Safety as a Platform for Launching a
Lean Management System
November 2014
Karen Rancich Demmert
Experience
• 1992—present: Seattle Children’s Hospital
• 2013—present: Senior Director of Improvement Consulting
Services
• 2001—2013: Director of Home Care Services
• 1992—2001: Various management roles
• 1982—1992: Speech/Language Pathologist in public
elementary schools
Education
• B.S. in Speech and Hearing Sciences
• M.A. in Speech Communications
Seattle Children’s Hospital
• 278-bed free-standing
pediatric teaching hospital
• Coverage WA, ID, WY, MT, AK
• 5569 employees
• Scope of Service (FY13)
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357,206 annual visits
14,494 Admissions
15,513 surgeries
60 pediatric subspecialties
Seattle Children’s Hospital
• Affiliated with
• University of Washington School of Medicine
• Seattle Cancer Care Alliance
• Seattle Children’s corporate entity includes a Research
Institute and Foundation
• Research Institute
• 4 locations, 9 Research Centers, 2 programs, and 1 global initiative
• 1186 research institute workforce members
• 26 research guilds
• Foundation
• 450 guilds, 6200 guild members
The Challenge
• To develop and deploy an effective
business and quality management system
that integrates lean methodology and
continuous performance improvement with
the principles of a High Reliability
Organization
• To embed Safety behaviors and routines
as the priority content to start
• To Reduce Preventable Harm
Seattle Children’s Continuous Performance
Improvement (CPI) Philosophy
Focus on the patient and family
• Involve patients and families in our improvement work
• Don’t imagine we know what they want: listen!
• The uniqueness of our patients should be our only variation
Support faculty and staff in their work
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Give people the opportunity to participate
We are partners to be engaged, not customers to be served
Make it easy to do the right thing
No layoffs
Take a long term view
• Relentless, iterative improvement (Plan, Do, Check, Act)
• Patience, this is generational work
• Focus – avoid constantly moving to the next shiny object
Seattle Children’s CPI Journey
1999-2001:
Non-Clinical
Point
Improvement
Events
2002-2004:
Clinical Point
Improvements –
without
Physician
Leadership
2004-2006:
Clinical &
Research
Improvements –
with Physician
Leadership
2007-2009:
Value Stream
Approach
Integrated
Facility Design
2010-Present:
Clinical Standard
Work
Strategy
Deployment
Daily Management
& Leader Standard
Work
The 5 Principles of High Reliability
• Preoccupation with Failure
• Deference to Expertise
• Sensitivity to Operations
• Reluctance to Simplify
• Capability for Resilience
HPI Engagement
• 2012
• Diagnostic Assessment
• Daily Safety Brief
• 2013
• Error Prevention Tools
• Leadership Methods
• 2014
• Lessons Learned
• Safety Coach Program
• Cause Analysis
Seattle Children’s
CPI Management System
Seattle
Children’s CPI
Management
System
Daily Management System Definition
What do we mean when we say DMS?
A system that guides and directs the actions
and efforts of the team that promotes
personal and organizational success
… it’s about behavior!
...it’s a Human Performance System!
Daily Management System
Leaders are key to
establishing and
running the DMS.
It is all about our
behavior!
Multi-Step Implementation Process
1) Baseline beginning for all employees
•
Training and education in Safety Behaviors
• All employees in Error Prevention Techniques/Tools
• Leaders in Leadership Methods
2) Initial expectation for managers and above
•
Weekly documented use of leadership methods
• Safety as a Core Value
• Rounding to Influence with 5:1 Feedback
• Current organization focus on an Error Prevention Tool
Leader Standard Work for Safety
Multi-Step Implementation Process (cont.)
3) Implement DMS by department prioritizing Safety at the
core
•
Standard leadership structure and operational routines partnered
with expectations of reliable management including use of Safety
Behaviors
•
Each employee has the right and responsibility to participate in
situational awareness analysis and raise safety, clinical, and
operational concerns every day
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Organizational transparent focus on Preoccupation with Failure
Daily Management System (Safety Focus)
• Tiered accountability for daily management roles
• Built in coaching and feedback observation schedules
• Daily team and department huddles with “Red Words” exchange
of information
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High-risk, non-routine procedures, patients, activities?
Situations or conditions that distract?
Issues impacting other departments?
Deficiencies in staffing, materials, equipment, environment?
Impactful conditions outside our unit or outside hospital?
• Visibility boards with “Red Words” data collection and “watcher
board” sections with ownership for resolution
• Defined problem escalation and response communication
pathways including Daily Safety Brief
• Daily event reviews and reporting
• Weekly leadership and monthly staff meetings
Tiered Accountability Matrix
Putting it Together
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12-Month Process Metric (Participation)
• 17 executives, 20 physician leaders, and 300 middle
management leaders house wide practicing
• Leadership Methods setting Safety as a Core Value and
Rounding to Influence with 5:1 Feedback and monthly focus on
an Error Prevention Tool
• 65 departments have implemented or in the process of
implementing DMS (Safety Focus)
• DMS structure with leadership routines and behaviors with the
Safety Culture content
• Reliable management focused on operations with all employee
involvement
• Active problem solving and continuous improvement activities
Initial Results
• At August 2014 Pulse Check, HPI found 34%
overall penetration of Error Prevention Tool
knowledge
• In areas where DMS was most mature, that
knowledge and use of language was 25-30%
higher
• HPI feedback: We are on the right track!
Next Steps
• Continue rollout of DMS (Safety Focus) across
Seattle Children’s Hospital
• Started with Acute Care and Critical Care areas
• Moving into Ambulatory Services
• Non-Clinical departments next
• Provide support for leaders to operate their
systems and keep focus on Safety & Reliability
• Continue to integrate more HPI model
components and principles of HRO into our CPI
Management System
Questions?