Fast Track Decision Making, A Rapid Problem Solving Method Guest was Nancy Riebling of North Shore LIJ Health System
Business901 Podcast Transcript
On the Business901 podcast, I had the pleasure of interviewing Nancy Riebling, Director of Operational Performance Solutions and a Master Black Belt for the North Shore- LIJ Health System. Operational Performance Solutions is a division of the Health System’s Corporate University located at the Center for Learning & Innovation. North Shore-LIJ Health System headquartered in Great Neck, NY is the third largest nonsectarian health system in the country. This is a transcript of the podcast. In her role as Director she over sees 3 system master black belts, teaches the six sigma and lean methodologies as well as mentors projects through out the health system. Working with senior leadership, she translates strategic goals and initiatives into six sigma, lean, or FTD (fast track decision making) projects to drive improvement across the organization. Nancy is a certified Medical Technologist who holds Master degrees in Clinical Chemistry & Pharmacology. She was part of the initial management team that developed the Core Lab and was the Manager of the Automated Robotic Laboratory for five years. Nancy served as Black Belt for the department of Laboratories for a year before joining the staff at the Center for Learning & Innovation in 2003 as the first system Master Black Belt. Nancy is an adjunct professor at: Hofstra University, Hempstead New York. She teaches a class in six sigma as part of the health system’s joint MBA program with a specialization in Quality.
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Since the program began, the Center for Learning has trained 36 black belts, 124 green belts & 7 Master Black Belts. In conjunction with Six Sigma & Lean training, employees acquire valuable change management skills by taking classes in change acceleration process & fast track decision making. Change acceleration process is a philosophy & tool set designed to help overcome cultural barriers to change by creating a shared need, shaping a vision, & mobilizing commitment. Fast track decision making (North Shore’s version of GE work-out) is a rapid problem solving approach with team involvement and in-meeting decisions. It is a catalyst for change focusing on the process to drive improvement and empowering the people closest to the process to develop & implement appropriate solutions. The Transcript: Joe Dager: Thanks everyone for joining us. This is Joe Dager, the host of the Business901 Podcast. Participating in the program today is Nancy Riebling, director of Operational Performance Solutions for the North Shore Long Island Jewish Health System. Nancy, could you give us a brief overview of North Shore, and what your position entails? Nancy Riebling: North Shore LIJ Heath System is a health system in New York. We're predominantly on Long Island and Queens. We encompass 15 hospitals, and we service about 500,000 people in our area. It's a very tight demographic area. We're composed of three tertiary hospitals, 10 communities, a children's hospital, and a psychiatric center. We do about 500,000 emergency visits a year. And we have about 30,000 employees. My role as the director of operational performance solutions is part of our corporate university, which is called The Center for Learning and Innovation. We're the training and learning arm of the health system, and I teach the Six Sigma and Lean methodologies throughout the health system.
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Joe: When you say it's a university, is it a separate complete body then from the hospital? Or is it part of it, and just what you could call a department that's the training? I mean you don't take anyone other than people that are employees of the hospital? Nancy: We take all the employees in the hospital. We are in a separate building so we're not on any hospital campus. We're actually in a standalone building. Part of the corporate university is that we teach Six Sigma and Lean, but we also teach core management enrichment classes. We also have a patient safety institute. So, we do a lot of different types of training. We do simulation. We do interactive training. And then like I said, we do hands on Six Sigma training where we have teams going through and we're teaching the Six Sigma and Lean methodology. And they're actually working on real life issues or real life problems for their facilities as they go through the training. So, it is like a mini campus, and actually will be growing because we will be partnering with Hofstra University and opening a medical school. Joe: Oh really? Nancy: Yeah. And that's in, I believe, 2011. Joe: Well, that's not too far in the distant future then. Nancy: No, it isn't. Actually they are renovating the space, they are building the curriculum. And we're an active part of that. Joe: One of the things I notice to be a central theme that surrounds the culture in North Shore was change acceleration, or fast track decision making. Can you define that for me, and explain how you utilize it there?
