Reducing Length of Stay Using

Service Line Lean Concepts

Social for Health Systems – February 19, 2011
 Participants Will Learn

1. Service line lean and rapid improvement concepts.

2. Lean concepts for improving length of stay and

patient flow.

3. Sustainability concepts using process control plan.

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 Lean Service Line Management

 Value Stream Management means working on the big

picture, not just an individual processes—Improving the
whole, not just optimizing parts. But mapping the entire
stream may be too much for getting started.
You may
Your Facility Customer
start here!
Suppliers
Access to Care Care Delivery Follow-up / Support

Total Value Stream

Referral Scheduling inpatient flow Disease Mgmt.

Education /
clinic flow
Prevention
Medication Mgmt.

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 The Product Family

In Manufacturing:
A family is a group of products that pass through similar
processing steps over common equipment—identify
product families from the customer end of the value stream.

In Healthcare:
A family is a group of people (patients) that pass through
similar processing steps requiring the specialized
knowledge of care providers, diagnostic and therapeutic
treatments and/or procedures, and environment of care—
identify product families from the customer end of the value
stream.
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 Two Types of Kaizen
Flow Kaizen focuses on patient and information flow and
Process Kaizen focuses on people and process flow.

Senior Mgmt.
Flow Kaizen
Value-Stream Improvement

Process Kaizen
Elimination of Waste

Front-line

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 Project Selection

Cost Reduction
Hospital
Performance Benchmark
Data Net Income Effect Data
from Revenue
Enhancement

Strategic
Deployment

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 Overview of Results and Return

Targets 50% of total possible returns

Excludes performance metrics when 2009 actual is better than

the target.

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 Opportunities Based on Performance Gaps

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 Rapid Improvement Events

Lean/Six Sigma
Rapid Improvement
Deliverables Checklist
 1. Review Project Charter
 2. SIPOC
 3. Voice of the Customer to Critical to Quality (CTQ)
 4. Walk the Process/Patient Experience
 5. Current State Value Stream Map
 6. Data Collection Plan
 7. Identify Opportunities for Improvement
 8. Future State Value Stream Map
 9. Create Standard Work
 10. Communication Plan
 11. Implementation/Pilot Plan
 12. Process Control Plan
 Problem and Goal

Problem Statement: Currently at Feel Better Hospital,

the Average Length Of Stay (ALOS) for patients under
Hospitalist care exceed the benchmarks for large
community non-teaching hospitals. Longer than
necessary LOS results in excess costs of $1,393,850
annually.

Goals/Objective: To achieve the following by 7/31/10

(50% of benchmark):

1. Reduce ALOS for Hospitalist's patients from 6.1

days to 5.1 days.
 Project Scope

In Scope: All patients with a Hospitalist MD

assigned as attending physician on 6B.

Out of Scope: All patients not assigned with a

Hospitalist MD assigned as attending physician or
patients not on 6B.

Process Boundaries: The process begins with the

decision to admit the patient and ends when the
patient leaves the hospital.
 High-Level Process Map (SIPOC)

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 Voice of the Customer

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 Inpatient Care Current State VSM
Inpatient Care Current State Value Stream

S Paper Micro Bed STAR PACS Connect

Soft Lab ONE Staff MD Cares MAC Lab HED Pyxis Accudose HEO HMM HPF
P? Chart medix Tracking Radiology HMI Rx

ED E- Rounding Medi
ED Chart 3M Risk Man
Tracking Discharge Sheet Links STAR

At A Transport Lanier
ORSOS
Glance Queue Dictation ADT

Acute
Hospital

Internal Procedural/
Ancillary Departments

Swing Bed
Facility

Outpatient Clinic

Rehab
Transferring Hospital

Discharge
Nursing
Sign-In Registration Transport Planning Nursing
Patient’s Home Assessment
Assessment Home

Referring Provider’s Provider History

Office Diagnostic
and Physical
Testing SNF
(H&P)

