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LEAN STRATEGYDEPLOYMENT:HOSHIN PLANNING TO ALIGN13,000 STAFFBrock Husby, Senior Lean Six Sigma Coach, Altarum InstituteTammy Daniels, Project Manager, Scott & White Healthcare

SummaryyLargeg Healthcare SystemySetting system goals for several yearsLimited progressp gOur response: Deploy Hoshin planning to aligngoals at all levels of the organizationToday we’ll share Methodology Results LessonsLearned

About UsAltarum OverviewNon-profit health systems research and consultingorganization Over 500 staff based at 9 different locations Lean Six Sigma (LSS) Practice Area provides Leanfacilitation and program development for a wide variety ofclients across the US Highly trained and experienced LSS Coaches that develophealthcare organizations to become self-sufficient in theircontinuous improvementpjourneyjy Helps healthcare organizations address their criticalchallenges through a holistic and sustainable approach topcontinuous improvement Provides clients with the training, tools, analysis, discipline,and flexibility to be successful

About UsScott & White Overview Integrated,non-profit healthcare system 12 hospitals, 2 skilled nursing facilities, 60 60 clinics Largest multi-specialty practice in Texas One of largestg multi-specialtypy practicespnationwide 13,000 staff, 900 physicians & scientists, 400 medicalresidents and fellows Scott & White Health Plan – 180,000 members

Terminologygy ReviewLeanIdentify value-added steps in a process Work to minimize/ eliminate non-value-added steps andremove wastet Hoshin Kanri Ho-shin Hoshin Direction; Kan-ri Kan ri Management“Catchball” 2-way goal-setting conversationSWAT Scott & White Alignment Tool

Once Uponp A Time Flagship hospital in a small Texas town grew into aBIG healthcare systemStrategic planning and goal alignment were neverEASY

Now It Was REALLY Difficult C Suite ShuffleC-SuiteSignificant Growth: Organic and acquisitions/ mergersGeography: More than 29,000 square milesHealthcare ReformBenefits and Compensation ChangesFinancial ChallengesImpending Audits from Regulatory Agencies Both Joint Commission and CMS visited during our roll-out

Time to Act!Senior leaders had clarityy about our goals,g,strategy, visionClear disconnect between senior leaders and frontline staffReport from Gallup corporation : 2010 staffengagement survey opportunitiesi i ffor iimprovement “The greater the distance between an employeeand leadership,leadership the greater the opportunity forthem to be disengaged and feel disconnected.”

We Needed Help p

Lean Groundwork2008: Core leader group attended University ofMichigan’s Lean Healthcare Certification ProgramCLIP Office VPplus 4 full-time coaches4-day4day “deepdeep dive”dive course held monthly 900attendees to date2-hr classes on specific lean tools 5S,A3 Problem Solving, Waste Walk

May to December(R ll O t NOT Romance!)(Roll-Out,R!)May Org Goals PilotJun Tool Roll-OutJulAug Training LeaderCatchball LeaderGoalsDueSepOctNovDec FY 12 StaffCatchball All staffgoals due New hires Processing Results PProject toPermanent Tracking

May:y SystemyGoals & PilotSenior leaders set SMART system goalsC-level accountable owner for every goalRe name the initiative: SWAT!Re-name (Don’tforget – we’re special!)Facilitated Hoshin (catchball) sessions AllC-levels Target pilot areas:areas Hospital,Hospital Clinic,Clinic Shared ServicesServices,Shared Services

June: Refine ToolSWAT Form Overview Mission,Vision, Values System Goals Leader Goals Staff Goals Alignment Indicators “Other Initiatives”

Hoshin “Direction Management”JJune:RefineR fi ToolT l

June 24: Roll-OutCouncil for Strategic Activation (CSA)450 physician and business leadersSystem goals and strategic plan unveiledOverview of SWAT process, training, tool, timeline

July:y Stepp 1– SWAT Overview TraininggAttending 11-hourhour SWAT overview session wasassigned as “pre-work” to all leaders and staffBaseline knowledge for more effective catchballsessions4 Altarum Coaches plus 12 internal coaches trainedto present these overview sessions and field generalquestionsLocal or assigned coach at every regional site

