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The shortest distance between You and Improved
Lean, Six Sigma & Emotional Intelligence
Medical Staff Presentation
April 1...
The shortest distance between You and Improved
Program Overview
• Introduction to Lean & Six Sigma
• Case Study
• What we’...
The shortest distance between You and Improved
We believe that healthcare leaders should have
all the tools they need to e...
The shortest distance between You and Improved
Insert your own horror story here
The time I was abandoned by Air China in ...
The shortest distance between You and Improved
Why improve processes
when you can simply apologize nonstop?
The shortest distance between You and Improved
Why improve processes
when you can simply apologize nonstop?
Is this an
opt...
The shortest distance between You and Improved
Better idea: “Learn to Lean”
Accelerate the speed and reduce the cost of an...
The shortest distance between You and Improved
Cost of Quality
© All Rights Reserved.
Up to 40%
Productive
Quality
Adding
...
The shortest distance between You and Improved9
Cost of Poor Quality
• 20% to 50% = not always valued by the
customer
• Up...
The shortest distance between You and Improved
Why is it difficult to
eradicate waste?
Patient
Asks for
Information
Patien...
The shortest distance between You and Improved
Bottlenecks
Flow of work = process time + delay time = cycle time!
The shortest distance between You and Improved
Hand-offs
“Lessons from DMV”
The shortest distance between You and Improved
PULL
PERFECTION
Principles of Lean Thinking
© All Rights Reserved.
VALUE1.
...
The shortest distance between You and Improved
“The Hidden Hospital”
Rework
Hidden Hospital
NOT OK
OperationInputs First T...
The shortest distance between You and Improved
VALUE-ADDED
• Alters the work
• Meets customer
wants or needs
• Is done rig...
The shortest distance between You and Improved
Mastectomy Mistake: 'You Don't Have Cancer‘ Woman Told She Has Breast Cance...
The shortest distance between You and Improved
Two Six Sigma “blackbelts” sitting at a bar...
The shortest distance between You and Improved
Six Sigma is Process Improvement
Process
X1
X2
Y
X3
Process Input
Variables...
The shortest distance between You and Improved
Six Sigma is Project Management
Who is the customer?
What do they want?
Is ...
The shortest distance between You and Improved
Six Sigma is a Metric
s s s s s s
LSL m
A six-sigma (6s) process
The distan...
The shortest distance between You and Improved
A Six Sigma Project
“Home Run”
 Identify and eliminate NVA activity
 Iden...
The shortest distance between You and Improved
System Performance
0
100
200
300
400
500
600
700
800
900
50.00% 60.00% 70.0...
The shortest distance between You and Improved
System Performance
0
100
200
300
400
500
600
700
800
900
50.00% 60.00% 70.0...
The shortest distance between You and Improved
Linking Lean and Six Sigma
• While Six Sigma will focus on the “critical fe...
The shortest distance between You and Improved
USLLSL
Center
Process
Reduce
spread
USLLSL
Off-Center
USLLSL
Unpredictable
...
The shortest distance between You and Improved
Case Study:
Lean Project in Hospital Lab
The shortest distance between You and Improved
Problem Statement: Survey data from the American College of Pathologists sh...
The shortest distance between You and Improved
• Phlebotomist not available (28)
• Locating patient (26)
• Patient refusal...
The shortest distance between You and Improved
• Phlebotomist not available (28)
• Locating patient (26)
• Patient refusal...
The shortest distance between You and Improved
Measure Phase
Determining Stability of Process
Establishing Baseline Perfor...
The shortest distance between You and Improved
Whether Lean or Six Sigma,
it all begins with Current State
The shortest distance between You and Improved
Process Flow Diagram - Troponin
ED
Lab1
Lab 2
ED
Start
Physician
Writes Ord...
The shortest distance between You and Improved
30 90 150 210 270 330 390
95% Confidence Interval for Mu
66 71 76 81
95% Co...
