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Lean Methods for Lean Times Premier Annual Breakthrough Conference Orlando, FL June 21, 2006

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Title: Lean Methods for Lean Times Premier Annual Breakthrough Conference Orlando, FL June 21, 2006


1
Lean Methods for Lean TimesPremier Annual
Breakthrough Conference Orlando, FL June 21, 2006
Jonathan Flanders, MHSA, BSMT, MT
(ASCP) Lean/Patient Safety Officer
June 12, 2002
2
Session Objectives
  • Define how the Lean Production Model can be used
    operationally, clinically, financially and in
    supply chain to improve clinical outcomes and
    patient satisfaction.
  • Explain strategy of using Rapid Improvement
    Events (RIEs) to drive change operationally and
    culturally.

3
What Does Lean Healthcare Look Like?
Adapted by J. Flanders from J. Liker, 2006
4
Based on the 5 Principles of Lean Thinking
  • Value What is the customer really buying?
  • Value Stream How value is created delivered?
  • Flow Improve the value stream
  • Pull Triggering every flow from actual demand
  • Perfection Continuous improvement forever

source LEAN THINKING, Womack and Jones, 1996.
5
Memorial Health Lean Transformation Roadmap
Decide
Prepare
Start
Accelerate
Expand
Decide
Prepare
Start
Accelerate
Expand
1 month
6 months
8 to 12 months
2 to 4 years
5 years
6
Memorial Health Lean Transformation Roadmap
Expand
Decide
Prepare
Start
Accelerate
  • Actions for Senior Leadership
  • Find a change agent
  • Get lean knowledge
  • Find a lever
  • Decide on a path to follow
  • Commit time and resources to Lean
  • Deliverables
  • Visits to other organizations and attendance at
    conferences
  • Understanding that costs and wastes continue to
    increase while reimbursement decreases
  • Intent presented to leaders
  • Partnership with a consultant

7
Memorial Health Lean Transformation Roadmap
Expand
Decide
Prepare
Start
Accelerate
  • Actions for Senior Leadership
  • Select Sensei
  • Begin Lean training
  • Create support infrastructure
  • Prepare redeployment policy
  • Conduct enterprise wide value stream
  • Develop first year plan that sets an aggressive
    pace of change
  • Share the vision for Lean transformation
  • Deliverables
  • Engaged consulting support from Simpler
  • Leaders participated in awareness workshops
  • Lean Oversight created and core team established
  • Identified and prioritized value streams and
    metrics
  • Implementation plan
  • Communication Plan

8
Memorial Health Lean Transformation Roadmap
Expand
Decide
Prepare
Start
Accelerate
  • Deliverables
  • Ideal, future, current state maps
  • Baseline of current performance
  • Lean dashboard
  • Improvement plan
  • Alignment Review
  • Financial, cell and facility assessment audits
  • HR, budget, and policy decisions to support
    improvement
  • Model cell and value stream
  • Actions for Senior Leadership
  • Map value streams
  • Support pilot project teams (RIEs, projects and
    Just Do Its)
  • Establish assessment and measurements
  • Initiate infrastructure for project, resources,
    training, reward and recognition, scoreboards and
    communications
  • Remove or re-assign antibodies

9
Memorial Health Lean Transformation Roadmap
Expand
Decide
Prepare
Start
Accelerate
  • Actions for Senior Leadership
  • Reorganize by product family
  • Greatly increase activity
  • Initiate strategy deployment
  • Integrate into other business processes
  • Expand knowledge and teaching of lean principles
    to leaders
  • Take corrective actions to remove problems in
    quality, cost and morale
  • Deliverables
  • Process village and monuments removed
  • Strategic deployment plan
  • 3P, project management, pull systems, visual
    management

10
Memorial Health Lean Transformation Roadmap
Expand
Decide
Prepare
Start
Accelerate
  • Actions for Senior Leadership
  • Leverage knowledge and savings
  • Expand lean enterprise to payors, suppliers,
    community partners
  • Manage cultural transformation
  • Instill perfection mindset
  • Deliverables
  • Expanded market share
  • Growth strategies funded by savings
  • Reduced cost burden to community
  • Shared risk models
  • Transition to a balanced top-down, bottom-up
    improvement

