1. Lean Healthcare Deployment and Sustainability Chapter 10: Standardize Best Practices Sydney Herrin

2. Planned Done Checked Act Eliminate Barriers Ensure there is a stable Quality Management System (QMS) Ensure that new and improved processes are hardwired PDCA (p. 87) ISE 428 ETM 591 SLH Lean Healthcare Chapter 10

3. What is a Stable System? (p. 87) • Consistent adherence to well-defined policies and procedures. • Two pieces: • Policies and procedures exist • They are followed • ISO 9000 ISE 428 ETM 591 SLH Lean Healthcare Chapter 10

4. Example: Operating Room Turnover (p. 89) • Average: 93 minutes • Significant daily variation • Points outside control limits • Out of control Source: Dean Figure 10.1 (System out of control) ISE 428 ETM 591 SLH Lean Healthcare Chapter 10

5. Example: Operating Room Turnover (p. 89) • Average: 87 minutes • No points outside control limits • More stable and predictable • In control Source: Dean Figure 10.2 (System in control) ISE 428 ETM 591 SLH Lean Healthcare Chapter 10

6. Example: Operating Room Turnover (p. 90) • Average: 46 minutes • Average significantly decreased • Narrower control limits • Improved Source: Dean Figure 10.3 (Improved system in control) ISE 428 ETM 591 SLH Lean Healthcare Chapter 10

7. Successful Improvement Requires a Stable System (p. 91) Source: Dean Figure 10.4 (Relationship between a stable system and process improvement) ISE 428 ETM 591 SLH Lean Healthcare Chapter 10

8. Step 1: Eliminate Barriers Identify during transformation support meetings Ensure an environment of open and honest inquiry How Do I Do It? (p. 91) ISE 428 ETM 591 SLH Lean Healthcare Chapter 10

9. How Do I Do It? (p. 92) • Step 2: Ensure There Is a Stable QMS • Infrastructure • Corporate office headed by executive reporting to CEO • Sufficient support staff • Quality Management Council ISE 428 ETM 591 SLH Lean Healthcare Chapter 10

10. How Do I Do It? (p. 92) • Step 2 cont. • Quality Management System • Documented policies and procedures • Structure for reviewing and updating policies and procedures • Internal audit system • Rigorous training and development program • Corrective and preventive action system • Continual improvement component ISE 428 ETM 591 SLH Lean Healthcare Chapter 10

11. Step 3: Ensure That New and Improved Processes Are Hardwired Ongoing review and oversight to ensure QMS documentation is continually updated QMS is responsive to external requirements and internal improvements Work instructions are developed, documented, and updated at process level Policies and procedures are developed, documented and updated at the healing pathway level New opportunities are identified and implemented A culture of continual improvement How Do I Do It? (p. 93) ISE 428 ETM 591 SLH Lean Healthcare Chapter 10

12. CEO, Will Patterson “We have to define the way we are going to do things, and ensure consistent adherence across the system.” (p. 93) “The more we can improve the quality of care and do so at a lower cost, the better we will be.” (p. 93) The Healing Way Case Study: Healing University (p. 93) ISE 428 ETM 591 SLH Lean Healthcare Chapter 10

13. GLOSSARY Stable System (p. 87) A system in which there is a consistent adherence to well-defined policies and procedures ISE 428 ETM 591 SLH Lean Healthcare Chapter 10

14. References / Contact Information Dean, M.L. (2013). Lean Healthcare Deployment and Sustainability. New York, NY: McGraw Hill. Contact Information: Sydney Herrin sydney.l.herrin@gmail.com ISE 428 ETM 591 SLH Lean Healthcare Chapter 10