LEAN Enterprise Methods in Healthcare:
VA Boston Mental Health
Jordan Peck
LAI Annual Conference
March 25, 2010
http://lean.mit.edu
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
2
VA Mental Health – Boston
ESD.62J/16.852J: Integrating the Lean Enterprise
Ellen Czaika
Clayton Kopp
Orietta Verdugo
Zakiya Tomlinson
Jordan Peck, Facilitator
http://lean.mit.edu
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
3
Agenda
Project Overview
Enterprise Description
X-Matrix
Process Waste
http://lean.mit.edu
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
4
Project Overview
Collect Data
–
11 individuals interviews
–
Phone and site interviews—Brockton, Bedford, Jamaica Plains
–
Metrics, process and procedure, organizational charts, financial statements
Conduct Analysis
Validate Findings
Formulate Recommendations
Present Recommendations
Project
Approach
Analyze the VA BMHS through a Lean assessment and suggest strategy for a Lean
transformation
Project
Goals
http://lean.mit.edu
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
5
To serve the veteran through the delivery of timely quality care by staff who
demonstrate outstanding customer service, the advancement of health care
through research, and the education of tomorrow's health care providers.
Mission &
Vision
Serve Boston Health Services
Team-oriented and Integrated Care
Quality Improvement
Compliance
Evidence-based Care through Educational Residencies
Become World Class Research Hospital System
Accessible Care
Strategic Goals
Boston Mental Health Service is largest within VA New England region
Locations – Brockton, Jamaica Plains, West Roxbury + CBOCs
Services – Inpatient, Outpatient, Residential Programs
Overview
http://lean.mit.edu
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
6
Organization Chart
Director
Director
Dir. of Impatient &
Transitional
Programs
Dir. of Impatient &
Transitional
Programs
Director of
Outpatient Service
Director of
Outpatient Service
Associate Director of
Outpatient Service
Associate Director of
Outpatient Service
Dir. of Residential &
Vocational Programs
Dir. of Residential &
Vocational Programs
Chief Psychology
Chief Psychology
Associate Director of
Mental Health
Services
Associate Director of
Mental Health
Services
Director of
Residency Training
Program
Director of
Residency Training
Program
Program Support
Assistant
Program Support
Assistant
Psychiatrist
Psychiatrist
Clinical Associate
Clinical Associate
Boston Health
Boston Health
Mental Health
Mental Health
VA New
England
VA New
England
Veteran
Affairs Office
Veteran
Affairs Office
Key Insights
Funding and strategic planning is driven from the top down
Programming and research is volatile and dependant on politicians
Communication channels between each enterprise
Key Insights
Funding and strategic planning is driven from the top down
Programming and research is volatile and dependant on politicians
http://lean.mit.edu
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
7
Financials
Key Insights
Budgets are based on previous years number of patients and number of
complex patients
http://lean.mit.edu
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
8
Universities & Residents
Stakeholder Value Comparison
Doctors
Pharmacy
Hospital Management
Employees
VA Leadership
Community
Politicians
Finance
Volunteers
Homeless Shelters
Patients
Supply Chain
Partner Hospitals
Tax Payers
