Presented by Jacob Edwards

Slides:



Advertisements
Similar presentations
Cancer Treatment Centers of America ® The Transformation of Healthcare Forum OCHI-CSC Presented by: Lynn Valz, MBB Director, Lean Six Sigma Operations.
Advertisements

Sutter Solano Laboratory Lean Six Sigma Project
Personnel Assets –50 – personnel DMAT –US PHS Behavioral Health Team –American Red Cross –Medical Response Corp NY City School Nurses –Americorp Volunteers.
Healthcare Operations Management © 2008 Health Administration Press. All rights reserved. 1.
Reducing Delays at the Appointment Mark Murray, MD, MPA Mark Murray & Associates 2209 Capitol Avenue Sacramento, CA (fax)
Nursing Assistant Program Bradwell Institute
August 2012 If you have an Emergency Department, you are in the Behavioral Health Business…..
Surge Capacity Plan EMERGENCY DEPARTMENT.  Surge capacity strategies will be implemented when volume exceeds staffing and/or treatment space POLICY:
Memorial Hermann Healthcare System Clinical Integration & Disease Management Dan Wolterman April 15, 2010.
Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. The Pharmacy Technician: Foundations and Practices.
Value Stream Management for Lean Healthcare ISE 491 Fall 2009 The Identification of Waste in Healthcare - Lecture 4.
CROPIA Project IIE ANNUAL CONFERENCE & EXPO forums.pmcorp.com NEW! Project Scope Evaluated (by on-site observations and intervention)
Dispensing to in and out patients or Drug distribution system
Copyright © 2011, 2009, 2003 by Saunders, an imprint of Elsevier Inc. All rights reserved. 1 Chapter 3 Appointment Scheduling.
1 Fairview Health Services: A LEAN Case Study “Using Data to Make Decisions and Drive Quality and Results ” Institute for Quality in Laboratory Medicine.
Component 1: Introduction to Health Care and Public Health in the U.S. Unit 3: Delivering Healthcare (Part 2) Outpatient Care (Retail, Urgent and Emergency.
Component 1: Introduction to Health Care and Public Health in the U.S. Unit 3: Delivering Healthcare (Part 2) Lecture 3 This material was developed by.
15: The ‘Admin’ Question Patient flow Dr Tony Kambourakis.
Nicole Sutherlin Brianna Mays Eliza Guthorn John McDonough.
Lean Healthcare - The Identification of Waste in Healthcare
Physicians and Health Information Exchange (HIE) The Value of HIE to a Physician’s Practice and Consumers.
In-Reach Hospital Program In-Reach Hospital Program Coordinating Multiple Service Providers Rare Presentation Partnership between: South Central Human.
Revenue Enhancements and Cost Reductions Sherry Jensen, MBA VP, Finance and Clinic Operations Halifax Regional Medical Center August 14, 2013 Sherry Jensen,
GB.DRO f, date of preparation: January 2010 Dartford and Gravesham NHS Trust Pharmacy Services in Hospital.
Chapter 3 Being a Health Literate Consumer 1. Being an Informed Health Consumer  Anyone who purchases or uses health products or services  Knows how.
LEAN METHODOLOGIES IMPACT TO RESPIRATORY CARE SERVICES DEE GRAVELY, BSRT, RRT, RCP – CAROLINAS HEALTHCARE SYSTEM.
Care Transitions for Medication Safety in the Community
Cape Fear HealthNet: How Physicians can help March 2010
CHAPTER 9 Lean Manufacturing.
Notification of Observation Status
Antibiotics: handle with care!
Health Insurance Key Definitions & Frequently Asked Questions
Quality Improvement at MBSH
Virtual Provider in Triage
A Foundation for Paul Grundy MD, MPH IBM Chief Medical Officer Director, Healthcare Transformation Healthcare Industry A Foundation.
WP Detox Admission Lean
Health System Organization
McGraw-Hill/Irwin ©2009 The McGraw-Hill Companies, All Rights Reserved
UTMB Laboratory Pre-analytical Time Improvement
Emergency and Unscheduled Care Right patient, right place, first time Update to Trust Board 3 June
Medication Reconciliation ROP Compliance
University Medical Center of El Paso Neighborhood Healthcare Centers
Lean Healthcare - The Identification of Waste in Healthcare
Hospital influx scenarios
Lean Hospitals 3rd edition by Mark Graban
Chapter 7 Appointments.
Dynamic Discharging in Medicine
Engaging a Microsystem to Reduce 30-Day Readmissions on an Acute Care Unit Erin Johnson, MSN, RN, Sara Stetz, MSN, RN.
GP Social Enterprise led Call Handling & Nurse Triage Project
THR Behavioral Health Service Line
Organization Wide Daily Safety Huddle
Children’s Emergency Services
Case Study 1.
ISE 468 ETM 568 Healthcare Process Improvement
Harper University Hospital Orientation
To Admit…or not to Admit…that is the question!
FOCUS ON RURAL HEALTHCARE
Barriers to Safe Transitions
HOSPITAL READMISSION REDUCTION’S IMPACT ON ASSISTED LIVING
For Patients: Frequently Asked Questions
Presented by Janea Spillers Mechanical Engineering Student
For Patients: Frequently Asked Questions
Lab Tech.
To speed up the processing of blood draws:
Karmanos Cancer Institute
Operational site management principles
Pharmacy Technician Led Accident and Emergency Pharmacy Service
Operational site management principles
Patient Safety It’s the Way WeCare Buffy Key
MO Medicaid Managed Care Health Plan Transportation Committee
Presentation transcript:

