Use of Kaizen in the Re-design of an Emergency Department


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Use of Kaizen in the Re-design of an Emergency Department

  1. 1. Use of Kaizen in the Re-design of an Emergency Department WCBF 10 th Annual Lean Six Sigma and Process Improvement in Healthcare Summit Presented by: Greg Horner, Operational Excellence Leader
  2. 2. Loyola University Health System Maywood, IL <ul><li>Loyola is a nationally recognized leader in providing health care and in conducting groundbreaking research to treat heart disease, cancer, organ transplantation and neurological disorders. </li></ul><ul><li>Loyola University Medical Center (LUMC) is the core of Loyola and one of the nation’s leading academic medical centers. </li></ul>Loyola University Medical Center is a teaching, tertiary-care, 570 licensed-bed facility that includes a Level 1 trauma center and a Burn Center.
  3. 3. A Sense of Urgency <ul><li>Change in the world economy </li></ul><ul><ul><li>Recession/depression with collapse of mortgage industry and stock market </li></ul></ul><ul><li>Change in state finances </li></ul><ul><ul><li>Arrest and indictment of state governor </li></ul></ul><ul><ul><li>Threat of financial insolvency of the State of Illinois </li></ul></ul><ul><li>Institutional “financial challenge” </li></ul><ul><ul><li>Decrease in patient volumes </li></ul></ul><ul><ul><li>Increase in “state insured patients” in a state where we were not receiving payment </li></ul></ul><ul><ul><li>Health Care reform </li></ul></ul>
  4. 4. Lean Transformation <ul><li>A change in thinking </li></ul><ul><ul><li>Individual optimization to process optimization </li></ul></ul><ul><ul><li>Questioning “what we’ve always done” </li></ul></ul><ul><ul><li>Considering improvement as part of our daily job </li></ul></ul><ul><li>A change in behavior </li></ul><ul><ul><li>Defining the critical few metrics and opportunities </li></ul></ul><ul><ul><li>Measuring performance at all levels </li></ul></ul>
  5. 5. Kaizen “How We Do It” Kaizen Event Week Day 1 Day 5 Day 4 Day 3 Day 2 Tool Specific Training Observe & Analyze Current Process / Begin Improvements Continued Improvements Refinement And Finalize Improvements Final Presentation Leader Meeting Leader Meeting Leader Meeting For Quality Improvement Purposes
  6. 6. Areas of Work…….. Creating Flow <ul><li>Education & Training </li></ul><ul><li>Patient Flow </li></ul><ul><ul><li>Identify access points </li></ul></ul><ul><ul><li>Elimination of Waiting </li></ul></ul><ul><ul><li>Establish discharge processes </li></ul></ul><ul><li>Supply Chain </li></ul><ul><ul><li>Product movement </li></ul></ul><ul><li>Care Coordination </li></ul><ul><ul><li>Ambulatory </li></ul></ul><ul><ul><li>Inpatient </li></ul></ul>
  7. 7. Through a series of Kaizen Events <ul><li>In the GI Lab </li></ul><ul><li>Increased capacity by 70% </li></ul><ul><li>Cost avoidance: $13m expansion </li></ul><ul><li>How: </li></ul><ul><ul><li>Value Stream Mapping </li></ul></ul><ul><ul><li>Roadmap of events </li></ul></ul><ul><ul><li>5S/Std Work </li></ul></ul><ul><ul><li>TPI </li></ul></ul><ul><ul><li>MDI </li></ul></ul><ul><li>In Supply Chain </li></ul><ul><li>Implemented pull systems </li></ul><ul><li>Cost reduction: $14m </li></ul><ul><li>How: </li></ul><ul><ul><li>Value Stream Mapping </li></ul></ul><ul><ul><li>Roadmap of events </li></ul></ul><ul><ul><li>5S/Std Work </li></ul></ul><ul><ul><li>TPI </li></ul></ul><ul><ul><li>MDI </li></ul></ul>
  8. 8. Kaizen to support the OR 7 Flow Lines Setup Feeding the Sterilizers Disciplined Execution
  9. 9. Numeric Driven Preference Cards Femur Facture Numeric Alias Numeric Alias Numeric Alias Femur Facture Svc Line Level Preference Card MD Customization Table Positioning Implants Carmen/Jon Before 20-30 Trays After 12-16 Trays
  10. 10. Emergency Department Re-design Building the bridge while we walk on it
  11. 11. “ A Burning Platform” <ul><li>Level I Trauma Center </li></ul><ul><li>142 patients a day </li></ul><ul><li>29 treatment bays </li></ul><ul><li>6 hour average cycle time </li></ul><ul><li>Increase in “Care Accelerated” </li></ul><ul><li>Change in Senior Management Team </li></ul><ul><li>Financial challenge to the Medical Center </li></ul><ul><li>Workforce reduction program </li></ul><ul><li>Physician foundation joins medical center </li></ul><ul><li>Vacant ED manager position </li></ul><ul><li>Loss of geography for the ED </li></ul>Mark Cichon, DO ED Medical Director
