Applying Lean Principles in Hospital Renovation and Redesign: A Case Study

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  • 1. Angela Beck, RN Six Sigma Black Belt 6 D.M.A.I.C. LEANGlobal Lean, Six Sigma & Business Improvement Summit October 16th, 2008 Orlando, Florida
  • 2. – Formed with the merger of Clarkson Hospital and UNMC’s University Hospital in 1997– 690 Beds Private Not-for-Profit Hospital– Tertiary/Quaternary Academic Medical Center • $651 FY2007 Annual Revenues • 26,404 inpatient discharges (including newborns) • 143,070 patient days (FY2008) • 456,678 outpatient visits (FY2008)
  • 3. – J.D. Power & Associates; 2007 Distinguished Hospital for Cardiovascular Excellence– J.D. Power & Associates; Three consecutive years Outstanding Patient Experience for Inpatient Services– Ranked nationally in U.S. News & World Report’s America’s Best Hospitals 2008, 39th Cancer Care and 41st Neurology & Neurosurgery– First in the State: Named Blue Distinction Center for Complex and Rare Cancer by Blue Cross Blue Shield of Nebraska– Awarded the American Heart Association Gold Performance Achievement Award for performance in treating stroke patients using the Get With The Guidelines program.
  • 4. “The Three Goods” Achieve better clinical outcomes Achieve better clinical outcomes and service for our patients and and service for our patients and their families their families Make operations more efficient and Make operations more efficient and effective for serving our customers effective for serving our customersGlenn Fosdick, FACHE and maintaining financial stability and maintaining financial stability President and CEO Make jobs easier to do for our staff Make jobs easier to do for our staff and physicians and physicians
  • 5. Radiology Department• Completed 227,846 radiological studies* in FY 2008. * includes Diagnostic Xray, Mammography, Interventional Radiology, CT, MRI, Ultrasound, Nuclear Medicine/PET• Twelve phase renovation plan.• Planning and design for all project areas completed up to 5 years ago.• First department renovation completed August 2006.Departments/Areas Designatedfor Lean Assessments1. Ultrasound2. Waiting Room3. Remote Reading Room4. Main Reading Room5. Diagnostic Radiology
  • 6. Facilities Management & Planning Senior Facility Analyst Subject Matter Experts Process experts within each departmentArchitect Partner Construction Partner Project Architect Project Manager
  • 7. 6D.M.A.I.C. LEAN Music during the exam was the number one patient request Staff requested comfortable, adequately sized work areas in the new space
  • 8. 6D.M.A.I.C. LEAN Tech Work Room Tech Work Room
  • 9. 6D.M.A.I.C. LEAN Exam Room Exam Room
  • 10. 6 D.M.A.I.C. LEAN •Reduce traffic in and out of tech work room•Centrally locate frequently used items for staff and patients
  • 11. 6D.M.A.I.C. LEAN
  • 12. 6 LEAN D.M.A.I.C. 20 40 60 80 00 20 40 60 80 W ednes day W ednes day 07:00 07:00 W ednes day W ednes day 08:00 08:00 W ednes day W ednes day 56% 09:00 56% 09:00 Patients 33% Patients 33% W ednes day Members W ednes day Members 10:00 Adult Family 10:00 Adult Family2004 numbers 2004 numbers W ednes day W ednes day 11:00 11:00 W ednes day W ednes day 12:00 12:00 W ednes day2007 numbers W ednes day 2007 numbers 13:00 13:00 Who is in the Waiting room Wednesday waiting room W ednes day W ednes day Who is in the WaitingRoom? Wednesday waiting Room? 14:00 14:00 W ednes day W ednes day 15:00 15:002012 numbers 4% 2012 numbers 7% 4% 7% W ednes day W ednes day Children 16:00 Children 16:00 Wheel Chairs Wheel Chairs W ednes day W ednes day 17:00 17:00
  • 13. 6D.M.A.I.C. LEAN Entry Coffee Bar Child Area
  • 14. 6D.M.A.I.C. LEAN
  • 15. 6D.M.A.I.C. LEAN
  • 16. 6D.M.A.I.C. LEAN
  • 17. 6Six Sigma •Centrally located frequently used items •Adjustable height desks/chairs •Straight desk tops for optimal teaching purposes •Doors/walls located to reduce light •Modular walls used between workstations for easier relocation •Task lights controlled on desk to reduce repetitive tasks
  • 18. 6D.M.A.I.C. Peds LEAN Chest Ultrasound N. Campus Details • 4 entrances Neuro • 8 specialties • 31 workstations Bone • No clear path thru dept G.I. • Under-utilized Nuc Med spaces N. Campus
  • 19. 6D.M.A.I.C. LEAN1. Translated learnings from Remote Reading Room mock up2. Translated recommendations from ergonomic assessment done during Remote Reading Room project3. Provided virtual tour of proposed floor plan for Radiologists4. “Lean challenge” of floor plan by Black Belts/Lean Process Consultant
  • 20. 6 D.M.A.I.C. LEAN1. Reduction in Transportation• Relocated electrical closet and equipment alcove• Located view boxes in/near each specialty
  • 21. 6 D.M.A.I.C. LEAN1. Reduction in Transportation• Relocated electrical closet and equipment alcove• Located view boxes in/near each specialty2. Reduction of Under-Utilized/Wasted Space• Relocation of work stations in each specialty
