19 Measures v20130530

Mod 19 – Measures
GPS
MUDA MUDA
Cost Reduction Profit =

By Eliminating Waste Just-in-Time Price - Cost
GPS Depth Study Quality Cost Delivery

TAKT Time Map
Measures
NVA/VA- Measures Capacity Tables
Functions/Mgrs Safety Morale
Jidoka Standard Total Visual

R Productive
(human Control
e
automation)
Operations Maintenance
d
e
p
l
o
y
m
Setup Reduction
Changeover
Heijunka
(Leveling)
Poka-yoke
(mistake
proofing)
Module 19
e
n Multi-process Continuous
t
Operations Flow Kanban Andon
3P
RPIW Kaizen Kaikuku Prod
Prep
7 Flows 7 Flows
Factory Product/Patient Quantity Analysis Medicine
• Sweeping
• Sorting 7
4 No’s
• Simplifying 5S • Standardizing
• Self Discipline Wastes
Value Stream Mapping
ONE PIECE FLOW TAKT TIME PULL PRODUCTION

Global Production System
© 1996-2013, John Black and Associates LLC
(modified from Hiroyuki Hirano, Productivity Press).
19 Measures v20130525 1 ©1996-2013, John Black and Associates LLC

Committed Leaders Licensed Materials – USA Copyright Laws Apply
Mod 19 – Measures
Measures: Key Points

 World Class Measures Quality, Cost, Delivery, Safety,
and Morale (QCDSM) lead to full customer satisfaction.
 You can’t improve what you can’t measure.
 Cascading measurement and accountability creates
alignment.
 Strategic Visibility process, Weekly wall walks focused on
Service Lines, and Visual Daily Management are
components of this alignment process.

Licensed Materials – USA Copyright Laws Apply
Mod 19 – Measures
Measuring World-Class Quality Ensures

Survival Through Full Customer Satisfaction
Reliability
Responsiveness
Quality Assurance
Empathy
Tangibles
Assurance of Quality
Cost Effective
Cost
World-Class Price Effective
Quality for Total Full
Survival Right Place Customer*
Satisfaction
Delivery Right Time
* Patient
Right Amount
For Patient
Safety
For Provider
Morale Everyone Cares

Mod 19 – Measures
Park Nicollet Health Services/Used with Permission
Weekly Stand-Up Meeting Wall

Mod 19 – Measures
Park Nicollet Health Services/Used with Permission
Visibility Room
Mod 19 – Measures
Quality
 Products and services received by the customer must fit
their precise intended use, while serving the customer’s
needs better than do the products and services of
competitors.
 These products and services must meet customer
requirements and conform to customer specifications.
 They must be accompanied by excellent service before,
during, and after their sale or delivery.
In health care, the Customer is the Patient.

Mod 19 – Measures
“Quality in a product or service is not what the supplier puts

in. It is what the customer gets out and is willing to pay
for. The product is not quality because it is hard to make and
costs a lot of money, as manufacturers typically believe. This
is incompetence. Customers pay only for what is of use to
them and gives them value. Nothing else constitutes quality.”
-- Peter F. Drucker
Professor and Management Consultant,
1991

Mod 19 – Measures
Quality Measures in Health Care

 Patient Defects, examples include:
 Surgical site infections
 Ventilator acquired pneumonia
 Central line infections
 Patient/Client/Resident Experience Data - Surveys
 Patient Complaints
 Patient Health Outcomes
 Patient Stories

Mod 19 – Measures
Quality
Quality of Care
• In alignment with the overall goals
of the organization, each Service
Line Leader reports their quality
of care metrics in the form of
defects as they relate to kaizen
activities such as RPIWs and 5S
events.
• Examples of Quality of Care
metrics include surgical site
marking defects (for surgery),
standard rooming defects
(primary care), door to discharge
>120 minutes (emergency).

Mod 19 – Measures
Used with permission, Florida Hospital Zephyrhills

Mod 19 – Measures
Quality
Clinical Quality
• These goals are determined by
the organization and outside
affiliates (ie JCAHO).
• Goals such as anticoagulation,
MRSA, falls, Diabetes measures,
ventilator-assisted pneumonias
etc are tracked and incorporated
into Kaizen activities such as
RPIWs.

