Lean presentation april 8, 2009


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Going "lean" in Healthcare with simulation modeling

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Lean presentation april 8, 2009

  1. 1. Navigant Consulting, Inc. Tools in Your Toolbox Using Lean Concepts & Tools to Provide  an Optimized Care Delivery System and  Inform Healthcare Facility Design Debbie Hoffman April 8, 2009 Page 0
  2. 2. Today’s Topics Why Change? Laying the Foundation for Process  Change Tool Box Current State to Future State Questions Page 1
  3. 3. Can we afford to continue doing business as usual? • US Health care spending represents 18 % Plus of GDP in 2008 and has been forecasted  to be 20 % by the year 2017. This is Two times more than any other country. * Source:  NIH, 2008 • Over the last 35 years, while the nation’s spending on all goods and services has risen  at an average annual rate of 7.2 % the amount spent on healthcare as grown at a rate of  9.8 %..as a consequence, Americans simply cannot afford adequate care. 1 • If Federal government spending remains relatively constant % of GDP, the rising cost  of Medicare within that budget will crowd out all other spending.1 • If governmental financial statements reported the liabilities they face from contractual   commitments to provide healthcare for retired employees, every city and town in the  US would be bankrupt. There is no way for them to pay except by denying funding to  other projects or raise taxes to extremely levels. 1 1  The Innovator’s Prescription – A Disruptive Solution for Health Care, Christensen,Clayton 2008 Page 2
  4. 4. Planning for Optimized Care Delivery There are two types of costs that need to be considered in the optimization of  health care delivery‐ first time building cost & continuing operational costs. Staffing  Efficiency Physician /   Quality of Staff  Care Optimized  Satisfaction Health Care  Delivery  Adaptability /  Patient  Flexibility/    Satisfaction Sustainable Operational Process  Page 3
  5. 5. Laying the Foundation for Process Change What does LEAN bring to the table? Predictability of  workflow‐ Decrease cycle  standardization  times =  of processes  decrease ALOS Adaptability of  space allowing  Space  flexibility – requirements  increasing  reduced‐ utilization  and  elimination of  LEAN decrease  duplicity  obsolescence Balancing  spaces needs  versus utilization Less process  steps = less  Development of  handoffs = less  a “future state” errors Page 4
  6. 6. Creating a New Level  of Collaborative Design  Environment Key elements for success • Guiding Principles‐ WHAT DO THEY VALUE? • What does the client want to solve? • Everyone having a seat at the table • Consensus building • Sharing of all documents • Value analysis throughout design  Page 5
  7. 7. Tools in the Tools Box Project Flow – Key Elements Value Stream Modeling / Narravtive Simulation Modeling “What if’s” – Case Study  Application of Metric  Page 6
  8. 8. Project Flow Changing the typical project flow will result in dividends by reducing first time building  cost and continuing of operations  Functional / Strategic Delivery Care Simulation Schematic Design & Space Planning Models Modeling Design Construction Program › Identify key › Identify service › Draw flow charts › Balance # of › Blocking and › Project oversight trends and line › Data collection rooms versus stacking › Risk assessment growth patterns configurations utilization diagrams › Pilot program › Define program & › Prepare workload › Define functional › Internal and › Test “what-if” adjacencies facility priorities projections external scenarios › Feasibility Study › Quantify staffing Simultaneously  Determine › department flows › Optimize optimal needs adjacencies departmental › Value Stream based on care Modeling area allocations delivery efficient › Detail room-by- room / needs Page 7
  9. 9. Areas to Consider for Modeling  Key Flows Defining Key Elements of Patient Encounter Encounter Post‐ Pre‐Encounter Arrival Encounter Check‐Out Encounter Scheduling Building Rooming Schedule follow‐ Chart completion Pre‐registration Prep or assessment up: Billing Drop off/greeting Pre‐certification Chaperoning Visits Results reporting Way finding Financial counseling Clinician  Patient referrals Referring physician  Orientation/ Clinical information  directions notification Testing or  communication capture Care delivery procedures Patient  Building amenities Patient instruction  Clinical  Urgent  communication Elevator protocols transmission documentation consultations Patient monitoring Appointment  Destination Ordering/  Sub‐acute care or  Prescription  confirmation Registration/ prescribing therapies management Chart preparation check‐in Education &  Patient satisfaction  Financial/business  research survey services Patient tracking Patient & family  waiting Consent for service Page 8