High
Low
High
E
n
ter
p
ri
se
V
a
lu
e
D
el
iv
er
y
t
o
S
ta
ke
h
o
ld
er
Stakeholder Relative Importance to Enterprise
VA BMHS
Lean Insights
http://lean.mit.edu
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
9
http://lean.mit.edu
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
10
http://lean.mit.edu
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
11
2 2 2 2 2 2 2 2 1 2 0 2 2 2 1 1 1 4 4 2 2 2 1 3 1 12 2 3 1 5 4 4 4 4 4 4 5 5 5 4 4 5 4 5 6 4 3 0 1 5 3 0 2 1 3 23 1 1 0 1 6 6 6 6 6 6 7 7 6 6 4 7 7 7 7 5 4 4 5 7 5 2 3 4 4 35 3 4 1 6 01313 s s s s s s s s s s s s sServe Boston Healthcare
System s s s w w w w s w ww w s 1358 01212
s s s s s s s s s s s s
Team Oriented - Integrated
Care s s s s w s w s ws s w 1284
01313s s s s s s s s s s s s s Quality Improvement s s s s w w w w 8 44
01313s s s s s s s s s s s s s
Complience -VA Code of
Patient Concern & JCAHOw s w w w 5 14
12012
w w w w w ww w w w w w
Evidence Based Care (inc. Through Educational
Residencies) s s s s w s s ws s s w w
1394
11011w w w w w ww w w w w
Become W orld Class
Research Hospital w w s s s s ws s s s w w 1385 056 s s s s s Accessible Care s s w s w w s s w w sw w w w 1569 V oc at iona l I ndus tr y P rogr am S ubs tanc e A bus e O ut pat ient P rogr am S ubs tanc e A bus e I nt ens iv e O ut pai tent P rogr am R es ident ial P rogr am ( R E A C H ) M H IC M P rogr am -D ay P rogr am M et hadone C li ni c M ent al H eal th O ut pat ient Im pat ient S er vi c e W ai ti ng T im es -C lin ic T obac c o M eas ur e MH : S MI -M HI CM Ca p a c it y M ent al H eal th A c c es s M ent al H eal th M eas ur e C or rec tnes s of di agnos is and tr eat m ent T im el ines s of di agnos is and tr eat m ent Q ual it y of pat ient ex per ienc e ( m ini m a l di s c om for t r es pec tf ul et c ) T im el y and ac c ur at e i nf or m at ion fl ow S af et y /S ec ur it y of pr em is es C lean, H igh Q ual it y F ac il it y A c c ur at e P at ient R ec or ds A vai labi lit y of m edi c at io ns , s uppl ies , and equi pm en t O per at ing w it hi n budget F ai r W ages for s er vi c es S uf fi c ient Inpat ient and O ut pat ient C apac it y R eas onab le ex pec tat ions and res pec tf ul tr eat m ent of em pl oy ees R es ear c h A dv anc em ent K now le dg e T rans fer C om m u ni c a ti o n and Im pl em ent at io n of V A c ul tur e and val ues E ff ic ient R es our c e M anagem ent A c c ur at e and w el l-doc u m en ted m onet ar y tr ans ac ti ons U ps tandi n g m em ber of l oc al c om m un it y 000 Transfer from VA ER to Inpatient s w s w 4 22
000 Transfer from Urgent Care
to Inpatient s w s w 4 22
000 Transfer from Outside ER
to Inpatient s w s w 4 22
101 w Inpatient Treatment s w s s w w 6 33 000 Transfer from Inpatient to
Residential s w s w 4 22
011 s Discharge from Inpatient w s w s w 5 23 011 s Residential Treatment s w s s w w 6 33 000 Transfer from Residential to
Inpatient s w s w 4 22
011 s Discharge from Residential s w s w 4 22 000 Transfer to Outside Facility s w s w 4 22 3811s s s w ws s w s s s Outpatient Treatment s w s s w w 6 33
000 Referral to Inpatient s w w w 4 13
000 Referral to Residential s w w w 4 13
011 s W alk-in to Outpatient s w s w 4 22
000 Purchasing (Supplies &
