In this webinar you will:
- Learn about the purpose and building blocks of hoshin kanri
- Understand how health care organizations arrive at and use hoshin
- Understand why hoshin is the quintessential PDSA and how experience with small tests of change and A3s create a foundation for hoshin
- Learn about some common rocks in the hoshin road and what can be done about them
Presenters:
Joanna Omi
Principal | Rona Consulting Group, the Lean practice of Moss Adams
Craig Vercruysse
Principal, CEO | Rona Consulting Group, the Lean practice of Moss Adams
Cascading Strategy Through Hoshin Kanri (Strategy Deployment)
1. Cascading Strategy Through
Hoshin Kanri
Mark Graban
VP of Improvement & Innovation Services
KaiNexus
@MarkGraban
Joanna Omi
Consulting Director
Moss Adams
@JoannaOmi
Craig Vercruysse
Partner
Moss Adams
@CraigVercruysse
2. Webinar Logistics
• Presentation (45 minutes)
• Q&A (10 minutes)
– Use the GoToWebinar
Meeting Panel to
submit a question at
any time
• Recording link & slides will be sent via email
– Also – see the “Handouts” feature and Chat box
4. Learning Objectives
• Learn about the purpose and building blocks of hoshin kanri
• Understand how health care organizations arrive at and use hoshin
• Understand why hoshin is the quintessential PDCA/PDSA and how
experience with small tests of change and A3s create a foundation for
hoshin
• Learn about some common rocks in the hoshin road and what can be
done about them
7. What is hoshin kanri?
• Also called strategy deployment, policy deployment.
• A means of connecting the macro with the micro. (John Shook)
• A management process aligning—both vertically and horizontally—an
organization’s functions and activities with its strategic objectives. A
specific plan—typically annual—is developed with precise goals,
actions, timelines, responsibilities, and measures. (Lean Lexicon, LEI)
• An organizational learning method and competitive resource
development system. (Hoshin kanri for the lean enterprise, Tom
Jackson)
8. What is it NOT?
• Traditional strategic planning.
• A “thump report.”
• Top–down dictate.
• Limited to annual (or less
frequent) reviews.
• Owned solely by executives.
9. Hoshin kanri
Just in time Jidoka
leveled production (heijunka)
cost reduction through the elimination of muda
people
materials
equipment
standard
work
standard
WIP
andon &
availability
takt time
production
flow
production
system
pull system
production
5S
Hoshin is the roof of the Toyota management system
10. (Scan), plan, do, check, act
Scan: understand the environment.
Plan:
• Understand foundational mission, vision, and
values.
• Identify “True North” dimensions and targets.
• Identify “breakthrough” strategic themes or
goals.
• Identify one-year measures, responsible
managers, and sub-teams.
• Create visual management.
• Play catchball to finalize plans.
Do: implement the plan.
Check: monthly management meetings to ensure
success.
Act: develop and implement countermeasures when
fall-off occurs.
Plan
Do
Check
Act
Scan
(internal and
external)
Hoshin Kanri for the Lean Enterprise
As we explained above, the hoshin team takes responsibility for the first three experi-
ments of the hoshin system. Once in the Plan stage, the hoshin team will help form and hand
4 Teams
Hoshin Team
Tactical team
Operations team
plan
check
doact
plan
check
doact
plan
check
doact
plan
check
doact
plan
check
doact
plan
check
doact
plan
check
doact
7 Experiments
1. Long-term strategy
2. Midterm strategy
3. Annual hoshin
4. Tactics
5. Operations
6. Kaikaku
7. Kaizen
Action Team
Figure 1-1. The 4 Teams and the 7 Experiments
12. PLAN: Step-by-step
Establish
guiding True
North
Define
outcomes
Develop
initiatives to
achieve
outcomes
Define
incremental
measures and
targets
• Quality.
• Safety.
• People.
• Growth.
• Financial
stewardship.
• (The short list.)
• Define and
prioritize strategies
to achieve defined
outcomes.
• “What,” not
“how.”
• (Another short
list.)
• What of ”the
whole” can we
achieve this
period?
• Recognizes
required
reporting and
overall
reporting
burden.
• Answers “how
will my work be
affected?” and
“how does my
work
contribute?”
• Define and
quantify success
within the True
North
dimensions.
• Language is
widely
accessible.
• Outcome/
lagging
measures.