Nursing Home/ Long

Term Care Provider Nursing
Vital Signs and Transport
Day of Discharge Discharge Discharge
Sign-In Registration ED Transport Set Up for New Start I.V. Line Consults
Planning Teaching and Instructions/ Home
Admit
Instructions Patient Education

Collect Diagnostic Radiology Echo

Procedures
Specimens LTAC
Pharmacy GI Lab

Laboratory
Administer
Diagnostic Treatments/
Emergency Medications/
Testing Medications Cath Lab Hospice
Department Treatments

PT/OT

Psych
Facility
Inpatient Bed to
Decision to Admit to Inpatient Bed = Discharge Order to Left Hospital = 116 +/- 23 Minutes
1st Vital = 64 +/- 5 minutes.

Admission to Discharge Order = 4.8 +/- 0.3 Days

Chemical
Depend

LOS = 6.1 Days

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 Plan for Data Collection
Questions to be answered:
•How satisfied are patients with inpatient care?
•What is the time from decision to admit the patient until they are in the
bed?
•How long does it take to get a transporter once requested?
•How long does it take to turn over a room?
•How long does it take for a patient to have a procedure once the order
is written?
•How long does it take a consultant to see a patient once the initial call
is made?
•How long does a patient wait for a provider to see them once they are
in the bed?
•How many avoidable days are experienced by patients?
•How long does it take for a patient to leave the hospital once the
discharge order was written?
•What is the LOS for Hospitalist patients?
•How long does it take to get diagnostic results back?
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 Hospitalist Average Length of Stay

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 Hospitalist LOS Capability Analysis

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 Affinity Groups for Improvement Opportunities

1. Admissions 2. Pt. Transport 3. 1st Day (12 Hours)

• Reduce wait times • Transport wait times Clinical
• Phone # and fax issues • Nurse transports • Coordination of care
• Patient type issues • Transport times
• Change Hospitalist name/ Hand-
• ED admissions delay • Patient information Flow off of patient
• Bed management • Assessment delays
• Patient information flow • I.V. start delays
• Admission order to 1st vital
• Variation in MD processes
4. Discharge 5. Procedure TAT • Documentation review
Process • Procedure TAT • Provider Coverage
• D/C planning initiation • Coordination of procedure • Core measure compliance
schedule • Clinical pathways
• Complex patient
management • Consult book
• Move up discharge • Consult follow up time
instructions
• Consolidate discharge • Variation in consult knowledge
teachings • Ancillary consult response time

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 Future State Service Line VSM
Inpatient Care Future State Value Stream

S Paper Micro Bed STAR PACS Connect

Soft Lab ONE Staff MD Cares MAC Lab HED Pyxis Accudose HEO HMM HPF
P? Chart medix Tracking Radiology HMI Rx

ED E- Rounding Medi
ED Chart 3M Risk Man
Tracking Discharge Sheet Links STAR

At A Transport Lanier
ORSOS
Glance Queue Dictation ADT

Acute
Hospital

Internal Procedural/
Ancillary Departments

Swing Bed
Facility
1st Day of Care
Outpatient Clinic Clinical

Day Before
1st Day Care 2nd Day Care Day of Discharge
Discharge
Admissions Rehab
Transferring Hospital

Discharge
Greet Transport Planning Nursing
Patient’s Home Assessment Home

Referring Provider’s
Office Diagnostic
Start I.V. Line
Testing SNF
Discharge
Process
Nursing Home/ Long
Term Care Provider Nursing
Registration, 1st Transport
Nursing Collect Diagnostic Discharge Discharge
Greet ED Transport Vital and Room Consults
Assessment Specimens Teaching and Instructions/ Home
Set Up
Instructions Patient Education

Transport Provider History Administer Radiology Echo

and Physical Medications/ Procedures
(H&P) Treatments Procedure TAT LTAC
Pharmacy GI Lab