Services) s s w s 4 31 000 Patient Data Managements w s s w w s s s 9 63 000 Research w w w w s s s s s w 1055 000 Facilities and Maintance s s s s s sw w w s 1073 000 Quality Assurance s s w w s s w w s 9 54 000 Payroll s w w w s 5 23 000 Human Resources s w s s s s w 7 52 1 1 1 1 1 1 1 1 4 1 1 1 1 9 16 15 7 1 3 3 2 9 21 3 3 3 21 2 3 1 1 1 1 0 0 1 0 4 0 1 1 1 7 9 5 5 1 1 3 2 5 110 1 1 4 2 1 0 0 0 0 1 1 0 1 0 1 0 0 0 2 7 10 20 2 0 0 4 1 3 2 2 17 02
X-Matrix
Metrics StakeholderValues
Key Processes Strategic Objectives
Metrics StakeholderValues
Key Processes Strategic Objectives
Stakeholder
Values
Key
P
ro
cesses
Enterprise
Metrics
Str
a
te
g
ic
G
oa
ls
Very strong alignment with
most metrics on target
Goals are not formal or
documented
Research is a goal but not
measured locally
Metrics vs. Objectives
Values vs. Goals
Strong alignment with
areas in service, care, &
research
Gap lies in aligning goals to
values such as:
–
Operating within budget
–
Well-documented
monetary transactions
Strong alignment in areas
of service, research, &
quality
Processes addressing the
least stakeholder values
are primarily patient
movement
Processes vs. Values
Strong alignment with
outpatient treatment and
clinic wait times
Missing metrics for key
processes
–
Transfers to inpatient
–
Program referrals
Metrics vs. Processes
Strong Alignment
Weak Alignment
http://lean.mit.edu
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
12
X-Matrix
2 2 2 2 2 2 2 2 1 2 0 2 2 2 1 1 1 4 4 2 2 2 1 3 1 12 2 3 1 5 4 4 4 4 4 4 5 5 5 4 4 5 4 5 6 4 3 0 1 5 3 0 2 1 3 23 1 1 0 1 6 6 6 6 6 6 7 7 6 6 4 7 7 7 7 5 4 4 5 7 5 2 3 4 4 35 3 4 1 6 01313s s s s s s s s s s s s sServe Boston Healthcare
System s s s w w w w s w ww w s 1358 01212
s s s s s s s s s s s s
Team Oriented - Integrated
Care s s s s w s w s ws s w 1284
01313s s s s s s s s s s s s s Quality Improvement s s s s w w w w 8 44
01313
s s s s s s s s s s s s s
Complience -VA Code of
Patient Concern & JCAHOw s w w w 5 14
12012
w w w w w ww w w w w w
Evidence Based Care (inc. Through Educational
Residencies) s s s s w s s ws s s w w
1394 11011
w w w w w ww w w w w
Become W orld Class
Research Hospital w w s s s s ws s s s w w 1385 056 s s s s s Accessible Care s s w s w w s s w w sw w w w 1569 V oc at iona l I ndus tr y P rogr am S ubs tanc e A bus e O ut pat ient P rogr am S ubs tanc e A bus e I nt ens iv e O ut pai tent P rogr am R es ident ial P rogr am ( R E A C H ) M H IC M P rogr am -D ay P rogr am M et hadone C li ni c M ent al H eal th O ut pat ient Im pat ient S er vi c e W ai ti ng T im es -C lin ic T obac c o M eas ur e MH : S MI -M HI CM Ca p a c it y M ent al H eal th A c c es s M ent al H eal th M eas ur e C or rec tnes s of di agnos is and tr eat m ent T im el ines s of di agnos is and tr eat m ent Q ual it y of pat ient ex per ienc e ( m ini m a l di s c om for t r es pec tf ul et c ) T im el y and ac c ur at e i nf or m at ion fl ow S af et y /S ec ur it y of pr em is es C lean, H igh Q ual it y F ac il it y A c c ur at e P at ient R ec or ds A vai labi lit y of m edi c at io ns , s uppl ies , and equi pm en t O per at ing w it hi n budget F ai r W ages for s er vi c es S uf fi c ient Inpat ient and O ut pat ient C apac it y R eas onab le ex pec tat ions and res pec tf ul tr eat m ent of em pl oy ees R es ear c h A dv anc em ent K now le dg e T rans fer C om m u ni c a ti o n and Im pl em ent at io n of V A c ul tur e and val ues E ff ic ient R es our c e M anagem ent A c c ur at e and w el l-doc u m en ted m onet ar y tr ans ac ti ons U ps tandi n g m em ber of l oc al c om m un it y 000 Transfer from VA ER to Inpatient s w s w 4 22
