On Best Practices

Quality month: sharing improvement stories

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Root Cause wideRecently I wrote that October was Quality Month and I highlighted Dr. Richard Shannon’s excellent talk, part of our Lean Thinker’s Series. I “teased” that I would comment on the Quality Month poster sessions in an upcoming post.

For two days, 48 quality improvement teams displayed their stories as posters. I spent about an hour checking out the posters and talking with people from the teams. I targeted the ones with potential scalability or an IT connection.

Jennet Malone, a manager at The Briarwood Center for Women, Children and Young Adults, explained how they increased use of the portal.

Here are a few worth noting:

Got Portal? –The Briarwood Center for Women, Children and Young Adults

We rolled out our patient portal more than 3 years ago. Patient enrollment has been fairly successful  with over 200,000 active users but this is still not at the level we need. This health center established specific goals for making portal functionality part of everyday clinic workflow and used by patients and families. They increased their marketing efforts and established staff incentives for meeting short term goals. They purchased iPads to help staff sign up patients. They added the portal metric to their daily huddle. The result: Briarwood Center for Women, Children and Young Adults has the highest percentage of patients on the portal when compared to other clinics! Continue reading →

Power of Collaboration

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It was a long but productive 24 hours. A team of us from the health system flew to Durham, NC, on Tuesday evening, spent a 10 hour day on Wednesday at Duke Medicine, and then flew home. It was a site visit aimed toward learning from each other and determining opportunities for collaboration.

UMHS and Duke have similar profiles: our overall size, IT infrastructure and core applications. We are in similar places on our EHR journey with Epic. And we are both very focused on analytics – the impetus for our visit.

Duke’s CIO, Dr. Jeff Ferranti, and I know each other; we thought the proposal for a visit was a great idea. Our Chief Medical Information Officer, Dr. Andrew Rosenberg, and Duke’s Chief Health Information Officer, Dr. Eric Poon, planned and organized the day’s agenda.  We let Andrew and Eric run with it and they did a terrific job!

Two important clinical leaders joined our Michigan team of several senior IT leaders — Dr. Jeff Desmond, our Chief Medical Officer, and Dr. Steve Bernstein, Associate Dean for Clinical Affairs. We needed them there as we talked broadly about analytics and support for population health. Continue reading →

October is Quality Month!

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Each year UMHS celebrates Quality Month and this year is no exception. Last week as part of our Lean Thinker’s Series, Dr. Richard Shannon, EVP Health Affairs, University of Virginia Health System, gave an excellent talk titled “Patient Safety and Quality: The New Currency in Academic Health Centers”.

It was good to hear how another academic medical center is approaching similar challenges and applying lean. Some of my takeaways from his talk and the lunch discussion that followed:

  • Dr. Shannon described their Be Safe initiative – “Our Be Safe initiative is advancing our status as a high performing organization by systematically applying the scientific method (Lean Principles) to improve the safety of our patients and workforce through real time problem solving.” He shared examples of how they have reduced the incidence of hospital acquired infections, a problem for all hospitals.
  • Senior executives hold a “situation room” and digital report out each morning. They spend 15 minutes reviewing critical problems that have been reported and then spend the next 45 minutes actually going to the units to understand the specific problems more deeply. And they do it on Saturdays as well.
  • Their IT team plays a central role in providing data and reporting in support of their daily management system. They have developed the “Be Safe” reporting system. It is a common platform that supports daily manual entry from any employee and takes automated updates from other feeder systems. He emphasized the importance of having actionable data. All of their A3s are done online and uploaded to a library that can be queried. Patient safety events are documented with an online form as part of the system. I plan to reach out to their CIO, Rick Skinner, who has shared some of their lean stories with me in the past. Having heard Dr. Shannon’s talk, it’s time to get a much better understanding of their system.

Continue reading →

Fall, football and fleece

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Last Saturday was a wake-up call that Fall is fast approaching. With morning temps under 50, it was fleece time. It was also the first home football game for the University of Michigan under new coach Jim Harbaugh. Blue and maize was everywhere I went in Ann Arbor. Our new coach and football team delivered a resounding victory in the first home game to everyone’s delight. But this isn’t about football or fleece, it’s about adapting to change – something we are expected to do often.

Yes, I donned a fleece when I ran errands and walked the dogs but I didn’t fully adapt – I still wore my sandals. I will only make that adaptation when I have to. I figure I can hold out for a few more weeks at least.

Season changes are to be expected and there’s no use fighting them. For us Northerners, yes, that means cold and snow as well in another few months. But there are many changes that we can’t anticipate, even some that seem to smack us upside the head. There are changes we choose, often after much thought and deliberation. And there are the ones we don’t choose or have no control over. But we eventually learn to embrace or at least live with them.

In our work lives there are always new processes and tools to learn and adjust to. Continue reading →

Reducing costs while increasing value

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Except for maybe start-up technology companies, there isn’t an IT department anywhere that has an open checkbook. In health care, we know all too well the need to manage costs while answering what seems to be an insatiable demand for technology solutions. CIOs need to understand the technical debt of a large application portfolio and the total cost of ownership (TCO) for systems. They need to find ways to reduce the cost of commodity services, and to create capacity for new work.

At UMHS, we have an initiative called Value and Margin Improvement, or VMI.  The VMI program is a multi-year effort across the health system.  UMHS leadership launched VMI to help achieve our financial stewardship goals by empowering collaborative teams to design and implement sustainable improvements that enhance value and financial results.

VMI aims at reducing duplication, inefficiencies and non-value added work in order to more effectively manage our costs, improve the value we provide and increase our margin.  A positive operating margin allows us to invest in the future and better serve our patients, referring physicians, students, the research community, and other key stakeholders.