The shortest distance between You and Improved
Analysis Phase
“Rounding up the usual suspects”
Hypothesis testing
Identifi...
The shortest distance between You and Improved
In search of “X”
Analysis of Troponin Process
• Ho: No significant delay du...
The shortest distance between You and Improved
Does a multiple draw cause cycle time to increase or
decrease, or is it unr...
The shortest distance between You and Improved
Mood Median Test: TAT for Multiple vs Single Draw
Chi-Square = 37.60 DF = 1...
The shortest distance between You and Improved
Does it make a difference if Phlebotomist utilizes
Tube System or drops sam...
The shortest distance between You and Improved
Does it take a significant amount
of time for the Technician to inspect and...
The shortest distance between You and Improved
Improve Phase
FMEA Initiation
Brainstorming solutions
Fundamentally changin...
The shortest distance between You and Improved
Easy Hard
Ensure draw for
Troponin 100%
of the time
Leverage
Nurse-initiate...
The shortest distance between You and Improved
Trial Summary: Overall Performance
(new draws only)
• Troponin Before
– Ord...
The shortest distance between You and Improved
30 60 90 120 150 180 210
95% Confidence Interval forMu
55 59 63
95% Confide...
The shortest distance between You and Improved
6305805304804303803302802301801308030
95% ConfidenceInterval forMu
51.550.5...
The shortest distance between You and Improved
Control Phase
Celebrating Success
Holding the Gains
Looking Ahead
The shortest distance between You and Improved
Process Step
What's
Controlled?
Spec. Limits /
Requirements
Measurement Met...
The shortest distance between You and Improved
How we’ve evolved as an
organization, and
what we’ve learned
The shortest distance between You and Improved
Performance
Improvement
Training
&
Credentialing
How we’ve evolved as an or...
The shortest distance between You and Improved
“Culture Eats Lunch”
Q x A = E
Business
Results
Quality of solution times i...
The shortest distance between You and Improved
The ”burning platform” approach to
change management
© All Rights Reserved.
The shortest distance between You and Improved
• A man working on an oil platform in the North Sea
awakened one night by a...
The shortest distance between You and Improved
The shortest distance between You and Improved
The Golden Rule has Limits!
The shortest distance between You and Improved
EQ Leadership
• EQ leaders create resonance
(connection) among their
follow...
The shortest distance between You and Improved
Why EQ Leadership?
The shortest distance between You and Improved
EQ Leadership
• How to recognize the behavioral
styles of peers and subordi...
The shortest distance between You and Improved
Champion
Training
&
Candidate
Selection
Performance
Improvement
Training
&
...
The shortest distance between You and Improved
• Number of CHC Clients = 10
• Number of Projects = 150
• Average Cost per ...
The shortest distance between You and Improved
$-
$20,000,000
$40,000,000
$60,000,000
$80,000,000
$100,000,000
$120,000,00...
The shortest distance between You and Improved
What Success Looks Like
A statistically significant improvement in “Corpora...
The shortest distance between You and Improved
Thank you for the opportunity to be with you today!
Ian R. Lazarus
irl@crea...
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Lean, Six Sigma and Emotional Intelligence

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An introduction to Lean and Six Sigma process improvement techniques as well as Emotional Intelligence in leadership to a medical staff. Using Lean can help 1) Reduce cost 2) Improve Reliability and Safety and 3) Increase the Quality of Care. Using Six Sigma can improve processes by reducing variation. Leadership with high Emotional Intelligence create the optimal environment to implement Lean and Six Sigma strategies.