July:y Stepp 2 – Leader CatchballCatchball 22-wayway conversationTHE single most important ingredient in HoshinWave 1: Senior team completed one-on-oneone on onecatchball sessions with President/ CEO to documenttheir goals “Center– Out” approachThird party “coach”coach or facilitator is KEYLeader goal completion tracked/reportedfor accountability

Catchball ResourcesPeoplep Seniorchampion, C-level exec. (Owners) VP, Director (Barrier Busters) Altarum Partners (Movers & Shakers) Project Manager (Details) 122 master trainers// catchballhb ll coachesh (W(Workerk Bees)) 2 Central SchedulersTechnology Laptopsand flash drives Paper and pen will work, too

August:gLeader Goals DueCompliance tracking by CC-levellevel leader rollroll-upupAll Director-level leaders and above(approximately 450) were due by 8/31Target was 95% complianceResult: 87% by 8/31 Continuedto trickle in – 93%

September: FY 12 Begins,St ff CatchballStaffC t hb llLeader catchball and goals completed by 8/31Catchball “cascade” to all staff began in earnestIncreased demand for coachesLeaders realize 2-3 catchball sessions needed

October: SWAT in Orientation,All GoalsG l DueDTraining to the “masses”masses complete in October10 master trainers and 9 orientation trainersprepared to teach SWAT processEvery new staff member receives SWAT overview inorientation at every regional location2 homework assignments Reviewyour leader’sleader s goals within 1 week Submit your goals within 30 daysRevised Department Orientation Checklist

October: We just THOUGHT we werebbusylastl t month!th!Leader Forms425420415410405400395390385380419Leader Forms395393AugSepOct

October: We just THOUGHT we werebbusylastl t month!th!Staff 6Staff Forms120Aug527SepOct

October: Evidence of Alignmentg

November: Drum Roll,, Please!Veryy ppublicized goal:g90% staff completionpHistorically, accountability wasn’t a strong suitSWAT project team had an off-the-record betProject Manager: 60% Altarum Consultant: 62% H.R.H R RRepresentative:t ti 63% VP: 65% Director: 72%% C-level Exec: 73% Sr. Project Manager: 80% She was really new to the organization!

Results

December: Projectj TransitionMove SWAT from “project”p jto “permanent”pIt’s a way of lifeWorkflow shiftNew hire goals Goal updates from existing staff C iContinueandd emphasizeh i theh 5-step5PROCESSTraining Catchball Plan Track Meaningful Progress Conversations

December: Stepsp 3-5 ((Plan,, Track,, Talk!))Hoshin is NOT just a oneone-timetime processLong-term focus on continuous improvement is key“Tracker”Tracker form is built in to spreadsheetStaff member owns goals ProjectP j t“plan”“ l ”ddatat bby monthth AND trackt k actualt l resultslt

St 3:Step3 PLANThe “Cliff”or “Step”“Steady asshe Goes”Monthly “GetGetThereQuickly”“QuarterlyC eep”Creep”No baseline?“Yes or No?”

St 4Step4: TTrackk

Stepp 5: Meaningfulg ConversationsMonthly or Quarterly?4 questions What’sWh t’your goal?l? How are you doing on that goal? WhatWhat’ss your plan? How can I help you?

Meet Face-to-FaceWhat should you have prepared BEFORE themeeting? (Send, printed, etc.)How can you put the staff member at ease asyou discuss sometimes “stretch” and strategicgoal progress?How would YOU want to be treated duringthesehprogress meetings?i ?

HOSHIN“DIRECTIONMANAGEMENTMANAGEMENT”Successes

Aha! Moments“I didn't realize jjust how critical myy action themesare to this year’s strategy.”“I aligned well with my boss, but even better withth system.”thet ”“I’m a lot more aligned than I thought I ever was.”“ThisThis is just a really good overdue conversationwith my boss.”“Wow,, it was hard and challengingg g time-wise,, butI'm glad we had these conversations before the FYstarted."

