2017 Lean Healthcare Transformation Summit

Palm Desert, California
Monday, June 05, 2017

Experiments Around the Network

Every day, Catalysis Healthcare Value Network (CHVN) member organizations are running experiments to increase value through the application of lean thinking. This session provides the opportunity to hear about experiments conducted by (12) CHVN member organizations. See how the application of lean tools and a lean management system can remove waste, improve quality and decrease cost. See four different 15-minute presentations during each learning session.

Wednesday 10am session: Model cell experiments and comprehensive spread

At the end of this session, attendees will gain insight into how to develop a model cell and then spread to other areas of the organization, insight into challenges that arise in developing the model cell, and ideas to take back to your organization for redesigning your care delivery.

Wednesday 11:30am session: Finance experiments

At the end of this session, attendees will gain an understanding about the improvement work being done within the areas of revenue cycle, shifting from budgeting to forecasting and payment model experiments.  Opportunities will exist to see payment models that reward value and how to engage leadership in working in these areas.

Thursday 1:00pm session: Information Technology (IT), business intelligence, and analytics experiments

At the end of this session, attendees will gain an understanding and be able to discuss how important the relationship is between the lean transformation journey work and business intelligence/analytics.  Also, they will gain insight into and be able to describe improvement work performed within IT and the importance of this work to the strategic goals of the organization.

Facilitator: Chris Weisbrod, Catalysis

HR and CI: Building Synergy in Lean Transformation

People and culture are at the heart of lean transformation.  Driving lean transformation without engaging the powerful human capital systems of the enterprise is short sighted, and likely to lead to sub-par outcomes.  Human capital systems play a critical role in talent selection and on-boarding, talent training, development and retention, organization change, rewards, leadership development, and comprehensive talent management systems that ensure that the right talent is in the right place at the right time.  Human capital systems and processes pervade every division of the enterprise, hence by integrating these systems thoughtfully with the CI process within the organization can be a great catalyst for lean transformation.  Our study reveals gaps in understanding between HR and CI leaders, common barriers to collaboration, and strategies for overcoming these barriers. Attempting to know when Human resources is fully utilized in a lean healthcare transformation the elimination of waste of talent will be realized as the selection process, on boarding, training, development, will be focused on the needs of the patient and their families. 

HR policies and processes, working in sync with organizational and business processes, have the promise to be facilitative of enterprise excellence.  On the other hand, HR policies and practices, out of sync with the cadence of excellence and continuous improvement, may be burdensome and distractive to business leaders seeking to drive transformation throughout the enterprise.  This study uses a grounded theory approach to tease out and explore the relationship between these two functions in organizations pursuing a lean journey.  Drawing from a series of ten focused case studies we build foundational theory regarding perceptions and actions that facilitate and/or constrain lean transformation.  

At the end of this session, through instruction, an exercise, discussion, and Q&A, attendees should be able to:

  1. Identify how Continuous Improvement (CI) Leaders can facilitate continuous improvement in the Human Resource (HR) Function.
  2. Explain how having HR on board can accelerate lean transformation in Health Care.
  3. Discuss common barriers to effective coordination between HR and CI leaders.
  4. Identify strategies for overcoming common barriers
Presenters: Jamie Andrus, Shingo Institute, Jon M. Huntsman School of Business, Utah State University

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A Journey of Transformation at the Largest Public Health System in the US

NYC Health + Hospitals is a $6.7 billion integrated healthcare delivery system and is the largest municipal healthcare organization in the country. Driven by its mission to serve all New Yorkers regardless of ability to pay, the system serves 1.3 million New Yorkers every year, more than 450,000 of whom are uninsured. Our system provides medical, mental health and substance abuse services through its 11 acute care hospitals, four skilled nursing facilities, six large diagnostic and treatment centers and more than 80 community based clinics. NYC Health + Hospitals operates its own 485,000 member health plan, MetroPlus, and Health and Home Care provides in-home and telehealth services in three boroughs across the city.

Breakthrough (Lean/Toyota Production System) is the organization's fundamental approach to problem solving and improvement. In late 2007, the system initiated the use of Lean to achieve exponential improvements across clinical, operational and financial dimensions of the system. To date, over $650 million in cost savings and new revenue have been generated through more than 1,800 rapid improvement events, implementation of our Daily Management System and thousands of other kaizen activities at 19 sites. Achievements in perioperative services, emergency departments, ambulatory care, behavioral health and more than twenty additional value streams are active throughout the system.

