High Reliability:
AIM4Excellence Improvement
Model
Is Healthcare Highly Reliable?
Highly Reliable?
o Medical Errors (ME)
 3rd leading cause of death; more than heart disease and cancer.
(Source: M. Allen, Scientific American, 2013)
 1 in 10 chance of a medical error upon entering hospital (Source:
World Health Organization)
 1 in 300 chance of wrongful death due to medical error (Source:
World Health Organization)
Death due to plane crash: 1 in 10 MILLION
(Source: WHO)
What is an HRO?
"High reliability organizations (HRO) are
organizations with systems in place that
make them exceptionally consistent in
accomplishing their goals and avoiding
potentially catastrophic errors…"
-Quint Studer
What is St. Thomas Health doing to
become an HRO?
Introducing …………….
The Ascension Improvement Model for Excellence
“AIM4Excellence”
– Respect Every Individual
– Lead with Humility
– Embrace Transparency
Enterprise Alignment
– Create Constancy of Purpose
– Think Systemically
Continuous Process
Improvement
– Focus on Process
– Embrace Scientific Thinking
– Focus on Flowing and Pulling
Value
– Assure Quality at the Source
– Seek Perfection
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Importance of Culture
St. Francis teaches:
“He who works with his hands is a laborer.
He who works with his hands and his head is a
craftsman.
He who works with his hands and his head and his
heart is an artist.”
AIM4Excellence teaches: When
people feel respected they give far
more than their hands; they give
their minds and hearts.
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The AIM4Excellence
Standard Improvement Philosophies and Techniques
The AIM4Excellence model focuses heavily on:
1.
Lean – A quality improvement philosophy and set of principles
originated by Toyota
2.
Plan-Do-Check-Act (PDCA) – A central tenet of continuous
improvement and Lean where the Scientific Method is applied to
improve daily work processes
3.
Management System - A disciplined, closed-loop, visual
management system that:
–
Communicates what’s important
–
Reveals current performance
–
Identifies gaps
–
Empowers people to continually improve
–
Ensures leadership accountability
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What is Lean?
•
•
•
•
Is…
Eliminating waste
Providing value
Focused on
customer
• Engages the
frontline as process
experts
• Makes the right work
easier to do
• Is Not…
• An FTE reduction
strategy
• Only focused on cost
• A quick fix or silver
bullet
• Possible without
leadership
commitment
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Creating “Value”
• VALUE IS DEFINED AS:
• Outcome or activity for which the customer is willing to pay
• The right work at the right place, the right time, and without delay
• OUR ULTIMATE GOAL IS TO “CREATE VALUE FOR
EXTRAORDINARY PERSON-CENTERED CARE”
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Examples of Value-Added vs. Non-Value-Added
An Outpatient Office Visit
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The Destroyer of Value = Waste
Waste: Any activity that consumes resources but creates no value. (Lean
Lexicon, 2006)
Waste is disrespectful to:
Patients or
guests by
asking them
to endure
processes
with no value
You as
associates
because it
asks you to
do work
without value
Society
because it
wastes
scarce
resources
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What is PDCA?
The Backbone of Continuous Improvement
PDCA is the four-step methodology for continuous improvement, also
known as the Deming Cycle.
• Plan
– Respect the problem enough to fully understand it
• Do
– Attack the waste with Countermeasures/Improvement Methods
• Check
– Check results - Is our improvement plan working?
• Act/Adjust
– if working great – standardize and spread;
– if not working, learn & plan next intervention)
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How does all of this work together?
The AIM4Excellence Management System
• It’s simply a disciplined system to:
– Communicate what is most important
• Goals and Key Performance Indicators we must win each day
– Reveal current performance
• Are we winning or losing?
– Identify gaps between actual performance and expected
performance (goal)
• Visual, daily management of the most critical goals
– Empower people to continually improve
• Total Associate Involvement
– Ensure leadership accountability
• Standard Leadership Follow-up/Rounding
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“A3” Problem Solving
•
Is “Deeper Thinking”
•
It’s HOW we solve problems by following the
scientific method & PDCA cycle
•
Prevents “Solution Bombs”
•
Helps you tell your story to build consensus
AIM4Excellence Goal:
Create an army of
A3 Thinkers/Problem Solvers
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A3 Problem Solving
Why not treat problems like we treat patients?
Chief Complaint
Treatment Plan
Physical
Assessment
Follow-up Visit
Diagnostic Tests
Adjustments
The Closed-Loop Management System
• Communicates
what’s important
• Answers “What
does it mean to
win or lose?”
• Shows the Gap
between actual
results & Goal
• Answers “Are we
winning or losing?”
Enterprise
Alignment
Focused
Visual
Management
Mission
Critical
Results
Standard
Leadership
Follow-Up
• Leaders coaching
to Close the Gap
• “What can we do
today to win more
often?”
Total
Associate
Involvement
• Empowers team to
Close the Gap
• Answers “If not
winning, what are
we doing about it?”
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Visual Management Board
Key Element of the Closed Loop Management System
Key Goals – Monthly Trending
Department
Scorecard
The Critical Few, Not Important Many
Pareto Thinking (Don’t Assume)
Major Reasons for not hitting target
Suggestion
System
A3 or PDCA Log
Activity Addressing the Root Cause(s)
“Check” via Process Indicators
Process Metrics updated daily showing
Performance toward Goal
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Why is the Management System important?
•
Provides Focus and Clarity to those doing the work
– Healthcare suffers from Recurrent Major Initiative Syndrome
whose most devastating pathologic consequence is
Managerial Attention Deficit Disorder (MADD) – Designed to
Adapt, 2009, p.73.
•
•
Engages the People
– Respects and Engages frontline staff to participate in solution
development and builds ownership
– Focuses on bad process, not bad people
– Gemba Walks emphasize to frontline associates the
importance of their work
– Culture focused on “we” (our overall performance)
Drives Critical Results
– Focus on process indicators to better predict success for the
Critical Few Goals in each department
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Revisiting our Objectives
•
Introduce the AIM4Excellence model, so that you:
– Recognize that our top goal is creating Value to
enable Extraordinary Person-Centered Care
– Develop a foundational understanding of Lean,
Plan-Do-Check-Act (PDCA), and the Management
System for driving focused improvement
– Apply and spread learnings within your daily work
processes
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