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Lean, Six Sigma and Emotional Intelligence

  1. 1. The shortest distance between You and Improved Lean, Six Sigma & Emotional Intelligence Medical Staff Presentation April 15, 2015
  2. 2. The shortest distance between You and Improved Program Overview • Introduction to Lean & Six Sigma • Case Study • What we’ve learned from 16 years in supporting health systems
  3. 3. The shortest distance between You and Improved We believe that healthcare leaders should have all the tools they need to excel in their mission. Segment Leadership: • Founded 1998 • ACHE, ASQ, & UM solutions • Prolific publishing activity • Average tenure per staff > 12 years • Full suite of PI technologies • Pure production in healthcare space • 3 Baldrige Award winning clients
  4. 4. The shortest distance between You and Improved Insert your own horror story here The time I was abandoned by Air China in Beijing The time(s) Delta lost my luggage in Italy The time United changed my flight without telling me The time I was stuck on the tarmac in Denver for hours… The time I was stuck on the tarmac in Phoenix for hours.. The time I was stuck on the tarmac in Boston for hours…. The time I was…….
  5. 5. The shortest distance between You and Improved Why improve processes when you can simply apologize nonstop?
  6. 6. The shortest distance between You and Improved Why improve processes when you can simply apologize nonstop? Is this an option for your Organization ?
  7. 7. The shortest distance between You and Improved Better idea: “Learn to Lean” Accelerate the speed and reduce the cost of any process by removing non-value-added activities “Re-examine the way you think about waste, as it is often difficult to recognize. Start by making waste obvious to everyone.” Taiichi Ohno, Founder Toyota Production System
  8. 8. The shortest distance between You and Improved Cost of Quality © All Rights Reserved. Up to 40% Productive Quality Adding Features • Preventing problems • Detecting and correcting problems before the customer sees them • Dealing with problems after they occur
  9. 9. The shortest distance between You and Improved9 Cost of Poor Quality • 20% to 50% = not always valued by the customer • Up to 40% of the expense budgets in an organization are associated with COPQ (it may be even higher in health care) • Every 4% reduction in waste increases operating margin by 1% • - Murphy Leadership Institute
  10. 10. The shortest distance between You and Improved Why is it difficult to eradicate waste? Patient Asks for Information Patient Gets Answer PERCEIVED WAIT TIME Patients over estimate their wait time by 50% or more; PERCEPTION IS REALITY A B C D ACTUAL WAIT TIME Determined by the process to retrieve information
  11. 11. The shortest distance between You and Improved Bottlenecks Flow of work = process time + delay time = cycle time!
  12. 12. The shortest distance between You and Improved Hand-offs “Lessons from DMV”
  13. 13. The shortest distance between You and Improved PULL PERFECTION Principles of Lean Thinking © All Rights Reserved. VALUE1. VALUE STREAM2. FLOW3. 4. 5.
  14. 14. The shortest distance between You and Improved “The Hidden Hospital” Rework Hidden Hospital NOT OK OperationInputs First Time Yield OK 98% Customer Quality Described below is any process that meets a customer need 98% Yield After Inspection or Test 65% 35% Inspect Exposing waste made more difficult by the way we map, and the way we measure This classic approach does not account for the “Hidden Hospital” Rework: 20-30%
  15. 15. The shortest distance between You and Improved VALUE-ADDED • Alters the work • Meets customer wants or needs • Is done right the first time NON-VALUE ADDED • Eliminate it • Consolidate it • Automate it Protocol to Eradicate Waste
  16. 16. The shortest distance between You and Improved Mastectomy Mistake: 'You Don't Have Cancer‘ Woman Told She Has Breast Cancer, but Learns After Operation Her Biopsy Slide Was Mixed Up Darrie Eason talked to "Good Morning America" about undergoing a double mastectomy after a lab mix-up. (ABC News) Oct. 4, 2007 A state report blames Eason's mix-up on a former technician at CBLPath lab who mislabeled her biopsy results. The report said the technician "cut corners." “The technician was batching the specimens” They could not confirm that the other person, who did have breast cancer was ever notified. Stakes are High in Healthcare
  17. 17. The shortest distance between You and Improved Two Six Sigma “blackbelts” sitting at a bar...