Now the system is transforming and has laid out a new Vision 2020. Three foundational bodies of work define the Transformation Strategy for our system:

  • DSRIP: A Delivery System Reform initiated by our state that is aimed at reducing hospitalizations by 25% in 5 years
  • Vision 2020: A new set of principles and initiatives aimed at improving our patient experience and employee engagement
  • One NY: An unprecedented response by the mayor’s office to transform our system across four areas:
  • Provide sustainable coverage and access to the uninsured
  • Expand Community Based Services with Integrated Supports addressing the Social determinants of health
  • Transform Health + Hospitals into a High-Performing System
  • Restructure Payments and build partnerships to support healthy communities

Using the principles of operational excellence, our system is transforming to meet the expectations of a demanding healthcare market, focusing on three service lines: ambulatory care, inpatient care and post-acute care, focusing on a future vision for clinical services, an approach for data analytics and business intelligence, workforce planning and development, and cultural change.

At the end of this session, through instruction, small group work, discussion, and Q&A, attendees should be able to: 

  1. Learn and describe NYC Health + Hospitals history and approach to improvement: “Breakthrough”
  2. Understand and explain the evolution in Breakthrough’s approach to achieve NYC Health + Hospitals Transformation… from CEO to front line
  3. Observe demonstrated and sustained results of Model Cells
Presenter: Carlos Scholz Moreno, NYC Health + Hospitals

Lean & Agile Methodologies Maximize "Big Data" Initiatives

Learn how MemorialCare’s analytics leadership team leveraged their formal Lean leadership training and experience to developed new guidelines for standard work related to the adoption and deployment of “big data” analytics technologies.  While modern tools offer extraordinary computing power, the implementation of meaningful solutions that can be used by clinical and business leaders and team members to drive process improvement requires adoption of methods that match the technology to processes in ways that have not been common across IT.  A Lean/Agile hybrid approach can deliver high value in short time frames, with high degrees of customer engagement from idea through to outcome

At the end of this session, through instruction, discussion, and Q&A, attendees should be able to:

  1. Understand and discuss the fundamentals of the Agile methodology, and how it complements Lean
  2. Differentiate between traditional and modern analytics solution development methods
  3. Describe ways of adopting and realizing the benefits of a “Go to Gemba” mentality within analytics activities
Presenter: Dan Exley, MemorialCare Health System

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Learner-in-Chief: The Leader as Coach and Mentor

What is the actual work of leaders? How do effective leaders help their organizations transform? This session will describe why it’s not sufficient for leaders to be good problems solvers, why they must also develop the organization’s problem solving capability through coaching and mentoring others. We will investigate the root causes of what prevents good healthcare organizations from achieving their full potential. Why problem solving in healthcare is simple, but not easy. Why healthcare leaders need to develop an experimental mindset, and learn from the work.

We will discuss Fujio Cho’s leadership prescription: “Go See, Ask Why, Show Respect” as a framework for scientific problem solving and organizational learning. Together, we will explore two robust methods for building problem solving muscle: 1) Practicing the daily improvement kata and 2) A3 thinking.

We will conclude with a reflection on the oft-heard question “How can I get my people to do this?”, and a discussion of how leaders must role model the behaviors they want to embed in the culture.

At the end of this session, through instruction, practice, discussion, and Q&A, attendees should be able to:

  1. Articulate the leader’s role as coach and mentor in a lean organization
  2. Describe how scientific problem-solving and PDCA cycles apply to problems in the healthcare environment, including defining the difference between an implementation mindset and an experimental mindset
  3. Realize and explain the value of the improvement kata and the A3 process as:  a PDCA-based methods of problem solving and fostering organizational learning
Presenter: John E. Billi, M.D., University of Michigan

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Making it Stick: Training Reliably to Improve Outcomes

Do you find that a few weeks after a kaizen, the gains and progress simply do not stick? How often do we attempt to resolve these issues with the solution of re-training staff? Our traditional ways of “training” usually involve purely telling staff about the changes or the new process (via email, meeting, flyer, or hand-out). These traditional methods of “training” can be a key driver for why our gains do not stick.

Learn how Providence Little Company of Mary Medical Center in Torrance, CA, has engaged frontline caregivers in the use of Training Within Industry Job Instruction to dramatically improve patient outcomes, refine our use of the instruction method, and spread across the hospital. This session will highlight the four step method for instruction and how it was used in multiple clinical settings within the hospital to reduce harm to patients.