Plan
14. True North: the “what” of strategy deployment
Safety
Customer
experience
Quality
Growing
our people
Financial stewardship
Equity
True North: A balanced scorecard
of leading and lagging indicators
that plot the course of your
organization's movement from
one "strategic position” to
another.
15. Do, Check, Act
Establish
process &
cadence of
accountability
• Visually
managed.
• Tiered
accountability.
• Rolled up from
the actual work
to managers to
executives.
• Missed targets
provide an
opportunity for
coaching and
require counter-
measures.
Do – Check – Act
Scan… Plan…
21. A story – integrating the adoption of lean into the x-matrix
• DMS (Daily Management
System) is currently active in
76 areas in 12 different
facilities
• DMS will be launched at a
total of 77 areas by end of
June 2015.
Countermeasure:
ü As of April, a corporate-wide
review of plan against actual
revealed a significant slowing
of new launches. Sites are
using this unanticipated lull to
strengthen and stabilize
existing DMS work, as well as
ensure alignment of DMS to
value stream objectives.
However, it represents a
significant reduction in the
original plan, which would
have led to 118 of 244
planned areas launched by
the end of FY15.
Note:
• DMS has been launched in 33
HK focused values streams.
41
54 54 54
54
71 71 71
80
90
110
118
44
47
52 53
54 59
63 67
72
75 76
0
20
40
60
80
100
120
140
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN
Target
Daily management
system engagement
As of May 31, 2015
22. Increase the Event Sustainment Rate (% kaizens sustaining improvements for > 90 days)
As of May 31, 2015
• Consistent monitoring of sustainment rates and ongoing on-site
meetings with facility staff to review both process of calculating
sustainment rate as well as improving rate are being completed
each month.
• Metropolitan did not have events during the reporting period and
therefore could not report sustainment rate. Lincoln did not
report their sustainment rate in time for inclusion in this report.
Countermeasures:
ü Facilities are reviewing the scope and goals of new RIEs to ensure
that the events can be closed in a timely fashion and the goals are
achievable.
ü Facilities are working to complete pre-event preparation including
having all needed data available. The lack of adequate preparation
was identified as a major cause for not achieving goals in required
time frames.
ü Quality vs quantity of RIEs has been stressed by the Enterprise
Breakthrough Office.
ü Successful sustainment strategies developed at some facilities are
now being shared with all facilities.
ü Visual management (control boards) are being installed at facilities
(or electronically) to better track event sustainment.
Notes:
• Event sustainment rate is defined as: Over a rolling 12 month
period, the percent of Rapid Improvement Events (of all
completed RIEs) for which improvements have been sustained for
more than a 90 day period.
• Goal is 60% in FY15; 72% in FY 16 and 85% in FY 17.
• As RIEs are both the major sources of improvements and are very
resource intensive, this is the unit selected for measure.
South Manhattan Generation Plus Queens North
Central
Brooklyn
South
Brooklyn
North
Central
Brooklyn
53 53 53 54 55 55 56 56 57 58 59 60
48 48
46
45
54 53
46
51 51
53
56
30
40
50
60
70
JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN
Target Actual
G
O
A
L
53
44
86 75 78
50 50
60 67
45
56
38
0
20
40
60
80
100
24. Acute stabilization KPI performance – 90 days post live
# Status Group Trend Pillar Metric Name
Reportin
g
Period
Baseline Threshold
Full
Performance
Previous
Value
Current
Value
Report Date
1 Physician
Clinical
Quality
Inpatient CPOE
Utilization Rate
24 Hours 78% 78% 80% 88% 90% 01/20/2014
2 Physician
Clinical
Quality
Inpatient Medication
Reconciliation Compliance
Weekly 35% 35% 50% 69% 89%1
1/14-20/2014
3 Clinical
Clinical
Quality
Pharmacy Bar Coding
Medication Administration
Compliance
Weekly
N/A
%
85% 93% 89% 89%2
1/6-12/2014
4 Clinical
Clinical
Quality
Medication Turn Around
Time
Order to Rx Verification
Weekly 9
Minutes
15 9 8.3 7.892
1/6-12/2014
5 Physician
Clinical
Quality
Problem List Weekly