VMI projects take a balanced approach to improve and sustain overall value while still maintaining the desired safety, quality, service delivery, and employee engagement metrics. The program promotes the use of lean methodologies and collaborates with our central lean team, the Michigan Quality System (MQS).

We are systematically moving through Continue reading →

Commit to a healthy workforce

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Last week I joined the second “Summer Walk” that the MHealthy champions in our IT department organized. It was a 1.5 mile round trip between our two main office facilities during the lunch hour. We had about 60 participants for each walk. What a great way to get some exercise, connect with colleagues and show our shared commitment to healthy living!

I wasn’t planning to do the walk when I first saw the announcements and flyers around our office. I expected that I had meetings during that time. But when one of the MHealthy champions reached out directly and asked me to show my commitment to healthy living, how could I say no?  It turned out that I could join them if I left a meeting 15 minutes early. I’m glad I did; literally “walking the talk”.

Our department is so committed that we were recently recognized as being one of the top performing areas, with 58% of employees participating in the University’s MHealthy Rewards program. More than 21,000 people throughout the University took advantage of the annual opportunity to review their health status, develop an action plan for improvement, and participate in helpful programs and services such as Active U, Weight Watchers, tobacco treatment, or stress-management programs. This is the program’s seventh year.

Our department’s MHealthy workgroup is developing new plans for activities and events to promote physical activity, healthy eating, and other positive health behaviors. The Summer Walks on the last Friday of each month are just the beginning.

They have also started a FitBit community for the department. Continue reading →

Leaders learning lean — time for a field trip

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Say that title fast! We held our quarterly IT leadership retreat this week. As we continue on our lean journey, I decided a field trip was in order.

James Goebel explains how employee can see their scheduled tasks on the resource management digital board at Menlo Innovations.

We spent two hours at Menlo Innovations getting a private group tour from co-founder James Goebel. To prepare, we read the “The Joy of Lean Innovation: A Case Study of Menlo Innovations” and listened to a Gemba Academy podcast of an interview with Richard Sheridan, Menlo Innovation’s founder and CEO. Many others from University of Michigan Health System have visited Ann Arbor based Menlo over the years. I’d been encouraged to make a visit by my lean coach, Margie Hagene, and our internal UMHS lean champion, Dr. Jack Billi.

Menlo is a software design and development company. But we weren’t visiting to understand their approach to software. Rather, we wanted to understand how they have applied lean principles to run their business and create the culture that Richard Sheridan describes in his book, “Joy, Inc. – How We Built a Workplace People Love.”

Two of our new IT directors are in their third week, so we started the retreat by each describing the most effective leadership team experience we’ve had. The themes that emerged Continue reading →

Time to stop and smell the roses

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That old saying “stop and smell the roses” could be updated for the road warriors among us to “stop and look at the incredible aerial views”.  Recently, I was on a flight that included the dreaded holding pattern and circling.

The destination airport was closed due to heavy fog. But out my window was a beautiful sight. Light, fluffy clouds and green forests dotted with little towns as far as I could see.

I had been doing my usual on a business trip…..catching up on email and work reading. I prefer aisle seats but this flight I ended up in a window seat. So with a great view, why not “stop and smell the roses” a bit.  Or call it being mindful as many of us are now trying to be more often– fully aware and in the present moment.

The pace we go is faster and more intense than we may like. Weekends are filled with commitments, errands, and more work. I think “what would it have been like to live the slower or simpler life of my grandparents,” but then I’m quickly back to reality. I do appreciate the many advances we take for granted.

We’re in constant motion. Continue reading →

So what’s the problem – A3 thinking

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If you don’t know what an “A3” is, don’t worry. When I started at University of Michigan Health System, I didn’t either.  When I first saw an A3 meeting on my calendar, I asked “What group is that?”

Plan, do, check, act. PDCA on white isolated background. 3d

There were so many groups with different acronyms!  Turned out it was a meeting with a few colleagues to update our status report on major UMHS IT initiatives. We were using an A3 format for our report.

So what is an A3? It is a tool used as part of Plan-Do-Check-Act (PDCA).  The A3 name actually comes from the paper size (11 x 17 sheet) that tells a story laid out from the upper left-hand side to the lower right.

Telling the story of a problem on an A3 includes looking at the background (why and what), describing its current condition (where things stand), and doing a root cause analysis. And then, establishing goals and targets, proposing countermeasures, making an action plan and determining success metrics.   Continue reading →

Safety hurts, service heals

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Patient safety is at the top of our list as health care providers. My experience on a recent flight from Boston to Detroit reinforced the importance of “safety first.” We left an hour late due to weather. But, twenty minutes into the flight, the pilot told us there were problems with the landing gear; the safest thing to do was to return to the Boston airport. He told us he’d know more after we landed. Problems with the landing gear but we were going to land OK? Of course the next half hour was one of the longest ever. We did land safely, de-boarded and waited for news of when we’d depart.

The first word we got was via text and email notification – we’d depart on a different plane around 11:20PM. We originally were to arrive in Detroit at 9PM. In the next few hours, the departure notifications got worse and worse – 11:45PM, 12:20AM, 12:45AM, 1AM, and back to 12:45AM. Passengers with connecting flights tried to get re-booked on other flights that night or in the morning. Some decided to fly to other cities first adding to the number of connecting flights they’d have. I was on a direct flight heading home so I waited patiently for whenever we would eventually leave.

We finally departed at 1:45AM. I got to my house at 4:30AM – about six and half hours later than planned.

What amazed me during all this was that Continue reading →