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Nancy: What we found is a health system; from a quality perceptive, we've always been a very strong heath system as far as our patient care and our quality. What we sometimes struggle with is change, and getting people to accept the change. The 15 hospitals were all individual hospitals before they became part of the North Shore LIJ Heath System. We're very fortunate in that a lot of our employees are long term employees. I mean it's not unusual to have people that have been at their sites for 25, 30 years. As we start to roll out things as a heath system, as far as best practices and standard operating procedures. It's getting people to accept the change that we sometimes have to struggle with a little bit, because each site has its own individual culture, and we don't want them to lose that, because it's important because we have diverse communities on Long Island, and in Queens and Staten Island. So, you want them to still have their individuality, but yet we want to be a health system and have the same standard operating practice throughout the heath system. Joe: How does that work? How can you keep the same culture when you are sitting there giving some one best practices to follow? Nancy: I think you can do it when... An example we did is we used three of our tertiary sites, which are Staten Island Hospital, Long Island Jewish, and North Shore at Manhasset. Each of them is very big hospitals and tertiary facilities. And they did the same project, and they were looking at moving patients out of the ED once they had orders to admit them. And what we did is we looked at each of their processes, and there are certain key things that are core that have to be the same. And yet there were individual things that could be a little different. By having them all in the same class we could put SIPOCs or process maps up there, show them how they were all the same, and yet show them how they could be a little bit different.
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Some of the challenges we have is some of our hospitals had technology that other hospitals didn't. When it came to this project where we were moving people out of the ED, actually Staten Island hospital had an electronic bed board system. At that point Manhasset didn't. So, you couldn't cookie cut the methodology because what each hospital had was a little bit different. But yet, having them use the same, the [inaudible 05:38] methodology and look at their processes, they could share best practices and learn from each other. And that was something we were able to do. Joe: Implementing Six Sigma practice with such a varied workforce seems virtually impossible. Numerous hospitals seemed like a huge undertaking to do. How long have you been doing this? Nancy: We've actually started in 2002 is when we did or first training project for the Center for Learning. I've been the master black belt, and we had an active program since 2003. So, actually we've been doing it for six years now. And also what we've learned over the six years is we're trying to get away from just using Six Sigma and Lean on projects. And we're trying to create that common language. So, what we've begun to do is to introduce some of the other tools into some of other programs that we have throughout the health system. When you talked about how each hospital is a little different, one of the things we do have are called value analysis teams. And they're for major divisions like the laboratory, radiology, the O.R. It's at the director level that they meet on a monthly basis. And what we're trying to do is to get them to standardize products they use, and also processes they use; and also to share best practices amongst each other. So like with the project, when I just spoke about with the ED and moving patients out, we could get all three hospital to look at the belonging sheets. When patients are moved
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from the ED up to the floor, you literally fill out a document that says "Yes, I brought their clothes, their eyeglasses, their jewelry with them." And we found everybody's was a little bit different. And what we were able to do is to say "OK, we should be able to standardize this." Now, in one hospital, maybe the nursing assistant fills out this document. In another hospital, it might be the nurse. It really doesn't matter who does it, but let's do it the same way. Joe: You talked a little bit about the role of the sponsor. How critical is that for successful use, can you explain the role of a sponsor at your facility? Nancy: I think we underestimated, originally, the role of the sponsor. We felt that was a senior level person that was in the background, and their role really was to break down barriers. And in time, we learned it's a lot more than that. They're really the ones that have the pulse on the people within their areas. So, they're critical for team selection. And what we've learned is you don't want to just have on the team the early adopters. You want to put some of those skeptics on your team also, and you want to draw them together. With our sponsors, we've also learned that the charter needs to really be a living, breathing document. A lot of times, initially, when we did the charter, we handed it off to the sponsor and they would sign it. Now we've got them so that they understand - you know what? We expect you to make changes on the charter. We want you to cross things out. Because by doing that, as the Master Black Belt, you and I can to start to communicate. And I can start to understand really where you want to go with this issue, so that I can help guide the team. Also, the Master Black Belts and the Black Belts aren't part of the facility. We're outside the facility, and our role is to help them with the tools and to mentor them. It's really the sponsor that they need to report out to, and the sponsor is the one that helps you drive in that Fast Track Decision Making, A Rapid Problem Solving Method
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accountability. When they realize the importance of the sponsor, it becomes more important to the team. They can also empower the team. But, we have to teach the sponsors they have to accept some of the decisions the team makes. Part of that is letting them make mistakes sometimes. And maybe they're going to come up with a solution that's not exactly how the sponsor was going to do it. So, what we have to do - it's critical that the sponsor understands they have to be a little bit open-minded and be willing to give people a chance. It's OK if they make a mistake; that's how we all learn. And they're the ones that can really reward and recognize the team. Also, after the Master Black Belt or the Black Belt goes on to another project, they're the key to sustaining it. Joe: So, when you have the project charter done and the team members, you have a Master Black Belt really as an advisor and then a sponsor that is at the head of the project. Nancy: The sponsor is the one who actually helps charter the project and says all right, this is our problem; this is what I need the goal to be. The sponsor is really who we want the team to report out to periodically to demonstrate how they use the tools, how they came up with the solutions, and how they're sustaining the improvements. Joe: You talked about getting a very diverse force onto the team. And I know that Long Island is heavily unionized. How does the union react to Lean Six Sigma? Nancy: In our healthcare facilities, we are half unionized, and the other half is nonunionized. What we have are called labor management partnerships, and the accountability. When they realize the importance of the sponsor, it becomes more important to the team.
