THE ZSFG WAY. Jim Marks, M.D., Ph.D. Kim Nguyen, MHSA

Transcription

1 THE ZSFG WAY Jim Marks, M.D., Ph.D. Kim Nguyen, MHSA

2 TRUE NORTH 2

3 3

4 BACKGROUND Jan 2017 Strategic Planning Three pillars: people, systems, and tools Hired Rona to support Value Stream Mapping, Kaizen Workshops, lean tools Hoshin Planning -- Identified Seven True North Goals A3 Thinking, Daily Managemen t System to five model cells, Tiered Huddles icare, no meeting zone, leader standard work, principlebased behaviors The ZSFG Way is the name we use to describe our approach to align, enable and improve Hoshin (Strategic planning) Daily Management system Leader standard work Coaching Strategic Deployment using A3 thinking Principle Based Leadership PDP A3 Tiered reporting 4

5 1 A3 Thinking Completion 2 Leader Standard Work 3 (LSW) Completion A 3 T h i n ki n g i s a t e r m w e u s e t o d e s c r i b e o u r s t a n d a r d i z e d language and approach to p r o b l e m s o l v i n g, w h i c h r e i n f o r c e s : C r i t i c a l t h i n k i n g, n o t r e a c t i v i t y o r a s s u m p t i o n H u m i l i t y a n d r e s p e c t P r o b l e m s a s o p p o r t u n i t i e s L e a r n i n g t h r o u g h d a t a, f a c t s, o b s e r v a t i o n P r o c e s s & s y s t e m s t h i n k i n g E ngagem ent and alignm ent CURRENT CONDITIONS: 2017 Achievements E a c h l e a d e r s h o w s d i s t i n c t i o n o f D a i l y, w e e k l y, a n d m o n t h l y c o m m i t m e n t s A l i g n e x p e c t a t i o ns t o l e a n l e a d e r s h i p a n d p r i n c i p l e s ( a l i g n, i m p r o v e, a n d e n a b l e ) S h a r e c o m m i t m e n t s w i t h e x e c u t i v e a n d d i r e c t r e p o r t s f o r f e e d b a c k Personal Development Plans (PDP) Completion D e velop l e a n coaching p rinciples a n d p ractices D e velop a p e rsonal p l a n u sing A3 T h i n king t o d e velop a draft o f p e rsonal plan f or developing more e ff e ctive coaching skills Competencies Baseline 2016 Actuals 2017 Goal 2017 Percent Completion A3 Thinking Completion % LSW Completion % PDP Completion (Not officially a FY2018 Goal) % 5

6 CURRENT CONDITIONS: 2017 Achievements AHRQ SURVEY Executives observed, in general, that units who adopt lean principles and practice improvement activities yielded positive results in AHRQ scores. 8 out of 14 units are high performers (high performers had scores over 70% in AHRQ Survey). TN Category Safety AHRQ Question and Outcome Metrics We are actively doing things to improve patient safety AHRQ Score 6264 Unit Operating Room 3M Clinic 4C Clinic 6G Clinic Pathology Lab Endoscopy Clinic H4244. H3238 ICU Cards/ Medicine Clinical Labs 4A SNF Materials Management 360 Question 360 Q Score 82% 90% 82% 96% 95% 100% 85% 100% 89% 91% 85% 70% 83% Participates in continuous improvement workshops or daily continuous improvement WCD In this unit, people treat each other with respect. 79% 87% 72% 87% 91% 100% 92% 100% 95% 100% 81% 84% 94% Treats colleagues and patients with respect WCD WCD My supervisor/manager seriously considers staff suggestions for improving patient safety My supervisor/manager seriously considers staff suggestions for improving patient safety 76% 83% 79% 96% 82% 95% 77% 100% 92% 91% 72% 93% 100% Practices humble inquiry by understanding and learning from what others say 76% 83% 79% 96% 82% 95% 77% 100% 92% 91% 72% 93% 100% Pursues new knowledge through humble inquiry WCD Mistakes have led to positive changes here. 63% 73% 76% 82% 86% 78% 92% 91% 66% 68% 65% 68% 85% Turns missed opportunities and honest mistakes into learning opportunities Safety After we make changes to improve patient safety, 62% 81% 57% 86% 89% 72% 62% 100% 73% 68% 73% 90% 82% Demonstrates a problem we evaluate their effectiveness. solving mindset by modeling PDSA Quality Diversion Quality LOS N N Quality Readmissions Y Y Quality LLOC N N Quality ED to UCC Quality First Case on Time Starts N FS Favorable salary variance: Within 10% Budgeted N Y Y N Y N Y Y Y Y Operational Spenidng Safety Zero Hero Award Safety SSI Reduction On Target On Target Safety SSI Reduction On Target On Target Safety Falls with Injury Prevention On Target On Target Safety Cauti On Target Safety Sentinal Events (Susan) TN Adopting Lean Principles and Behaviors 6264 Unit Operating 3M Clinic 4C Clinic 6G Clinic Pathology Endoscopy H4244. H3238 ICU Clinical 4A SNF Materials Category Process Metrics Room Lab Clinic Cards/ Labs Management Medicine WCD Huddles: any Y Y Y Y Y Y Y Y N Y Y Y WCD PIPS A3 Reporting Targets Achieved: More green Y N y Y Y Y N Y Y N than red WCD Status Sheets: Daily Management 1:1 Y Y Y N N N N N N N N N WCD LSW: Board Posted and Complete within 1 day Y Y Y Y Y N Y Y Y Y Y Y WCD NMZ: Time spent in Gemba between 8 and 10 Y Y Y Y Y Y Y Y Y Y Y Y WCD Kaizen (Director participation) Y Y Y N N N N Y N Y N Y WCD VSM: (Director participation) Y Y Y N N N N Y N N N N WCD PDSA: Frontline Supervisors can complete Y Y Y Y Y Y Y Y Y Y Y Y independently WCD Process Observation: Managemnet Completes at Y N N N N N N Y N N N N least weekly WCD #A3 Trained >1 Y Y Y N N N Y Y Y Y N Y WCD Icare N N N N N N N N N Y N Y 360 Q Score Self DMS Tool A3 Thinking I-Care Status Sheet and Huddle Status Sheet and Huddle Status Sheet and Huddle A3 Thinking C a p tion: Snapshot o f u n i t s w i t h more greens t h a n red. G r e e n = a b o ve 70% i n AHRQ Survey 6