N/A
%
40% 80% 53% 95%3
1/12-18/2014
6 Clinical
Clinical
Quality
Core Measures
Composite
Monthly 98% 90% 97% N/A 97% 11/30/2013
7 Financial Finance
Outstanding A/R Days For
Uncoded DNB Accounts
Month to
Date
5.11
Days
5.11 3.74 4.40 3.73 01/20/2014
8 Financial Finance Average Daily Revenue
Month to
Date
$10.033M $10.033M $10.39 $10.14M $10.13M 01/20/2014
9 Financial Finance Days In Candidate For Bill
Month to
Date
10.2
Days
10.2 8.4 14.9 13.2 01/20/2014
10 Financial
Service
Excellence
Patient Registration
Weekly Average Time
Weekly
ED
Non-ED
Minutes
10:52
7:27
9:50
5:48
8:55
5:40
8:46
5:28
1/12-18/2014
25. # Status Group Trend Pillar Metric Name
Reporting
Period Baseline Threshold
Full
Performance
Previous
Value
Current Value Report Date
11 Clinical
Service
Excellence
Press Ganey Patient Satisfaction
Scores
HCAPHS Drill Down Measures
Communication With Nurses
Communication with Doctors
Communication about Meds
Discharge Instructions
Overall Satisfaction/ Responses
Amb Surg
ED
OP
Monthly
72.5
78.9
59.8
83.1
71.61
75.84
58.23
81.41
72.5
78.9
59.8
83.1
68.1
76.6
54.5
82.7
181 responses
82.1
85.2
64.6
84.0
68 responses
Reported data
received
through 1/20
aggregated per
Discharge
Dates
11/1-30
Previous
12/1-31
Current
91.3
85.9
85.3
89.75
84.05
84.55
91.3
85.9
85.3
93.0 /24
84.0/182
88.1/ 440
88.4/ 22
82.8/125
88.7/ 233
12 Clinical
Targeted
Growth
Emergency Department
Average Length of Stay
Daily
187
Minutes
200 177 208 168 1/20/2014
13 Clinical
Targeted
Growth
Admission Time
from Emergency Department
to Inpatient Unit
Weekly
N/A
Minutes
Weekly
Average
TBD
137 148
Report in
Validation4
14 Clinical
Targeted
Growth
In-Patient
Average Length of Stay
Month
To Date
4.51 OCT 2013
4.83 YTD 2013
Days
5.12 4.59 5.27 5.11 01/20/2014
15 Clinical
Targeted
Growth
BTMG Interfaces
Operational per Charter
To Date N/A UP UP UP UP
As of
1/20/2014,
SLAs have been
met
Acute stabilization KPI performance – 90 days post live
27. Multiple vehicles for developing people
• Deploying hoshin kanri through catchball.
• Coaching managers, genuine and humble inquiry.
• Problem solving at multiple levels of the organization.
28. Developing an organization’s problem solving capabilities
• Cascading strategies respects the expertise of the people closest to
the work and ensures relevance.
• Coaching engages people in a two-way dialogue.
• Enabling problem solving develops critical thinking, acknowledges
value.
What?
How?
29. Coaching using humble inquiry behaviors
It’s not a checklist,
it’s a set of behaviors
Genuine curiosity
Interest in what the
other has to say
Listening vs. telling
Edgar Schein
Humble Inquiry:The gentle art
of asking instead of telling
(2013)
30. A story: connecting strategy to front line improvement in Perioperative Services
31. A story: connecting strategy to front line improvement in Perioperative Services
32. Organization level hoshin
Sterile Processing
Service line hoshin
Level 0
Reduce harm
events
A story: connecting strategy to front line improvement in Perioperative Services
Level 1
Eliminate post-
op infections
Level 2
Daily defects in
flash sterilizing
process
34. Common rocks… and lessons learned
• Weak organizational “strategy
muscle”
• Starting too high up the
organizational tree
• Underlying project management
discipline
• Imprecise measurements
• Failure to deploy
• Individualism
• Developing strategy takes time
• Start where there is pull
• Define, and expect adherence to,
deliverables and dates
• Clarity and specificity matter
• Enable and empower all levels of
the organization
• Hoshin requires a well-functioning
TEAM with measures only
achievable across silos
Rocks Lessons Learned
35. We’ve joined the Health Care Consulting Practice at
Moss Adams effective September 1, 2017.
This combination is built on a shared culture
that cares about our people and our clients—
and helping them succeed.
37. Our Next Webinars
• Register at www.KaiNexus.com/webinars
• November 29 – "Healthcare Collaboration"
– Dr. John Toussaint and Paul Pejsa, Catalysis
• December 7 –
"4 Components of an Employee-Led Lean Initiative"
– Simon Murray and Benny Ausmus, Big Change Agency