Presented by Jacob Edwards Lean Hospitals: Improving Quality, Patient Safety, and Employee Engagement By: Mark Graban Ch. 9 Improving Flow Presented by Jacob Edwards

Processes Should Flow Like a River Smooth, steady flow through a value stream should be a hospital’s primary goal. Smooth flow of support products, or smooth flow of patients through the hospital. Flow improvements do not come from doing the value- adding work faster; they come from reducing and eliminating waiting, interruptions, and delays from the value stream. ETM 568 Jacob Edwards

Uneven Workloads as a Barrier to Flow Many delays for patients and products are caused by uneven workloads. “Heijunka” – Leveling One of three foundations of the Toyota house. Some unevenness in our demand occurs naturally, but a large amount is due to our own policies and choices. ETM 568 Jacob Edwards

Mura 1 “Mura” – Unevenness, irregularity. Mura Caused by Morning Rounds Morning rounds by physicians leads to mura for support departments such as the laboratory. In one lab, 34% of the daily volume arrived in a 3-hour timeframe from 3am-6am. Also, morning rounds create a spike in patient discharge activity. ETM 568 Jacob Edwards

Mura 2 Mura Caused by Suboptimizing Courier Routes Labs will get several large shipments of specimens throughout the day. This led to workers being rushed for periods of time and the labs would have to pay for overtime, The labs requested smaller samples being delivered from morning to afternoon. While it was more costly, the labs returned results faster and had less worker idle time. ETM 568 Jacob Edwards

Mura 3 Mura Created by Clinic Scheduling Outpatient chemotherapy center had mid-day peaks of patients. Led to delays. Off site oncologists were creating this schedule to help the patients. They thought that if the treatments happened earlier, the patients could get home earlier. The clinic and treatment center created a plan to distribute the chemotherapy patients throughout the day, leveling out the schedule. ETM 568 Jacob Edwards

Mura 4 Mura in the Patient Discharge Process Discharge delays can keep patients from being admitted into the ED. When a hospital has a high percentage of Medicare or Medicaid patients, this delay directly impacts the hospitals bottom line. A hospital estimated that a length of stay reduction by half a day, which is created by delays, would represent a $6 million dollar savings. Leveling out discharges throughout the day takes away the high load put on other hospital resources. ETM 568 Jacob Edwards

Addressing Mura by Matching Staffing to Workloads If workloads cannot be leveled, the next best alternative is to make sure staffing levels vary with demand. Staffing levels and workloads are not always synchronized. By analyzing workloads, staffing can be done to match. ETM 568 Jacob Edwards

Improving Patient Flow Emergency Department Boarding – Waiting for an inpatient room to become available. In 2001, 90% of patients waited two hours. 20% had an average boarding time of eight hours. Use of the 5 whys helps determine the root causes. Outpatient Cancer Treatment Appointment lengths vary creating scheduling issues. Doctors schedule appointments to have a steady stream of patients which causes a patient backlog. ETM 568 Jacob Edwards

Improving Flow for Patient Care and Support Improving Flow in Clinical Laboratories Lean efforts begin in the lab area because testing volumes are highest and the turnaround time expectations are the fastest and most critical. Reducing Delays in Specimen Collection Specimens are grouped into batches and are not submitted individually Batching makes sense from the nurse and patients point of view, but not the phlebotomist. Managers must know that the phlebotomist must be treated fairly and cannot be held to a faster standard than others. This can cause errors with the phlebotomist working at a faster pace. ETM 568 Jacob Edwards

Reducing Delays in the Lab’s Receiving Areas Specimens arrive at the receiving area. That area is further divided into an accessioning area and processing area. In many labs, the processing department is located out of the main flow and specimens must backtrack for testing. The separation leads to batching, which slows the process. At the Children’s Medical Center of Dallas, Texas, the accessioning and processing departments were combined into a single area. Employees of the labs were cross-trained and the result was sample time being reduced from 30 minutes to 5-10 minutes. ETM 568 Jacob Edwards

Improving Flow Also Improves Quality and Teamwork When batches are created, the same defect can be created for every specimen. With single piece flow, a defect can be caught immediately, preventing the accumulation of defects. Benches were created where specimens were processed and centrifuged by a lab assistant who the then handed the specimens across the workbench to the technologist. This led to increased communication and allowed immediate feedback. Also, the lab equipment was easily accessible to both the lab assistant and the technologist. ETM 568 Jacob Edwards

Improving Flow in Pharmacies Technicians may walk miles per day because tools they use may not be located in the same area. If the pharmacists are separated from the technicians, batching can occur. If meds are prescribed for a patient in multiple doses per day, it is better to send them dose at a time and not all at once. Memorial Health of Savannah, GA, redesigned their pharmacy to reduce wastes and improve response times. Staff of the hospital rated the redesign and the service of the new pharmacy highly. ETM 568 Jacob Edwards

Lean Lessons (page 175) Make improvements that remove rocks instead of covering the problems with more water (workarounds or waiting queues). Single-piece flow is a direction, more than an absolute mandate. Unevenness in flow can be the result of natural occurrences or our own policies. Lean teaches us to not accept mura as a given. When flow is interrupted, ask why and fix the systemic causes of batching or other delays. Improving flow often improves quality and teamwork. Faster is not always better, depending on the customer needs. ETM 568 Jacob Edwards