A radically different management system is required to deliver and sustain improvement
Sustainable improvement results require moving away from a project mentality for improvement to a system transformation which builds a continuous improvement culture. Most every organization can improve something if it focuses enough resources on it. On the other hand, developing a management process than supports frontline workers to solve problems every day is the way to ensure that improvement happens every minute of every day. This requires standard work for management which means managers and executives have a new playbook for their behaviors and actions. At ThedaCare this is called the Business Performance System. We have found the tools of lean are not enough to deliver improved quality, lower cost, and improved staff morale, the three outcomes cornerstones of successful lean activity.
The system starts with an 8-10 am meeting free zone each day. During this time all managers and executives attend "gemba" which means they go to where the real work is done or where value is added to the customer. They will spend this time in the E.R., ICU, clinic etc. They go with a specific set of questions concerning the quality, safety, people, delivery and cost of delivering care that day. From this problems are identified by staff, managers, and executives which are solved immediately by front line staff. The staff is given the tools, training and encouragement to tackle almost any problem. When they can’t solve the problem it escalates to a higher authority until it eventually ends up at the president’s desk. One can imagine if every medication error ended up on the president’s desk we might not be on course to deliver 300 million errors this year alone.
The ten components of this management system are taught in a 16 week course for managers and executives which is mandatory. This learning occurs not in a class room but in the work, supported by knowledgeable coaches the students must prove competency through observation to be installed as a permanent manger.
The results of this management system implementation which began in 2008:
In 2010 across all departments at ThedaCare’s two urban hospitals, 88% of safety and quality indicators improved, 85% of customer satisfaction indicators improved, 83% of staff engagement indi cators improved, and 50% of financial indicators improved.
From 2008-2011
ThedaCare’s days cash on hand has increased from 180 to 202 which equates to a $36 million improvement
Cash flow margin has improved from 10.5% to near 12.5%
The above while maintaining a 4% margin in 2011 despite a doubling of Medicaid volume due to layoffs in the local marketplace.
References:
Joint Commission journal of quality and Patient Safety Vol.37,no.9,387-397
