Building a Profound Lean Infrastructure for Durable Success .


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Building a Significant Incline Foundation for Solid Achievement. Sam Carlson, MD, FACP Boss Restorative Officer and EVP, Park Nicollet Wellbeing Administrations John Dark, John Dark and Partners, LLC. Updated 2/28/08. Irreconcilable situation. John Dark of John Dark and Partners LLC (JBALLC)
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Building a Profound Lean Infrastructure for Durable Success Sam Carlson, MD, FACP Chief Medical Officer and EVP, Park Nicollet Health Services John Black, John Black & Associates, LLC Revised 2/28/08

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Conflict of Interest John Black of John Black and Associates LLC (JBALLC) John Black is President of JBALLC and his counseling firm counsels to Park Nicollet Health Systems on Lean, Global Production System. The introduction could be seen as a contention as JBA gets installment for administrations for counseling to Park Nicollet on the Lean, Global Production System standards displayed in this introduction.

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Park Nicollet Health Services is… Non-benefit incorporated care framework 8000+ representatives 600+ utilized doctors Over $1 billion yearly income

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Park Nicollet Health Services is… Park Nicollet Clinic - 45 restorative strengths and sub-fortes in 25 center areas in rural Minneapolis 3 million patient visits every year Park Nicollet Methodist Hospital – 426 bed office 26,000 affirmations every year Park Nicollet Institute – Engages in research, training and advancement to enhance quality and open and private basic leadership in human services. Stop Nicollet Foundation – The raising support arm of Park Nicollet Health Services, utilizing altruism to construct solid groups by supporting patient care, research and instruction.

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Why is PNHS Aiming at World-Class Performance? We understood we were far shy of where we should have been We knew we had loads of inadequate, non-esteem included procedures and exercises AND we knew the U.S. medicinal services industry overall was not "world class" Prior change techniques weren\'t having footing

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Why Did We Take a Look at Lean? Since we knew we weren\'t conveying "world class" medicinal services Because we had heard promising reports about usage of the Virginia Mason Production System (Lean) at VM\'s Medical Center in Seattle We were charmed with its potential, yet needed to do a trial at Park Nicollet before withdrawing from our six sigma change procedure

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Construction of the Bridge in 1967. I35W Bridge, Minneapolis, MN, previously, then after the fact crumple What Does Infrastructure Mean? Why Is It Important? Reasonable justification: Federal agents have inferred that steel plates on the [I-35W] scaffold that broken down the previous summer in Minneapolis were insufficient to hold the structure together… Design changes in 1977 and 1998 included extra asphalt and solid hindrances that expanded the heaviness of the extension… Gusset plates are level steel structures used to jolt together the steel supports that convey the heaviness of an extension. Connect builds commonly plan the plates to be far more grounded than the braces in light of the fact that on the off chance that one fizzles, the entire scaffold will fall. In the destruction of the I-35W scaffold, agents discovered 16 gusset plates that were broken… Eight of the plates were in the area on the south side of the extension where the fall started… What [engineers] found was that the half-inch thick plates ought to have been an inch thick – twofold the size… USA Today , 1/15/08

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Creating the Vision "Everybody minding each day, making with the people we serve ideal wellbeing and more prominent esteem"

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By 2012, # one of a kind patients served develops by 20% #1 territorially in cutting edge measures of value & security for high effect conditions 2012 Reduce add up to hazard balanced per capita cost of care in respect to other MN mind frameworks to underneath normal Patients react decidedly to: "I get precisely what I need (and need), precisely when I need (and need) it" Operating edge ≥ 3.5% Our Strategic Plan

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Traditional PN Organization Chart

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Kaizen Promotion Office Leadership Fellows Healthcare Lean Organization Prototype Lean Organization CEO Operations Finance Purchasing 25 President Human Resources Marketing Facilities JBA Consultants *KOT-Kaizen Operations Team 20 Model Lines Special Ops KOT 15 Cancer Hospital Surgery KOT 10 Surgery KOT 10 Cancer KOT 10 Service Lines Hospital KOT 10 Clinics KOT 10 Administration KOT 10

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Model Line (Future) – Surgical Specialties Primary Care Defining Best Practice Guidelines Pre-Op Preparation Pre-visit L/T Use of Non-Surgeon Clinicians Total Surgical Specialties Patient Lead Time/7 days Daily Management Boards Staggered Starts Day of Clinic Visit L/T Implemented Underway Not Started Standard Rooming 22 minutes Reduced Surg./staff NVA Time OR Scheduling Process Med. Rec. Post-Visit L/T Nurse Post-operation Clinics TBD Case Carts: Standardize, Waste Pre-Surgery L/T 8 days Materials Flow Staggered Starts Day of Surgery L/T Accurate Surgery Times Standardize Rooms Pull Signals Visual Control Pre-Op Patient Prep 208 minutes PICIS: Surgery Information System Load Level During Day Staff Cross Training Turnover Time Instrument room OR 21 Load level by DOW Interoperative Standard Work for MDs Pat. Comes back to Function In Patient Hospital TBD Pre-Op Preparation

