Sustainability of LEAN Iniatives. François Lemaire, RN, BScN, MBA Lise Vaillancourt, CD, MPA, B.Pharm

Transcription

1 Sustainability of LEAN Iniatives François Lemaire, RN, BScN, MBA Lise Vaillancourt, CD, MPA, B.Pharm

2 AGENDA Our Goal Background Steps to a LEAN Project Montfort s Strategy 2

3 Goal of this presentation To share Montfort s model on how to maintain i gains for LEAN Initiatives 3

4 BACKGROUND 2008 Montfort s ED wait times were amongst the worst in Ontario 13% of admitted patients from ED reached the 8hr target 6 pts /day on average had a stay of more than 24hrs Average wait time for a bed: 17 hrs Low acuity Patients < 4 hours : 41% 4

5 AND VACANT POSITIONS. Leading to low morale 5

6 The project allows better patient care, from ED arrival to discharge from medical ward (average) Reduced offload time Reduced access time to bed Reduced overall length of stay without ALC Patients (medicine) From hours From 3.33 hours From 8,3 days to 25 minutes to 1.2 hours to 7 days 6

7 MAJOR INDICATORS Indicator FY2008 FY2009 FY2010 FY2011 Cum. To Q3 Patients left without being seen 6.6% 6.7% 5.6% 3.9% Length of stay (LOS) Medicine (days) Stays more than 24 h alos admitted patients (h) % < 4h low acuity patients 41% 63% 81% 85% % < 8h - high acuity patients Non admitted 69% 79% 78% 80% 7

8 INCREASED VOLUME AND ACUITY Indicator FY2008 FY2011 Cum. To Q3 Number of visits 36,000 50, Low acuity CTAS 4 & 5 60% 35 % High acuity CTAS 1, 2 & 3 40% 65 % 8

9 FIVE STEPS TO A LEAN PROJECT Define Mesure Analyse Improve Control Preparation phase Diagnostic phase Solution Design phase Pilot and Implementation phase Deployment phase 9

10 SEVEN STEPS TO A LEAN PROJECT Prepare Define Mesure Analyse Improve Control Sustain Preparation phase Diagnostic phase Solution Design phase Pilot and Implementation phase Deployment phase 10

11 HOW WE SUSTAINED OUR GAINS 1. All key yplayers involved 2. Daily performance measures and audits 3. Champions / New structure 4. Dedicated LEAN ressources to follow-up initiatives / Culture 5. Developped internal expertise and standards 6. Regular communication 7. Celebrate our success 11

12 SERVICES INVOLVED IN PATIENT FLOW Portering Admitting Pt flow DI, Lab Housekeeping Nursing 12

13 DART (Data access reporting tool) 13

14 EFFICIENCY Clear targets well known to all Daily Performance Indicator Weekly meetings of performance management 14

15 New Structure 15

16 STRUCTURE TO IMPROVE PATIENT FLOW vement Patient Flo ow Impro Co ommittee Controller Owner Owner Owner expert Lean Direction / GDC/ GP Admission Emergency Floor Support Ambulatory Patient Flow Elective Patient Flow Emergency Patient Flow Improvement Team 16

17 Patient Flow Improvement Committee Responsabilities Sets goals Budget Allocation Approval and prioritization of projects Validation of project charters Availability and resource capacity support Improvement of Lean Change Management Monitoring of projects (high level) 17

18 IMPROVEMENT TEAM Owner process (patient flow): Leader Sponsor: Support PP & GP Manager of processes: project manager for improvement, coaches employees Lean Expert BB: Instructor & Coach 2-3 People, support & physicians: Help implement improvements Controller: Support PP & GP 2-3 People: Help implement improvements 18

19 LEAN CULTURE Daily yperformance indicator accessible to all hospital employees Frequent communication with MD and staff on projects LEAN 101 sessions 5S initiatives 5S at the nurses station in the ED Before 5S After 5S 19

20 The change in culture achieved ensures a solid foundation for Montfort to truly become a continuous improvement organization «««»»» 20

21 INVESTMENT : OUR PEOPLE LEAN Training 90 people trained at the white belt level 55 people at yellow belt level 12 green belt 1 black belt 21