At the end of this session, through instruction, small group work, discussion, and Q&A, attendees should be able to:
  1. Describe the value in standardizing the training method 
  2. Describe Job Instruction and the four step method 
  3. Discuss how Job Instruction could be incorporated into their lean transformation journey
Presenters: Jennie Baek, Providence Little Company of Mary
                   Catrice Nakamura, Providence Little Company of Mary
                    Lili Bacon, Providence Little Company of Mary

Model Cell: Applying Innovation Process to New Care Model Design

Achieving breakthrough performance in model cell experiments is a critical component of system transformation. However, rapidly changing payment models have made it difficult to ‘waste-free’ our way to breakthrough performance. Fundamental care model redesign is necessary.  The Atrius Health Innovation Center was created in response to this challenge with a mission to reliably design, test, and spread new models of care.  While traditional lean improvement pulls knowledge from lean manufacturing techniques to remove waste from existing processes, the Atrius Health Innovation Center process pulls from lean product development techniques and design thinking and focuses on disrupting the current way of delivering care. A high level overview of the innovation process will be presented with interactive learning exercises and examples from the “Care in Place” elder urgent home care program which was developed in 2016 using the process. “Care in Place” has shown a 50% reduction in hospital admissions for those eligible for the service.

Atrius Health is a large multispecialty primary care practice and pioneer ACO serving over 750,000 patient lives in the greater Boston area.

At the end of this session, through instruction, small group work and discussion, and Q&A, attendees should be able to:

  1. Understand innovation as a distinct process that can be applied to clinical care models and identify how this application is made
  2. Have a better understanding of and explain when innovation and lean product development can be applied in healthcare delivery
  3. Grasp the basic underlying thinking and processes used to challenge the assumptions and beliefs of current care models and describe the thinking and processes used
Presenters: Ted Toussaint, Atrius Health
                    Sarah Steinberg, Atrius Health

Patient Responsibility: Continuous Improvement and the Revenue Cycle

Beginning April 2016, Nemours Children’s Health System embarked on an enterprise-wide Continuous Improvement effort focused on the Revenue Cycle, specifically, Patient Responsibility.  Patient Responsibility (PR) is defined as any dollars that patient-families owe for their healthcare, including co-pays, co-insurance, deductibles, and past due balances.  In 2015, Nemours wrote off over $27M of PR dollars to bad debt, constituting a significant financial opportunity for the organization.  With the changing healthcare environment and patients becoming more financially responsible for their care, this opportunity is bound to increase over time, making it a natural entry point for CI work in the Revenue Cycle.  

This session will provide attendees with an overview of the successes, failures, and learnings from the PR work, including the establishment of a Management Guidance Team, alignment and prioritization of projects, data victories and challenges, sequenced RPIWs, patient-family engagement, and standard work across sites and reporting lines.  Most significantly, this session will provide an in-depth review of the sustainability model, including the approach used for implementation across 6 states and over 3 dozen sites, training of 800+ Revenue Cycle associates, and comprehensive daily management.  It will conclude with initial results and plans to continue work through FY 2017 and beyond.

At the end of this session, through instruction, an interactive game, discussion, and Q&A, attendees should be able to: 

  1. Identify successful methods for large scale, multi-site, multi-function Continuous Improvement projects
  2. Thoughtfully use patient and family engagement strategies in Revenue Cycle improvement work
  3. Adapt learning from the Nemours Patient Responsibility model to improve the Revenue Cycle in their own organizations
Presenters: Bill Britton, Alfred l DuPont Hospital for Children
                    Kellie Olmstead, Nemours Children's Health System
       Hal Williams, Nemours Children's Hospital

Peer-to-Peer Learning: Strategy Deployment Adaptation

Last summer the Carolinas Healthcare Systems’ hosted a gemba visit for fellow Catalysis Healthcare Value Network members, true to the Network motto of Learn-Share-Connect.  The focus was sharing their Strategy Deployment and Daily Management systems. One of the groups in attendance was the senior leadership team from Mercy Oklahoma City (Mercy OKC). The Mercy team learned, reflected, and translated what was shared at the gemba visit back into their own Strategy Deployment system and model cell work in Oklahoma City. In this multi-faceted learning session you’ll learn about the Carolinas Healthcare System’s strategy deployment system. You’ll also hear how Mercy OKC interpreted what they learned and how they introduced the learnings into their own organization.

At the end of this session through instruction, discussion, and Q&A, you should be able to:

  1. Articulate the value of peer-to-peer learning
  2. Understand and describe the basics of the Carolinas’ strategy deployment system
  3. Understand and describe how Mercy OKC translated and applied learnings to their own strategy deployment system and model cell work.
Presenters: Michael Johnston, Carolinas HealthCare System
                    Aaron Steffens, Mercy Hospital St. Louis

Physician Participation in Leader Standard Work

Leaders are the key to making and sustaining a lean transformation.  One of the central elements in a Lean management system is leader standard work.  Leader standard work defines expected behavior of leaders and shifts the focus from results only to process first and results second.  Leader standard work requires visibility (observation of work, process metrics, and making problems visible), responding (stop & fix problems, clear escalation pathways, off-line improvements), and coaching (daily improvement thinking, development of team members and leaders).