Day of Discharge Laboratory

Planning
Diagnostic Treatments/ Patient
Emergency Testing Medications Itinerary
Department Cath Lab Hospice

PT/OT

Psych
Facility

LOS = 5.1 Days

Chemical
Depend

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 Project Selection Criteria Matrix

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Project/Rapid Improvement Event Plan

LOS – May 10th – July 31st

Discharge 5/10 – 5/31

Procedure Coord 5/24 – 6/11

1st Day Care 6/9 – 7/2

Control 7/2 – 7/31

 Discharge Current State VSM
VSM – Current State
Hospitalist Notes Star HPF 3-M

Quantros Care Manager E-Discharge Pharm D

RCH

Admitted
Discharge Nursing Home with
Patient Discharge Planning Progress
Planning Discharge HomeHea
Assessment Form Notes
Notes Summary
Nursing
Home

Out of State
Hospital
Hospitalist Discharge Hospitalist Round
Nurse –
Assessment Planning Discharge Order/
Discharge Transport Select
Discharge Assessment Discharge
Teaching
Questions Follow-Up Instructions
W W W W W UMC

Swing
Discharge Bed
Planning Consult
Assessment
Hospice
W W Day of Discharge
Rehab
1st Day
(10) Sleep
Study Results
(5) Too Many
(6) Timing of Initial
(1) Patient Lack of Hand-Offs (11) Admission to
Discharge Assessment
Understanding Discharge Order Time
with Discharge Process (9) Lack of
Accountability
(3) Hospitalist use of
Planning assessment (7) Consults TAT
(12) Hosp SLA
Discharge Order
(2) Delay in Patient (4) Lack of Care (8) Wait Time for (13) Consolidation of Forms
Type Change / Transfer & Coordination Initial Provider Visit
 Future State VSM
Hospitalist Notes Star HPF 3-M
Future State VSM
Discharge Process Quantros Care Manager E-Discharge Pharm D
RCH

Nursing
Admitted Patient Discharge Planning Progress Notes/ Contingency
Discharge
Assessment Form Discharge Planning Notes Discharge Orders
Summary

Home Health
Bed Board/ Bed Board/
Contingency Intent to
Call from Discharge Discharge
Unit Clerk

Nursing Home

Discharge
Discharge Discharge Rounding Hospitalist RN/
Hospitalist
Planner Planner Team Bedside RN

Multidisciplinary Out of State Hospital

Discharge Planning Contingency
Hospitalist Discharge Rounding
Discharge Planning Follow-Up – Assign Discharge Order
Assessment – Assign to Include
Assessment Target Discharge Evaluation/Discharge
Target Discharge Day Contingency
Time Instructions
Discharge Orders

Select UMC
1st 12 Hours of Care Day After Admission Day Before Discharge Day of Discharge

Admission to H & P
Swing Bed
Target < 12 Hours

Target Admission to Discharge =

DRG Target LOS minus 1 Day
Hospice

Rehab
Discharge Process Improvement Strategies

1. Provide Hospitalist/Discharge Planner collaborative

documentation to improve communication.
2. Provide Hospitalist/Discharge Planner collaborative
documentation to improve communication.
3. Move Discharge Order up in the value stream.
4. Eliminate duplication and improve collaboration of Hospitalist
RN and bedside RN to meet Discharge time.
5. Discharge planning to begin upon admission.
6. Consult SLA for Level 1 vs. Level 2 and weekend.
7. Visual management for discharge date/time notification on
unit.
8. Centralize Hospitalist patients
Multidisciplinary Discharge Rounding
―Day Before Discharge Multidisciplinary Rounding Team

No
Writes Order for
Contingency Discharge
Hospitalist Discharge Order
Signs Transport Order Follow Up
Tomorrow?
Appointments

