LEAN METHODOLOGIES IMPACT TO RESPIRATORY CARE SERVICES DEE GRAVELY, BSRT, RRT, RCP – CAROLINAS HEALTHCARE SYSTEM

BACKGROUND THE HEALTHCARE FIELD MAKES UP THE COUNTRY’S LARGEST INDUSTRY. THE DECREASING REIMBURSEMENT RATES COUPLED WITH INCREASING OPERATING EXPENSES GENERATES A SIGNIFICANT PROBLEM. FOR HOSPITALS TO SURVIVE IN THESE TIMES, THERE IS A NEED TO THINK OUTSIDE OF THE BOX AND LOOK FOR WAYS TO DELIVER PATIENT FOCUSED, VALUE-ADDED CARE. ALTERNATIVES LIKE LEAN MANAGEMENT PHILOSOPHY AND QUALITY IMPROVEMENT METHODOLOGY ARE BECOMING MORE POPULAR IN THE MEDICAL ARENA WITH VERY SUCCESSFUL OUTCOMES. THE FOCUS OF THIS RESEARCH IS THE IMPACT LEAN METHODOLOGIES CAN HAVE ON RESPIRATORY CARE SERVICES.

WHAT IS LEAN? LEAN IS ONE OF MANY QUALITY IMPROVEMENT STRATEGIES AVAILABLE TODAY. THE CORE IDEA OF LEAN IS TO MAXIMIZE CUSTOMER VALUE WHILE MINIMIZING WASTE. IT IS A SYSTEMATIC WAY OF THINKING TO FOCUS ON ELIMINATING WASTE AND SPOTLIGHT THE PROCESS AND WAYS TO OPTIMIZE A PROCEDURE TO BENEFIT THE CUSTOMER’S NEEDS AND ADD VALUE TO THEIR HEALTHCARE EXPERIENCE. LEAN METHODS ARE USED TO PROVIDE THE BEST VALUE FROM THE PATIENT’S POINT OF VIEW AND AT THE SAME TIME USE THE TALENTS OF THE TEAMMATES IN THE INSTITUTION WHILE USING THE LEAST AMOUNT OF RESOURCES. LEAN APPLIES IN EVERY BUSINESS AND EVERY PROCESS. IT IS NOT A TACTIC OR A COST REDUCTION PROGRAM, BUT A WAY OF THINKING AND ACTING FOR AN ENTIRE ORGANIZATION.

EIGHT WASTES OF LEAN

LEAN TOOLS WASTE WALK TO IDENTIFY TYPES OF WASTE SPAGHETTI DIAGRAMS -TRACKS THE PHYSICAL FLOW OF PEOPLE OR PRODUCTS 5S – SORT, SET, SHINE, STANDARDIZE, SUSTAIN TEAMMATE INVOLVEMENT AND ENGAGEMENT KANBAN – INVENTORY CONTROL SYSTEM TIME STUDIES STANDARD WORK – THE SAME WAY EVERY TIME VISUAL MANAGEMENT – REAL TIME COMMUNICATION TOOL “5 WHYS” PROBLEM SOLVING FLOW LAYOUTS – FACILITY DESIGN ERROR PROOFING – MEDICATION SCANNING GEMBA – GO AND SEE WHERE THE WORK IS DONE VALUE STREAM MAPPING – MAP OUT EVERY STEP IN THE PROCESS KAIZEN – CONTINUOUS IMPROVEMENT

THE FOCUS TASKS RESPIRATORY THERAPISTS ARE COMPLETING THAT INTERRUPTED PATIENT CARE.

DATA COLLECTION SURVEY 29 INSTITUTIONS TO OBTAIN THE STANDARD PRACTICE. WASTE WALK/OBSERVATIONS TO SEE EXACTLY WHAT IS HAPPENING WHERE THE WORK IS BEING DONE. TIME STUDY TO EVALUATE THE AMOUNT OF TIME BEING SPENT COMPLETING THIS TASK.

RESULTS 29 INSTITUTIONS REVEALED THAT 76% OF RESPIRATORY DEPARTMENTS DO NOT DELIVER OXYGEN TANKS.

RESULTS OBSERVATIONS TOOK PLACE WHERE THE WORK IS BEING DONE WITH FINDINGS OF MULTIPLE INTERRUPTIONS IN PATIENT CARE TO DELVER OXYGEN TANKS. WASTES IDENTIFIED – WAIT, EXCESS MOTION, INTELLECT

RESULTS IN FOLLOWING A THERAPIST’S AND CONDUCTING THE WASTE WALK, IT WAS DISCOVERED THAT AN AVERAGE OF 11 MINUTES AND 3 SECONDS WERE USED TO DELIVER OXYGEN TANKS PER CALL UP TO 5 CALLS PER SHIFT. EXCESS MOTION OF THE THERAPIST COVERED.31 MILES TO COMPLETE THIS NECESSARY TASK. THIS LED TO WAIT TIMES FOR BOTH PATIENTS AND THE NURSE. THERAPIST IS NOT WORKING AT THE TOP OF THEIR LICENSE IN PROVIDING THIS SERVICE.