  18. 18. The shortest distance between You and Improved Six Sigma is Process Improvement Process X1 X2 Y X3 Process Input Variables Process Output Variable Customer Requirements In-Process Variables X1 X2 X3 X…n Six Sigma focuses on the “critical X” that drives process performance more than any other variable. The aim of Six Sigma is to fix the problem “for the last time”
  19. 19. The shortest distance between You and Improved Six Sigma is Project Management Who is the customer? What do they want? Is the data clean or dirty? What is the baseline performance? What is the project objective? What are the various x’s? What are the critical x’s? What solutions will control the x’s? What are the specs for the x’s? What is the data integrity of x’s? What is the capability of the x’s? Can the improvement stand the test of time? Y x Define Measure Analyze Improve Control Describe The customer experience Optimize The customer experience
  20. 20. The shortest distance between You and Improved Six Sigma is a Metric s s s s s s LSL m A six-sigma (6s) process The distance between the mean (m) and the inflection point is the standard deviation (s).
  21. 21. The shortest distance between You and Improved A Six Sigma Project “Home Run”  Identify and eliminate NVA activity  Identify and reduce variation
  22. 22. The shortest distance between You and Improved System Performance 0 100 200 300 400 500 600 700 800 900 50.00% 60.00% 70.00% 80.00% 90.00% (Utilization (Throughput / Max. Theoretical Throughput) CycleTimeORWorkinProcess What’s Going On Here? Understanding The Role Of Variation In Process Performance
  23. 23. The shortest distance between You and Improved System Performance 0 100 200 300 400 500 600 700 800 900 50.00% 60.00% 70.00% 80.00% 90.00% (Utilization (Throughput / Max. Theoretical Throughput) CycleTimeORWorkinProcess Impact of variation What’s Going On Here? Understanding The Role Of Variation In Process Performance
  24. 24. The shortest distance between You and Improved Linking Lean and Six Sigma • While Six Sigma will focus on the “critical few,” Lean focuses on the “trivial many” • Lean focuses on speed, efficiency, and waste • Six Sigma focuses, defects, variation and quality of products and processes LEAN Six Sigma Six SigmaLEAN Either method provides a prescriptive approach to performance improvement 24
  25. 25. The shortest distance between You and Improved USLLSL Center Process Reduce spread USLLSL Off-Center USLLSL Unpredictable Centered A BTarget Remember... customers experience our variation, not our averages Lean/Six Sigma Improvement Strategy
  26. 26. The shortest distance between You and Improved Case Study: Lean Project in Hospital Lab
  27. 27. The shortest distance between You and Improved Problem Statement: Survey data from the American College of Pathologists shows that physicians think troponin TAT should be 45 mins or less, while laboratories strive for 60 mins or less. Currently, the hospital is incapable of meeting its goal consistently, failing over 50% of the time. Failure can frustrate physicians, threaten patient safety and erode the hospital’s commitment to quality care. Who Are The Customers? COPQ: Treatment delays, physician and patient disatisfaction, potential impact on morbidity ED physician and patients & mortality What is Critical To their Satisfaction (CTS): Defect Definition: TAT > 60 minutes Consistent and timely delivery of results (CTD) Baseline Sigma: - 0.48 Project Scope Test ordered Result delivered 0 10 20 30 40 50 60 70 80 OD DR RV Total Hema Panel Troponin Project Charter: Lab Cycle Time
