A team at Alcoa Power and Propulsion developed and implemented a structured process management approach across their business unit to improve product quality, reduce waste and costs, and cut costs. By defining and standardizing key processes, the unit minimized variation, shared best practices, and sustained improvements, reducing scrap, saving millions of dollars, and improving customer satisfaction. The project was named a finalist in an international team excellence award competition for its success in implementing process management approaches.

1. Making the Case for Quality
Process Management Approach
Reduces Scrap, Saves Alcoa Millions
• A team at Alcoa Power
and Propulsion sought
to improve product
quality, reduce waste and
inefficiency, and cut costs.
• To achieve these goals,
the team developed
and implemented a
structured process
management approach
across the business unit.
• By defining and then
standardizing key
processes, the unit
minimized variation,
shared best practices, and
sustained improvements.
• The project improved
customer satisfaction,
reduced costs of poor
quality, and saved
millions of dollars.
• The team was named

2. a finalist in ASQ’s
2015 International
Team Excellence
Awards competition.
At a Glance . . .
As Alcoa Power and Propulsion sought to minimize
manufacturing process waste,
inefficiency, and related expenses, two key findings caught the
attention of the
business unit’s executive leadership team. Customer satisfaction
surveys revealed
60 percent of respondents held an unfavorable or neutral
opinion of the unit, while
at the same time, internal quality measures revealed the
business unit recorded the
highest levels of scrap in the organization for the year. The
findings represented
a significant opportunity, but improvement would require rapid
deployment in a
methodical, deliberate, and sustainable manner.
About Alcoa Power and Propulsion
Alcoa Power and Propulsion (APP), a unit of New York City-
based Alcoa Inc., is divided into three
segments: structural castings and special products, industrial
gas turbine airfoils, and aerospace airfoils.

3. This business unit serves the defense, energy, aerospace, and
industrial markets, where its products
are used in military and commercial aircraft engines as well as
power-generation turbines. Additional
products and services include molds, hot isostatic pressings,
specialty coatings and tools, as well as
machinery. APP operates 25 production facilities around the
world, employing more than 9,000 people.
Working to Improve Processes
The APP leadership team discovered scrap and rework issues
were resulting in high customer claims
and delivery issues, therefore they sought solutions for
significant reductions to scrap levels to improve
delivery, rework, and customer satisfaction. In the past,
substantial scrap level decreases were thought
to be unattainable because casting is a particularly complex
process (see the sidebar, The Investment
Casting Process, for more details) with many sources of
variation.
In late 2011, APP’s quality focus shifted toward sustainable and
continuous process improvement,
particularly at nine of the unit’s super alloy foundries (five in
the United States, three in Western
Europe, and one in Japan). While these foundries were the
starting point for the initiative because
they recorded the highest levels of scrap, the ultimate goal for
APP was to create a sustainable solu-
tion for deployment at the plant level by mid-2012. The right
solution would need to capture and
by Janet Jacobsen
May 2016

4. ASQ www.asq.org Page 1 of 5
ASQ www.asq.org Page 2 of 5
communicate tribal knowledge as well as monitor capable
processes. Creating
a new approach could directly impact financial performance by
reducing scrap,
rework, and returns.
Identifying Stakeholders and Building the Team
One of the first steps in forming a project improvement team
was to identify
stakeholder groups from which team members would be
selected. The following
stakeholders were included:
• Internal groups:
engineering
process owners,
business unit and
site managers,
operations
personnel, and
members of the
quality staff.
• External groups:
Alcoa and the
business unit’s
customers.