Physicians by the nature of current healthcare systems are seen as leaders.  Therefore, their behaviors or lack thereof can profoundly influence system performance.  However, engaging physicians in standardized practice routinely meets significant resistance.  Through repetitive cycles of testing, we describe how Seattle Children’s developed and implemented leader standard work for a cohort (approximately 60) physician leaders.  In addition, gaps, challenges, learning, and next steps will be shared.

At the end of this session, through instruction, small group work, discussion, and Q&A, attendees should be able to:

  1. State the elements and intent of leader standard work.
  2. Discuss the potential benefits of engaging physician leaders in system improvement through leader standard work.
  3. Describe the iterative learning process used at Seattle Children’s to successfully initiate leader standard work for physician leaders.
Presenters: Lynn D. Martin, M.D., Seattle Children's Hospital
                   Darren Migita, M.D., Seattle Children's Hospital

Rapid Cycle Strategic Learning

Healthcare organizations adopting lean thinking principles and methods eventually use strategy deployment to align and focus resources on the critical few priorities they believe will propel them toward True North. However, the same troublesome patterns emerge as these organizations struggle with the concepts and tools.

First, avoidance of making strategic choices is creating overburden. Second, the lack of deploying differentiation from competitors is contributing to a commoditized industry. Third, absence of rapid cycle learning is creating organizational inertia. Finally, inability to hold meaningful dialogue in the catch-ball process is creating confusion about expectations and performance.

Successful organizations in other industries use a process of strategic learning that avoids these pitfalls. They clearly define what success will look like. They make explicit choices of spaces or segments in which they must succeed, versus others where they will hold their ground. Then they make critical choices of the processes they believe will create competitive advantage. They treat their strategy as a hypothesis, dependent on assumptions about internal capability, customer response, and competitor reactions. Their strategy deployment uses “lean learning loops” to rapidly study and adjust to get the most gain at the greatest velocity with the least pain.

This learning session exposes the participants to this framework, and immerses them in experiential learning as they apply it to their own situation.

At the end of this session, through instruction, practice, small group interaction, and Q&A, attendees should be able to: 
  1. Practice making strategic choices of what to focus on, and what not to focus on
  2. Apply more rapid cycle learning loops to their deployment process
  3. Have more meaningful dialogue as they “catch ball” throughout the deployment process
Presenter: Jeff Hunter, Jeff Hunter Strategy

Revolutionary Transformation of Community Healthcare with the TPS

The Toyota Production System Support Center (TSSC) has applied their approach to continuous improvement for more that twenty years with other manufacturers, non-profits and community organizations to help them find better ways of doing their day-to-day work.  Known as the Toyota Production System (TPS), this methodology is being adapted to the healthcare environment.  Winona Health’s vision is to be a recognized leader in the revolutionary transformation of community healthcare.  Winona Health is the first Healthcare Value Network member to pilot the TSSC methodology in two model cells: primary care and operating rooms’ core supplies area.  Results include: improved patient access and flow through Primary Care and improved presentation and control of supplies in the Operating Room core.
At the end of this session, through instruction, discussion, and Q&A, attendees should be able to:

  1. Differentiate the TSSC-TPS methodology from other TPS-like implementation (ie, unique elements of the TSSC methodology)
  2. Understand and describe the necessity of applying the concepts alignment, engagement and improvement to a successful transformation
  3. Spread the TSSC improvement methodology from a model cell to other areas in the organization
Presenters: Bobby Graves, Toyota Production System Support Center, Inc (TSSC)
                    Marti Bollman, Winona Health
                    Jan Brosnahan, Winona Health

The Role of Nurses and Nursing in a Lean Transformation

Nurses and nursing leaders have a unique position in our healthcare organizations, and in an organization’s lean transformation. Catalysis is responding to Voice of the Customer from our Network’s nursing executives by hosting a first-ever CNO/CNE learning session at the 2017 Summit.  The purpose of this learning session is to help these healthcare executives learn, share, and connect around issues important to their unique role in healthcare.

At the end of this session, through large and small group discussion, attendees should be able to: 

  1. Understand and describe how top issues for nursing leadership related to lean transformation are identified and prioritized
  2. Explain what is of value when considering nursing leadership-oriented gemba visits
  3. Describe what the value of a CNO/CNE learning – sharing – connecting cohort might be
Presenters: Julie Firman, Southern Illinois Health
                    Paul Pejsa, Catalysis

Stop Having Your Leaders Solve All the Problems

“How do we sustain these improvements?”  “Why won’t our leaders mandate this change” Both are common phrases heard in any central lean office.  At Cleveland Clinic, we have found the key to sustaining change and engaging leaders in a culture of improvement is to STOP HAVING LEADERS SOLVE ALL THE PROBLEMS.  To build a culture of problem solvers it starts with leaders not solving all the problems.