11
Memorial Health Lean Transformation Roadmap
Expand
Decide
Prepare
Start
Accelerate
  • Value Streams
  • Emergency Department
  • Surgical Services - SSI Bundle
  • Pain Management Clinic (Six Sigma Lean)

12
the "magic" of Rapid Improvement Events is simple
  • highly focused teams
  • right people involved
  • accountability "by Friday"
  • close observation (see waste)
  • application of proven principles
  • experienced coaching

measurements -gt targets action -gt deliverables
13
Emergency Department Value Stream Results
KeyMeasures
14
Emergency Department Value Stream Goals
  • Decrease ED average LOS for discharged home
    patients by 40 from 152 min. to 91 min. by
    12/31/2006
  • Decrease ED average LOS for admitted patients by
    40 from 440 min. to 264 min. by 12/31/2006
  • Reduce use of overtime by 50 from 7.74 to 3.87
    by 12/31/2006
  • Reduce patient identification errors by 50 from
    1.29 to 0.64 by 12/31/2006
  • Reduce medication errors by 50 from 0.74 to 0.37
    by 12/31/2006

15
Emergency Department Events
  • Value Stream Analysis July, 2005
  • RIE for Triage/Registration Process August 2005
  • RIE for Radiology Process September 2005
  • RIE for Acute Care Flow October 2005
  • RIE for Laboratory Process November 2005
  • 6-S Event for Trauma and Cardiac Rooms January
    2006
  • RIE for Medication Process February 2006
  • Flow Cell Assessment for all Processes March
    2006

16
ED Triage/Registration
  • Focus Combine triage and registration to reduce
    wait times, improve safety, create standard work
    and improve patient flow

17
ED Imaging Process
  • Focus Standard work for physicians, visual
    management of imaging results, and improve
    transport process.

18
Laboratory/Medication Processes
  • Focus Standard work for ordering, specimen
    collection, administration and visual cues for
    results.

19
6-S Events
  • Focus Sort, Straighten, Scrub, Standardize,
    Sustain, and Safety for all Trauma and Cardiac
    Rooms

20
Emergency Department Value Stream Metrics
21
Surgical Services Value Stream Results
22
Surgical Services Value Stream Goals
  • Reduce SSI rate by 80 implementing the SSI
    bundle by 12/31/06
  • Increase on-time starts of all surgical cases by
    50 from 11 to 17 by 12/31/06

23
Surgical Services Events
  • Value Stream Analysis July 2005
  • RIE for Surgical Site Infection Bundle August
    2005
  • RIE for Day Surgery September 2005
  • RIE for Posting/Scheduling October 2005
  • RIE for Pre-Surgical Testing November 2005
  • RIE for Operating Room Turnover January 2006
  • Flow Cell Assessment for all processes February
    2006
  • 6-S Event for Pre/Post Anesthesia Care Unit
    April 2006

24
Surgical Services Events
  • August Accomplishments for SSI Bundle
    Implementation (IHI)
  • Implemented SSI bundle
  • September Accomplishments for Same Day Surgery
  • Standard work implemented for RN, Tech and Unit
    Secretary
  • Improved direct patient time and patient
    experience
  • Implemented in-room registration for most
    patients
  • Improved accessibility to Pyxis supplies
  • Implemented fanny pack for mobile supplies

25
Surgical Services Events (Cont.)
  • October Accomplishments for Posting
  • Creation of standard work for Posting staff
  • Developed or revised forms used for surgical
    posting
  • Developed standardized script for Posting staff
  • Piloting new process for Savannah Surgical Group
    and Savannah Colon Rectal Surgery
  • November Accomplishments for PST
  • Creation of standard work for Interview RN,
    Resulting RN, Resource RN, Chart Coordinator
    PCTs
  • Magnificent revision/consolidation of Informed
    consent procedure and all signature requirements
    down to 1 (10 yrs of work in 1 week)
  • Patient Centered Focused process.
  • Redesigned anesthesia process to decrease calls
    rework
  • Improved supply an equipment management