22 COMMUNICATION LEAN-5S Contest Hôpital Montfort - Indicateurs Journaliers de Performance (IJP) Aller au Graphique Aller au tableau de board 0 Moyenne pour RÉFÉRENCE Hier (mar, Nombre 24/01/12 au 28/02/12 CIBLE Indicateurs Fév /02/12) (36 jour) Urgence Nombre de visites à l'urgence Nombre de demandes d'admission Pourcentage d'admission 10% 10% 11% Patient qui ont quittés sans être vu (LWBS) 6% 2,61% 4% 2% (*) Nombre de patients admis - Directement à l'unité A l'urgence temporaire A l'urgenence temporaire et transférés a l'unité de soins Nombre de patients admis sans lit a minuit Nombre de patient admis a l'urgence qui ont eu leur départ de l'hopital 0 Indicateurs de résultats P4R Patients non admis CTAS 4 & 5 DMS < 4 heures 77% 88% 82% 90% (*) Patients non admis CTAS 1 & 2 & 3 < 7 heures 66% 48% 65% 90% (*) Patients admis tous CTAS DMS < 8 heures 20% 9% 20% 40% (*) Nombre de patients avec DMS > 25 heurs a l'urgence (&) DMS moyenne en heure a l'urgence 6,52 5,98 6,08 DMS moyenne en heure a l'urgence pour patient non-admis 4,20 4,82 3,90 DMS moyenne en heure a l'urgence pour patient admis 19,60 17,64 18,59 ANS Patients en attente pour un autre niveau de soins (nombre) (*) Nombre de patients au 4CTR Pourcentage de lits de patients en attente d'une autre ressource 14,0% 10,34% 12,05% 6% (*) Admission Délai d'attente pour avoir un lit (heures) 16, ,8 4 (*) Pourcentage des admissions avec délai < 4 heures 22% 23% 50% (&) Séjour et Pourcentage de patients ayant quitté avant 11am 36% 18% 44 30% 50% (*) congé Pourcentage de patients ayant quitté avant 11am - Médecine 35% 22% 9 26% 50% (*) Pourcentage de patients ayant quitté avant 11am -Chirurgie 45% 19% 16 39% 50% (*) Pourcentage de patients ayant quitté avant 11am -Readapt 84% 33% 3 76% 50% (*) Pourcentage de patients ayant quitté avant 11am Santé Mentale 49% 0% 1 28% 50% (*) Pourcentage de patients ayant quitté avant 2pm 68% 59% 44 65% 80% (*) Pourcentage de patients ayant quitté avant 2pm - Médecine 72% 56% 9 59% 80% (*) Pourcentage de patients ayant quitté avant 2pm - Chirurgie 77% 75% 16 75% 80% (*) Pourcentage de patients ayant quitté avant 2pm - Readapt 98% 67% 3 91% 80% (*) Pourcentage de patients ayant quitté avant 2pm - Santé Mentale 74% 100% 1 76% 80% (*) Durée moyenne de séjour - (SANS LES PATIENTS ANS) 5,2 6,5 5,1 - Unité 4A (SANS LES PATIENTS ANS) 8,7 7,8 8,8 7,6 - Unité 3C (SANS LES PATIENTS ANS) 0,0 6,1 5,4 4,0 3CMED ANS) 0,0 12,4 9,4 7,5 - Unité (SANS LES PATIENTS - Unité 5CCHIR (SANS LES PATIENTS ANS) 0,0 3,3 4,0 4,0 - Unité 6C (SANS LES PATIENTS ANS) 10,9 19,9 10,8 7,6 - Unité 3B PSM (SANS LES PATIENTS ANS) 16,3 23,1 12,6 14,0 Weekly IJP Données en dessous de la cible de plus de 25% (*) Cible Montfort Données a 25% près de la cible (&) Cible MSSLD Données égale ou mieux que la cible Selon données Winrecs 22

23 CELEBRATE OUR SUCCESS 23

24 REVIEW Some principles to take home.. 24

25 HOW WE SUSTAINED OUR GAINS 1. All key yplayers involved 2. Daily performance measures and audits 3. Champions / New structure 4. Dedicated LEAN ressources to follow-up initiatives / Culture 5. Developped internal expertise and standards 6. Regular communication 7. Celebrate our success 25

26 Comments or questions? 26