5. Once these groups
were determined and
the required knowledge
and skills for each group identified, skill and knowledge gaps
were identified. For
example, the engineering process owners needed training on the
DMAIC method,
while the quality group required additional training on the audit
process. Corporate
quality staff provided introductory training on the
organization’s process manage-
ment methodology, and APP created a Six Sigma training class
for its engineers.
It made sense to build upon already-existing team structures and
working relation-
ships at APP where there are business unit process owners and
corresponding plant
process owners. The improvement project’s deployment team
included members
from these process owner groups.
The project goal was to develop a sustainable methodology to
reduce the APP scrap
rate by 10 percent year over year by June 2012, as depicted in
Figure 1. The team
was to develop manufacturing process models for key areas,
validate the methodol-
ogy at pilot locations, and then prepare a full implementation
plan.
Analyzing the Opportunity
When analyzing the improvement opportunity at hand, the team
quickly realized the
part-focused scrap reduction methodology, which had been used

6. for years, reached
the point of diminishing returns. To achieve the additional scrap
reductions required
to meet the stated goal, process stability became the new focus.
Since the investment casting process includes several complex
steps, the team cre-
ated process maps to identify, understand, and analyze each step
for its savings
potential. Pareto charts helped illustrate the contribution of
each step to the overall
scrap rate. Brainstorming, scrap rates, and defect data were used
to identify potential
The majority of APP’s business is related to
its investment casting process, which includes
the following steps:
• APP receives a design from one
of its customers, and through a
collaborative process, the proper
shape of the casting is determined.
• A die is constructed, usually in
wax, to produce the pattern.
• This wax die is then assembled
into a cluster to produce multiple
castings economically through a
single pour of molten alloy.
• The wax cluster process continues as
a ceramic slurry is applied, followed
by ceramic sand, and then into
the controlled drying step until the
desired shell thickness is achieved.

7. • The wax is then melted out and the
resulting shell is fired to create a hard
ceramic ready for casting. Selective
insulation that eliminates casting
defects, such as micro-shrinking, may
be applied at this point before the
shell proceeds to the casting stage.
• During the casting step, metal is melted
under vacuum to maintain purity.
Once melted, the mold is loaded
through a vacuum-lock system.
• After the mold is cast, the gating
is removed and the castings move
through the post-cast operations
and quality inspection.
• Once approved, the certified casting
is shipped to the customer.
THE INVESTMENT
CASTING PROCESS
This is the casting portion of
the investment casting process.
Pe
rc
en
t
Year
2011 2012 2013

8. Figure 1: Desired Scrap Trend Across APP
ASQ www.asq.org Page 3 of 5
improvement opportunities within the
process. In addition, the team utilized
scrap rates at each APP location to
search for potential savings.
Scrap by point-of-cause data was analyzed
within each process area to determine
which processes held the greatest savings
potential. In addition to pinpointing spe-
cific processes for improvement, quality
tools such as Pareto analysis were also
useful in determining which plants to tar-
get for early implementation.
At the outset, the project scope was
quite broad—global business unit scrap
reduction—a hefty challenge. After
reviewing the data and securing buy-in
from leadership, the improvement team
narrowed the scope to focus on the great-
est opportunities—the wax, shell, and
cast manufacturing operations of nine
selected locations. Although the scope
was now more narrowly focused, the
challenge was still immense, requiring
the engagement of the entire operation.
At this point, team membership grew
to include additional process owners,

9. engineers, quality staff, operations,
and leadership personnel from plants
involved in the project.
Developing
Solution
s
Because the nine APP locations for this
improvement initiative were located
around the world, it was imperative to
create a cohesive language that could tie
all the foundry processes together. This
common language was necessary for not
only deploying the methods and tools,
but also identifying the key operations
and sub-processes at various plants for
comparative and benchmarking purposes.
Process-mapping exercises, shop-floor
interviews, brainstorming sessions, and
benchmarking studies generated data
to help develop potential solutions.
The data was first used for comparing

10. Alcoa plants with similar processes and
improvement requirements. The com-
pany saved $20 million at seven Alcoa
plants that had implemented process
management initiatives. These results
inspired the improvement team to pursue
a similar approach within APP.
The left portion of Figure 2 depicts a
typical plant-based approach to process
improvement where efforts are confined.
In contrast, the right side of Figure
2 shows how an integrated approach
involving plants throughout the BU
enables the sharing of approaches with
common templates and coordinated
plant projects. The new approach would
Figure 2: Potential Implementation Approaches for Process
Management Directive
Plant 3
Plant 2