  12. 12. An Opportunity <ul><li>Generous Donor </li></ul><ul><li>Make a visible difference </li></ul><ul><li>Improve patient experience </li></ul><ul><li>Improve staff experience </li></ul><ul><li>Implement lean </li></ul>“ Let’s do something different…” Deborah Kull System Director, Operational Excellence
  13. 13. Engagement <ul><li>Administration </li></ul><ul><li>ED Leadership </li></ul><ul><li>Operational Excellence </li></ul><ul><li>Next Level Partners </li></ul><ul><li>Pratt Design </li></ul><ul><li>Walsh Construction </li></ul><ul><li>Operations </li></ul>
  14. 15. What is 3P? <ul><li>A method for designing facility layouts that better meet Patient and Caregiver needs with improved Safety, Quality, Delivery and at Lower Total Cost </li></ul><ul><li>A rapid cycle process that focuses on generating lots of ideas; with simultaneous input from all stake holders up front for the layout of the Emergency Department </li></ul><ul><li>A method to prioritize and rank the outcomes (layouts) relative to each other </li></ul><ul><li>Trystorming and mockups of the preferred solutions </li></ul>Madhu
  15. 16. “ Executive leadership is critical to success of the process ” Jason Keeler VP of Healthcare Operations Lessons Learned Executive Leadership
  16. 17. Voice of the Customer Customers: Patients, Patient families, Staff, External Resources (e.g. Ambulance) Sources: Avatar Dept Surveys Staff Interviews Gemba Walks
  17. 18. 12 Ideas <ul><li>Separated Into 2 Teams with all Functions; Architects, Construction, Clinical, Facilities, Security, Admin </li></ul><ul><li>Each Team Generated 6 Layout Ideas </li></ul><ul><li>Each Team Evaluated & Ranked Each Layout per the Criteria </li></ul>
  18. 19. 12 Ideas to Top 3 <ul><li>Teams Presented Each of the 12 Ideas </li></ul><ul><li>Entire Team Evaluated then Ranked to Determine the Top 3 Layout Ideas </li></ul><ul><li>Similar Ideas Were Consolidated to Final 2 Layouts </li></ul>
  19. 20. Trystorming <ul><li>Constructed the Current State ED </li></ul><ul><li>Built a Full Size Half Scale Mock-Up of Layouts </li></ul><ul><li>Walked the RN, MD & Patient Flows for Current State and New Layouts </li></ul><ul><li>Generated Spaghetti Diagrams of Each Acuity Level of the New Layout </li></ul>
  20. 21. Layout
  21. 22. “ Bend over: This is going to hurt ” Carol Schleffendorf, RN ED Director of Nursing Lessons Learned It is a Painful Process
  22. 23. Detailed Design - Trauma <ul><li>Teams presented each of the 10 ideas </li></ul><ul><li>Entire team evaluated then ranked to determine the top layout ideas </li></ul><ul><li>Similar ideas were consolidated to a final layout </li></ul>Gaming Design Consolidate Ready to Trystorm Trystorming in a full scale mock-up
  23. 24. “ No Problem is a problem ” Sharon O’Keefe President Lessons Learned: Surface Problems
  24. 25. Detailed Design – Staff & Support
  25. 26. Detailed Design – Patient Bays Kiosk Greeter Triage ED Bay
  26. 27. Designed Layout
  27. 28. Results Michelle
  28. 29. “ No additional rooms??? Are you Nuts?” ED Staff Lessons Learned: Flow Builds Trust
  29. 30. Impact of Flow – Peak Hours
  30. 31. “ Respect your extended network of partners” Jeffery K. Liker The Toyota Way Lessons Learned: Include the Vendors
  31. 33. Concerns
  32. 36. Questions?
  33. 37. Speaker Bio Greg Horner is an Operational Excellence Leader at Loyola University Medical Center where he is leading transformational change and utilizing lean principles to improve the staff and patient experience. Greg is an ASQ certified Six Sigma Black Belt and a student of the Toyota Production System (Lean). He has studied TPS under a 1 st generation Sensei from Toyota including the proper use of 3P and standard work. Greg is a certified systems engineer, database administrator and is currently earning a master’s degree in Enterprise Improvement and Innovation from DePaul University in Chicago.