(HILL) Proposal

Healthcare Improvement Lean Learn/Innovate/Share

Submitted by:
Cindy Jimmerson
Missoula, Montana
and
Susan Sheehy
Boston, Massachusetts
March 20, 2009

Table of Contents

Background
Project Objectives
Provision of Proposed Funding
Project Timeline
Implementation Plan for Participating Healthcare Organizations
Implementation on Work Units
Baseline Data
Quarterly Reporting
Project Directors
Application Criteria for Participating Organizations
Appendix A – Job Descriptions: Organization Coordinator and Educator
Appendix B – Big Sky Leadership Retreat Review 
Appendix C – Hill Project Time Line

Healthcare Improvement Lean Learn/Innovate/Share (HILL) Demonstration Project
Adapted from the Toyota Production System (TPS/Lean) for Healthcare

The HILL Project (The Project) will make available to other healthcare organizations nation and worldwide the knowledge and experience gained by the participation of 32 healthcare organizations in a comprehensive plan to improve quality in healthcare and reduce the cost of healthcare delivery.

This is an effort to expeditiously modernize the US healthcare system and to lower cost and improve healthcare quality, as recommended in:

Background  ^ table of contents ^
Since 2000 healthcare organizations have been adapting concepts and practices borrowed from the Toyota Production System (TPS/Lean) to improve the delivery of care and reduce costs.  A variety of approaches have been implemented, some more successful than others and some in specific areas of the organization, but few with a comprehensive plan that would optimize all areas of healthcare operations.  This proposal strongly suggests that the witnessed successes of some can be realized across the industry if executed with a comprehensive plan and shared openly.  The plan outlined in the Program proposed herein would provide structure for the participating organizations and demonstration of the plan and results to limitless numbers of observers/adopters. 

The essence of the Project (education/direct application/coaching/sharing) does not require proof of concept. The proposed approach was developed as a result of research funded by the National Science Foundation (2001-2004, NSF grant # 0115352) and practiced by the project directors and staff with more than 50 healthcare organizations since that time.  Additionally, many other healthcare organizations have adopted similar programs that meet the objectives of the program. In retrospect, a comprehensive plan for methodically spreading TPS/Lean concepts and practices across the entire organization optimizes the efforts that, in many organizations, are currently limited to a few departments. This robust plan provides a template for thorough and progressive inclusion of every work-unit in any healthcare organization. With this comprehensive participation it is possible to harness the good ideas, intelligence and experience of every healthcare worker in the organization to improve care and bring cost under control. 

This proposed program would begin education and application of the concepts and practices immediately when funded.  It may be the only option to meet the imminent crisis without additional legislation and delay.  Every healthcare organization willing to participate will start improving effectiveness in the same way that the crisis was created, one activity and one process at a time. While improving effectiveness is only one facet of a very complex plan for healthcare reform, this one can begin to demonstrate improvement and savings immediately.

Project Objectives ^ table of contents ^

  1. Use proven TPS/Lean principles and methods adapted to healthcare with a comprehensive implementation plan in 32 healthcare organizations (acute care/long term care/physician office practice/community health clinic/public health department, etc) to:
    • Reduce errors: improve delivery of care
    • Reduce waste: increase capacity for care/reduce cost and improve access to care
    • Improve workplace appreciation to retain/recruit quality talent
    • Improve leadership skills
  2. Prepare within each organization a Lean coordinator and Lean educator to understand Project goals and strategies and to support and sustain participation of the organization in the Project
  3. Collect experience of each participating organization quarterly per standard reporting
  4. Disseminate collective experience of the participating organizations on open website for view/comment by any organization or individual
  5. Conduct open webinars quarterly to share focused successes and challenges and expand learning
  6. Report/account outcomes to Congress.

Provisions of the Proposed Funding  ^ table of contents ^
Acceptance and funding of this proposal will provide (for 3 consecutive years):

  1. 1. Funding to 32 healthcare organizations to afford them the opportunity to learn/implement/improve share their Lean healthcare Plan (the Plan), using the funding to help support Lean coordinator and/or educator positions, administrative support, and or Lean education programs for staff. Additionally, this team will be responsible for reporting the results of challenge, success and adaptation of the Plan in their participating organization and will be expected to participate in at least 75% of group exchanges to accelerate learning. (Appendix A - job descriptions)
  2. Annual attendance of two members of participant the participating healthcare organization’s Senior Leadership Team (SLT) or their assignees at the Lean Leadership Retreat for the purpose of collaboration and sharing regarding leadership challenges and successes. The format for this retreat has been well established with a 5-year history of engagement by SLT and physician members. (Appendix B - Review of Big Sky Lean Leadership Retreat)
  3. Annual attendance of organization Lean Coordinator and Lean Educator at Project Conference specifically designed for coordinators and educators to network, share experiences, and brainstorm ideas and specific applications.
  4. Project oversight by two national directors - one each in Eastern and Western locations. (Appendix C for CVs)
  5. Program fiscal and data administration by George Washington University Department of Health Services Management and Leadership. (Preliminary approval for participation received verbally)

Project Timeline  ^ table of contents ^

  1. Funding assignment: Spring, 2009
  2. Selection of healthcare organization participants: Summer, 2009
  3. Initiation of Comprehensive Plan in each facility: Fall 2009
  4. Completion of Plan/reporting: Winter 2013