26
Surgical Services Events (Cont.)
  • January Accomplishment for OR Turnover Process
  • Developed SOPs in compliance with JCAHO and Red
    Rules (Found areas of non-compliance and
    rectified)
  • ID high priority supply and instrument need (ie
    specimen containers, larger trash bags, and O2
    tanks and holders facilities will attach O2
    holders to all new beds by 2-28-06)
  • Developed checklists and forms (Room cleaning,
    supply equipment needs for TF cases, and PCT
    transport form
  • Developed Production Control Board
  • Revised workflow for ORST into PODS
  • Identified communication needs between workgroups
    (Recommended implementation of Vocera for ORST
    and PST)
  • Identified additional visual and work flow needs
    (Navicare Screens and additional Printer)
  • Trained coordinators on new process and obtained
    their buy in for implementation

27
6-S Event in PACU
  • Focus Sort, Straighten, Scrub, Standardize,
    Sustain and Safety central desk and medication
    room.

28
Surgical Services Value Stream Metrics
29
Define Charter Pain Management Clinic
Project Definition
Project Deliverables/Benefits
Problem Statement The Pain Management Clinic
(PMC) is currently experiencing median LOS of 110
min. (95 CL from 93 to 130 min.) and patient
satisfaction scores of 74, which results in loss
capacity and potential revenue for Memorial
Health. Inefficient scheduling and high LOS
result in 745 per month use of OT. Project
Scope The project will include all patients seen
in the PMC. The boundaries of the project
include Physician order to discharge. Project
Aim To reduce median LOS times by 25 from 110
min. to 83 min. by 4/30/06. To improve overall
patient satisfaction score from 80 to 90 by the
end of 2nd quarter 2006.
Key Deliverables Increased case load
capacity Single-piece flow for patient
experience Increased customer satisfaction Busine
ss Case Total hours worked/day from 9.2 to 6.9
results in capacity for 3 cases per day, 15 per
week or 750 per year. Average operating income
for PMC of the past 5 years is 411 per case. If
targets are reached and cases are scheduled to
match capacity, then PMC could realize potential
increase in operating income of 308,250.
Elimination of overtime will result in savings of
8940.
Roles Responsibilities
Process Area Lynn Melton, RN, Elizabeth
Richardson, Yolanda Andrews, Suzanne Thompson,
Willette Cook, Stephen Rogers, M.D., James
Routon, M.D. and Joyce Steuber, Patient
Champion Ramon Meguiar, M.D.
Process Owner Michele Stephens, N.P.
Project BB Jonathan Flanders
30
Analyze Statistical Analysis
2
1
4
3
Conclusion The analysis showed that the only
statistically significant cause of variation at
the 95 CL was the type of procedure.
31
Analyze Value Stream Analysis (Current State)
32
Analyze Value Stream Analysis (Current State
Continued)
33
Analyze Value Stream Analysis (Current State
Continued)
34
Analyze Value Stream Analysis (Current State
Continued)
35
Analyze Root Causes Vital Few Xs
  • Procedure type The current scheduling model
    does not account for different procedure types
    which have been statistically significant to the
    average LOS for PMC at the 95 CL.
  • The current patient flow process is not capable
    of meeting the desired average LOS of 83 min.
    The current process is 69 waste or non-value
    added activities to the patient.
  • The current staffing model does not appropriately
    utilize human resources.

36
Improve Future State Map
37
Improve Future State Map Continued
Improvement Summary Current State 24 steps, 145
min. total, 101 NVA min., 44 VA min. (68
Waste) Future State 13 steps, 94 min. total, 45
NVA min., 49 VA min. (48 waste)
38
Improve Project Plan
39
Improve Risk Assessment
40
Lessons Learned
  • Lean is hard work!
  • CEO, SLG and Physician support is vital
  • Gaining buy-in from those doing the work is the
    key to meaningful improvement and sustainability
  • Scope of value streams and projects
  • Data measurement systems needed work
  • Good value streams and good data and important,
    so dont rush
  • Committed and educated resources are a necessity

41
Lean Methods for Lean TimesPremier Annual
Breakthroughs ConferenceOrlando, FL June 21, 2006
Questions?
June 12, 2002
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