Mod 19 – Measures

Mod 19 – Measures
Weekly Stand-Up Wall Walk
Patient Experience
The organization measures patient experience not only with Press Ganey and
other survey types, but through precise measurement of lead time and
reported out by the Product Line Leader.
Mod 19 – Measures

Mod 19 – Measures
Patient Stories

Mod 19 – Measures
Cost
 Products and services must be cost-effective.
 During planning, design, and delivery, these products and
services must be cost-effective for the producer.
 To ensure strong demand for services, they must be
priced effectively.
 World-class organizations make concentrated efforts to
eliminate waste, and they do only those things that add
value for the customer.
 These organizations also control costs with suppliers and
vendors, resulting in lower costs for the same product or
service over time.

Mod 19 – Measures
Cost Measures in Health Care

 Cost of supplies per surgical procedure.
 Productivity gain or loss.
 Inventory.
 Lost time, sick time.
 Cost of overproduction.
 Duplicate lab tests and digital imaging.
 Cost of excess laundry delivered and not used.

Mod 19 – Measures
Patient Cost
Here patient cost is measured
through cost per unit of service and
operating margins for the specific
service line as reported by the
Service Line Leader.

Mod 19 – Measures
Profit or Margin
Profit is displayed as it relates to
FTEs as defined by the organization
and reported by each Service Line
Leader.

Mod 19 – Measures
Delivery
 Superior delivery of products and services is critical.
 Customers must receive the right amount, in the right
place, at the right time, in the right package.
 Delivery must be timely, reliable, and courteous.
 Customer satisfaction depends greatly on company
responsiveness, which comes from having short cycle
times to product or service delivery.
 As demand increases, customers receive benefits of
economies of scale and organizational learning.
 Finally, customers expect reliable new product or service
development systems, so that they can be assured that
your delivery will continue to meet their needs in the
future.
Mod 19 – Measures
Delivery Measures in Health Care

 Patient appointments available on day of choice.
 Volume of patients waiting for service (waitlist).
 Length of time patients wait for service.

Mod 19 – Measures
Safety
 The importance for the customer of safety and security in
using an organizations products and services is obvious.
 Providing full satisfaction to the customer also means
ensuring safety and security for all employees who
produce those goods and services.
 Customers cannot be assured of quality if employees
work in unsafe conditions or insecure places.
 Furthermore, a company’s products and services must
be environmentally safe, avoiding pollution and ensuring
reuse or recycling of materials.

Mod 19 – Measures
Safety Measures in Health Care

 Patient critical incidents.
 Patient falls.
 Adverse events, near misses.
 Hand hygiene.
 Staff injuries.
 Needle sticks.

Mod 19 – Measures
Visibility Room Review
Safety
• The safety category displays the organization’s adverse events and high
level safety indicators.
• Other information is related to infection control, blood and body fluid
exposure, and falls.
• Adverse events and high level safety indicators call for root cause analysis
and poke-yoke implementation.

Mod 19 – Measures
Employee and Patient
Safety Visibility Wall
Seattle Children’s Bellevue Surgery Clinic/

Used with Permission

Mod 19 – Measures
Morale
 Workmanship, product reliability, and substantive quality
require that people have high morale and competence.
 Employee morale and education become critical aspects
of full customer satisfaction.
 Customers must be assured that the people who deliver
their products and services really understand and care
about doing a good job.

Mod 19 – Measures
Morale Measures in Health Care

 Employee Survey Results.
 Staff turnover.
 Staff retention.

Mod 19 – Measures
Visibility and Alignment of Measures

 As referenced in the World Class Management Module, Visibility and
Alignment of measures is done across the 3 Management System
Components:
 Management by Policy (Hoshin Kanri)
 Monthly Reviews of Strategic Visibility Room
 Cross Functional Management
 Weekly Wall Walk of Operational Wall, by Service Line, QCDSM
 Daily Management
 Daily Huddles at Visual Daily Management Boards
 Measures identified as part of a Break Through Initiative (Hoshin)

can and usually will cascade From the Strategic Visibility Room,
through the Weekly Wall Walk, right to Visual Daily Management
Boards (as identified on the next chart).
 However, measures on the Strategic Visibility wall are focused on the
Breakthroughs only and do not cover the entire operation (as
represented on the second following chart).

