Re Thinking at HAP A Continuous Improvement CI

Re. Thinking at HAP A Continuous Improvement (CI) Journey Health Alliance Plan (HAP) 5/20/16 – Michigan Lean Consortium Healthcare Symposium Business Transformation (Continuous Improvement)

Objectives HAP Re. Think Journey • Provide background of HAP, Health Ford Health System, and Henry Ford • Explain changes that HAP has gone through since 2013 • Share influencers of our journey • Demonstrate the reasons why Lean was the right solution • Introduce HAP Re. Think • Described our accomplishments • Share the hurdles • Summarize our Secret Sauce • Explain our desired future road map 2 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

HAP Re. Think Journey Who is HAP? HAP is a subsidiary of the Henry Ford Health System (HFHS) - one of the nation's leading health care systems – that provides coverage to individuals, companies and organizations. We partner with doctors, employers and community groups to improve the overall health and well-being of every community we serve. Our mission is to enhance the health and well-being of the lives we touch. Company highlights: • Founded in 1960 • Based in Detroit, Michigan • More than 675, 000 members and more than 1, 000 employees Source: www. hap. org 3 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

Who is Henry Ford Health System? HAP Re. Think Journey Founded in 1915 by auto pioneer Henry Ford and now one of the nation's leading health care providers, Henry Ford Health System is a not-for-profit corporation managed by Chief Executive Officer Nancy M. Schlichting and governed by a 21 -member Board of Trustees, with volunteer-led advisory and affiliate boards providing additional leadership. It is comprised of hospitals, medical centers and one of the nation's largest group practices, the Henry Ford Medical Group, which includes more than 1, 200 physicians practicing in over 40 specialties. The System's flagship, Henry Ford Hospital in Detroit, is a Level 1 Trauma Center recognized for clinical excellence in cardiology, cardiovascular surgery, neurology and neurosurgery, orthopedics, sports medicine, multi-organ transplants and cancer treatment. With more than 23, 000 employees, Henry Ford Health System is the fifth-largest employer in metro Detroit, and amongst the most diverse. Generating more than $1. 7 billion of annual economic stimulus, it proudly acts as one of Michigan's anchor institutions. Source: www. henryford. org 4 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

Who was Henry Ford and how did he get involved in health care? HAP Re. Think Journey Two of his philanthropic projects were particularly conspicuous, because of both their size and their strategy. The first was the Henry Ford Hospital in Detroit. In 1914, the residents of Detroit started a subscription campaign to build a modern medical facility. Construction began, but was halted when the half-completed facility foundered in debt. Ford took over, completing the project with his own funds, served as its first president, and over the course of his lifetime, gave it about $14 million. To this day, it remains one of Detroit’s largest hospitals. Ford wanted the Henry Ford Hospital to reflect his philosophy of work and self-reliance. The hospital’s patients were workingmen and their families—solid citizens who wanted excellent health care but did not want to beg for charity to settle the bills. He thus subsidized some of the cost of the medical care, but took pains to ensure that patients would still have to bear some of the costs they incurred. “There are plenty of hospitals for the rich, ” Ford explained. “There are plenty of hospitals for the poor. There are no hospitals for those who can afford to pay only a moderate amount and yet desire to pay without a feeling that they are recipients of charity. ” Source: www. Philanthropy. Roundtable. org 5 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

What changes has HAP gone through since 2013? HAP Re. Think Journey • Generational core system overhaul challenges • Major regulatory impacts to business and technical processes resulting from the Affordable Care Act (ACA) • More market emphasis on Customer Experience • CEO changes • Health. Plus merger and other regional impacts • Cultural transformation 6 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

HAP Re. Think Journey Who influenced our journey? Dr. W. Edwards Deming Dr. Shigeo Shingo (Toyota Production System) Dr. Richard Zarbo (SVP of HFHS Pathology and Laboratory Medicine) Michael Rashmi HAP CI Team Larry Mr. Ritsuo Shingo (son of Dr. Shingo and Toyota executive) 7 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

Who influenced our journey? Quality is doing it right when no one is looking -Henry Ford HAP Re. Think Journey A bad system will beat a good person every time. -W. Edwards Deming Come to work, Do the work, IMPROVE the work, go home safely… -DTE Energy The most dangerous kind of waste is the waste we do not recognize -Shigeo Shingo Most people spend more time and energy going around problems than in trying to solve them. -Henry Ford Improvement usually means doing something that we have never done before. -Shigeo Shingo Time waste differs from material waste in that there can be no salvage. The easiest of all wastes and the hardest to correct is the waste of time, because wasted time does not litter the floor like wasted material. -Henry Ford Insanity: Doing the same thing over and over again and expecting different results. - Albert Einstein 8 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

