unceasing efforts to57
Unceasing Efforts to :
  • Remove Waste
  • Eliminate Defects
  • Reduce Variability

“All work is a system, every system has processes and every process has waste and variability.”

some wicked questions
Some Wicked Questions
  • What are we trying to accomplish with respect to our performance?
  • What level of quality and safety are we pursuing?
  • How do we measure it?
  • How is our performance changing?
  • What are we doing to improve it?
  • What are our latent costs?
  • What are our Costs of Poor Quality?
  • How is the CFO involved?
leaders must59
Leaders Must
  • Eliminate Preventable Harm
  • Develop Highly Reliable Systems
  • Improve Outcomes Year-to-Year
  • Reduce Costs of Care Year-to-Year
slide61
Leadership for Reliable SystemsAugust 21, 2006

The Quality Colloquium

Stephen R. Mayfield

Senior Vice President

[email protected]

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