Professional Documents
Culture Documents
Ann Dohn, MA
DIO, Director of Graduate Medical Education
Stanford Health Care
This session will focus on use of available data tools as well as evaluation
metrics that enable DIOs/GME to communicate effectively with the C-
Suite.
Participants will be exposed to the A3 tool, which is extremely useful in
solving inter-departmental problems
Other tools, e.g., scorecards, fishbones, paretos, and trend analyses will
be incorporated into the presentation.
At the conclusion, participants will be able to apply the A3 model to
challenging institution specific situations and discuss available metrics
and development of an approach to resolution the situation.
Strategies
− Complex Care, Coordinated
Care
Objectives
− Goals, Operating Plans,
Dashboards
Performance
− Improvement and Management
RVU’s
Visibility Wall
GEMBA
− problems are visible (or make them visible) and the best improvement ideas come form
going to the genba – leadership goes to the departments/wards to look for waste and
opportunities to improve or practice kaizen.
Five Whys – ask why 5 x’s to get to the ….
4 M’s
5 S’s
A3s
− SMART
− Fishbone Diagram – Ishikawa Chart
Confidential – For Discussion Purposes Only 6
Understanding C-Suite Language:
“Lean” – Focus and Tools
Make problems visible – not hide them or “not talk about mistakes/problems”
Fix problems permanently – get to the “root cause” and eliminate it.
Keep asking ‘Why’ until you discover the root cause of the problem
− No magic in 5 –
might be 3, or 7, or 10
Why do we? (conduct orientation in person, fill out multiple forms, take on line
training for non MDs)
Manpower/Personnel
Materials
Method(s)
Machines / Equipment
People
Process
Policy
Principles
Materials Methods/Process
WHY? WHY?
xxx hr
wait time
WHY? WHY? in ER
Manpower/People Machine\Equipment
Sorting = Seiri
Simplifying = Seiton
Sweeping = Seiso
Standardizing = Seiketsu
Self Discipline = Shitsuke
Quick Exercise
14
Confidential – For Discussion Purposes Only
What is an A3?
1. What is the problem or gap? (What 2. What causes are preventing us from meeting
are we trying to improve?) our target(s)? What are the “root” causes?
Cause
Gap Cause
Target
Cause
Effect/Problem
Current Cause
Cause
Performance
Cause
4. Which actions will address the 3. Based on data, what are the
most important causes? causes in order of importance?
Goals By Who &
Actions
(Cause) When
1. What is the problem or gap? (What 2. What causes are preventing us from
are we trying to improve?) meeting our target(s)? What are the
“root” causes?
4. Which actions will address the 3. Based on data, what are the
most important causes? causes in order of importance?
Goal Actions By When/
(Cause) By Who
Sponsor:
Participants:
Title Start Date:
Revised Date
Implementation Plan:
Goals/Dashboard Metrics:
Follow Up:
Problem Analysis:
Sustain Results:
Date Revised:
Confidential – For Discussion Purposes Only Version #:
What Type of Information is Included in an A3?
The Top of the A3 Chart
Accountability
− Who is responsible for the project?
− Sponsors, Team Leaders
Project Title
− Brief description of the project
Project Team
− All people involved in the development and completion of the project
Draft Status
− Date and version
The left side contains information and discoveries about the current state
− Issue (the problem)
Objective description with data
Stated through the customer
− Background
History
Significance (how does this fit within the organizational goals?)
− Baseline
Simple graphic of current state
− Requires observation
− Includes major pain points (problem areas within the process)
− Goals / Dashboard Metrics
Data that will be measured to provide evidence of success
− Problem Analysis
Identifies the root cause of current state problems
− The 5 Whys, Fishbone, Pareto, etc.
The right side develops the vision and action plan for the goal
− Future State
The ideal state you want to achieve
− Countermeasures
What you will need to change to get from current state to the desired future state
− Implementation Plan
How the countermeasures will be achieved
Show who, what, when and outcome (accountability)
− Follow-Up
What will be done to ensure the project is maintained
− Sustain Results
The measured outcome or ongoing measurement of the project’s impact
− Often the direct measure of the problem
9. Monitor results
− Allocate time for measuring results after implementation
− Measure and analyze results
− Report results
AIR - APEs
Program Expansion
CCC Matrix
Data-driven decisions
Multiple sources
Pre-emptive