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Key Strategies to Implement Across the Enterprise
 Time Matters
- Staff are tuned to "minutes" in their work
- Consistently fulfill expectations for key work activities
- Key Performance Indicators (KPIs) used to monitor how well a unit is achieving objectives
- Setting KPIs requires thresholds & back up systems
- KPIs then create the criteria for formal backup systems
- Setting KPIs allows staff to be successful—multiple times, every day
- Weekly feedback on performance
Helpful Organization
- "Air Traffic Controller" for each core service monitors work activities, continually reallocates resources
- Automated high census protocols make this happen
- If resources not available, predefined backup system is activated
- Staff can predictably deliver a defined work activity because they can confidently request, receive and offer assistance.
Interlocking Accountability
- Joint accountability among multiple departments to meet end-to-end targets
- "Swim together or sink together"
- Joint ownership of KPIs with predefined backups among each constituency
- Performance evaluations of each linked to same KPIs around core subprocess
Designed Process
- Process: an organized group of related activities that together create value for customers
- Prescribes how individual units of work come together to achieve the overall goal
- A ruthless focus on decreasing variability in order to create consistent thresholds & backup systems
- Specifies exactly what work is to be done, in what order, where, and by whom.
- Process design is a prerequisite for repeatability
Anticipating Work
- Hospital processes occur most successfully when the receiving staff knows when work is coming and can then preplan for it
- Anticipation of work creates a compelling reason for "Pull Systems"
- "Pull Systems" are the most robust way to predictably deliver on a work task
- Inpatient intake for patients from ED or PACU
- EVS Staff anticipate room cleans and preplan resource request
- Pharmacy anticipates Series patient arrival and has medications available to meet need
Flawless Handoffs
- Well-designed transitions of care between each constituency
- Scripts
- Defined expectations for each group's work
- Formally-designated owner who watches, real-time, that handoffs are done consistently
Transparency
- Instant inspection instead of "patrolling"
- "Air Traffic Controller" reallocates resources vs. gathering info
- Consistently measure performance against thresholds
- Real-time monitoring of work activity against targets
- Back up plans used every day become part of hospital culture
Hardwired Management
- Manager's role is inspector of the designed process, not an innovator for change
- Create consistent, standardized management of operations by using:
- Real-time monitoring systems
- Weekly reporting
- Automated action plans for immediate implementation and progressive improvement
Focused Change
- Allocated resources for implementation
- Large amount of change to quickly get to "tipping point"
- Large rollout to uncover early adopters
- Active inspection by front line workers to ensure that change is adopted and issues accurately identified
- Process owners control innovation
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