  28. 28. The shortest distance between You and Improved • Phlebotomist not available (28) • Locating patient (26) • Patient refusal/not available (26) • Phone interruptions (19) • Staff attitudes (17) • Accuracy of labeling (16) • Multiple draws (15) • Poor communication (13) • Poor workflow (10) Only 17% of the total TAT is impacted by these obstacles… Q. What are the obstacles to improved TAT in delivering Lab results to ED? What they said first, and next
  29. 29. The shortest distance between You and Improved • Phlebotomist not available (28) • Locating patient (26) • Patient refusal/not available (26) • Phone interruptions (19) • Staff attitudes (17) • Accuracy of labeling (16) • Multiple draws (15) • Poor communication (13) • Poor workflow (10) Only 17% of the total TAT is impacted by these obstacles… …but observations and data reinforce the impact of these issues Q. What are the obstacles to improved TAT in delivering Lab results to ED? What they said first, and next
  30. 30. The shortest distance between You and Improved Measure Phase Determining Stability of Process Establishing Baseline Performance Ensuring Data Integrity Establishing Capability Integrating Subjective Input
  31. 31. The shortest distance between You and Improved Whether Lean or Six Sigma, it all begins with Current State
  32. 32. The shortest distance between You and Improved Process Flow Diagram - Troponin ED Lab1 Lab 2 ED Start Physician Writes Order Order Given To Unit Clerk Input Sent Order Arrives In Outpt. Lab Order Has Correct Information? Phl. Goes To Outpt. Or ED Computer For Another Patient Phl. Draws Specimen Phl. Tries To See Another Patient? Phl. Makes Multiple Draws? Specimen Arrives In Lab Specimen To Hematology Blood RolledBlood Spun Specimen Processed Specimen To Instrument Specimen To Instrument Specimen To Chemistry Results Verified And Sent To ED Results Sent To Chart Physician Reviews Results End Unit Clerk Immediately Inputs Order? Draw Complete Results Arrive In ED Results Reviewed Immediately? No Specimen To Instrument Specimen Sent For Troponin Analysis Yes Pt. in room? Yes Yes No No Phl. Tubes Specimen To Lab? No No Yes Specimen Logged In? Yes Input Delay No Yes Specimen Walked To Lab Specimen Delayed Getting To Lab Yes Specimen Movement Delayed No Delay in reviewing results NO Yes What’s wrong with this picture?
  33. 33. The shortest distance between You and Improved 30 90 150 210 270 330 390 95% Confidence Interval for Mu 66 71 76 81 95% Confidence Interval for Median TAT Troponin First Qtr 2003 A-Squared: P-Value: Mean StDev Variance Skewness Kurtosis N Minimum 1st Quartile Median 3rd Quartile Maximum 76.037 38.863 67.000 74.078 0.000 78.7104 40.6673 1653.83 4.03449 22.2818 891 36.000 57.000 68.000 86.000 419.000 81.384 42.649 70.000 Anderson-Darling Normality Test 95% Confidence Interval for Mu 95% Confidence Interval for Sigma 95% Confidence Interval for Median Descriptive Statistics Turnaround Time: Troponin
  34. 34. The shortest distance between You and Improved Analysis Phase “Rounding up the usual suspects” Hypothesis testing Identification of Critical X’s
  35. 35. The shortest distance between You and Improved In search of “X” Analysis of Troponin Process • Ho: No significant delay due to multiple draws • Ho: No impact from use of pneumatic tube • Ho: No significant time loss from end of instrument processing to delivery of results
