1. VMPS and Surgery
Applying the Virginia Mason Production System to the Operating Room
Rabia Nizamani, MD
General Surgery, R3
Thursday, July 19, 2012

2. What is VMPS? Adaptation of lean management used in manufacturing
Toyota Production System
Set of principles and tools to encourage and facilitate continuous incremental improvement

3. The Goals of VMPS Use lessons from commercial industry to:
Reduce waste
Reduce costs
Improve safety
Improve quality
And ultimately…
Deliver quality care to more patients for less money

4. Defining Value-Added Care
Does this task contribute to meeting patient needs?
Is the patient willing to pay for this task?
Does this task transform the service?
Does the patient want or need this transformation?
Is this task done correctly the first time, every time?

5. If not, it might be waste…
Type 1
Non-value added activities that are currently required
Type 2
Non-value added activities that can be stopped immediately without detrimental effects

6. Taiichi Ohno’s 7 Wastes Waste Transportation Defects Processing
Conveying, transferring, picking up, setting down, piling up and otherwise moving unnecessary items.
Defects
Waste related to costs for inspection of defects in
materials and processes, customer complaints and
repairs
Processing
Unnecessary processes and operations
Traditionally accepted as necessary
Overproduction
Producing what is unnecessary, when it is unnecessary, and in unnecessary amounts
Motion
Unnecessary movement
or movement that does
not add value.
Movement that is done
too quickly or slowly.
Inventory
Maintaining excessive amounts of supplies,
materials, or information for any length of time.
Having more on hand than what is needed and used.
Time
Waiting for
people or services
to be provided.
Time when
processes, people or equipment are idle.
Waste

7. Do or do not…there is no try.
Managing Data
PDSA
Scientific Method
Plan Do
Study
Act
Formulate hypothesis
Test it
Analyze the results
Determine next steps
Do or do not…there is no try.

8. 5S – Managing the Work Space
Sort
Simplify
Sweep
Standardize
Self-discipline

9. Change Events
Kaizen
continuous improvement of existing processes
1-3 day (Kaizen) and 5 day (RPIW) events to evaluate and improve a value stream

10. 5S in the OR
Pilot project to 5S the Minimally Invasive Spine surgery set
Evolution to create methodology to 5S any sterile instrument set

11. 5S Results

12. 5S Outcomes Pre-5S Post-5S Difference Instruments 197 58 -139
Set-up time
13 mins
8 mins
-5 mins
Processing cost/case*
$152
$45
-$107
*528 cases annually, est annual savings ~$56,500

13. Set-up
Includes gathering, transporting, opening, assembling, adjusting, etc
Internal vs external set-up
Can often externalize internal set-up
Then reduce remaining set-up

14. More Change Events - 3P Production Preparation Process Form of Kaikaku
Radical improvement
“to blow up and start over”
Leads to further Kaizen work

15. Setting-up for Faster Turnover

16. Set-up Reduction Outcomes
Main OR’s
L5 OR’s
% reduction
Pt travel
189 steps
48 steps
74%
Anes travel
243 steps
73 steps
70%
Turnover time
37 min
17 min
54%
Note turnover time – the staff is the same, only facility is different

17. Mistake-Proofing Inspection Standard Work Visual Controls Devices…
Prevent mistakes from becoming defects
Standard Work
Defines and assigns responsibilities - transparency
Allows identification of opportunities
Visual Controls
Kanbans and Andons
Devices…
Kanban – visual cue that a task must be done; andon – alarm to alert to problems, eg nurse call light

19. 5S, Set-up, Mistake-Proofing
Which anesthesia cart would you prefer…
Reorganized after patient died – wrong med given; now resus meds are kept separate from induction and reversal meds, contents of each syringe are specified by its location
As a provider?
As a patient?

20. Acknowledgements Graduate Medical Education
Division of General, Thoracic and Vascular Surgery
Division of Plastic Surgery
Department of Anesthesia
Sterile Processing Department Staff
Operating Room Staff
Dr. Farrokh Farrokhi