000 Transfer from Urgent Care
to Inpatient s w s w 4 22
000 Transfer from Outside ER
to Inpatient s w s w 4 22
101 w Inpatient Treatment s w s s w w 6 33 000 Transfer from Inpatient to
Residential s w s w 4 22
011 s Discharge from Inpatient w s w s w 5 23 011 s Residential Treatment s w s s w w 6 33 000 Transfer from Residential to
Inpatient s w s w 4 22
011 s Discharge from Residential s w s w 4 22 000 Transfer to Outside Facility s w s w 4 22 3811s s s w ws s w s s s Outpatient Treatment s w s s w w 6 33 000 Referral to Inpatient s w w w 4 13 000 Referral to Residential s w w w 4 13 011 s W alk-in to Outpatient s w s w 4 22 000 Purchasing (Supplies &
Services) s s w s 4 31 000 Patient Data Managements w s s w w s s s 9 63 000 Research w w w w s s s s s w 1055
000 Facilities and Maintance s s s s s sw w w s 1073 000 Quality Assurance s s w w s s w w s 9 54 000 Payroll s w w w s 5 23 000 Human Resources s w s s s s w 7 52 1 1 1 1 1 1 1 1 4 1 1 1 1 9 16 15 7 1 3 3 2 9 21 3 3 3 21 2 3 1 1 1 1 0 0 1 0 4 0 1 1 1 7 9 5 5 1 1 3 2 5 110 1 1 4 2 1 0 0 0 0 1 1 0 1 0 1 0 0 0 2 7 10 2 0 2 0 0 4 1 3 2 2 17 0 2
2
2
2
2
2
2
2
2
1
2
0
2
2
4
4
4
4
4
4
5
5
5
4
4
5
4
6
6
6
6
6
6
7
7
6
6
4
7
7
0
13
13
s
s
s
s
s
s
s
s
s
s
s
s
s
0
12
12
s
s
s
s
s
s
s
s
s
s
s
s
0
13
13
s
s
s
s
s
s
s
s
s
s
s
s
s
0
13
13
s
s
s
s
s
s
s
s
s
s
s
s
s
12
0
12
w
w
w
w
w
w
w
w
w
w
w
w
11
0
11
w
w
w
w
w
w
w
w
w
w
w
0
5
6
s
s
s
s
s
M
ental
H
eal
th M
eas
ur
e
Serve Boston Healthcare System
Team Oriented - Integrated Care
Quality Improvement
Complience -VA Code of Patient
Concern & JCAHO
Evidence Based Care (inc. Through
Educational Residencies)
Wai
ti
ng Ti
m
es
C
lini
c
Tobac
c
o M
eas
ur
e
M
H
: S
M
I
M
H
IC
M
C
apac
ity
M
ental
H
eal
th A
c
c
es
s
Become World Class Research
Hospital
Accessible Care
V
oc
ati
onal
Indus
tr
y
P
rogr
am
S
ubs
tanc
e A
bus
e O
utpati
ent
Pro
g
ra
m
S
ubs
tanc
e A
bus
e Intens
iv
e
O
utpai
tent P
rogr
am
R
es
identi
al
P
rogr
am
(
R
E
A
C
H
)
M
H
IC
M
P
rogr
am
D
ay
P
rogr
am
M
ethadone C
lini
c
M
ental
H
eal
th O
utpati
ent
Im
pati
ent S
er
v
ic
e
Metrics
Stakeholder
Values
Key Processes
Strategic
Objectives
Metrics
Stakeholder
Values
Key Processes
Strategic
Objectives
http://lean.mit.edu
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
13
X-Matrix
2 2 2 2 2 2 2 2 1 2 0 2 2 2 1 1 1 4 4 2 2 2 1 3 1 12 2 3 1 5 4 4 4 4 4 4 5 5 5 4 4 5 4 5 6 4 3 0 1 5 3 0 2 1 3 23 1 1 0 1 6 6 6 6 6 6 7 7 6 6 4 7 7 7 7 5 4 4 5 7 5 2 3 4 4 35 3 4 1 6 01313s s s s s s s s s s s s sServe Boston Healthcare
System s s s w w w w s w ww w s 1358 01212
s s s s s s s s s s s s
Team Oriented - Integrated
Care s s s s w s w s ws s w 1284
01313s s s s s s s s s s s s s Quality Improvement s s s s w w w w 8 44
01313
s s s s s s s s s s s s s
Complience -VA Code of
Patient Concern & JCAHOw s w w w 5 14
12012
w w w w w ww w w w w w
Evidence Based Care (inc. Through Educational
Residencies) s s s s w s s ws s s w w
1394 11011
w w w w w ww w w w w
Become W orld Class