  10. 10. Value Streaming Patient Flow Operational Benefits • Eliminates waste Current State ‐ From this….. • Decreases handoffs • Reduces steps  and cycle times • Increases predictability of  workflow • Decrease staffing requirements • Improves quality of outcomes • Defines constraints  and enablers • Reduce errors Facility Impacts • Space requirements reduced • Fewer dedicated spaces Future State‐ to this! • Removes walls that create silos • Minimizes patient  movements • Increases opportunity to “Broadband” Page 9
  11. 11. Overall VSM‐ Patient Access to Treatment Mall‐ Future  State Page 10
  12. 12. VSM‐ Single Clinic Visit Page 11
  13. 13. VSM to Design Implications Page 12
  14. 14. Recommendations Page 13
  15. 15. Inside Simulation Modeling • A tool to measure operating performance What it is… • Most effective when focused on defined and specific issues • Most useful in addressing complex, interactive systems What it isn’t… • A “virtual reality” that will mimic all operating conditions • Creating, testing and refining operating models Principal benefits… • Provides factual basis for setting performance objectives – human resources, capital resources, patient and staff satisfaction • Trade off room utilization versus room needs • Travel distances per staff, patient, supplies for various scenarios • Avg. & Max waiting times Key Questions • Space needs of facility by  the time of day and day of week • Test optimal  scenarios given constraints of space, schedule, &  staffing Page 14
  16. 16. Simulation Model ‐ Example Page 15
  17. 17. Simulation Model ‐ Example Page 16
  18. 18. Case Study Benefit and Value The principal value of the simulation modeling proved to be in three areas: Testing alternative  Participation of service line  Testing of physical capacity  operational configurations  directors and key staff in  at peak demand conditions and concepts for the  modeling to obtain informed  prep/recovery function buy‐in • Quantifying the number  • Test program with changes  • Involvement of key staff to  of rooms and resources  in operational  identify opportunity for  needed to staff the new  assumptions (e.g. extended  improving intra‐ hospital hours, increased volume) departmental and inter‐ departmental patient flow • Identify amount of room  • Identify prep/recovery  within space program for  configuration that can  • User participation to  future growth adequately support peri‐ improve project buy‐in  operative areas and staff morale Page 17
  19. 19. Case Study – Children’s Memorial Hospital Lincoln  Park Lake Michigan CMH Current Facility Northwestern  University  Feinberg School  of Medicine Navy Pier New CMH Campus/  Medical School Page 18
  20. 20. Questions Asked How many trauma and Critical Care Facility Entrance  urgent care rooms are Point needed? How often does each room type reach What are the average wait Emergency times for a machine? How capacity? What are the Dept. many prep and recovery implications of a bi-level ED? spaces are needed per modality/floor? Critical Care Diagnostic NICU/PICU Imaging What is the max number What prep/recovery of rooms demanded? configuration is most How often is the max Prep/ economical? How many reached? Recovery/ spaces are required? What Obs efficiencies are gained by sharing prep and stage II What is the max number of areas? rooms demanded? How Procedure Acute often is the max reached? Suite What happens to the ED What time will the OR’s when the Acute IP is full? finish their cases at the end What is the average and of the day? What Psych operational issues arise from max wait times for a bed? a bi- or tri-level operating room? Medical Surgical IP Units Patients Patients Page 19
  21. 21. Questions Answered Will the IP units reach capacity during peak What are the implications of adding another months? How much space is there for machine or extending operating hours on wait program growth? times? Inpatient Max Utilization Acute Census What is the impact of a full IP on the ED? How late will ORs need to stay open to finish projected caseloads? What is the impact of reducing turnaround? Page 20
  22. 22. Conclusions Simulation modeling is a tool that has the potential of helping managers and planners  not only in functional and space programming and planning but also can play a  significant role in :   Ongoing Operational  Staffing & Budgeting Equipment Planning Analysis » Accurately account for  » Effectively track equipment  » Lean value stream mapping  variable costs by tracking  utilization patterns across  to understand which  usage rates and assigning  time  processes add value to a  cost information into the  work flow » Illustrate outcomes of  model utilizing resources with  » Identify opportunities in  » Printed reports of value  different treatment times reducing turnaround times,  added, business value  cost implications of  » Count the number of scans  added, and non‐value  standardizing medical  machines in radiology will  added classifications instruments, ideal  incur in defined set of time  departmental adjacencies,  » Quantification of staff  for capital planning  and recovery  required to maintain  purposes configurations certain utilization rates and  to ensure proper staffing  resources Page 21
  23. 23. Your Comments & Questions For additional information or case studies please call Debbie Hoffman 949 395‐1482 Page 22