Who influenced our journey? HAP Re. Think Journey 14 Points of Management 1. Create constancy of purpose for Improvement-customer focus 2. Adopt the new philosophy 3. Cease dependence on mass production 4. End the practice of awarding business on price alone 5. Constantly & forever improve systems of production & services 6. Institute modern methods of training on the job 7. Institute modern methods of supervision & leadership 8. Drive out fear 9. Break down barriers between departments 10. Eliminate numerical goals for workforce 11. Eliminate work standards & numerical quotas 12. Remove barriers to pride of workmanship 13. Institute a vigorous program of education & training for everyone 14. Create a structure in top management that will push every day on the above 13 points Source: Dr. Richard Zarbo (Henry Ford Health System Lab/Pathology) 9 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

HAP Re. Think Journey Who influenced our journey? Toyota Culture “The process improvement tools and techniques, while important, are not the key for successfully transitioning from conventional manufacturing to LEAN manufacturing. The key is the culture – that supports and stimulates continuous growth and improvement. ” (J. Womack) Source: Dr. Richard Zarbo (Henry Ford Health System Lab/Pathology) 10 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

Who influenced our journey? “We know from the changes that have already been brought about that far greater changes are to come, and that therefore we are not performing a single operation as well as it ought to be performed. ” ~ Henry Ford Source: Dr. Richard Zarbo (Henry Ford Health System Lab/Pathology) HAP Re. Think Journey Chapter 9 Bringing Ford’s Ideas Alive at Henry Ford Health System Labs through PDCA Leadership; Dr. Richard Zarbo 11 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

Who influenced our journey? Source: www. shingo. org HAP Re. Think Journey 12 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

Who influenced our journey? HAP Re. Think Journey Conferences/Gembas: Shingo; Michigan Lean Consortium; Thedacare; DTE Energy 13 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

Why was Lean the right solution and what is being applied? Source: Dr. Richard Zarbo (Henry Ford Health System Lab/Pathology) HAP Re. Think Journey 14 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

Why was Lean the right solution and what is being applied? Source: Dr. Richard Zarbo (Henry Ford Health System Lab/Pathology) HAP Re. Think Journey 15 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

Why was Lean the right solution and what is being applied? Source: Dr. Richard Zarbo (Henry Ford Health System Lab/Pathology) HAP Re. Think Journey 16 16 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

Why was Lean the right solution and what is being applied? HAP Re. Think Journey Master and Apprentice We all start as Padawans Source: Lucasfilm Limited (Star Wars) 17 17 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

Why was Lean the right solution and what is being applied? 2014 2015 / 2016 Years 2 and 3 Year 1 Metrics Introduce CI into HAP Culture Structure Change Enablement Reporting to Leadership Committee 2017 / 2018 Years 4 and 5 Core and Enabling Processes and Owners Key Pilots and Quick Hits HAP Re. Think Journey Core and Enabling/Shared processes integrated into Corporate Strategies and Culture along with Implementation of key process improvements Roll-out CI curriculum to improve employee competencies, awareness, and Lean maturity Sustainable process improvement driven/owned by business areas for organizational optimization We are here Multi-year plan with high benefits throughout… 18 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

What is Re. Think? GOALS • Introduce Continuous Improvement team and LEAN principles to HAP employees • Create campaign brand identity and tactics – disruptive, memorable, inspirational, sustainable • Ignite culture change HAP Re. Think Journey RETHINK CONCEPT • Inspired by clinical “time out” • Empowers employees to question processes and their environment • Cultivates atmosphere of ownership and innovation (increased engagement and productivity) 19 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

HAP Re. Think Journey What is Re. Think? Core and Shared/Enabling Functional Architecture 1. CORE FUNCTIONS Core Function Process Owner(s) Key activities that add primary value to HAP’s output for customers and stakeholders Develop Products & Solutions Market the Organization [VP] Re. Think Champions Re. Think Champion Enroll & Perform Billing Acquire & Retain Maintain & Payment Customers Members and Reconciliation Groups [VP] Process & Pay Claims / Encounters Service Members & Providers [VP] Manage Network Medical Mgmt. & Providers [VP] [VP] Re. Think Champion Re. Think Champion Activities that provide support to the Core Processes in order to ensure success for HAP’s future competitiveness Support Services 2. SHARED & ENABLING FUNCTIONS (Director) Re. Think Champion Healthcare Affordability. Re. Think (VP) Champion Support Information Technology Initiatives Manage Human Resources Support Financial Operations Perform Quality & Compliance (VP) (VP/VP) (VP) Re. Think Champion Conduct Auditing / Integrity (Director) Support Corporate Planning Re. Think Champion Conduct Business Intelligence (Analytics & Reporting) (AVP) Re. Think Champion (VP) Re. Think Champion Perform & Manage Legal Operations (VP) Re. Think Champion Manage Governmental Affairs Perform Community Outreach (Director) (VP) Re. Think Champion Manage Communications (VP) Re. Think Champion Manage Subsidiaries (CEO – ASR Health Benefits ) (SVP - HAP Midwest) Re. Think Champion 20 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

What is Re. Think? HAP Re. Think Journey 21 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

What is Re. Think? HAP Re. Think Journey 22 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