Research Hospital w w s s s s ws s s s w w 1385 056 s s s s s Accessible Care s s w s w w s s w w sw w w w 1569 V oc at iona l I ndus tr y P rogr am S ubs tanc e A bus e O ut pat ient P rogr am S ubs tanc e A bus e I nt ens iv e O ut pai tent P rogr am R es ident ial P rogr am ( R E A C H ) M H IC M P rogr am -D ay P rogr am M et hadone C li ni c M ent al H eal th O ut pat ient Im pat ient S er vi c e W ai ti ng T im es -C lin ic T obac c o M eas ur e MH : S MI -M HI CM Ca p a c it y M ent al H eal th A c c es s M ent al H eal th M eas ur e C or rec tnes s of di agnos is and tr eat m ent T im el ines s of di agnos is and tr eat m ent Q ual it y of pat ient ex per ienc e ( m ini m a l di s c om for t r es pec tf ul et c ) T im el y and ac c ur at e i nf or m at ion fl ow S af et y /S ec ur it y of pr em is es C lean, H igh Q ual it y F ac il it y A c c ur at e P at ient R ec or ds A vai labi lit y of m edi c at io ns , s uppl ies , and equi pm en t O per at ing w it hi n budget F ai r W ages for s er vi c es S uf fi c ient Inpat ient and O ut pat ient C apac it y R eas onab le ex pec tat ions and res pec tf ul tr eat m ent of em pl oy ees R es ear c h A dv anc em ent K now le dg e T rans fer C om m u ni c a ti o n and Im pl em ent at io n of V A c ul tur e and val ues E ff ic ient R es our c e M anagem ent A c c ur at e and w el l-doc u m en ted m onet ar y tr ans ac ti ons U ps tandi n g m em ber of l oc al c om m un it y 000 Transfer from VA ER to Inpatient s w s w 4 22
000 Transfer from Urgent Care
to Inpatient s w s w 4 22
000 Transfer from Outside ER
to Inpatient s w s w 4 22
101 w Inpatient Treatment s w s s w w 6 33 000 Transfer from Inpatient to
Residential s w s w 4 22
011 s Discharge from Inpatient w s w s w 5 23 011 s Residential Treatment s w s s w w 6 33 000 Transfer from Residential to
Inpatient s w s w 4 22
011 s Discharge from Residential s w s w 4 22 000 Transfer to Outside Facility s w s w 4 22 3811s s s w ws s w s s s Outpatient Treatment s w s s w w 6 33 000 Referral to Inpatient s w w w 4 13 000 Referral to Residential s w w w 4 13 011 s W alk-in to Outpatient s w s w 4 22 000 Purchasing (Supplies &
Services) s s w s 4 31 000 Patient Data Managements w s s w w s s s 9 63 000 Research w w w w s s s s s w 1055
000 Facilities and Maintance s s s s s sw w w s 1073 000 Quality Assurance s s w w s s w w s 9 54 000 Payroll s w w w s 5 23 000 Human Resources s w s s s s w 7 52 1 1 1 1 1 1 1 1 4 1 1 1 1 9 16 15 7 1 3 3 2 9 21 3 3 3 21 2 3 1 1 1 1 0 0 1 0 4 0 1 1 1 7 9 5 5 1 1 3 2 5 110 1 1 4 2 1 0 0 0 0 1 1 0 1 0 1 0 0 0 2 7 10 20 2 0 0 4 1 3 2 2 17 02
0
0
0
0
0
0
0
0
0
1
0
1
w
0
0
0
0
1
1
s
0
1
1
s
0
0
0
0
1
1
s
0
0
0
3
8
11
s
s
s
w
w
s
s
w
s
s
s
0
0
0
0
0
0
0
1
1
s
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
1
1
1
1
1
1
1
4
1
1
1
1
1
1
1
1
0
0
1
0
4
0
1
1
1
0
0
0
0
1
1
0
1
0
1
0
0
0
M
ental
H
eal
th M
eas
ur
e
Wai
ti
ng Ti
m
es
C
lini
c
Tobac
c
o M
eas
ur
e
M
H
: S
M
I
M
H
IC
M
C
apac
ity
M
ental
H
eal
th A
c
c
es
s
V
oc
ati
onal
Indus
tr
y
P
rogr
am
S
ubs
tanc
e A
bus
e O
utpati
ent
Pro
g
ra
m
S
ubs
tanc
e A
bus
e Intens
iv
e
O
utpai
tent P
rogr
am
R
es
identi
al
P
rogr
am
(
R
E
A
C
H
)
M
H
IC
M
P
rogr
am
D
ay
P
rogr
am
M
ethadone C
lini
c
M
ental
H
eal
th O
utpati
ent
Im
pati
ent S
er
v
ic
e
Transfer from VA ER to Inpatient
Transfer from Urgent Care to Inpatient
Referral to Inpatient
Transfer from Outside ER to Inpatient
Inpatient Treatment
Transfer from Inpatient to Residential
Discharge from Inpatient
Residential Treatment
Transfer from Residential to Inpatient
Discharge from Residential
Transfer to Outside Facility
Outpatient Treatment
Referral to Residential
Walk-in to Outpatient
Human Resources
Purchasing (Supplies & Services)