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They can also empower the team. But, we have to teach the sponsors they have to accept some of the decisions the team makes. Part of that is letting them make mistakes sometimes. And maybe they're going to come up with a solution that's not exactly how the sponsor was going to do it. So, what we have to do - it's critical that the sponsor understands they have to be a little bit open-minded and be willing to give people a chance. It's OK if they make a mistake; that's how we all learn. And they're the ones that can really reward and recognize the team. Also, after the Master Black Belt or the Black Belt goes on to another project, they're the key to sustaining it. Joe: So, when you have the project charter done and the team members, you have a Master Black Belt really as an advisor and then a sponsor that is at the head of the project. Nancy: The sponsor is the one who actually helps charter the project and says all right, this is our problem; this is what I need the goal to be. The sponsor is really who we want the team to report out to periodically to demonstrate how they use the tools, how they came up with the solutions, and how they're sustaining the improvements. Joe: You talked about getting a very diverse force onto the team. And I know that Long Island is heavily unionized. How does the union react to Lean Six Sigma? Nancy: In our healthcare facilities, we are half unionized, and the other half is nonunionized. What we have are called labor management partnerships, and the predominant union that we have here is 1199. The 1199 members and management work together on projects. What we've done is embed Black Belts and Master Black Belts onto these teams to help them use the tools. What it does is it really helps them speak the Fast Track Decision Making, A Rapid Problem Solving Method
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same language. We stress things like operational definitions. We talk about measurement systems analysis. The teams don't do it; actually, the Black Belt or the Master Black Belt does it behind the scenes. But, let's look at the data we're collecting. Is it accurate? Is it good data? Or, do we need to take a step back and say all right, let's fix our data collection process? Joe: So, the union has been receptive when they see the numbers and other data. I don’t want to make that sound bad in any terms, but when people think of Lean they think of getting rid of... downsizing the workforce, which really isn't what it's about. Nancy: Exactly. And that is not what it is about with us. We're looking at it as how can we make our processes more efficient. And the frontline employees are the ones doing the process. They know what works, and they know what doesn't work. What we use Lean and Six Sigma for is to help them speak the same language as management, so that they both can understand each other. A lot times, the misunderstanding comes because they're both saying two different things, and neither one understands what the other is saying. So, we're trying to get them to use the same language. What's a valueadded step? What's a nononvalue-added step? What's the operational definition for this? What are we looking at? What's in scope or out of scope? Joe: How many Master Black Belts do you have on staff? Nancy: We have four Master Black Belts on staff. We've trained about 34 Black Belts and about 135 Green Belts. Joe: That's a pretty big number. Nancy: We have 30,000 employees. So, it is a large number, but it's still a small pool. Fast Track Decision Making, A Rapid Problem Solving Method
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Joe: You're presenting at the WCBF conference in Orlando on taking Six Sigma and Lean beyond projects in healthcare. Can you give us a quick overview on that presentation? Nancy: I'd be glad to. Like I said before, what we have found is we were very good at doing projects. Where we struggled was in translating what we learned from one project and putting that knowledge in another area. So, what we found is that by getting away from just doing Six Sigma and Lean projects, and putting Black Belts and Master Black Belts on things like our value analysis teams, our labor management partnerships - we actually also do joint MBA program with Hofstra University in quality in business and health administration, and we teach Six Sigma there - is teaching all these people the tools. Not everything has to be a Six Sigma or a Lean project. But, we can incorporate those tools into a lot of the mediums we currently have. That helps the spread the knowledge, and that helps to spread the best practices. We also do it as part of our medical fellows in Schneider Children's Hospital, their critical care program. They take an abbreviated Six Sigma class, where we teach them about metrics, data collection, measurement systems analysis. Joe: Does your track all on quality and healthcare, is that the part of the track that you're in? And I think you are on day two, October 15th. Nancy: Yes, at four o'clock in the afternoon. Joe: Oh, you'll have to keep everybody awake, then, won't you? Nancy: I'll try real hard. Joe: You'll do a great job, I'm sure.