Actual AlignmentgL. Holmes,Director:gy OppCardiologyMargin – 33%J. Fajkus,Administrator:Dept of Med OpDept.Margin – 14.7%B. Quinn,Clinic Manager:Decrease clericalovertime by 65%T. Elkins,PatientServiceSpecialist:pMaintain lessthan 1 hourper month ofovertime

CollaborationIn the ppast,, pphysiciansyand “business partners”phadseparate goal setting-processes, even though physiciansare employeesTh result?Thel ? VERY diffdifferent goals lThis year, collaboration was evidentHow did we gain physician buy-in?buy in?Physician-led organization: President/CEO and CMO CMO’s messageg to direct reports:pPhysicianyparticipationppisnot optional Office of CMO sent out joint appointments to physiciandepartment chairs and administrators

Results of Collaboration?Co-Catchball Sessions CMO,Physician Department Chair, and Administratorworked together to document and prioritize goalsSimilar (if not identical) targets in critical areas: Qualitybenchmarks ContributionCib i margini Staff Engagement Patient Satisfaction RVU’sProcess was repeated out through the physician/business partner ranks

“Other Initiatives”Catchball process allowed leaders to take ununaligned tasks OFF their plateIn other goalgoal-settingsetting methods, tasks were nevertaken away only added!

Bigg WinsCommitted senior leadersMultiple modes of learning and communication Classroom,video, webinars, website, e-mailCoach availability/ flexibility Deepbackground knowledge of Lean AND operations All other tasks removed: FOCUS on SWAT! Do-Whatever-It-Takes attitudeAltarum Partners Predictissues, pitfalls and recommend strategies HelpH l iimplement,lt bbutt tteachh us tot own it ourselvesl

Remember our Lean Groundwork?System was starting to trust that traditional Lean tools influenceoutcomes 5S, A3 Problem Solving, Waste Walk, VSMIn ggoal-settingg sessions,, sometimes the “what” was clear,, but the“how” wasn’tLeaders and staff looked to Lean tools to help with the “how”and listed Lean pprojectsjin the “Action Steps”p area of theSWAT formExamples of 5 new VSM projects: O.R.O R scheduling H.R.H R orientation Retail pharmacy Call Center O.R. turnover

HOSHIN“DIRECTIONMANAGEMENTMANAGEMENT”Lessons Learned

Lessons Learned ((The HARD Way)y)Involve Project Manager earlyFinalize the steeen-kin’ form prior to pilotBrace yourself for naysayers, skeptics, grouches,and jjust pplain old mean ppeoplepCentralized scheduling is a bear

And Project the “processing time” needs and staffappropriately (3 minutes x 9,700 forms ?)Don’t underestimate the number of ways people cangoof up an Excel formDetermine minimum standards WhenWhtot sendd theth formfbackb k tot owner forf revisioniiBelieve your consultants when they say that truecatchball takes an hour!“catchball”Believe your consultants when they say that 1-3separate “catchball”catchball sessions may be required tofinalize goals!

Three More Just for Leaders Ask top tier leaders to commit to TRUE catchballsessionsiaheadh d off timeiSend appointments and block calendars EARLY Crammingg a catchball session into 20 minutes isn’t feasible,,especially the first time REQUIRE “plan” data from senior team when goals aresetNo excuses, no exceptions Best guess and then revise later if necessary 2-tiered completion deadlines insufficientTop tier (450) took 2 months Delayed cascade Remaining 9,000 staff had to complete in 2 months

SummaryyDon’tt confuse “simple”Donsimple with “easy”easy HoshinPlanning IS simple. It is NOT easy.Year 1 won’twon t be perfect Theheart of lean is continuous improvement – it’s okayto take risks,, make mistakes,, and *gasp*g p fail.Use carrots, not sticksSenior leader champion is essential

Questions?Brock Husby,Husby Altarum Institute brock.husby@altarum.org 321-446-9654321 446 9654 www.altarum.orgTammy Daniels, Scott & White Healthcare TDANIELS@swmail.sw.org@g 254-724-1009 www.sw.org

Lean Six Sigma (LSS) Practice Area provides Lean facilitation and program development for a wide variety of clients across the US Highly trained and experienced LSS Coaches that develop healthcare organizations to become self-sufficient in their continuous imppjyrovement journey Helps healthcare organizations address their critical challenges through a holistic and sustainable approach to .File Size: 2MBPage Count: 50