Patient Data Management
Research
Facilities and Maintance
Quality Assurance
Payroll
Metrics
Stakeholder
Values
Key Processes
Strategic
Objectives
Metrics
Stakeholder
Values
Key Processes
Strategic
Objectives
http://lean.mit.edu
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
14
X-Matrix
s
w
s
w
4
2
2
s
w
s
w
4
2
2
s
w
s
w
4
2
2
s
w
s
s
w
w
6
3
3
s
w
s
w
4
2
2
w
s
w
s
w
5
2
3
s
w
s
s
w
w
6
3
3
s
w
s
w
4
2
2
s
w
s
w
4
2
2
s
w
s
w
4
2
2
s
w
s
s
w
w
6
3
3
s
w
w
w
4
1
3
s
w
w
w
4
1
3
s
w
s
w
4
2
2
s
s
w
s
4
3
1
s
w
s
s
w
w
s
s
s
9
6
3
w
w
w
w
s
s
s
s
s
w
10
5
5
s
s
s
s
s
s
w
w
w
s
10
7
3
s
s
w
w
s
s
w
w
s
9
5
4
s
w
w
w
s
5
2
3
s
w
s
s
s
s
w
7
5
2
9
16
15
7
1
3
3
2
9
2
13
3
3
21
2
3
7
9
5
5
1
1
3
2
5
1
10
1
1
4
2
1
2
7
10
2
0
2
0
0
4
1
3
2
2
17
0
2
U
ps
tandi
ng m
em
ber
of l
oc
al
c
om
m
uni
ty
Transfer from VA ER to Inpatient
C
or
rec
tnes
s
of di
agnos
is
and
tr
eatm
ent
Ti
m
el
ines
s
of di
agnos
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tr
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(m
ini
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tful
, etc
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Ti
m
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and ac
c
ur
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nfor
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ati
on fl
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S
afety
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of pr
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is
es
C
lean, H
igh Q
ual
ity
Fac
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ty
R
eas
onabl
e ex
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tati
ons
and
res
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tr
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pl
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C
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em
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of V
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anagem
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c
c
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l-doc
um
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m
onetar
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tr
ans
ac
ti
ons
Transfer from Urgent Care to Inpatient
O
per
ati
ng w
ithi
n budget
Fai
r Wages
for
s
er
v
ic
es
S
uffi
c
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C
apac
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A
c
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A
v
ai
labi
lity
of m
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c
ati
ons
, s
uppl
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,
and equi
pm
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Referral to Inpatient
Transfer from Outside ER to Inpatient
Inpatient Treatment
Transfer from Inpatient to Residential
Discharge from Inpatient
Residential Treatment
Transfer from Residential to Inpatient
Discharge from Residential
Transfer to Outside Facility
Outpatient Treatment
Referral to Residential
Walk-in to Outpatient
Human Resources
Purchasing (Supplies & Services)
Patient Data Management
Research
Facilities and Maintance
Quality Assurance
Payroll
Metrics
Stakeholder
Values
Key Processes
Strategic
Objectives
Metrics
Stakeholder
Values
Key Processes
Strategic
Objectives
http://lean.mit.edu