Yes
Hospitalist Medication Bedside
Transport Forms
RN Reconciliation Form Nurse

Discharge Transport or Pick Up Discharge

Destination Post-Acute Needs
Planner Time Planner

Bedside Unit
Status Update
Nurse Clerk

Contingency Discharge on Bed

Board
 Procedure Coordination Current State VSM
6B Current State VSM – Procedure Coordination Paper
Chart

STAR Soft Lab

Results Human Error
Improve or
LAB

Print Collect Transpo Process Results Reduction

Order ACC Tested Evaluate Staffing Reduce TAT Increase
Labels Spec rt Spec ed Veriftied Electronic
d Improve
W W W W W Transport
Documentation

TAT Increase E-Order

Usage
E- Care
Orders Fusion
Improve RN / RPL
Communication by
Recover Transpo Meds Manager
GI LAB

Patient Transpo Procedu y Physicia rt

Schedul Admit Physicia Physicia Report
Post Prep & rt re n sees Patient
e Patient n Arrives n Called
Consent Patient Begins Patient Back to Care
Be sure Orders
are entered
W W W W Docume W W Floor Manager Improve
nt Comment Data

Star
Radiolog
Radiolog y
Tech
Chart Tech Procedu Radiolog ist Improve
Arrives Transpo Images Report
RAD

Clarify Orders Patient

Call Patient Call Transpo taken to Asks re y Transcri Reviews
Post to rts sent to Prints to Tracking
Floor Prep Floor rt performi Questio Perform Reviews bed and
Holding Patient PACS Floor
W W ng area W to Area
ns ed W Images W W Release
s HMI
Transpo
Transpo
Reduce Improve Chart Proper Prep Educate Departments rt to
rt to
Inform Patients Patient Wait Times Checking For Tests on Test Prep Holding
Floor
Re. Proceed Availability Area
PT - Eval

Assign Therapis Therapis

Add to Evaluati Plan of Results Paper
order to t t goes to Lanier
Schedul on Care Docume Schedul
Therapis Reviews Patient Cross Departmental Dictation
e Started formed nted es Rad
W t W Chart Room W Communication

Paper
Connect
Schedul
Rx
PT - treat

Assign Determi e PT
Transpo
Plan of Schedul to ne Transpo Review Treatme Docume
rt to
Care e Therapis Therapy rt Chart nt nt
Room
W t Location W W W W
HMM

Pharma
Work cist Dispens Pharma McKess
Rx

Delivery
Queue Order e cy Verify on
W Entry W W Automati
on
W/C

Ret Review Consult Evaluate Gather Provide Write

Consults Chart Nurse Patient Supplies Care Order
W W
Future State VSM – Procedure Coordination

Ticket to Ride

6B
Clinical Transporter
Laboratory

GI
Lab

Unit
Radiology Clerk

Hospitalist

Pharmacy Patient Tracker/

Itinerary
E-Order

PT/OT/ST

Cath
Lab

CV Suite
Procedure Coordination Improvement Strategies

 Coordination of patient care and procedures between

ancillary areas and the nursing unit.
 To improve the % of time orders clear, concise and
correct.
 To improve handoff communication between ancillary
areas and nursing units.
 Patient Tracker with Ticket to Ride
Home Screen Shot 1
TICKET TO RIDE
Unit Drop Down Menu  6B Date: _________________ Transport Time: _________________

Account No. Last Name, First Name Room No. Location (PLEASE PRINT)
DESTINATION:  MULTIPASS
001234567 Flanders, Jonathan 6037 NM RADIOLOGY CV DIAG  GI LAB
 X-Ray  CUS  PT/OT
101234567
201234567
Gurley,
Neel,
Dawn
Jason
6038
6039
X-Ray
6039
Feel Better  CT
 US
 MRI
 NIVL
 STRESS
 CATH LAB
 OTHER
___________