Easy to say, harder to do.  Through the use of the Kata questions and the creation of a repeatable problem solving system Cleveland Clinic leaders are doing just that.  We are shifting our leader behaviors by providing a simple, visible, and tangible process that is used consistently across all healthcare processes. And it works everywhere. Our approach (including templates and standard work) can be rapidly utilized in other organizations to engage the front line in solving problems.

At the end of this session, through dialogue, observation and small group, attendees should be able to:

  1. Describe and articulate how creating a system for problem solving creates long term front line engagement
  2. Describe the correct use of kata questions to shift manager behaviors to coaching versus problem solving
  3. Conduct and describe their own problem solving huddle that engages all caregivers in solving problems
Presenters: Nate Hurle, Cleveland Clinic

Unique Lean Partnerships, Innovations, and Leadership Engagement

The Richard L. Roudesbush VA Medical Center will share their journey of sharing experience at the leadership to frontline staff levels.  We will demonstrate how leadership involvement and encouragement grows an innovative collaborative effort and then blossoms into partnerships outside of the Medical Center.   We will demonstrate how we utilize flexibility and adaptability in our everyday work environment and create opportunities that may not have been available to us.

Building an environment of sharing knowledge and experience helps create an avenue for collaboration and partnerships.  The RLR VAMC is seen as a forerunner in applying Lean Management systems within its organization.  As such, an increase in site visits within and outside of the Department of Veteran Affairs organization has lent itself to collaborating with lean practitioners in the healthcare industry in our Indianapolis metropolitan area.  

At the end of this session, through instruction, discussion, and Q&A, attendees should be able to:

  1. Understand and describe how RLR VAMC created an environment for partnership, innovation, and sharing
  2. Learn and explain how to become adaptable for any request for innovation and partnership ideas
  3. Understand and describe how RLR VAMC set up their structure and environment for leadership engagement
Presenters: Penny Butler, Richard L Roudebush VA Medical Center
                   Cathy Lee-Sellers, Richard L. Roudebush VA Medical Center

Using a Kata Mindset to Drive Your Strategy

A great strategy poorly executed will lead to poor patient and business outcomes.  Anyone can see that relationship.  At the same time, much organizational energy is given to creating the ‘right’ strategies, yet much less time is put into figuring out how to make sure everyone stays focused.  Mike Rother’s work around Toyota Kata has highlighted a pattern of behavior, based off of principles that provides focus on the most important things, gives a framework for improvement and coaching to achieve process and outcome improvements.  Those routines that have proven to be extremely effective at improving process can be used to help your operational units and executive teams focus, prioritize, and drive your overall business strategies toward your goals.  Ali and Bill will show you a practical routine used within ThedaCare over the last year to help unit and divisional teams focus and drive the right work.

At the end of this session, through instruction, practice, small group interaction, and Q&A, attendees should be able to:

  1. Understand and explain the overall framework of the improvement and coaching kata patterns
  2. Understand and identify how to frame strategies/initiatives into manageable pieces that can be acted on weekly
  3. Walk away with a routine for weekly reflection and prioritizing for a leadership team and be able to apply this routine to practice
Presenters: Ali Coenen, ThedaCare
                    Bill Boyd, ThedaCare

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Contact Information

  • Call Catalysis: (920) 659-7500

Payment Instructions

  • Registration Fees
    Summit Registration $1400
    Fees Include: Participation in the 2-day Summit, Welcome Reception, breakfast and lunch each day.

    Pre-Summit Workshop(s) $800/day ($600/day with Summit Registration)
    Fees Include: Participation in the workshop(s), participant materials, breakfast and lunch each day.

    Payment Methods
    We accept MasterCard, Visa and American Express. Payment made by check must be received within 30 days of registration in order to guarantee registration. If we do not receive payment by this dates, your registration will be cancelled. To pay by check, download the invoice in your confirmation email, reference the Invoice Number on your check and mail to:

    Catalysis Inc.
    100 W. Lawrence Street, Suite 422
    Appleton, WI 54911

    Cancellation and Substitution Policy
    Substitutions may be made without penalty at any time. Full refunds will be issued if written notice of cancellation is received on or before April 7, 2017. If cancellation is received after April 7, 2017, a refund will be issued minus a $250 cancellation fee.