1. HOSPITAL EXCELLENCE OPERATION MODEL Miguel Angel Moreno, Abraham Mendoza IIE Annual Conference and Expo 2014 Applied Solutions Sessions Montreal, Canada May 31 – June 3, 2014

2. Importance Certification requirements that guarantee the competence of doctors and hospitals 1993, first effort: Mexico, Canada and United States. 2007, Proposed as national standard of quality in health. 2009, first version approved for certification of hospitals. 2012, latest version which integrates the requirements of the Joint Commission International.

3. Equipment, Materials & Medicine Manufacturers DistributorsHospitalsPatient Goods and services Information / Money Health Sector Supply Chain (HSSC) A supply chain in the Health Sector includes a number of different parties, including manufacturers, distributors, third party logistics (3PL) providers, transportations companies, hospital receiving and materials management departments, nursing, and finally, the patient. Langabeer (2008)

4. HCSC in Mexico

5. HCSC Key Proceses Inventory ManagementFacilities Management  Procurement Process  Purchasing Scheduling  Forecast  Optimum level definition  Economic Order Quantity  Warehousing  Network and complexity  Localization and number of facilities  Size and localization of warehouses  Layout design  Materials management equipment  Sistema de almacenamiento DistributionPatient Service  Route and personnel scheduling  Re-abastecimiento  System selection  Equipment  Expedite  Availability of service  Service Level perception  Response time ( lead time )  Key Information availability  Total cost of service Minimize unproductive inventories. Increase the perception of value. Ensure the application and delivery of medical services in time and correctly. Build strategic alliances with suppliers. Define the service levels expected for suppliers and service providers. Use of information technologies in the communication of requirements. Constant review of methods and business processes to reduce response times. Strategies

6. Great Dilemma Hospitals in Mexico How did they do the continuous improvement process? Step by step taking at least 8-12 years to achieve Lean (best hospital in Jalisco) 1 st Quality System definition and implementation (2004, started in 2002) 2 nd CGS certification (2005) & ISO (2007) 3 rd “H” Award (2009) 4 th JCI certification (2010) 5 th Quality Award & ISO 14001 (2011) 6 th Start Lean Healthcare (2012) CERTIFICATI ON LEAN HEALTHCAR E 6 SIGMA Continuous Improvemen t Culture

7. Strategies for achieving operational excellence Waste sources elimination Waste sources elimination Processes critical sources of variation elimination Processes critical sources of variation elimination Processes continuous improvement standardization and auditing Processes continuous improvement standardization and auditing Business Process Management (BPM)

8. Synerg y

9. A systematic process Standardization and deployment Customer satisfaction improvement Cost reduction, service level improvement and processes variability reduction Organization becomes an Industry reference Improvement as decision-making Interrelationship betweenen processes Impact of processes on the overall result Reduction on cost operation Documentation of improvements Standardization of the efforts Ready for certification Managing the expected outcome Customer orientation Individual proces in a systematic manner Processes interrelationship Results vs. Capacity and effectiveness Focus on the resources and methods Bases for continuous improvement culture Process Diagnosis (Phase 1) Lean Introduction (Phase 2) Lean philosophy deployment throughout the organization (Phase 3) Continuous improvement culture as decision- making process (Phase 4) Hospital Excellence Operation Model

10. Phase 1 Diagnosis Key Processes Mapping Processes Interrelationship Key Performance Indicators Lean Maturity

11. Phase 1 (Implementation) Diagnosis Key ProcessesCurrent Status Which one (pilot)? Future StatusHow should be?What tools?IdentifyTrainingApplicabilityData analysis Improvement Standardization Deployment

12. How we propose to solve it? Creating Synergies CGS & JCI Standard vs HEOM

13. How we propose to solve it? Creating Synergies CGS & JCI Standard vs HEOM

14. How we propose to solve it? Creating Synergies CGS & JCI Standard vs HEOM

15. Implementation (Public Hospital)

19. After 3 months with the hospital Quality System designed Key and support procceses defined Key proceses mapping (2 of 5) Basic documents ready Pending documents Key proceses mapping (3 of 5) Support proceses Mapping General policies (care and Safety) Validate compliance with the standard

20. Conclusions 1.Key business processes (PCN) are similar in any hospital: admission, triage, outpatient treatment, hospital treatment and discharge. 2.The Support process (PS) are similar in any hospital: financial, supply, maintenance and safety, social work and technology information. 3.The HEOM proposed shows clear, simple and flexible methodology to be developed in a short time. 4.By integrating the BPM, Leanhealthcare and Six Sigma it is possible to establish in a same effort everything you need for certification and process improvement.

21. Conclusions 5.Identify key business processes that give value to the patient. 6.Minimizing the number of documents needed to comply with the certification standard. 7.You can set the levels of service expected for suppliers and service providers. 8.Automation or information technology implementation processes are identified.