U Of I Slides 11 09

Industrial Engineering in an Unusual Healthcare Setting Richard Blackwell Project Director, Process Quality Cermak Health Services November, 2009

Summary
Brief history of IE and Quality
Background on Cermak Clinic
Describe the problem: distribution and administration of medications to CCJ detainees
Discuss the approach taken, results to date, and expected outcomes
Outline other IE projects being considered at Cermak
Discuss the potential impact of IE in healthcare and other service industry applications

Goals
Discuss and demonstrate use of several IE techniques in an unusual healthcare setting
Value Stream Analysis and process mapping
Six Sigma process improvement (DMAIC)
Quality Management System support of accreditation audits
Suggest possible career directions for IE students

Who I Am
Graduated from U of I with MSIE in 1978
Career trajectory
Manufacturing and distribution applications of OR/MS techniques
Owned my own consulting and software development company
Telecommunications from 1997 to 2009; Project and Product Management; Marketing; Quality
Currently Project Director for Process Improvement at the Cermak Clinic of Cook County Jail
After 30+ years in Industry, I still consider myself an IE; everything else is just what I happen to be working on

Quality Management Systems - Quick Background
Industrial Engineers (as Scientific Managers) basically invented the Quality discipline – Walter Shewhart, Joseph Juran, W. Edwards Deming
Starting in the 1970s, traditional Quality Control shifted to more comprehensive Systems approaches
Good Manufacturing Practice (GMP) driven by the FDA
International Standards Organization (ISO) Certification
Malcolm Baldridge Award (Motorola the first winner in 1988)
Motorola’s Six Sigma methodology
During the 1990s, an expansion of formal QMS Certification into new areas
Software Engineering Institute’s Capability Maturity Model -> CMMI
ISO “Variants” (TL 9000, QS 9000, AS 9000, …)

Our Approach
Starts with Six Sigma as a structured problem-solving approach
Methods (e.g. DMAIC)
Tools: statistical and process/problem analysis
Uses Quality Management System certification as a goal and a club to drive organizational change

Cermak Health Services
Part of the Cook County, Illinois Health & Hospitals System
Located in the Cook County Jail
The largest single-site correctional healthcare facility in the US
Provides comprehensive care for ~10,000 detainees
150,000 sq ft in 129 bed infirmary plus satellite facilities within the jail
Responding to Department of Justice findings from 2008, Cermak is currently upgrading service delivery capacity and methods

Industrial Engineering in Healthcare
IEs (as Management Engineers) and other healthcare professionals have often used IE/OR/MS techniques
Process simplification and re-engineering
Process automation
Patient safety
Both IIE and ASQ have divisions that focus on healthcare
Opportunities will expand as healthcare cost containment efforts ramp up

Case Study - Medications Administration
20% of detainees receive medication, with many receiving more than 1
Patients are dispersed
129-bed Infirmary for acute care
3 step-down intermediate care units
General population is in 247 small living units (~50 per unit) in 17 stand-alone Divisions
A court has determined that detainees are to receive all prescribed meds within 24 hours of prescription

Complications
Detainees move around
Transferred at short notice, or may be in Court or school at meds admin time
Meds distribution methods vary
Dose by dose administration of TB, HIV, psychotropics, and controlled substances
7-day self-packs when appropriate
Dispensed from central pharmacy and also from meds rooms in some units

The Project
Develop a single, documented process that will be followed for all detainees in the system
Eliminate non-Value Add steps
Shorten the fulfillment cycle to 24 hours or less
Reduce/eliminate missed or incorrect meds
Institute control of drug inventory
Reduce returns
New process is the basis for the implementation of a new campus-wide computer system

The Approach – Six Sigma
DMAIC process improvement
D efine the problem
M easure the scope of the problem
A nalyze process data to understand the root causes of the problem
I mprove the system performance
Implement C ontrol system to monitor performance and prevent re-occurrence of the problem

D efine Stage
Form project team(s) and develop project charter
Map & document current processes
With groups of stakeholders
By direct observation
Develop a measurement plan
Anecdotal data from stakeholders not usually sufficient
Six Sigma requires independent data to ensure objectivity
Measurement allows you to develop and pre-test the metrics employed in the Control plan

A Process (“Swimlane”) Map Dept Process Logic Sub-Process Operation

Value Stream Analysis
A more elaborate form of process mapping used in Lean
Any step that does not add customer value is a candidate for elimination
Rich vocabulary of symbols for process steps
Moves
Delays
Etc.
Guides the development of a desired “Future State” from the “Current State”