Mod 19 – Measures
The Management System and Visibility and Alignment

BETTER CARE Strategy
Policy (Hoshin Kanri)
Strategic Visibility
Room (Breakthroughs/ 3-5 Year
0 NEVER EVENTS
Hoshins) Outcome Targets
Management by
Target Progress
Senior Leader,
Breakthrough Leader
#1 priority
Weekly Wall Walk -
Management
Reduce level 3 & 4

QCDSM pressure ulcers at LTC
Functional
Chart updated as of
Pressure Ulcer ______ Action to be taken
Level 3 and 4
Cross
to return to
Patient mortality related
to L 3& 4 pressure
Service Line Leader
ulcers
LTC Site 2
Management
LTC Site 1
Daily Visual
Management
LTC Site 3 LTC Site 4
Daily
Front Line Mgrs

Mod 19 – Measures
The Management System and Visibility and Alignment

Strategic Visibility Room
(Breakthroughs Only)
Hoshin 1 Hoshin 2 Hoshin 3
Wall Walks Quality Cost Delivery Safety Morale

(Monthly; CEO
Service Line #1
& Exec Team)
Service Line #2
Daily Visual Management

(Daily or Weekly; Manager and point of care staff)

Mod 19 – Measures
Strategic Visibility Room
Review: Key Points
 Dedicated space outlining the overall strategic plan and
corresponding Kaizen activity related to the goals.
 The review is lead by the CEO and mandatory attendees
include: senior/executive leaders, chiefs and VPs,
including the KPO VP.
 Monthly review to assess progress toward Breakthrough
Plans and related targets and metrics.

Mod 19 – Measures

Kaizen
• Displays kaizen activities such

as RPIWs, 5S events, 3Ps and
their results.
• Shows the progress of lean
certification from a system-wide
perspective.
• Utilizes individual Kaizen
Operation Teams’ integrated
timelines for strategic planning
of events.

Mod 19 – Measures

Who are we?
• Identifies the organization as a whole
with one slide for each of the following:
• Core strategic elements (ie world
class continuum of care).
• Economic engine (ie what do we look
like yesterday v. today v. tomorrow).
• Priorities for the current year (ie
increased productivity and decreased
leadtime.
• Mission.
• Vision.
• Outcomes management.
Mod 19 – Measures

Strategic Objectives
• Displays overall view of how
the organization is doing as it
relates to the QCDSM
metrics.
• Identifies plans and progress
for the following:
Volume of Service, Lead
Time, Caring, Cost,
Outcomes, Safety,
Marketing, Facility
Management, Leadership
Development, Revenue
Management, Systems
Reliability.

Mod 19 – Measures
Critical Success Metrics

• Displays the organization’s progress in the following categories:
Equitability, Profit & Growth, Productivity, Joy, Market Share,
Asset Turns, Publications and Philanthropy.
Mod 19 – Measures
Critical Business Processes

• Displays the organization’s progress in the following categories:
Compliance and Accreditation, Recruitment, Planning, and Governance.

Mod 19 – Measures
Clinical Quality
• Through the display of high level Value Stream
Maps and a PQA of conditions, clinical quality
is tracked by progress in such areas as
Diabetes Management, Heart Failure, Wound
Care, Readmissions, etc.
Mod 19 – Measures
Used with permission Florida Hospital Zephyrhills

Mod 19 – Measures
Production Control
• Demand vs. Capacity, Resource Need vs. Actual and the
organizational Takt Time Map are production control.
• These areas help identify what is v what is needed to meet the
demands of the organization in regards to patients and employees.
• Production control displays trends in market growth in the community
as it relates to age, demographics, and disease conditions.

Mod 19 – Measures

Mod 19 – Measures

Pay for Performance &
Transparency
• Pay for Performance displays
financial data in regards to how
the organization collects dollars
for meeting condition-based goals
• Transparency identifies how well
the organization is doing as it
relates to others in the community
through Leap Frog, Press Ganey,
HCAPS, JCAHO, etc.