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Nancy: I think we have important lessons that we can share from our mistakes that will help others. The thing is Six Sigma is very regimented and rigorous. And yes, a Six Sigma project has to go through all those phases and everything. But, there's a lot of other ways you can use these tools. And by using these tools in other arenas, I think it made us stronger. Joe: Where do you think Lean and Six Sigma's going at North Shore? Where do think it's headed in the future? Nancy: I think we're taking it to another step by doing it with these projects. We're also looking at E-learning. Some of the pushback that we get - and I know a lot of other organizations are the same thing - staffing is tight right now. It's hard to take people out of class for like three days of measure class, three days of analyze class. So, we're also looking at how can we incorporate E-learning into our model? We don't want to just do E-learning alone, because of the fact that we're 15 hospitals. Having them to come together in class is sometimes the first time these people meet their peers from other hospitals throughout the health system. That's really important, and that's a good thing. So, we don't want to lose that. But, we don't want to spend all the time in the classroom just teaching. We find that sometimes people that catch on quickly get bored, and we lose them. In the same breathe, there are sometimes people who don't catch on quickly, and we lose them because they're struggling. So, we're thinking of going to E-learning so that we can present the material ahead of time, you have a chance to absorb it, so that when you come to class and you're working on this real-life issue for your organization, you can apply that knowledge and you know what questions to ask.
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I can still remember when I did my black belt training, and I was trying to absorb all this knowledge plus do a project of an area in the laboratory which is where I came from, but not the area that I was in charge of. You didn't even have time to think of questions, you're so busy trying to absorb what they're presenting, thinking about, "All right, how do I apply this to what they gave me to do?" That you don't stop to think about what are the questions that you wanted to ask. We would like to get away from that so that you have time to absorb the material, so that when you're in class and you're applying it, you can stop and ask those questions, because probably the questions you have, somebody else will also have in the room. Joe: I think it's a great tool, E-learning, because there're certain things that you just need to digest at your own speed. Nancy: The other thing that we're looking towards is doing simulation, especially in complex environments of the ED and the OR, sometimes even doing a Six Sigma and a Lean project or a combination of them doesn't get you where you need to go, because those are such dynamic environments. So, we're looking at using simulation in those environments. Joe: That's very interesting. Do you separate Lean and Six Sigma, are they two different facets? Or is that all lumped together when you're doing a project? Nancy: We do both. When we teach the Six Sigma methodology, when we get to improve, we give them a smattering of Lean. We also teach a two day stand-alone course in strictly Lean. What we found over the years, is on our Lean teams, when we have people that are trained in Six Sigma as a black belt or green-belt and we have them on our Lean teams, we get results quicker and we're able to sustain them better. We do teach them as two separate classes. Fast Track Decision Making, A Rapid Problem Solving Method
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Joe: Do you use Lean as an introduction to get people started on quality and efficiency? Is that how you first introduce them to these methodologies? Nancy: It depends. It depends on the sponsor, how quick they need results. What are they charging with us to do? There is no definitive - sometimes, in some areas, we start with Lean first and then were like, "OK, we've got some quick hits, let's go to Six Sigma and look at some bigger processes." In other areas, we start with Six Sigma and then we put some Lean in there, too. Then in some areas, we do Six Sigma and there might be some little things that aren't part of the project, but if we can get some really quick hits, it'll help us get by in that acceptance piece and will do what we call FTD, or fast track decision making, which is an equivalent of GE workout. Joe: Where do you see the project breakdowns when you're using Lean Six Sigma? What doesn't work? Nancy: Where we struggle is usually with sustainability. What happens is we'll do great as long as there is a black belt or master black belt behind the scenes helping the process owner. Where we struggle is, after we've turned the project over to the process owner, six months later maybe it starts to slip. What we've done to try to alleviate that issue is we now have what we call a yearly sustainability report out. This was the idea of our CEO, Michael Dowling. It basically follows an R+, which for us is a quick report out format, where a year later we have the process owners report out to our senior leadership. What they're reporting is basically, "this was the problem, this was our initial metric, this is what we did to fix it, this is our current metric. That's not good enough, where are we going from here to take it to the next level?" That's helped us sustain things. We do that for Six Sigma projects and we do that for Lean projects. Fast Track Decision Making, A Rapid Problem Solving Method