  36. 36. The shortest distance between You and Improved Does a multiple draw cause cycle time to increase or decrease, or is it unrelated to cycle time? 60 160 260 360 460 560 95% Confidence Interval forMu 35 36 37 38 39 40 41 42 43 44 95% Confidence Interval forMedian Variable: TAT - Phlebotomist A-Squared: P-Value: Mean StDev Variance Skewness Kurtosis N Minimum 1st Quartile Median 3rd Quartile Maximum 41.335 23.945 35.000 73.588 0.000 42.5212 24.7560 612.861 3.55094 26.7708 1675 10.000 27.000 36.000 51.000 334.000 43.708 25.624 38.000 MDraw: Single Draw Anderson-Darling Normality Test 95% Confidence Interval forMu 95% Confidence Interval forSigma 95% Confidence Interval forMedian Descriptive Statistics 60 160 260 360 460 560 95% ConfidenceInterval forMu 41 46 51 95% ConfidenceInterval forMedian Variable: TAT-Phlebotomist A-Squared: P-Value: Mean StDev Variance Skewness Kurtosis N Minimum 1st Quartile Median 3rdQuartile Maximum 45.173 29.554 41.000 50.475 0.000 47.5972 31.1758 971.933 10.4494 171.578 638 11.000 33.000 43.000 54.000 608.000 50.021 32.987 44.000 MDraw: Mult. Draw Anderson-DarlingNormality Test 95% ConfidenceInterval forMu 95% ConfidenceInterval forSigma 95% ConfidenceInterval forMedian Descriptive Statistics
  37. 37. The shortest distance between You and Improved Mood Median Test: TAT for Multiple vs Single Draw Chi-Square = 37.60 DF = 1 P = 0.000 Individual 95.0% CIs M Draw N<= N> Median Q3-Q1 ----------+---------+---------+------ Mult. Draw 256 382 43.00 21.00 (-------+---) Single Draw 911 764 36.00 24.00 (---+-------) ----------+---------+---------+------ 37.5 40.0 42.5 Overall median = 38.00 A 95.0% CI for median(Mult. Dr) - median(Single D): (4.00,8.00) Does a multiple draw cause cycle time to increase or decrease, or is it unrelated to cycle time?
  38. 38. The shortest distance between You and Improved Does it make a difference if Phlebotomist utilizes Tube System or drops sample direct at the Lab? 6454443424144 95% ConfidenceInterval forMu 151311 95% ConfidenceInterval forMedian Troponin "Draw to Receive" 11.0000 8.7175 13.5792 Maximum 3rdQuartile Median 1st Quartile Minimum N Kurtosis Skewness Variance StDev Mean P-Value: A-Squared: 13.0000 10.0532 15.4629 66.0000 18.0000 12.0000 8.0000 0.0000 380 4.92349 1.79371 87.1895 9.3375 14.5211 0.000 11.930 95% ConfidenceInterval forMedian 95% ConfidenceInterval forSigma 95% ConfidenceInterval forMu Anderson-DarlingNormality Test Check inby Accessioning Descriptive Statistics 6454443424144 95% ConfidenceInterval forMu 11.810.89.88.87.8 95% ConfidenceInterval forMedian Troponin "Draw to Receive" 8.0000 7.3894 10.0289 Maximum 3rdQuartile Median 1st Quartile Minimum N Kurtosis Skewness Variance StDev Mean P-Value: A-Squared: 9.0000 8.4410 11.5124 50.0000 15.0000 9.0000 5.0000 0.0000 436 2.61618 1.38520 62.0944 7.8800 10.7706 0.000 11.184 95% ConfidenceInterval forMedian 95% ConfidenceInterval forSigma 95% ConfidenceInterval forMu Anderson-DarlingNormality Test Check inby Phlebotomist Descriptive Statistics
  39. 39. The shortest distance between You and Improved Does it take a significant amount of time for the Technician to inspect and release results? 0 40 80 120 160 200 240 95% Confidence Interval for Mu 3 4 5 6 7 8 9 10 11 12 95% Confidence Interval for Median Perform to Verify - Positive Results Only A-Squared: P-Value: Mean StDev Variance Skewness Kurtosis N Minimum 1st Quartile Median 3rd Quartile Maximum 4.263 19.493 3.000 30.710 0.000 7.8732 21.7640 473.672 8.69490 86.5909 142 0.000 2.000 3.000 7.250 235.000 11.484 24.638 5.000 Anderson-Darling Normality Test 95% Confidence Interval for Mu 95% Confidence Interval for Sigma 95% Confidence Interval for Median Descriptive Statistics
  40. 40. The shortest distance between You and Improved Improve Phase FMEA Initiation Brainstorming solutions Fundamentally changing the Process
  41. 41. The shortest distance between You and Improved Easy Hard Ensure draw for Troponin 100% of the time Leverage Nurse-initiated orders for Trop Implement best practices in Phlebotomy Ensure room or location ID on ED orders Eliminate Multiple Draws Drop off at Lab for Troponin Expedite attention to instrument 4 Quadrant Analysis - A Brainstorming Tool Effort