Mod 19 – Measures
Weekly Stand-Up
Wall Walk: Key Points
 One level down from the Visibility Room, the Weekly
Stand-Up Wall Walk brings all service line leaders
together to review the progress of Kaizen activity in their
area through the use of standard control charts by each
KOT.
 The Weekly Stand-Up Meeting Wall Walk is led by the
CEO at a standard day and time each week with each
Product Line Leader reporting their QCDSM metrics to a
Takt Time. Mandatory attendees include senior/executive
team, chiefs, KPO and KOTs, and directors.
 This form of cascading communication allows for
transparency and comingling of information across
the organization.
Mod 19 – Measures

Standard Work
Name of Activity: Weekly Wall Walk
Role performing Activity: Leadership

Standard Work
• The standard work is followed each
Location: Department:
Wall in Administration All
STANDARD Document Owner:
Carla Breedlove, Director Kaizen Promotion Office
WORK Date Prepared:
12/15/09
Last Revision:
12/17/09
Date Approved:
12/17/09
week and kept to a Takt Time by a
Standard Work Summary: Steps by which the weekly wall walk occurs; each presenter
has 10 minutes to report without interruptions from the audience and then can take up to 5
timekeeper.
minutes to field questions related to their report out. KPO Director (or designee) will
• Each week focuses on a different

monitor the takt time.
Task Task Definition Cycle Time

(mm:ss)
1. KPO Director calls the wall walk to order at designated time by stating
“Welcome to this week’s wall walk. Today is week (x) and we will be
1:00 set of metrics. A sample is shown
hearing reports on the metrics of (y).” (see reference below) and introduces
any guests who may be attending:
Wk 1: Goals, Integrated Timeline
here:
Wk 2: Quality, Cost, Delivery
Wk 3: Safety, Morale, Patient Experience
2.
Wk 4: RPIWs, 5S campaign, Lean Events
CEO, CFO, COO, CMO leads a prayer 0:30 • Week 1: goals & timelines.
3. CEO, CFO, COO, CMO, CNO, KPO reports on the appropriate metrics for 10:00
the “Overall” category.
4.
5.
CEO, CFO, COO, CMO, CNO, KPO takes questions from the audience
related to their report out.
Director for Emergency Department reports on the appropriate metrics for
5:00
10:00
• Week 2: quality, cost, delivery.
the “ED” service line.
• Week 3: safety, morale, patient

6. Director for Emergency Department takes questions from the audience 5:00
7. Director for Surgical Services reports on the appropriate metrics for the 10:00
“Surgical Services” service line.
8. Director for Surgical Services takes questions from the audience related to
their report out.
5:00 experience.
9. Director of Materials Management reports on the appropriate metrics for 10:00
the “Materials Management” service line.
10. Director of Materials Management takes questions from the audience
5:00
• Week 4: RPIWs, 5S, Lean.
11. KPO Director adjourns weekly wall walk and dismisses group. 0:30

Mod 19 – Measures

Run Chart
Pre-Service Leadtime
G.I. Clinic
100
90 Run Chart
80
Used across all service
70
Number Of Days
60
lines, these standard
50
charts make reading the
40
metrics easy and
30
consistent.
20
2006 Q1: 70.4 2006 Q2: 77.9 2006 Q3: 70.2 2006 Q4: 66.4
2007 Q1: 57.8 2007 Q2: 67.7 2007 Q3: 61.8 2007 Q4:
10 Delta: -18.0% Delta: -13.2% Delta: -12.0% Delta: #VALUE
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
Q1 Q2 Q3 Q4
Week / Quarter
Date Prepared: September 24, 2007
Report Contact: Demand Planning & Analysis, Gregg Teeter, 3-9238 2006 Actual 2007 Actual
Source: LastWord scheduling data mart
Refresh Cycle: Weekly (1 week lag) 2007 Goal Series1
Operational Def: 2006 vs 2007 weekly weighted AVG compared to goal (50% of 2005 4Q AVG)
Criteria: Weighted AVG appointment availability (weighting based on volumes of seen appointments by dept, facility, prov, appt type Series2

Mod 19 – Measures

Mod 19 – Measures
Growth
Each Product Line Leader addresses
their individual service line growth as
it relates to the strategic plan for
growth in the organization.