11. Plant 1
Coordinated pilot plant projects
Pilot efforts well-supported
Ef
cient local leveraging
Common process map template
Integrated BU-wide approach
Plant 3
Plant 2
Plant 1
Independent plant projects
Wasteful duplicated efforts
Poor leveraging
Independent process maps

12. Traditional plant-based approach
ASQ www.asq.org Page 4 of 5
leverage one plant’s independent ideas by sharing its
solutions across the entire business unit to spur global
improvement. This business-unit approach also enabled
process owners to transfer technical details through a
common language that was lacking in the past, and to
build a collaborative culture.
The team developed a three-stage plan to implement
its process management approach. The first stage
involved pilot plants; the second fast-follower plants;
before finally, implementation to a broad business-unit
approach. This three-stage rollout provided data that team
members used to validate the efficiency and speed of the
shared and integrated approaches.
The key to incorporating solutions throughout the busi-
ness unit was a structured, common process model, which
incorporates the tools recognized as the best-suited means
to get processes in control, and to identify key operations

13. and sub-processes at multiple plant locations. Utilizing
this process management approach, as illustrated in
Figure 3, would increase sustainability through manage-
ment review, quality audits, rigorous control plans, and a
focus on the correct variables.
The process management solution was validated through
the pilot and fast-follower stages. For example, one of
the pilot-stage plants deployed a new casting/mold wrap
process and demonstrated a 30 percent reduction in
related scrap in just three months. Then a fast-follower
plant used the same new process as the pilot plant and
achieved similar scrap reduction results, but this time
within just 30 days. This demonstrated that lessons
learned at one plant advance the process management
efforts at other locations when similar process improve-
ments are implemented.
Initial
assessment
Identi�cation of
key processes and
process managers

14. Audit and
management
review
Sustain
the gains
Process
improvement
In control,
capable, and
sustainable
Yes
No
Figure 3: Alcoa Process Management Approach
Overcoming Resistance
During the team’s initial analysis members discovered a few
areas of

15. resistance, including:
• Concerns regarding the availability of resources, particularly
the ability for employees to handle the new initiative while still
meeting production goals.
• Stakeholders at various levels lacked a sense of urgency and
showed some hesitancy about making changes.
• Because the process management approach was a
nontraditional
method for reducing scrap, a change in culture would be
essential
to inspire employees to embrace the new process-focused
method.
The team understood providing information and education was
vital to
achieve positive change, so the process management model
includes
routine communication such as holding team-building meetings
and shar-
ing monthly process audit databases. Resistance was also
mitigated by
engaging the entire workforce in the new process management

16. approach.
Examples included employees who helped by defining
improvement
opportunities, planning and prioritization activities,
participating in kai-
zen events, as well as establishing and executing control plans.
Exceeding Goals and Realizing Additional Benefits
Once the pilot and fast-follower stages were completed, APP
imple-
mented the process management model throughout the business
unit.
While the initial project goal was to reduce scrap by 10 percent
year
over year, those expectations were exceeded by more than $20
mil-
lion in improvements from the three key areas: wax, shell, and
cast.
Tyrus Hansen, APP team lead, said reductions in scrap and
other
costs of poor quality continue year over year, as highlighted in
APP’s
Quality Index, shown in Figure 4.