  42. 42. The shortest distance between You and Improved Trial Summary: Overall Performance (new draws only) • Troponin Before – Order to Draw • μ = 13.1 • σ = 14 – Draw to Receive • μ = 12.4 • σ = 9.2 – Receive to Verify • μ = 51.4 • σ = 40 – Total TAT • μ = 76.9 • σ = 40.7 • Troponin Trial Only – Order to Draw • μ = 11.0 • σ = 8.3 – Draw to Receive • μ = 7.9 • σ = 6.7 – Receive to Verify • μ = 40.1 • σ = 11.4 – Total TAT • μ = 59.0 • σ = 17.6
  43. 43. The shortest distance between You and Improved 30 60 90 120 150 180 210 95% Confidence Interval forMu 55 59 63 95% Confidence Interval forMedian Troponin TAT: June 1 - 20 A-Squared: P-Value: Mean StDev Variance Skewness Kurtosis N Minimum 1st Quartile Median 3rd Quartile Maximum 58.418 19.792 54.000 15.916 0.000 60.6562 21.2614 452.048 2.49118 11.0310 349 24.000 48.000 56.000 67.500 219.000 62.895 22.968 57.000 Anderson-Darling Normality Test 95% Confidence Interval forMu 95% Confidence Interval forSigma 95% Confidence Interval forMedian Descriptive Statistics Conducting the trial enabled the organization to anticipate impact of expansion
  44. 44. The shortest distance between You and Improved 6305805304804303803302802301801308030 95% ConfidenceInterval forMu 51.550.549.548.547.546.545.544.543.5 95% ConfidenceInterval forMedian TAT ALL TESTS - 2002 44.000 29.520 49.605 Maximum 3rdQuartile Median 1st Quartile Minimum N Kurtosis Skewness Variance StDev Mean P-Value: A-Squared: 45.000 30.508 51.002 656.000 60.000 44.000 33.000 8.000 7085 58.9612 5.06223 900.358 30.0060 50.3035 0.000 308.720 95% ConfidenceInterval forMedian 95% ConfidenceInterval forSigma 95% ConfidenceInterval forMu Anderson-DarlingNormality Test Descriptive Statistics 30 80 130 180 230 280 330 95% Confidence Interval forMu 37 38 39 40 41 42 43 44 45 95% Confidence Interval forMedian TAT ALL TESTS: JUNE 1 - 20 A-Squared: P-Value: Mean StDev Variance Skewness Kurtosis N Minimum 1st Quartile Median 3rd Quartile Maximum 42.342 25.256 37.000 91.965 0.000 43.4421 26.0115 676.600 4.81157 44.4322 2149 7.000 28.000 38.000 52.000 365.000 44.542 26.813 39.000 Anderson-Darling Normality Test 95% Confidence Interval forMu 95% Confidence Interval forSigma 95% Confidence Interval forMedian Descriptive Statistics Were improvements at the expense of other tests? Turnaround Time: All Tests Pre-Project Turnaround Time: All Tests Post-Project
  45. 45. The shortest distance between You and Improved Control Phase Celebrating Success Holding the Gains Looking Ahead
  46. 46. The shortest distance between You and Improved Process Step What's Controlled? Spec. Limits / Requirements Measurement Method Sample Size Frequency Who/What Measures Decision Rule/ Corrective Action SOP Order to Draw Patient Room ID In Process In Process In Process In Process In Process I n P In Process Order to Draw Multiple Draws No mult draw when one or more Trop ordered Compare check in time for different samples by Phlebotomist 500-1000 Monthly Cerner* TAT > 13.0 min Draw to Receive Check in to Chemistry Check in to Chem when Trop is ordered Compare Draw ID to Receive ID for Trop 500-1000 Monthly Cerner TAT > 10 min Draw to Receive Check in to Chemistry Phlebotomist logs on to PC Compare Draw ID to Receive ID for Trop 500-1000 Monthly Cerner Compliance < 75% Receive to Verify In Process I n In Process In Process In Process In Process In Process TAT > 50 Perform to Verify Attention to Instrument Use alarm to indicate instrument completion Monitor Peform to Verify from instrument 500-1000 Monthly Cerner TAT > 5 Troponin TAT TAT 60 mins or less Cerner stats, adjusted for drawn before ordered 500-1000 Monthly Cerner TAT > 65 *Need to identify staff person to process Cerner data Approved by: Approved by: Control Plan