Implementation Plan for Participating Healthcare Organizations ^ table of contents ^

  1. Orientation to TPS/Lean principles and methods (the Program) for Senior Leadership Team (SLT) and organization’s Board of Directors (Board)
  2. SLT and Board review of strategic plan for the Project period (3 years) and integration of TPS/Lean principles and methods into their strategic plan
  3. Recognition of a SLT “Lean Champion” who will own/report responsibilities for TPS/Lean activities within the organization
  4. Creation of an implementation plan (the Plan) that will achieve Project  objectives within the organization (including identification of work units on which to initiate education/improvement activities)
  5. Orientation of all directors/managers and supervisors to TPS/Lean principles and methods and the organizational implementation Plan
  6. Assignment/preparation of Lean Director and Lean Educator
  7. Initiation/continuation of education of staff and implementation of TPS/Lean principles and methods per the SLT implementation Plan
  8. Development of an organizational plan for sustaining the program independently within the organization.

The organizational implementation Plan must demonstrate focused activities to span the healthcare organization. The goal by end of year 3 is that least 12 work units will routinely demonstrate use of TPS/Lean principles and methods for daily problem solving to improve the delivery of services in their respective work units and be able to demonstrate cost effectiveness of each effort.

Although the goal is to engage every work unit, it must be acknowledged that this is a long term implementation plan and that satisfactory practice of this way to work on 12 work units by end of year three would create a realistic, substantial foundation for incremental, sustainable improvement, from which full organizational adaptation will extend with yearly extensions of the organizational plan.

Work units that may be selected for inclusion in the Program include but are not limited to:

  1. All clinical/patient care units
    1. Inpatient
    2. Outpatient
    3. Residential
  2. Support services:
    1. Environmental services/laundry
    2. Pharmacy
    3. Imaging and other diagnostic services
    4. Biomedical services
    5. Nutritional and food services
    6. Rehabilitation services (PT, OT, ST, etc.)
    7. Human Resources
    8. Materials management
    9. Intra-agency patient transport
    10. Scheduling/Bed Assignment
    11. Facilities Management (to include remodel and new construction)
  3. Administration
  4. Physician services
  5. Financial billing/coding/collections
  6. Information Technology/Health information management

Implementation on work units must include:  ^ table of contents ^

Baseline data will include:  ^ table of contents ^

Quarterly reporting to the Project by participating organizations will include (at a minimum):
^ table of contents ^

This information will be collated and updated quarterly and made publically available on a website developed specifically for the Project.  Information will be analyzed by the participating academic center/administrator.

The Project directors will select experienced speakers to present quarterly webinars to address the challenges recognized and to summarize the learning gathered by the quarterly reports. The lessons learned by the participating 32 organizations will be made available to unlimited numbers of organizations and individuals via website, webinars, reports, and publications.

The Project Directors - Cindy Jimmerson (West) and Susan Sheehy  (East)  ^ table of contents ^
The project directors will oversee all activities of the Project. Responsibilities include:

Application Criteria for Participating Healthcare Organizations  ^ table of contents ^

a. Plan for an in-house coaching structure (in progress or proposed)
b. Identification of physical space to house staff funded by the Project

  1. The amount requested (not to exceed designated dollar amount based on number of organization employees)
  2. A line item budget for the amount requested
  3. Justification for the amount requested

Appendix A
Job Descriptions: Healthcare Organization Lean Coordinator and Lean Educator  ^ table of contents ^

Job Description: Healthcare Organization Lean Coordinator(existing or funded by the Project)

Definition
To lead, plan, coordinate, and report the activities defined in the Plan. The Lean  coordinator is a professional healthcare specialist whose primary responsibility is to lead the organization’s reform effort based on the Project designed to:

Supervision Received and Exercised

Essential Responsibilities

Qualification/Knowledge/Skills/Abilities

Education and Experience Standards

Physical Demands
The physical demands and work environment described here are representative of those that must be met by an employee to successfully perform the essential functions of this position.  Reasonable accommodations may be made for individuals with disabilities in order to perform these essential functions:

Job Description: Healthcare Organization Lean Educator  (existing or funded by the Project) Role


Supervision Received and Exercised

Essential Responsibilities

1. Achieve their individual goals
2. Collectively achieve the objectives of the Plan and the Project

Qualification/Knowledge/Skills/Abilities

Education and Experience Standards

Physical Demands
The physical demands and work environment described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made for individuals with disabilities to perform these essential functions:

Appendix B – Big Sky Lean Leadership Retreat Review  ^ table of contents ^

The Big Sky Lean Leadership Retreat has been conducted annually for 4 consecutive years (5th annual event scheduled for September 21-23, 2009) as a forum for Lean Leaders (physicians, administrators, directors of healthcare quality departments, educators) to learn and share successful methods of Lean implementation across the functions of the healthcare organization.  

Progress from initial simple efforts to improve effectiveness of  everyday work processes to redesign of services and facilities has been enhanced by the collaboration, networking and knowledge shared at this event. 

With this funding this retreat will create a forum for executors of the 32 participating hospitals to meet face-to-face once a year. 


A work unit is defined as a specific department, floor, or service within the organization

Submission for funding must reoccur annually and will only be considered if quarterly reports demonstrate satisfactory progress in accordance with the Program objectives

Appendix C – Hill Project Timeline  ^ table of contents ^
Highslide JS

Hill Project Time Line