RESULTS IN DISCUSSING THE FINDINGS WITH THE TEAM, THE DECISION WAS MADE TO INVESTIGATE OPTIONS FOR THE DELIVERY OF OXYGEN TANKS. AFTER SEVERAL MONTHS OF CONVERSATIONS AND PLANNING WITH MULTIPLE DISCIPLINES, THIS LEAN PROJECT RESULTED IN TRANSFERRING OXYGEN TANK DELIVERY TO THE GUEST SERVICES DEPARTMENT.

RESULTS WITH THIS DISCIPLINE DOING THE WORK, THE RESPIRATORY THERAPISTS DOES NOT GET PULLED FROM PATIENT CARE TO DELIVER OR RESPOND TO EMPTY TANK REQUESTS. ADDRESSING THIS PROBLEM WAS A HUGE WIN FOR THE TEAM. STAYING AT THE BEDSIDE AND PROVIDING CARE IS VALUABLE TO THE CLINICIAN. AFTER WORKING THROUGH THIS PROCESS AND SEEING THE OUTCOME, THE TEAM IS ENGAGED AND READY TO TACKLE OUR NEXT PROJECT INVOLVING MATERIALS AND SUPPLIES.

CONCLUSION LEAN METHODOLOGIES PROVIDE THE EDUCATION AND TOOLS TO SEE THE WASTE, IMPLEMENT AN IMPROVEMENT PROCESS AND ENGAGE THE TEAM IN PROBLEM-SOLVING. THINKING THIS WAY CAN IMPROVE THE THERAPISTS WORK FLOW INCREASING THE TIME AT THE BEDSIDE. PROVIDE FASTER RESPONSE TIMES IN THE DELIVERY OF TREATMENT WITHOUT DELAY. HAS SIGNIFICANT COST SAVINGS. LEAN THINKING CAN MAKE A POSITIVE IMPACT ON RESPIRATORY CARE SERVICES BY SYSTEMATICALLY EVALUATING THE PROCESS AND SKILL SET REQUIRED TO DELIVER THE NECESSARY WORK.

REFERENCES HENRIQUE, D. B., RENTES, A. F., GODINHO FILHO, M., & ESPOSTO, K. F. (2016). A NEW VALUE STREAM MAPPING APPROACH FOR HEALTHCARE ENVIRONMENTS. PRODUCTION PLANNING & CONTROL, 27(1), IKUMA, L. H., & NAHMENS, I. (2014). MAKING SAFETY AN INTEGRAL PART OF 5S IN HEALTHCARE. WORK, 47(2), KER, J. I., WANG, Y., HAJLI, M. N., SONG, J., & KER, C. W. (2014). DEPLOYING LEAN IN HEALTHCARE: EVALUATING INFORMATION TECHNOLOGY EFFECTIVENESS IN US HOSPITAL PHARMACIES. INTERNATIONAL JOURNAL OF INFORMATION MANAGEMENT, 34(4), KIMSEY, D. B. (2010). LEAN METHODOLOGY IN HEALTH CARE. AORN JOURNAL, 92(1), LEGGAT, S. G., BARTRAM, T., STANTON, P., BAMBER, G. J., & SOHAL, A. S. (2015). HAVE PROCESS REDESIGN METHODS, SUCH AS LEAN, BEEN SUCCESSFUL IN CHANGING CARE DELIVERY IN HOSPITALS? A SYSTEMATIC REVIEW. PUBLIC MONEY & MANAGEMENT, 35(2),

REFERENCES POKSINSKA, B. B., FIALKOWSKA-FILIPEK, M., & ENGSTRÖM, J. (2016). DOES LEAN HEALTHCARE IMPROVE PATIENT SATISFACTION? A MIXED-METHOD INVESTIGATION INTO PRIMARY CARE. BMJ QUALITY & SAFETY, BMJQS POKSINSKA, B., SWARTLING, D., & DROTZ, E. (2013). THE DAILY WORK OF LEAN LEADERS–LESSONS FROM MANUFACTURING AND HEALTHCARE. TOTAL QUALITY MANAGEMENT & BUSINESS EXCELLENCE, 24(7-8), ROBERTSON, E., MORGAN, L., NEW, S., PICKERING, S., HADI, M., COLLINS, G., ARIAS, O., GRIFFIN, D., & MCCULLOCH, P. (2015). QUALITY IMPROVEMENT IN SURGERY COMBINING LEAN IMPROVEMENT METHODS WITH TEAMWORK TRAINING: A CONTROLLED BEFORE-AFTER STUDY. PLOS ONE, 10(9), E WARING, J. J., & BISHOP, S. (2010). LEAN HEALTHCARE: RHETORIC, RITUAL, AND RESISTANCE. SOCIAL SCIENCE & MEDICINE, 71(7),

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