Beth Murphy MD Ambulatory Block QI Session 2 20132014 Mr Potato Head Facts Created by George Lerner in Brooklyn NY Jumble of accessories meant to pierce a real potato Sold idea for 5000 to a cereal maker in 1951 ID: 404527
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Mr. Potato Head: A LEAN, Mean Quality Improvement Teaching Machine!
Beth Murphy, MD Ambulatory BlockQI Session #22013-2014Slide2
Mr. Potato Head FactsCreated by George Lerner in Brooklyn, NY
Jumble of accessories meant to pierce a real potatoSold idea for $5000 to a cereal maker in 19511952- Rights acquired by “Hasbro”1952-First toy advertised on TV and the first marketed directly to kids1987-“Spokes spud” for ACS Great American SmokeoutResurgence in 1990’s with Toy Story Movies/Disney2000-RI State Family Travel Ambassador & License Plate> 100 million have sold over past 60 years
Source: Yankee Magazine, Dec 2012Slide3
Mr. Potato Head LEAN Simulation Exercise
A fun, interactive, innovative way to demonstrate:Quality Improvement conceptsPatient Safety/Medical ErrorsLEAN Process ManagementTeamworkCommunicationCan do with 4 to >100 learnersCan do with learners of all levels and disciplinesSlide4
Mr. Potato Head has Traveled
California AdventureAnaheim, CADowntown DisneyOrlando, FLASlide5
Mr. Potato HeadCreated by Eric Dickson, MDUMMHC President and CEO
ER physicianProfessor of Emergency MedicineInstitute for Healthcare ImprovementSlide6
Lean Process ManagementDerived from Toyota Production SystemEfficiency and Quality are
both importantEvery step in process should add “VALUE”Eliminate all “WASTE” from the systemEVERY member of the team is valued for their contributions to the process AND their ideas for improving the system/insuring safetySlide7
“At Toyota we get brilliant results from average people managing a brilliant process. Others get average results from brilliant people managing broken processes.”
--The Toyota Motor CompanySlide8
Even Mr. Potato Head has Gone “Lean”
BEFOREA Slimmed Down SpudSlide9
LEAN BELT PROGRESSION
YELLOW BELT=SOME TRAININGGREEN BELT=USES TOOLSBLACK BELT=PROJECT LEADER
WHITE BELT=AWARENESSSlide10
What do your patients value?
What do you value as an employee?ValueSlide11
TYPES OF WORK
Work/Service the patient cares about and is willing to pay for Face time, Diagnosis, Treatment
Non-Value Added
(
Required
)
Non –Value Added
PURE WASTE
Value Added
Value-Added Work
No value in the patient’s eyes, but can’t be avoided
Billing, Regulatory tasks
Consumes resources but doesn’t add value.
Looking for supplies
Patient/Staff waiting
Re-work, redundant paperwork
Required Non-Value Added Work
Pure WASTE – Non-Value Added Work
MINIMIZE
ELIMINATE
INCREASESlide12
Forms of Waste: DOWNTIME
DefectsOverproductionWaitingNot Utilizing the Creativity of all EmployeesTransportInventoryMotionExtra-processingSlide13
There’s been a terrible accident!Slide14
The Situation…
A bus filled with 16 Potato Head family members is in a terrible crash!EMS arrives at the scene to find only potato body parts scattered about.Luckily, there is an electronic medical record showing what each family member looks like.Slide15
The Game
Your “team” is the Trauma Team in the ERThe goal of the game is to accurately assemble as many “patients” as possible in 7 minutesSlide16
The Rules
Only 2 people from each team can physically implant the Potato Head body parts (”Implantation Specialists”)Completed “patients” must be inspected.There are no other rules.Slide17
Before we start…We need 3 brave volunteersSlide18
System 1
System 2System 3
Systems & “Waste”Slide19
First Lessons Learned
Quality is influenced more often by the SYSTEM than the individual playersHow much “waste” is actually in “the system”Think LEAN!!Slide20
ASSEMBLE YOUR TEAMS
Choose your 2 “Implantation Specialists”Patient photos in the bagBring assembled patients to Check OutYou have 2 minutes to plan your team’s “system”You have 7 minutes to process all 16 patients.Slide21
TAKE A FEW MINUTES..
Take 2 Minutes to plan your team’s system.Slide22
Inspection Stations
Bring completed patient AND photo to your designated inspection stationSlide23
http://www.online-stopwatch.com/full-screen-stopwatch/Why did we pick 7 minutes?