Mod 19 – Measures
KOT Product Line

Other metrics shown on KOT’s area of the wall are their own product line’s current
and future state (12 months out) value stream maps, integrated timelines, RPIW
and 5S matrices, results, audits, target sheets, newspapers and goals.
Mod 19 – Measures
Measures Summary
 Quality, Cost, Delivery, Safety, and Morale are metrics
defined by the organization and the community (ie
JCAHO).
 Using cascading communication from one level of the
organization to another through the use of the Weekly
Standup Wall Walk and Monthly Visual Room Review, the
organization can stay in alignment of its goals and
strategic plan.


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Mod 19 – Measures

Cost Reduction Profit =

GPS Depth Study Quality Cost Delivery

Jidoka Standard Total Visual

Value Stream Mapping

ONE PIECE FLOW TAKT TIME PULL PRODUCTION

19 Measures v20130525 1 ©1996-2013, John Black and Associates LLC

Measures: Key Points

19 Measures v20130530 2 ©1996-2013, John Black and Associates LLC

Measuring World-Class Quality Ensures

Morale Everyone Cares

19 Measures v20130525 3 ©1996-2013, John Black and Associates LLC

Park Nicollet Health Services/Used with Permission

Weekly Stand-Up Meeting Wall

Park Nicollet Health Services/Used with Permission

In health care, the Customer is the Patient.

19 Measures v20130530 6 ©1996-2013, John Black and Associates LLC

“Quality in a product or service is not what the supplier puts

19 Measures v20130525 7 ©1996-2013, John Black and Associates LLC

Quality Measures in Health Care

In health care, the Customer is the Patient.

19 Measures v20130530 8 ©1996-2013, John Black and Associates LLC

19 Measures v20130530 9 ©1996-2013, John Black and Associates LLC

Used with permission, Florida Hospital Zephyrhills

19 Measures v20130525 10 ©1996-2013, John Black and Associates LLC

19 Measures v20130530 11 ©1996-2013, John Black and Associates LLC

Used with permission, Florida Hospital Zephyrhills

19 Measures v20130525 12 ©1996-2013, John Black and Associates LLC

Weekly Stand-Up Wall Walk

Used with permission, Florida Hospital Zephyrhills

19 Measures v20130525 14 ©1996-2013, John Black and Associates LLC

Used with permission, Florida Hospital Zephyrhills

19 Measures v20130525 15 ©1996-2013, John Black and Associates LLC

19 Measures v20130530 16 ©1996-2013, John Black and Associates LLC

Cost Measures in Health Care

19 Measures v20130530 17 ©1996-2013, John Black and Associates LLC

Weekly Stand-Up Wall Walk

19 Measures v20130530 18 ©1996-2013, John Black and Associates LLC

Weekly Stand-Up Wall Walk

19 Measures v20130530 19 ©1996-2013, John Black and Associates LLC

Delivery Measures in Health Care

In health care, the Customer is the Patient.

19 Measures v20130530 21 ©1996-2013, John Black and Associates LLC

19 Measures v20130530 22 ©1996-2013, John Black and Associates LLC

Safety Measures in Health Care

In health care, the Customer is the Patient.

19 Measures v20130530 23 ©1996-2013, John Black and Associates LLC

Visibility Room Review

19 Measures v20130530 24 ©1996-2013, John Black and Associates LLC

Seattle Children’s Bellevue Surgery Clinic/

19 Measures v20130530 25 ©1996-2013, John Black and Associates LLC

19 Measures v20130530 26 ©1996-2013, John Black and Associates LLC

Morale Measures in Health Care

In health care, the Customer is the Patient.

19 Measures v20130530 27 ©1996-2013, John Black and Associates LLC

Visibility and Alignment of Measures

 Measures identified as part of a Break Through Initiative (Hoshin)

19 Measures v20130530 28 ©1996-2013, John Black and Associates LLC

The Management System and Visibility and Alignment

Reduce level 3 & 4

Front Line Mgrs

The Management System and Visibility and Alignment

Wall Walks Quality Cost Delivery Safety Morale