HAP Re. Think Journey What is Re. Think? An A 3 template is really just a structured format for working through the PDCA cycle in order to solve a problem. General Info DO PLAN CHECK ACT 23 23 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

What is Re. Think? A Value Stream Map (VSM) helps you see the big picture of how a process flows from beginning to end. HAP Re. Think Journey An A 3 helps you focus on one specific waste that you may have uncovered while doing the VSM. The VSM helps the team uncover the wastes. The A 3 helps the team think through how to counter each waste, one at a time. 24 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

HAP Re. Think Journey What is Re. Think? The Winning A 3, “Purchase Order (PO) Submission Process” 25 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

HAP Re. Think Journey What is Re. Think? • At the end of each round, the metrics you want to gather are: o o o • # of workers Total # of dominos set up (before toppling) Time used to set up the dominos Total # of dominos which toppled Topple rate (total # of dominos toppled / total # of dominos set up) PDCA Domino Challenge Use the sheet in your packet labeled Metrics to document this data Source: Mike Rother Kata Exercise 26 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

What is Re. Think? HAP Re. Think Journey IT Division performing PDCA Domino challenge – Priceless Moment!!! 27 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

What is Re. Think? Source: Bronson Health and the University of Michigan Health Systems HAP Re. Think Journey 28 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

What is Re. Think? HAP Re. Think Journey 29 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

HAP Re. Think Journey What is Re. Think? [Vice President] [Director / Manager] [Director / Manager] [Director / Manager] 30 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

HAP Re. Think Journey What is Re. Think? 4 ft. * We have recently created a Standardized 4 x 6 foot, laminated, 3 hole grommet template that is at the printing shop now! 6 ft. 31 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

What is Re. Think? HAP Re. Think Journey Capitalizing on the Shingo Assessment (also using Huddle criteria) Source: Institute for Enterprise Excellence 32 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

What have we accomplished? • • • • HAP Re. Think Journey Successfully developed and launched the Health Care Reform strategy Stabilized HAP core system project impacts Created core/enabling function (process) architecture Corporate project support on requirements/objects/mapping Rapid Redesigns (1 -week Kaizens) for eight (8) cross-divisional processes and won awards (and promoted employees) as a result Facilitated a multitude of Value Stream Mapping (VSM) sessions across nearly all divisions at HAP Developed and rolled-out Re. Think brand, collateral, and Change Champion program with Communications Launched Visual Management (Huddle) Systems in nine (9) divisions affecting over half of HAP employees Trained 280 leaders in 2015 – Received 82 A 3 s for their work cells 80 new employees oriented with Re. Think Coaching Leadership Academy attendees with Henry Ford Performance Improvement team Participated in Bronze Lean Certification program with CI team Trained on Shingo-Assessment methodology for use at HAP Metrics Impacts prove that Re. Think works: Employee engagement jump in scores; Accuracy, Productivity, and Timeliness improvements; Inventory reductions; Cultural behavioral impacts (from Senior leadership to Line level employees); and excellent ($) Value 33 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

What key hurdles have been put in front of us and How have they been solved? HAP Re. Think Journey Issue: Paradigm shift in management philosophy Resolution: Elimination of the Top Down only approach to management. Issue: Changes/Stability from the top Resolution: Re. Think is fundamentally supported. Issue: Not fully engaged leadership at the Divisional level (VP’s) Resolution: Additional training and having them participate in other Divisions “Sharing the Gain” monthly Huddle Rounding's to see the value of doing 10 minute daily Huddle’s. Issue: CI Staffing Resolution: Realignment of the staff that currently oversees the HAP employees. Issue: Fear from the Front-liners to speak up (Blame Free environments/Empowerment) Resolution: Front-liner specific training, same as what leadership has taken. 34 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

What is HAP’s Secret Sauce? • • • • HAP Re. Think Journey Create functional foundation and owners Find mentors Demonstrate that Lean works in any industry Sell Lean (every day) Brand Lean with communication / marketing Leverage voice of the customer Include Lean in performance goals Sell the program as not time-intensive and deliver it as such Document work efforts Have your internal customers share their stories Utilize the strengths of your team (the talent) Show patience with progress to the organization but move rapidly Expand your discipleship Steal and use Lean knowledge/examples shamelessly but credit liberally Align Lean with Corporate North Star Make Lean enjoyable (fun) 35 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

HAP Re. Think Journey What does the Future look like? • • • Re. Think brand to continue as a sustainable model Less CI resources for Re. Think but more Champions Continue to train and coach employees on Re. Think Lean Certification classes Leaders and their work cells to complete more A 3 improvements Huddle system to target nearly 100% participation in 2017 Corporate performance goals to keep Lean top of mind Re. Think Champion program importance Shingo measurement criteria to be used to monitor behavior change Changing health care industry and competitive landscape More opportunities to partner with HFHS CEO changes • Face change with confidence and trust the model to work!!! 36 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium

Questions? Business Transformation (Continuous Improvement) HAP Re. Think Journey 37 HAP Presentation (5/20/16) – Michigan Lean Consortium H/C Consortium