© 2009 Massachusetts Institute of Technology /VA Mental Health /Peck 06/03/09
15
X-Matrix
2 2 2 2 2 2 2 2 1 2 0 2 2 2 1 1 1 4 4 2 2 2 1 3 1 12 2 3 1 5 4 4 4 4 4 4 5 5 5 4 4 5 4 5 6 4 3 0 1 5 3 0 2 1 3 23 1 1 0 1 6 6 6 6 6 6 7 7 6 6 4 7 7 7 7 5 4 4 5 7 5 2 3 4 4 35 3 4 1 6 01313 s s s s s s s s s s s s sServe Boston Healthcare
System s s s w w w w s w ww w s 1358 01212
s s s s s s s s s s s s
Team Oriented - Integrated
Care s s s s w s w s ws s w 1284
01313s s s s s s s s s s s s s Quality Improvement s s s s w w w w 8 44
01313s s s s s s s s s s s s s
Complience -VA Code of
Patient Concern & JCAHOw s w w w 5 14
12012
w w w w w ww w w w w w
Evidence Based Care (inc. Through Educational
Residencies) s s s s w s s ws s s w w
1394
11011w w w w w ww w w w w
Become W orld Class
Research Hospital w w s s s s ws s s s w w 1385 056 s s s s s Accessible Care s s w s w w s s w w sw w w w 1569 V oc at iona l I ndus tr y P rogr am S ubs tanc e A bus e O ut pat ient P rogr am S ubs tanc e A bus e I nt ens iv e O ut pai tent P rogr am R es ident ial P rogr am ( R E A C H ) M H IC M P rogr am -D ay P rogr am M et hadone C li ni c M ent al H eal th O ut pat ient Im pat ient S er vi c e W ai ti ng T im es -C lin ic T obac c o M eas ur e MH : S MI -M HI CM Ca p a c it y M ent al H eal th A c c es s M ent al H eal th M eas ur e C or rec tnes s of di agnos is and tr eat m ent T im el ines s of di agnos is and tr eat m ent Q ual it y of pat ient ex per ienc e ( m ini m a l di s c om for t r es pec tf ul et c ) T im el y and ac c ur at e i nf or m at ion fl ow S af et y /S ec ur it y of pr em is es C lean, H igh Q ual it y F ac il it y A c c ur at e P at ient R ec or ds A vai labi lit y of m edi c at io ns , s uppl ies , and equi pm en t O per at ing w it hi n budget F ai r W ages for s er vi c es S uf fi c ient Inpat ient and O ut pat ient C apac it y R eas onab le ex pec tat ions and res pec tf ul tr eat m ent of em pl oy ees R es ear c h A dv anc em ent K now le dg e T rans fer C om m u ni c a ti o n and Im pl em ent at io n of V A c ul tur e and val ues E ff ic ient R es our c e M anagem ent A c c ur at e and w el l-doc u m en ted m onet ar y tr ans ac ti ons U ps tandi n g m em ber of l oc al c om m un it y 000 Transfer from VA ER to Inpatient s w s w 4 22
000 Transfer from Urgent Care
to Inpatient s w s w 4 22
000 Transfer from Outside ER
to Inpatient s w s w 4 22
101 w Inpatient Treatment s w s s w w 6 33 000 Transfer from Inpatient to
Residential s w s w 4 22
011 s Discharge from Inpatient w s w s w 5 23 011 s Residential Treatment s w s s w w 6 33 000 Transfer from Residential to
Inpatient s w s w 4 22
011 s Discharge from Residential s w s w 4 22 000 Transfer to Outside Facility s w s w 4 22 3811s s s w ws s w s s s Outpatient Treatment s w s s w w 6 33
000 Referral to Inpatient s w w w 4 13
000 Referral to Residential s w w w 4 13
011 s W alk-in to Outpatient s w s w 4 22
000 Purchasing (Supplies &
Services) s s w s 4 31 000 Patient Data Managements w s s w w s s s 9 63 000 Research w w w w s s s s s w 1055 000 Facilities and Maintance s s s s s sw w w s 1073 000 Quality Assurance s s w w s s w w s 9 54 000 Payroll s w w w s 5 23 000 Human Resources s w s s s s w 7 52 1 1 1 1 1 1 1 1 4 1 1 1 1 9 16 15 7 1 3 3 2 9 21 3 3 3 21 2 3 1 1 1 1 0 0 1 0 4 0 1 1 1 7 9 5 5 1 1 3 2 5 110 1 1 4 2 1 0 0 0 0 1 1 0 1 0 1 0 0 0 2 7 10 2 0 2 0 0 4 1 3 2 2 17 0 2