 NM
301234567 Amis, Tammy 6040 PT/OT  SP
401234567 Stanic, Steve 6041 6041 PATIENT’S  NPO since:___________________________
NURSE: ______________________________
 Consent Signed
PHONE NUMBER:______________________

TELEMETRY: NEEDS O2: ISOLATION PRECAUTIONS:

Patient Screen Shot 2
 YES  NO  YES  NO  YES  NO Type:_____________________

PATIENT MENTAL STATUS: TRANSPORT MODE:  Bed

001234567 Flanders, Jonathan 6037  Wheelchair
 Alert  Confused  Unresponsive  Fall Precaution  Stretcher
Check if Risk Score >=3
COMMENTS:
Date: Area Transport Time Check Out Check In
 06/15/10
CT 11:00  11:30 RETURN TICKET TO RIDE
NM  
Please Initial Once the Exam/Procedure/Treatment is Complete:
11:30 RADIOLOGY CV DIAG  GI LAB (1027) _____
GI LAB     X-Ray (1722) _____
 CT (1723) _____
 CUS (4163) _____
 NIVL (1201) _____
 PT/OT (1496) _____
 OTHER (____) _____
CONSULT SURG     US (1329) _____
 MRI (1161) ______
 STRESS (1012) _____
 CATH LAB (1488) _____
___________

 06/14/10  NM (1288) _____

 SP (4198) _____
 06/13/10 COMMENTS:

NOTIFIED OF PATIENT’S RETURN: TRANSPORTER:

NAME:________________________________ NAME:_______________________________

TIME:_________________________________
 Current State VSM – 1st 12 Hours of Care
Current State VSM – 1st 12 Hours of Care

PATIENT HOSPITALI
HOSPITALI FLOOR NURSE TARGET PLAN OF
ORDER ROOM REPORT TRANSPOR ADMISSION ST NURSE PROVIDER ORDERS ORDERS
ST STAFF 1ST VITALS ASSESSME STAY OF CARE Discharge
ED WRITTEN ASSIGNED CALLED TED TO Hx ASSESSME H&P WRITTEN SCANNED
NOTIFIED NOTIFIED NT DC INITIATED
ROOM NT Process

CHART ER CARE No visual management

TAB MANAGER Of plan of care

HOSPITALIST PATIENT
/ NURSE
ARRIVES & ROOM ADMISSION TRANSPOR 1st VITALS & ADMISSION COLLECT PLAN OF Lack of coordination
NOTIFIES
Direct Admit SCHEDULIN IS ASSIGNED PROCESS T SETUP Hx Dx SPEC CARE Of plan of care
ADMITTED
G W W W
W
PHYSI PROG
HOSPITALIST CAL RESS MED
/ NURSE
Caregivers not aware NURSE MEDS
Patient is in rom. ADMINISTE ORDE RECO SHEET
NOTIFIES ASSESSME
CENTRAL R MEDS RS RD
NT
INTAKE

PHYSI
PROC PROG OPER
CAL
EDUR RESS ATION
ORDE
W W ES
RS
NOTES S

PHYSI
PROG CONS
PATIENT HOSPITALI CONS CAL
RESS ULT
ROOM ARRIVED & PROGRESS ST NURSE CARE ULTS ORDE
IV STARTS NOTES TAB
Transfer ASSIGNED IS NOTES ASSESSME MANAGER RS
ADMITTED NT

PHYSI
PROG
W INIT. CAL
RESS H&P
DIAG. ORDE
NOTES
RS
PROVIDER CONSULT
H&P SCREEN ANCIL
ANCIL PHYSI
PROG LARY
LARY CAL
RESS TABS
SERVI ORDE
NOTES (RESU
CES RS
LTS)