M easure Stage
Based on Define stage results, Mean Prescription Flow Time and Delivery Errors per Encounter selected as targets
In order to meet 24-hour requirement, need to know current state
Analysis of Flow Time will support determination of root causes for delays
Delivery Errors cause rework, increase mean flow time, and affect patient safety

Unfortunately…
No data is available in current computer systems
Current paperwork inconsistently filled out, results not tabulated
Measurement plan – limited sampling
Observe meds pass and note results
Work backwards through pharmacy records to determine what was prescribed and when
Analyze monthly nursing records for actual delivery

A nalyze & I mprove
DMAIC is not strictly linear; phases often overlap
In this case, some of the required improvements are known
We can use the data analysis to validate required process improvements after we start them
“ Surprises” can be leveraged as they occur

Process Results to Date
Pharmacy capacity is limited by several bottlenecks
Manual entry of Prescriptions
Label printing & manual sort
Staging of meds for delivery to Divisions
Administration in the Divisions contains significant non-Value Added steps
Redundant manual data transcription
“ Unnecessary” validation of delivered meds against patient’s medical profile
Impossible with current processes to verify that correct meds have been administered
Improvement approach is to document and implement one standard process

An Implementation Plan
Present plan to Senior staff
Form Working Group – CQI, Pharmacy, Nursing, Medical
Draft Context document, review with staff and Software Vendor for accuracy
Combine existing documents and process flows and adapt
Eliminate non-value adding steps
Leverage Software capabilities
Define and implement metrics support elements in Software
Review and revise with Senior staff
Pilot
Review with Dept of Corrections and revise as required
Final approvals
Develop training materials
Train
Monitor & mentor

Why Is Implementation So Hard?
Most Process Improvement Efforts Fail
One study shows that 60% of Six Sigma projects end in partial or complete failure
The reasons are not surprising
People don’t like to change
Organizations change all the time, making long-term committed efforts difficult
Management commitment is hard to get and keep
Some projects just don’t make sense

Improving the Odds
Techniques exist to improve the odds
Stakeholder & Force Field analysis: understand the management setting and risks before starting a project
Scope Management:
Avoid over-commitment and “creep” by clearly documenting realistic objectives and goals
Avoid projects lasting > 6 months
Change Management: a toolkit for overcoming resistance to change

The C ontrol Phase
Implemented using standards-compliant process documentation
Must be supported by senior AND line management
Will face scrutiny by employee unions
Includes key elements of a standard Quality Management System
A performance measurement system
Internal Audit (Self-monitoring)
Management Review; Corrective/Preventive Actions
Verified by an independent accreditation body (NCCHC)

Management Involvement
Management commitment to all aspects of the Quality System
Customer Focus
Management is focused on Customer satisfaction, relationship development and communication
Documented Management System
Documentation is available that provides policy, responsibilities and records in accordance with the Quality System
Internal Audit
Periodically conducted to verify effectiveness of Quality System
Document / communicate audit plan and ensure independence of auditors
Reviewed by Management
Improvement Processes
Monitor, measure and analyze processes for conformity and improvement to products
Corrective/Preventive Actions
Continual Management Dynamics Customer Focus Documented Management System Management Involvement Improvement Processes Internal Audit Quality System

Other IE Projects
Map & Streamline the sick call process
Map & Streamline the Mental Health care delivery processes
Design meds administration automation processes
Analyze and optimize layout and throughput of a proposed detainee admitting facility

Common IE Skills Used
Process analysis
Statistical analysis of process data
Process design, documentation & implementation
Design of management metrics systems
Support of certification/accreditation
Design & implementation of process automation
Cross-disciplinary team leadership

Career Ideas for New IEs
Healthcare – it’s exploding
Public Sector – Lord knows they can use us…
Software/Consulting – draw on IE training, & gets you into the game
Project Management – a natural step up from entry-level, and there are never enough PMs
Six Sigma – a natural for IEs; you already know most of this stuff
Lean – IE with a different name

Links and Resources
www.punshui.com : my slides and other materials
www.lean.org : lots of ideas and resources re Lean methods and tools
www.asq.org : starting point for Six Sigma and many other directions in Quality
http://www.iienet2.org/SHS/Community/Default.aspx : IIE Society for Health Systems
http://www.asq.org/healthcare-use/why-quality/overview.html : ASQ Healthcare Division
www.pmi.org : professional certification for Project Managers and lots of tools

Questions?

U Of I Slides 11 09

by rblackwell46

Accessibility

Upload Details

Usage Rights

1 Embed 1

Statistics

U Of I Slides 11 09 Presentation Transcript