17. Specific examples of dramatic cost savings include:
• A 77 percent improvement in wax expenses in one department
at
one plant, which resulted in a $38,000 annual savings.
• A sub-process involving shell weight control to reduce
material
costs at one production facility resulted in a 21 percent
improvement and an annual savings of $400,000.
• A sub-process of the cast/wrap step reduced scrap and rework
expenses by more than 30 percent, approximately $750,000, at
one location.
Not only did the new approach lower scrap rates, but it also
reduced
rework activities and customer returns, leading to more on-time
deliv-
ery and higher levels of customer satisfaction. At the outset of
this
project, all nine plants involved in the pilot were rated in the
poor
performance category, but since that time, all of the
manufacturing

18. locations have fully integrated the process management
approach.
An unexpected benefit of the work was an improved workforce
devel-
opment. Many team members completed training and then
gained
ASQ www.asq.org Page 5 of 5
valuable experience with basic problem-solving tools—new
skills that enabled employ-
ees to operate in a more proactive, process-focused manner.
Members of the improvement team learned valuable lessons
throughout the project, but
Hansen said the biggest lesson centered on discipline as team
members realized, “If we
maintain the discipline, quality will improve,” he said. “The
proactive work minimizes
the time spent managing problems and fighting fires.”
Sustaining the Momentum

19. The APP process management models for the wax, shell, and
cast operations were
revised to reflect the new approach. These models were
deployed through the process
owner group at each APP location. Results are measured and
reported at the process
and sub-process levels with metrics directly linked to each
location’s business case.
Reports and feedback soon became more proactive and process-
focused rather than
reactive and problem-focused as was the case before this
improvement initiative.
To ensure the new process management approach remains
sustainable and continues to
perform to expectations, APP implemented a number of
controls, including:
• The business case must drive all activities associated with this
approach and the
activities are measured for impact.
• A reporting structure was created to communicate specific
details on a regular basis.

20. • All efforts are recorded and included in the business unit
manuals and audit tools.
As APP continued to implement the process management
approach, the business unit
realized further benefits, such as:
• By emphasizing control of the entire process, additional
operators and supervisors
are engaged in more proactive roles.
• The workforce is more satisfied and engaged due to greater
stability, education,
and structure.
• With fewer daily “firefighting” activities, time to focus on key
process metrics for
employees increases, triggering reactions before issues become
scrap problems.
GOAL
reduction
from 2013
6.59%

21. Reduction
from 2013
9.23%
GOAL
reduction
from 2012
7.74%
Reduction
from 2012
17.24%
GOAL
reduction
from 2014
19.22%
Reduction
from 2014
2.11%
Represents millions
of dollars of opportunity

22. Actual
2012
Projected
2013
Actual
2013
Projected
2014
Actual
2014
Projected
2015
Actual
2015
Figure 4: APP Quality Index Trend from 2012 to 2015
Sharing the Team’s Story
The team has devoted a great deal of

23. time in sharing its success story with
others. Within Alcoa, the model used in
this project now serves as the corporate
standard and is being applied at various
locations and business units around the
globe with similar results. The team’s
effort was also highlighted at the 2014
Alcoa Corporate Process Management
Network Conference and was a can-
didate in the 2013 Alcoa Corporate
Impact Award Competition.
At the prompting of Alcoa’s cor-
porate quality department, the team
entered its project into the ASQ 2015
International Team Excellence Award
(ITEA) competition. The project was
named a finalist, and this recognition
enabled members of the team to share
APP’s proven process management
approach during the World Conference
on Quality and Improvement.
For More Information

24. • For additional information on
Alcoa Power and Propulsion,
visit the organization’s website at
www.alcoa.com.
• To learn more about this project
from a team interview, watch this
video http://videos.asq.org/alcoa-
six-sigma-and-teams.
• To view more examples of
successful improvement projects in
quality, visit the ASQ Knowledge
Center at asq.org/knowledge-center/
case-studies.
• Learn more about the International
Team Excellence Award Process
by visiting the official website at
asq.org/wcqi/team-award/index.aspx.
About the Author
Janet Jacobsen is a freelance writer
specializing in quality and compliance