CHART
CHART DISCH PHYSI
CONSULT PROGR D/C
H&P TAB ARGE CAL
TAB ESS PLAN
PLANN ORDE
NOTES NOTES
ER RS

NURSIN CARE Multiple versions of

G CARE MANA documentation
DICTATION
PLAN GER
SYSTEM

THERA
PY CARE
PLAN MANA
OF GER
CARE
WOUN
D
PROG
CARE
RESS
PLAN
NOTES
OF
CARE
Future State VSM – 1st 12 Hours of Care
Future State VSM – 1st 12 Hours of Care
Daily Patient Goals

Coordinated
ER Plan of Care
Patient Arrival Notification
to Care Team
Multidisciplinary
Start I.V.
Rounding

1st Vital Signs & Admission Hx &

ED Care MD H&P Consult Visit
Setup Med Rec

DC Planning
Assessment
Direct Admit Standard Plan of Care Form

15 mins.

Meds &
30 mins Treatments

12 hours
Transfer

Nurse
Assessment

Diagnostic
Specimen
 1st Hours of Care Improvement Strategies

 Improve team-based approach to LOS management.

 Notification of patient admission to multidisciplinary
team.
 Standardize Hospitalist LOS management process to
reduce variation.
Hospitalist Service Level Agreement
SLA Description of Process
Completed no later than one hour prior to
Medication Reconciliation Form discharge time by Hospitalist team
(Hospitalist and/or Hospitalist RN).
Completed no later than one hour prior to
Patient Transfer Form discharge time by Hospitalist team
(Hospitalist and/or Hospitalist RN).

A standard Hospitalist progress note that

includes the Multidisciplinary Rounding
Checklist to include Treatments, Patient
Progress Notes
Itinerary, Diagnosis, Discharge Plan, Plan
of Care and daily patient goals. Target
discharge date to be established within 24
hours of admission.
An anticipated/contingency discharge
Anticipated/Contingency order written the day before discharge that
Discharge Order identifies requirements for discharge the
next day.
Visual Management (Whiteboard)
Visual management to Care Team of the
Discharge Plan to Include
time/date of discharge and the standard
Rounding Time
rounding time for each Hospitalist.
A once per day per patient
Multidisciplinary Rounding Team to
Multidisciplinary Rounding
address plan of care, discharge planning
and daily patient goals.
Sunday Off-Service Hand-Off Use of a standardized off-service patient
Form hand-off form.
 Process Control Plan

Criteria for
Recording of What Record of
Unit of Frequency of Sample Measured Taking Action
Control Subject Subject Goal Sensor Measurement / Actions to Who Decides Who Acts Action
Measure Measurement Size by Whom (i.e. when to take
Tool Used Take Taken
action)

Avg. 5.1 Dr. McVey/

All 6B Monthly Avg. is Investigate Hospitalist
Days or less/ Written in Automated Sheila
LOS Time/Capability Weekly Hosp. STAR greater than 5.6 Any Process DOE LOS
>90% <5.1 Chart in STAR G./Wanda
Patients days Deviations Dashboard
Days T.

All 6B Hospitalist
20% Cost Accounting
Cost per Case Cost Chart Weekly Hosp. Scott R. TBD TBD TBD TBD LOS
reduction System
Patients Dashboard

> 90% within

24 Hours Investigate Control
Target Discharge Day Proportion Form Weekly 20 Control Plan Log Unit Clerk 1 Week < 90% DOE Dr. McVey
After Cases Plan Log
Admission

> 90% within

24 Hours Investigate Control
Target Discharge Time Proportion Form Weekly 20 Control Plan Log D/C Team 1 Week < 90% Wanda T. Wanda T.
Before Cases Plan Log
Discharge

> 90% of
Patients
Multidisciplinary Rounding Investigate Control
Have a Proportion Form Weekly 20 Control Plan Log Unit Clerk 1 Week < 90% Wanda T. Dr. McVey
Team Cases Plan Log
Documented
Round
Behavior
Sheila G.,
Multidisciplinary Rounding 100% al 1 Day per Investigate Control
Proportion Weekly Control Plan Log Wanda T., Not compliant Dr. McVey Dr. McVey
Team Compliance Observati Week Why Plan Log
Dr. McVey
ons
 Process Control Scorecard