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Model Line (Future) – Surgical Specialties Primary Care Defining Best Practice Guidelines Pre-Op Preparation Pre-visit L/T Use of Non-Surgeon Clinicians Total Surgical Specialties Patient Lead Time 7 days Daily Management Boards Staggered Starts Day of Clinic Visit L/T Implemented Underway Not Started Standard Rooming 22 minutes Reduced Surg./staff NVA Time OR Scheduling Process Med. Rec. Post-Visit L/T Nurse Post-operation Clinics TBD Case Carts: Standardize, Waste Pre-Surgery L/T 8 days Materials Flow Staggered Starts Day of Surgery L/T Accurate Surgery Times Standardize Rooms Pull Signals Visual Control Pre-Op Patient Prep 208 minutes PICIS: Surgery Information System Load Level During Day Staff Cross Training Turnover Time Instrument room OR 21 Load level by DOW Interoperative Standard Work for MDs Pat. Comes back to Function In Patient Hospital TBD Pre-Op Preparation

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Park Nicollet System of Care To Care for Patients the Right Way JUST IN TIME Jidoka One-by-one affirmation to distinguish variations from the norm. Stop and react to each variation from the norm. Isolate machine work from human work. Empower machines to recognize variations from the norm and stop self-rulingly. Work with the base asset required to reliably convey Just what is required. In simply the required sum. Exactly where it is required. Exactly when it is required . Leveled Production (Heijunka) Cost Reduction Through The Elimination of Muda (Waste or Non-Value Added) Standard Work People Takt Time Production Materials Standard Work in Process Kanban One Piece Flow Production Supermarket System Machines Andon Operational Availability Pull System Production © 2008, Park Nicollet Health Systems & John Black and Associates LLC

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Park Nicollet System of Care To Care for Patients the Right Way JUST IN TIME Jidoka One-by-one affirmation to recognize irregularities. Stop and react to each variation from the norm. Isolate machine work from human work. Empower machines to recognize anomalies and stop self-rulingly. Work with the base asset required to reliably convey Just what is required. In simply the required sum. Exactly where it is required. Exactly when it is required . Leveled Production (Heijunka) Cost Reduction Through The Elimination of Muda (Waste or Non-Value Added) Standard Work People Takt Time Production Materials Standard Work in Process Kanban One Piece Flow Production Supermarket System Machines Andon Operational Availability Pull System Production © 2008, Park Nicollet Health Systems & John Black and Associates LLC

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© 2008, Park Nicollet Health Systems & John Black and Associates LLC

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© 2008, Park Nicollet Health Systems & John Black and Associates LLC

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© 2008, Park Nicollet Health Systems & John Black and Associates LLC

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Kaizen Office Locations Park Nicollet Methodist Hospital Inpatient and Surgical/Orthopedic Services Visibility Room Park Center Campus Specialty Services (CV/Onc/Medical Specialties); Primary Care Corporate Services KPO Offices Stand-up divider

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Strategy and Tactics Kaizen Guidance Team CEO/CEO/CMO/VP and Chief of KPO/Consultants assess the general arrangement and advance Kaizen Leadership Team All administration line boss/VPs with Sr. Administration and KDs: yearly arrangement/timetable and advance CEO week by week "divider walk" and survey Progress towards yearly objectives Working the perceivability room Monthly audits of corporate wellbeing, quality, and get to information; setting longer-term technique

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CEO Weekly Wall Walk

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Succession Planning and Replacement Tables

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Park Nicollet Leadership Fellows at Boeing 777 Factory

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© 2008, Park Nicollet Health Systems & John Black and Associates LLC

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RPIWs Jidoka Daily Management Boards KPO 3P 5S VSM Wall Walk Just-In-Time KEEP Leadership Fellows Developing Our Own "Reality Class" Leaders

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What Does "World Class" Mean?

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"World Class" Companies Excel in Five Areas

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What Does "World Class" in Health Care Mean? Safe Effective Patient Centered Timely Efficient Equitable

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The Importance of Going to Japan Understanding the potential outcomes Seeing with "new eyes"

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Learning from Manufacturing Companies in Japan

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Learning from Manufacturing Companies in Japan Yamatake Corporation Isehara Plant Shonan Plant Toyota Motor Corporation Kamigo Plant(Engine) Motomachi Plant(Assembly & Welding) Tsutsumi Plant(Assembly & Welding) Toyota Boshoku Kariya Plant Denso Takatana Plant The Yokohama Rubber Co. Ltd. Hiratsuka Plant Aisin Nishio Plant Yamaha Motor Co. Ltd. Yamaha

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The Infrastructure Must Be in Sync wi

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