25. topics. A graduate of Drake University,
she resides in Cedar Rapids, IA.
www.alcoa.com
http://videos.asq.org/alcoa-six-sigma-and-teams
http://videos.asq.org/alcoa-six-sigma-and-teams
http://asq.org/knowledge-center/case-studies
http://asq.org/knowledge-center/case-studies
http://asq.org/wcqi/team-award/index.aspx
Making the Case for Quality
Systematically Improving
Operating Room Patient Flow
Through Value Stream Mapping and Kaizen Events
• Value stream maps (VSMs)
are effective tools for
facilitating incremental
improvements to complex
healthcare processes.
• Thomas Jefferson University

26. Hospitals utilized the VSM
approach to identify and
execute seven lean projects
within the perioperative
department over four years.
• Results include
preadmission testing
reduction in length of
visit from 110 to 92
minutes, 36 percent
reduction in preoperative
patient waiting, and an
improvement of on-time
first-case starts from
56 to 67 percent.
At a Glance …
The focus of hospital senior leaders on operations expense
reduction and management has been spurred
by increases in costs of pharmaceutical and medical supplies,
revenue movement from inpatient to

27. outpatient settings, and malpractice insurance.1 Key to
addressing these issues is successfully utiliz-
ing performance improvement methodologies to improve quality
and decrease variation, which saves
money.2 At Thomas Jefferson University Hospitals, inpatient
and outpatient operating room (OR)
activity accounts for a large percentage of total patient revenue.
The majority of OR cases occur at the
academic medical center known as the Center City campus.
As part of the perioperative (the department responsible for all
surgical procedure activities) strategic
plan overview, a team of certified lean practitioners was
assigned to analyze and improve the OR
patient flow process. Given the existing high volume of
procedures and strategic vision to increase
case loads, it was critical to ensure consistent flow throughout
the system. From preadmission test-

28. ing through the post-anesthesia unit, the entire process was
wrought with inefficiencies (i.e., delays
in preoperative patient processing, cases not starting on time,
and slow OR turnover case to case) and
bottlenecks that had compounding effects on the overall
department.
Representatives from all related disciplines and departments
converged to tackle the complex problem.
Facilitated by the lean team, a value stream mapping (VSM)
event was held in August 2010 to deter-
mine how to strategically solve key issues.
About Thomas Jefferson
University Hospitals
Thomas Jefferson University Hospitals
(Jefferson) is a 969-acute-care-bed healthcare

29. facility located in Philadelphia, PA. Jefferson
provides a full range of patient care in all
specialties and subspecialties. The southeast-
ern Pennsylvania, New Jersey, and northern
Delaware region includes more than 11 million
people. Annually, Jefferson clinical operations
include nearly 50,000 admissions, more than
120,000 emergency department visits, and almost
a half-million hospital-based outpatient visits.
by Dennis Delisle
October 2013
ASQ www.asq.org Page 1 of 7
Dennis Delisle, operations support director for Jefferson
University Hospitals, discussing a pay-off priority matrix
with team members.

30. Why Quality?
Committed to lean thinking since 2008, in 2010 Jefferson
hired a certified lean master to develop a robust education and
process improvement program. As part of this program, more
than 50 certified lean practitioners who are imbedded in vari-
ous clinical and nonclinical departments volunteer their time for
improvement projects. In addition to the formal university-
based
lean thinking and certification program, Jefferson offers staff
department-level training that emphasizes application of simple,
yet effective tools (i.e., 5S, visual management, process map-
ping) and leads to project execution on a smaller scale.

31. Jefferson
is dedicated to providing world-class care, and approaches like
lean thinking enable staff to contribute value-adding services
while reducing wasteful efforts.
The consumer-driven healthcare market demands a high degree
of
customer service and responsiveness. As such, Jefferson leaders
identified a need to streamline the perioperative department’s
pro-
cesses. The perioperative department engaged a team of
certified
lean practitioners to strategically evaluate opportunities and
facili-
tate change. Operating room patient flow is a complex process
that