7 CURRENT CONDITIONS: Performance on True North Metrics 67% of the True North metrics were off target Realign and refocus True North goals and metrics Move the focus to operational level 7

8 CURRENT CONDITIONS: 2018 Strategies 8 3 A d v a n c i n g E q u i t y I m p r o v i n g Va l u e a n d P a t i e n t O u t c o m e s E n s u r i n g F l o w a n d A c c e s s O p t i m i z i n g C a r e E x p e r i e n c e O p t i m i z i n g W o r k f o r c e C a r e & D e v e l o p m e n t T h e Z S F G Wa y B u i l d i n g f o r t h e F u t u r e I m p l e m e n t i n g a n e n t e r p r i s e - w i d e E l e c t r o n i c H e a l t h R e c o r d The ZSFG Way A d v a n c i n g E q u i t y I m p r o v i n g Va l u e a n d P a t i e n t O u t c o m e s E n s u r i n g F l o w a n d A c c e s s O p t i m i z i n g C a r e E x p e r i e n ce F i n a n ci a l S t e w a r d s h i p Building for the Future Implementing an enterprise-wide Electronic Health Record 8

9 PROBLEM STATEMENT Our leaders and staff are neither aligned nor enabled in a manner that allows us to improve our performance and achieve True North goals 9

10 TARGETS AND GOALS True North Targets Baseline Goal FY2018 Goal FY2019 Goal FY2020 DEV.PEOPLE DEV.PEOPLE DEV.PEOPLE Percentage of Expanded Executives that have completed a PDP A3 and identified one (1) personal target Percentage of Expanded Executives who have identified one (1) personal target Number of departments have at least 80% "full implementation" of the Daily Management System "Fully implemented" DMS, defined as: 80% of all components of DMS deemed in place: 1 "competent" unit leader (likely manager),regular status sheets, Huddles, unit leadership teams, 1 driver with daily data, A3, active PDSA, standard work. Average compliance rate for department across units. 33% 85% 90% 95% 0% 60% 80% 95% 0 14 TBD TBD Focus on leadership principles and behaviors in order to exemplify our values for aligning and enabling all staff so that we can improve as an organization. 10