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Also for Lean projects, what we found most manufacturing organizations do a 30 day report out for Lean, and then they turn it over, we sometimes take it a little longer, because it takes us a little longer to embed the change. So, we do a 30 day report out, maybe a 60 day report out and in some cases, we've had to do a 90 day report out. Joe: With the new initiatives in healthcare, and the efficiencies and the paperwork you're seeing with the new administration, how do you think that affects your role, or the Lean Six Sigma process there? Nancy: I think it makes our role more crucial to the organization. I think people will begin to see that you need to use these tools in order to be efficient. From a quality standpoint, healthcare is very strong. It's when we look at our processes, that we're all very good in our own individual areas at what we do. Like I said, I came from the laboratory - our turnaround time for lab results was excellent, but when we put together with the drawing of blood on the floor and the doctor coming back to look at the results, we can't look in just silos anymore, and that's where I think these tools help us look across the organization in a horizontal fashion, where we were very good at looking at things vertically in silos. Joe: Kind of like a supply chain, actually. Nancy: We can learn from manufacturing. Healthcare is different, but in some ways we also are the same. Joe: I've seen that where someone looked at some obvious ways where file cabinets are two offices down from where the person is working with them and using them 90 percent of the time. Simple things like that, it's amazing how a change like that can improve the work environment. Fast Track Decision Making, A Rapid Problem Solving Method
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Nancy: Absolutely. We did that with the CT project, which is a radiology project at one of our tertiary facilities. The printer where the order is printed out was all the way down the hallway. When we used Lean tools and they figured it out, they were walking 300 miles a year. That was a lot of wasted time that a radiology tech could be doing tests. Joe: It is one of the simple things of how crucial they are to efficiency. Would you like to add something about the conference? Nancy: I think healthcare is an important part of the conference, because a lot of changes are taking place in healthcare. I also think healthcare - and this is why I look forward to these conferences on a personal note, and I've been to many of them - we can learn a lot from other organizations. My favorite part of it is going to some of the non-healthcare tracks and learning from manufacturing or other transactional organizations and saying, "OK, what you're doing now, I think I can apply some of that in my world, too." That's a great thing. Joe: Just as you mentioned, with the diverse cultures, they get together and, "Gee, we're doing this over here." Nancy: It doesn't mean we have to be like everybody else and do it exactly the same way, but we can learn from each other and each of us can get stronger by looking at what the other person is doing. Joe: I'd like to thank you very much, Nancy, for being part of this conversation. If anyone would like to learn more about North Shore and Long Island Jewish Health System, they can be found at www.northshorelij.com, or for information about the Global Lean Six Sigma and Business Improvement Summit, that can be found at www.wcbf.com. You can download this podcast on your iPod and it is available on iTunes in Business901 stores. Fast Track Decision Making, A Rapid Problem Solving Method
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Joseph T. Dager Lean Six Sigma Black Belt
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Joe Dager is President of Business901, a progressive company providing direction in areas such as Lean Marketing, Product Marketing, Product Launches and Re-Launches. As a Lean Six Sigma Black Belt and a certified coach of the Duct Tape Marketing organization, Business901 provides and implements marketing, project and performance planning methodologies in small businesses. The simplicity of a single flexible model will create clarity for your staff and as a result better execution. My goal is to allow you spend your time on the need versus the plan. An example of how we may work: Business901 could start with a consulting style utilizing an individual from your organization or a virtual assistance that is well versed in our principles. We have capabilities to plug virtually any marketing function into your process immediately. As proficiencies develop, Business901 moves into a coach’s role supporting the process as needed. The goal of implementing a system is that the processes will become a habit and not an event. Part of your marketing strategy is to learn and implement these tools. Fast Track Decision Making, A Rapid Problem Solving Method
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