32. involves multiple areas, including:
• Physician offices
• OR scheduling
• Preadmission testing
• Registration
• Pre-procedure preparation
• Patient transportation
• Holding area unit
• Operating room
• Environmental services
• Post-anesthesia care unit
Given the numerous levels,
functions, and responsibilities
involved, leaders determined that
the best approach to initiate the
project would be a VSM event. The full-day facilitated effort
included the lean team working with a group of process experts
throughout the entire OR patient flow process.
Jefferson’s Quality Journey
Prior to initiation of the VSM event, the lean team conducted

33. voice of customer interviews with representatives from manage-
ment and frontline staff. The interviews focused on qualitative
analysis of key issues and barriers to patient flow. Throughout
the discussions, several themes became apparent: constant
changes to the OR schedule the day before or day of surgery,
poor communication among perioperative units, excessive
processes and patient travel due to poor layout, inadequate tech-
nology for decision making and monitoring flow, and workflow
variation across all disciplines.
Following the interviews, the lean team began observations. A
critical element of lean thinking is gemba walks. Gemba is a
Japanese term that stands for the place of action, or where the
work takes place.3 The approach is simple: Go to where work is
being done, observe the processes and workflow, and talk with
staff to understand their challenges.4 Gemba walks also enable
ASQ www.asq.org Page 2 of 7
OR Kaizen 5 Team – Improving On-Time, First-Case Starts
OR Kaizen 6 Team – Improving OR Patient Flow From SPU to
Holding Area

34. ASQ www.asq.org Page 3 of 7
the team to document process steps in the current state, a key
input in the VSM event. Additionally, observations were supple-
mented by the OR information system database providing key
performance indicators such as on-time, first-case starts, OR
turnover times, and cycle times across the patient flow process.
Together, these data helped shape the current state.
The lean team developed a comprehensive agenda that included
current state validation, brainstorming and prioritizing issues
and
barriers, future state design, and creating an improvement plan
for incremental progress over time. Managers and perioperative
department leaders participated. Inclusion of the right
stakehold-
ers (i.e., process expert, influential leader, creative problem
solver,
etc.) is a critical element of successful improvement efforts.
The
OR vice president and management team helped choose a group
of individuals to represent the broader department.
Figure 1 depicts the validated current state at the time of the

35. event. Participants went through a facilitated brainstorming ses-
sion to determine the key drivers of quality and efficiency
issues.
The problem-solving process used by the lean practitioners can
be seen in Table A.
The group then began the solution development process. The
pro-
posed solutions were prioritized based on impact (high/low) and
ease of implementation (easy/difficult). Figure 2 shows the
current
state, with proposed solutions represented as kaizen bursts.
This led to final recommendations of where the team should
focus (Figure 3: Proposed Action Plan). At the conclusion of the
event, the entire team presented the findings and recommenda-
tions to leadership, along with the timeline for implementation.
Lean thinking emphasizes incremental improvement over time.
These improvement efforts are typically known as kaizen
events.
Kaizen, a Japanese term, represents “change for good.” Lean
teams facilitate kaizen events with process experts in order to
rapidly develop and implement solutions. Jefferson lean teams
utilize the define, measure, analyze, improve, and control

36. (DMAIC) project structure to execute initiatives. The main
deliv-
erables for each phase can be seen in Table B.
The VSM team identified two areas as the priority focus based
on the majority of opportunities and solutions identified through
the VSM event. The first piece was patient arrival. Next, the
Table A — Problem-Solving Process
Step Description Deliverable
Brainstorm issues and barriers Through various brainstorming
activities, participants discuss and
document all issues and barriers related to the problem being
addressed.
Documented list of all issues and barriers that contribute to
inefficiencies and poor quality.
Prioritize issues and barriers The team determines which issues
and barriers are within their control.
These filtered issues are subsequently prioritized through
voting.

37. The highest priority issues/barriers (usually two to four in total)
are
selected for solution development.
Brainstorm potential solutions Through brainstorming activities,
the team discusses and develops
potential solutions to address the prioritized issues and barriers
from
the prior step.
Documented list of all potential solutions to address the
prioritized
issues.
Prioritize solutions The team prioritizes solutions based on
impact on the problem (high or
low) and ease of implementation (easy or difficult).
All solutions are prioritized, highlighting the high-impact and
easy-
to-do ideas.
Develop action plan A detailed action plan is developed for all
solutions that fall within the
high-impact, easy-to-do or low-impact, easy-to-do categories.