11 EXAMPLE OF PDP A3 11

12 TARGETS AND GOALS Executive Key Performance Indicators Equity Safety Quality Care Experience Developing our People Financial Stewardship Strategic A3s The ZSFG Way Building Our Future Implementing an Electronic Health Record Marks & Nguyen Boyo & Damiano Dentoni & May Boyo Dentoni & Williams Marks & May Johnson Marks & Nguyen Boffi By 6/30/19, Increase By 6/30/2019, Reduce By 6/30/2019, By 6/30/2019, By 6/30/2019, Increase By 6/30/2019, By 6/30/2019, Increase By 6/30/2019, Departmental PIPS total number of patient Reduce hospital Reduce % ICARE adoption and Increase the number % of ZSFG expanded Decrease salary reporting with at harm events to less than readmission from ambulance adherence through of ZSFG departments executive leaders with variance to 0 least one metric 10/month % to diversion from daily status sheets, staff that have one identified PDP A3 stratified by REAL to 14.32% (Prime) 52.8% to 40% celebrations and driver implemented DMS to target to 85% 35% or watch metric to department By 6/30/19, increase % of unique patients seen at ZSFG with complete REAL to 60% and complete SOGI to 15%. By 6/30/2019, Achieve % of EHR implementation defined by phase - Groundwork, Direction, Adoption, Testing, Training, Go- Live By 6/30/2019, Achieve % staff satisfaction and readiness for EHR by phase - Groundwork, Direction, Adoption, Testing, Training, Go-Live By 6/30/2019, Reduce # of days slippage for completion of capital projects to 60/month 12

13 PROPOSED COUNTERMEASURES Principle Based Leadership PDP A3 Strategic Deployment with A3 Thinking HOSHIN Coaching Tiered Reporting Leader Standard Work Daily Management System 13

14 PROPOSED COUNTERMEASURES No. Proposed Countermeasure Completion Date Status Update 1. Spread the daily management system to all areas of ZSFG June 2019 On target You are here Wave 1 Wave 2 Wave 3 Wave 4 Wave 5 JANUARY TO FEBRUARY MARCH TO JUNE JULY TO SEPTEMBER OCTOBER TO DECEMBER JANUARY TO MARCH Perioperative Services DOCC Rehab Critical Care Pharmacy Specialty Perinatal Emergency Specialty Finance Inpatient Imaging Primary Care Psychiatry 4A Specialty 14

15 Cascading information PROPOSED COUNTERMEAURES: DMS drives Strategic Goals Executive Key Performance Indicators Equity Safety Quality Care Experience Developing our People Financial Stewardship Strategic A3s The ZSFG Way Building Our Future Implementing an Electronic Health Record Marks & Nguyen Boyo & Damiano Dentoni & May Boyo Dentoni & Williams Marks & May Johnson Marks & Nguyen Boffi By 6/30/19, By 6/30/2019, Reduce By 6/30/2019, By 6/30/2019, By 6/30/2019, Increase By 6/30/2019, By 6/30/2019, Increase By 6/30/2019, Increase total number of patient Reduce hospital Reduce % ICARE adoption and Increase the number % of ZSFG expanded Decrease salary Departmental PIPS harm events to less than readmission from ambulance adherence through of ZSFG departments executive leaders with variance to 0 reporting with at 10/month % to diversion from daily status sheets, staff that have one identified PDP A3 least one metric 14.32% (Prime) 52.8% to 40% celebrations and driver implemented DMS to target to 85% stratified by REAL to or watch metric to % department By 6/30/19, increase % of unique patients seen at ZSFG with complete REAL to 60% and complete SOGI to 15%. By 6/30/2019, Achieve % of EHR implementation defined by phase - Groundwork, Direction, Adoption, Testing, Training, Go- Live By 6/30/2019, Achieve % staff satisfaction and readiness for EHR by phase - Groundwork, Direction, Adoption, Testing, Training, Go-Live By 6/30/2019, Reduce # of days slippage for completion of capital projects to 60/month Periop ALIGNMENT Unit-Level Key Performance Indicators: Drive (D) or Watch (W) Equity Safety Quality Care Experience Developing our People Financial Stewardship The ZSFG Way 1 Metric Stratified SSI (e.g skin cleansing) Add-On Wait Times ICARE Key Behavior 1 Department Dept. Salary Variance Building Our Future 100%/phase Implementing an 100% Electronic Health Record 15

16 PROPOSED COUNTERMEASURES No. Proposed Countermeasure Completion Date Status Update 2. Roll out structure and oversight for personal developments plans (PDP) for Expanded Execs with targets/metrics/improvement plans. Ensure the PDP aligns with lean leadership principles and values. Completed On target 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% % % Goal #2: Expanded Executives Completed PDP A3 and Identified One (1) Personal Target (YTD) 78.6% % Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 # completed # Incomplete Goal FY2019 Completion Rate Baseline 85% 34.0%

17 NEXT STEPS Next update to JCC is in three months Review Monthly DMS spread completion by cohorts Review Monthly Expanded Exec PDP completion and target identification Review Monthly Expanded Exec PDP targets achievement (coming) 17

18 WHAT QUESTIONS DO YOU HAVE? 18