Hospitalist Breakdown
Team D/C Date within 24 Hours (Y/N) D/C Time Day Before Discharge (Y/N) Multidisciplinary Round Documented (Y/N) Total
Team 1 Saulters 13 57% 6 26% 5 22% 23
Team 1 Dyess 5 28% 5 28% 6 33% 18
Team 1 Waldrop 12 52% 11 48% 10 43% 23
Team 2 Hebert 3 43% 2 29% 5 71% 7
Team 2 GLADNEY 1 8% 2 17% 1 8% 12
Team 2 Lewis 4 36% 3 27% 3 27% 11
Team 1 Fort 5 33% 1 7% 2 13% 15
Team 2 Pruett 1 17% 0 0% 0 0% 6
Team 2 Duddleston 0 0% 0 0% 0 0% 2
117

Team Progress
D/C Date within 24 Hours (Y/N) D/C Time Day Before Discharge (Y/N) Multidisciplinary Round Documented (Y/N) Target
Team 1 47% 31% 31% 100%
Team 2 24% 18% 24% 100%

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 Average LOS by Month

As of July 2010 discharges, the average LOS for all

hospitalist patients was 5.1 days.

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 Process Capability July 2010
Process Capability of DAYS
Calculations Based on Weibull Distribution Model

USL
P rocess Data O v erall C apability
LS L * Pp *
Target * PPL *
USL 5.1 PPU 0.04
S ample M ean 5.14086 P pk 0.04
S ample N 2506
E xp. O v erall P erformance
S hape 1.47214
P P M < LS L *
S cale 5.72305
P P M > U S L 430015.35
O bserv ed P erformance P P M Total 430015.35
P P M < LS L *
P P M > U S L 343974.46
P P M Total 343974.46

0.0 3.6 7.2 10.8 14.4 18.0

As of July 2010 discharges, 66% of patients experienced

a LOS of 5.1 days or less.

All Rights Reserved, Juran Institute, Inc. 37

 Cost per Case

Boxplot of OPERATING COST

20000

15000
OPERATING COST

10000

5000

0
Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10
DISCHARGE_1

Summary: Mean and median operating cost decreased

during the pilot months of May and June.
 Results Summary

Phase ALOS (Days) LOS Capbility Cost Per Case

Pre 6.1 59% $7,778
Post 5.1 66% $7,065
Difference 1.0 7% $713
 Lessons Learned

Deltas – The team brainstormed opportunities for improvement and

risks to consider for the next wave of projects.

 Unanticipated Hospitalist cultural resistance to change, lack of

leadership, lack of accountability at a senior level and lack of
operational processes to implement changes.
 Sporadic participation of key players delayed progress and
created rework for obtaining feedback.
 Lack of consistent communication for team members regarding
meeting times, team progress and project expectations.
 Lack of regular Champion reminders and communication to
project team and stakeholders of why the project is important
strategically to the organization.
 Standard weekly meeting time with project Champions.
 Competing initiatives disallowed senior leader participation when
expected or needed.
 Lessons Learned

Positives – The team brainstormed the value-adding components of

the project to consider for the selection of the next wave of
projects.

 Lean/six sigma methodology provided structure, challenging work,

and helped increase process improvement knowledge.
 Dedicate resources and team room.
 Team learning provided a common understanding of other’s
process and needs, which help break down silos.
 Real-time training provided understanding of concept prior to
application.
 Access to best practice concepts.
 Allowing team members to help participate in deliverable
documentation.
 Provided an opportunity to share process knowledge with
coworkers.
 Dedicated Department of Excellence and Director involvement.
Questions?

Jonathan Flanders, MHSA, MT (BSMT)

Lean Six Sigma Black Belt
Vice President and Patient Safety Executive
Juran Institute
(912)655-8289