If it takes 20-30 seconds to correctly assemble one Potato Head with no waste in the system, it should take maximum of 8 minutes to assemble all 16 if only 1 assembler. You have an entire team!Guinness Book of World Records’ fastest assembly of a Mr. Potato Head: Samet Durmaz of Turkey.7 Minutes!6.62 seconds!Slide24
Tracking Your Data/Progress
PDSA 1# built
# errors
# started
Time to 1
st
assembly
Team 1
Team 2
Team 3Slide25
PDSA Cycle #1
How many patients did you treat correctly during this cycle?How many errors did your team make?How long did it take you to complete first one?What changes will your team make for next cycle to eliminate waste and improve both quality and efficiency?Slide26
Sharing Best Practices
Team with Most # Patients SeenTeam with Least # ErrorsSlide27
PDSA CYCLESlide28
TYPES OF WORK
Work/Service the patient cares about and is willing to pay for Face time, Diagnosis, Treatment
Non-Value Added
(
Required
)
Non –Value Added
PURE WASTE
Value Added
Value-Added Work
No value in the patient’s eyes, but can’t be avoided
Billing, Regulatory tasks
Consumes resources but doesn’t add value.
Looking for supplies
Patient/Staff waiting
Re-work, redundant paperwork
Required Non-Value Added Work
Pure WASTE – Non-Value Added Work
MINIMIZE
ELIMINATE
INCREASESlide29
Forms of Waste: DOWNTIME
Defects (Medical Errors)Overproduction (Unnecessary testing)Waiting (Patients and Employees)Not Utilizing the Creativity of all EmployeesTransport (Moving patients)Inventory (Equipment, Discharge delays)Motion (Physical Plant/Flow)Extra-processing (Retesting, Readmissions)Slide30
BACK TO YOUR TEAMS
Take 2 Minutes to discuss how your team will improve the quality and efficiency of your patient care.Slide31
Start PDSA CYCLE #2
Switch Bags!You don’t see the same patients every day!Notice there are many differences in each body part (i.e. ears, eyes, mouths)Demonstrates how each patient is unique!You have 7 Minutes! Slide32
http://www.online-stopwatch.com/full-screen-stopwatch/
7 Minutes!Slide33
PDSA Cycle #2
How many patients did you treat correctly during this cycle?How many errors did your team make?How long did it take you to complete your first patient?How would you plot your data?What changes will your team make for next cycle to eliminate waste and improve both quality & efficiency?Slide34
Tracking Your Data/Progress
PDSA 2# built
# errors
# started
Time to 1
st
assembly
Team 1
Team 2
Team 3Slide35
RUN CHART: Plotting Your Data/Progress
# Patients AssembledSlide36
For PDSA Cycle #3
There’s been a change at work. Your Implantation Specialists have decided to work for your competing medical system across town and you now have Locum Tenens MDs filling in.Implantation Specialists must switch tables!Slide37
BACK TO YOUR TEAMS
Take 2 Minutes to discuss how your team will improve the quality and efficiency of your patient care with NEW TEAM MEMBERS!Slide38
Start CYCLE #3
Switch Bags Again!You Have 7 Minutes!http://www.online-stopwatch.com/full-screen-stopwatch/Slide39
Review PDSA Cycle #3
How did your new team do?
How did having new team members effect your quality and/or efficiency?
Did you change your system?Slide40
If we did PDSA Cycle #4…
Unfortunately, Federal Budget cuts continue and reimbursements from Medicare and Medicaid are down substantially.We have to lay off one team member from each team…The tallest person on the team has to step away from the table and observeSlide41
Team Outcome ReviewSlide42
What I learned from Mr. Potato Head:
The system is the critical determinant of performance.Good communication is essential for a high-functioning team.Good ideas for improvement can come from anyone on the team.Data is essential to drive improvement efforts.Repeating PDSA cycles is a valuable process.Efficiency is enhanced when value-added work is increased and waste is reduced. (LEAN)With very simple changes in system, you can improve quality, efficiency, and safety!QUALITY IMPROVEMENT CAN BE FUN!Slide43
MEDICINE IS A TEAM SPORT!Slide44
Remember…There are “Different” ways to achieve the same goals…Slide45
Suitcase of Tools
Thank you for participating!Be sure to take these tools back with you to your clinics, wards, ward/ICU teams!With very small changes, you can make BIG differences in both safety and efficiency! Slide46
Questions/Comments?