  47. 47. The shortest distance between You and Improved How we’ve evolved as an organization, and what we’ve learned
  48. 48. The shortest distance between You and Improved Performance Improvement Training & Credentialing How we’ve evolved as an organization, and what we’ve learned
  49. 49. The shortest distance between You and Improved “Culture Eats Lunch” Q x A = E Business Results Quality of solution times its Acceptance = Effectiveness See “The Missing Link to Improvement Capability,” Becker’s Hospital Review, February 2013
  50. 50. The shortest distance between You and Improved The ”burning platform” approach to change management © All Rights Reserved.
  51. 51. The shortest distance between You and Improved • A man working on an oil platform in the North Sea awakened one night by an explosion. Amidst the chaos, he made his way to the edge of the platform. As a plume of fire billowed behind him, he decided to jump from the burning platform even though jumping is a risky option for the following reasons: o It was a 150 – foot drop to the water. o There was burning oil on the surface of the water. o If jumping into 40°F water did not kill him, he would die of exposure within 15 minutes. • Luckily, the man survived the jump and was hauled aboard a rescue boat shortly thereafter. When asked why he jumped, he replied, “Better probable death than certain death.” The ”burning platform” approach to change management
  52. 52. The shortest distance between You and Improved
  53. 53. The shortest distance between You and Improved The Golden Rule has Limits!
  54. 54. The shortest distance between You and Improved EQ Leadership • EQ leaders create resonance (connection) among their followers • EQ leadership creates trust • EQ leaders can empathize with their followers • Ineffective leadership creates dissonance (disconnect) and mistrust among followers
  55. 55. The shortest distance between You and Improved Why EQ Leadership?
  56. 56. The shortest distance between You and Improved EQ Leadership • How to recognize the behavioral styles of peers and subordinates • How to recognize the needs of each behavioral style • How to adapt behavior to give staff “what they need” • How to create more harmonious and productive relationships
  57. 57. The shortest distance between You and Improved Champion Training & Candidate Selection Performance Improvement Training & Credentialing Portfolio Management System (“COMPASS”) How we’ve evolved as an organization, and what we’ve learned
  58. 58. The shortest distance between You and Improved • Number of CHC Clients = 10 • Number of Projects = 150 • Average Cost per Project = $45,000 • Average Return per Project = $327,058 • Median Project Return = $160,675 • Range of Returns from $60 to $3.75M • Average ROI = 7:1 Does our approach work?
  59. 59. The shortest distance between You and Improved $- $20,000,000 $40,000,000 $60,000,000 $80,000,000 $100,000,000 $120,000,000 $140,000,000 $160,000,000 $180,000,000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 CAMC Financial Impact 2001 - 2013 Cumulative Total Annual Improvements CHC Online Training
  60. 60. The shortest distance between You and Improved What Success Looks Like A statistically significant improvement in “Corporate Culture” Performance Improvement Scores 3.75 3.43 3.18 2.65 2.73 3.12 2.5 3.0 3.5 4.0 1998 1999 2000 2001 2002 2003 2004 2005 Year Average
  61. 61. The shortest distance between You and Improved Thank you for the opportunity to be with you today! Ian R. Lazarus irl@creative-healthcare.com www.creative-healthcare.com

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