38. The action plan consists of what, who, when, required
resources, and
expected outcome. Plans are executed within a six-week
timeframe,
often with pilots occurring during the actual kaizen event.
Patient Surgeon
OR
schedule
nalized
OR
schedule
nalized
Delivered
to central
scheduling
Patient
arrives

39. Check-in
by name Register
Check-in
by name
Clerk
pull
chart
Call
back to
cubicle
Instruc-
tions
Patient
changes
clothes
Prep for
surgery

40. Arrive @
holding
area
RN
assess-
ment
IV
insertion
MD
assess-
ment
Enter
OR
Call from
scheduling
Call from
scheduling

41. Patient
check-in @
admissions
Arrive
@ SPU
Prep for
surgery
Patient
arrives @
holding area
Enter
OR
SPU = short-procedure unit
Figure 1 — OR Patient Flow VSM
ASQ www.asq.org Page 4 of 7

42. recommendation was to look at the holding area process where
patients have an IV line placed and are then interviewed by the
surgical and anesthesia teams (interventions and outcomes of all
efforts can be found in the results).
After execution of the first and second kaizen events, the lean
team re-evaluated the VSM with perioperative department lead-
ership to identify additional opportunities for improvement.
Over
the course of four years, the lean team systematically addressed
issues and challenges through seven formal kaizen events. The
scope of the subsequent improvement efforts spanned
scheduling
through post-procedure processes and can be seen in Table C.
Patient Surgeon
OR
schedule
nalized
OR
schedule

43. nalized
Delivered
to central
scheduling
Patient
arrives
Check-in
by name Register
Check-in
by name
Clerk
pull
chart
Call
back to
cubicle

44. Instruc-
tions
Patient
changes
clothes
Prep for
surgery
Arrive @
holding
area
RN
assess-
ment
IV
insertion
MD
assess-
ment

45. Enter
OR
Call from
scheduling
Call from
scheduling
Patient
check-in @
admissions
Arrive
@ SPU
Prep for
surgery
Patient
arrives @
holding area
Enter

46. OR
High/easy High/dif
cult
Expand
ORSOS
access
OR
comments
Prioritize
calls
Signage Patient tracking
system
Admission
to 9410
Patient ID
process
OR transport

47. time
Holding area
whiteboard
Separate med/
surg patient
Inpatient patient
education
Add clerk
Inpatient status
in ORSOS
More
computers
Add clerk Lab slips
Pixis
Stretchers

48. First case
education
Transporter
education
Pacemaker IV insertion
New MD
education
MD
arrival timeIV bags/tubes
Supply
par levels
Add
unit clerk
More
computers
Implement
pull system

49. 10th St. open
4:30 a.m.
JIT patient
arrival
Update
scripts
Move
interviewers
FAR closed
on schedule
Larger OR
labels
Physician
of
ce education
Low/easy ORSOS = OR information system JIT = just-in-time
FAR =
rst available room Pixis = medication carousels on nursing units

50. Patient Surgeon
OR
schedule
nalized
OR
schedule
nalized
Delivered
to central
scheduling
Patient
arrives
Check-in
by name Register
Check-in
by name

51. Clerk
pull
chart
Call
back to
cubicle
Instruc-
tions
Patient
changes
clothes
Prep for
surgery
Arrive @
holding
area

52. RN
assess-
ment
IV
insertion
MD
assess-
ment
Enter
OR
Call from
scheduling
Call from
scheduling
Patient
check-in @
admissions
Arrive

53. @ SPU
Prep for
surgery
Patient
arrives @
holding area
Enter
OR
Kaizen 1 Kaizen 2
Figure 2 — OR Patient Flow VSM With Proposed