  • 22. 6D.M.A.I.C. LEAN1. Adjusting room locations: • Move high-volume rooms to ideal locations • Move lead office into work area2. Standardizing work areas: • Reorient Exam Rooms 3 and 4 • Room interior (i.e. sinks, cupboards)3. Adjusting room entry ways: • Increase access to tech workroom • Increase access to rooms 5 and 6
  • 23. 6D.M.A.I.C. LEAN O1. Adjusting room locations: • Move high-volume rooms to ideal locations • Move lead office into work area2. Standardizing work areas: Exam Exam • Reorient Exam Rooms 3 and 4 2 1 • Room interior (i.e. sinks, cupboards)3. Adjusting room entry ways: • Increase access to tech workroom CXR DEXA • Increase access to rooms 5 and 6 Pt Pt Exam Exam Outpatient Hold 5 6 PACS Waiting Room Hold
  • 24. 6D.M.A.I.C. LEAN1. Adjusting room locations: • Move high-volume rooms to ideal locations • Move lead office into work area Exam Exam2. Standardizing work areas:Exam Exam Exam Exam • Reorient 44 33 Exam Rooms3 and 4 2 1 • Room interior (i.e. sinks, cupboards)3. Adjusting room entry ways: • Increase access to tech workroom O • Increase access to rooms 5 and 6 Pt Pt Exam Exam CXR Hold 5 6 Hold DEXA
  • 25. 6D.M.A.I.C. LEAN1. Adjusting room locations: • Move high-volume rooms to ideal locations • Move lead office into work area Exam2. Standardizing work areas: Exam Exam Exam • Reorient 4 Exam Rooms3 and 4 3 2 1 • Room interior (i.e. sinks, cupboards)3. Adjusting room entry ways: • Increase access to tech workroom O • Increase access to rooms 5 and 6 Pt Pt Exam Exam CXR Outpatient Hold 5 6 Waiting Room Hold DEXA
  • 26. 6 D.M.A.I.C. LEAN Avoidance for Techs: Avoidance Techs & Pts: Avoidance for Techs & Pts: Avoidance for for Techs: Tech Total 1,245mi/yr 111mi/yr 41 mi/yr 1,245mi/yr 111mi/yr 41 mi/yr Patient Total102 ft difference @ 484 trips/month101 5,369 trips/month9 ft ft difference 2,110 trips/month9 ft 484 trips/month102 difference @ @ 5,369 trips/month101difference @ 2,110 trips/month
  • 27. Cost ConstructionProject Avoidance Schedule ImpactUltrasound $56,500 10 weeksRemote ReadingRoom $5,500 14 weeksWaiting Room $48,750 12 weeksMain Reading Room $43,000 7 weeksDiagnostic Radiology $225,000 26 weeks Totals $378,750 69 weeks
  • 28. Proactive Application of Lean & Six Sigma Tools Black Belt deployed full time in Facilities Management & Planning department with responsibilities including: Project leadership of renovation and new construction projects as well as participation in Master Plan Development. Mentoring of Facilities staff on facilitation/quality improvement tools and methods. Supporting Facilities department on internal process improvement. Receiving project requests prior to departments making requests for more physical space. Cardiac Rehabilitation Patient Flow & Capacity
  • 29. 6D.M.A.I.C. LEAN (Original) Based on cardiology as a center of excellence, the outpatient cardiac rehab department is not able to accommodate the increased volume of patients due to broadening coverage ofdiagnoses in the current space. Limited time and space leads topatient, staff, physician and overall customer dissatisfaction and and patient safety concerns. D M A I C
  • 30. 6 D.M.A.I.C. LEANAttendance Policy: # of Absences When Class Time Was Released Class time to be released after 14 consecutive days of patient absences Equals 6 class sessions Reserved class time released # of absencesData collection: Historical data Two 3 month time frames Patients D M A I C
  • 31. 6 D.M.A.I.C. LEAN Class Session InfoClass Sessions 7 class sessions offered Mondays, Wednesdays and Fridays Patients allowed each class is dependent on staffing – max is 12 # of Class SessionsData Collection: Real time data Two week time frame – historically, a high volume time period # of Patients Max Pts Allowed Total Pts Scheduled D M A I C Total Pts Attended
  • 32. 6D.M.A.I.C. LEAN Goal Statement Goal StatementCardiac rehab wants to increase capacity of phase II patients to80% (orientation and class attendance). This will beaccomplished by increasing patient and staff accountability, asevidenced by increased patient attendance and consistentevidenced by increased patient attendance and consistentimplementation of department policies and procedures by staff. D M A I C
  • 33. 6D.M.A.I.C. LEAN 80% Goal (total utilization) D M A I C
  • 34. •The collaboration of Subject Matter Experts with Facilities, Architecture and Construction partners on the Radiology project resulted in significant cost avoidance and construction delays.• The use of full scale mock ups, 3D imaging and virtual tours have proved to be invaluable tools during the design process.•The learning process has taught us that we need to refine our processes and examine workflow to before the construction process starts.• We are moving toward a culture of proactively using Lean tools in areas who have spatial challenges in order to examine opportunities to increase operational efficiencies.
  • 35. Angela Beck 402.559.3631abeck@nebraskamed.com