Page 0<br />GOING LEAN<br />Tools in Your Toolbox<br />Using Lean Concepts & Tools to Provide an Optimized Care Delivery S...
Page 1<br />Today’s Topics<br />
Page 2<br /><ul><li>US Health care spending represents 18 % Plus of GDP in 2008 and has been forecasted to be 20 % by the ...
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 %...
If Federal government spending remains relatively constant % of GDP, the rising cost of Medicare within that budget will c...
If governmental financial statements reported the liabilities they face from contractual  commitments to provide healthcar...
Page 3<br />There are two types of costs that need to be considered in the optimization of health care delivery- first tim...
Page 4<br />What does LEAN bring to the table?<br />LEAN<br />Laying the Foundation for Process Change<br />Predictability...
Page 5<br />Key elements for success<br /><ul><li>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 </li></ul>Creating a New Level  of Collaborative Design Environment<br />
Page 6<br />Project Flow – Key Elements<br />Value Stream Modeling / Narravtive<br />Simulation Modeling<br />“What if’s” ...
Page 7<br />Changing the typical project flow will result in dividends by reducing first time building cost and continuing...
Define functional adjacencies
Determine optimal departmental area allocations
Detail room-by-room  / needs
Identify key trends and growth patterns
Define program & facility priorities
Feasibility Study
Identify service line configurations
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Going Lean in Healthcare - Applying all the Tools

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  1. 1. Page 0<br />GOING LEAN<br />Tools in Your Toolbox<br />Using Lean Concepts & Tools to Provide an Optimized Care Delivery System and Inform Healthcare Facility Design<br />Debbie Hoffman<br />Debbiedetech@gmail.com<br />
  2. 2. Page 1<br />Today’s Topics<br />
  3. 3. Page 2<br /><ul><li>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
  4. 4. 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
  5. 5. If Federal government spending remains relatively constant % of GDP, the rising cost of Medicare within that budget will crowd out all other spending.1
  6. 6. 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</li></ul>1 The Innovator’s Prescription – A Disruptive Solution for Health Care, Christensen,Clayton 2008<br />Can we afford to continue doing business as usual?<br />
  7. 7. Page 3<br />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.<br />Staffing Efficiency<br />Physician / Staff Satisfaction<br />Quality of<br /> Care<br />Optimized Health Care Delivery <br />Adaptability / Flexibility/ Sustainable<br />Operational Process <br />Patient Satisfaction<br />Planning for Optimized Care Delivery<br />
  8. 8. Page 4<br />What does LEAN bring to the table?<br />LEAN<br />Laying the Foundation for Process Change<br />Predictability of workflow- standardization of processes <br />Decrease cycle times = decrease ALOS<br />Adaptability of space allowing flexibility – increasing utilization and decrease obsolescence<br />Space requirements reduced- elimination of duplicity <br />Balancing spaces needs versus utilization<br />Less process steps = less handoffs = less errors<br />Development of a “future state”<br />
  9. 9. Page 5<br />Key elements for success<br /><ul><li>Guiding Principles- WHAT DO THEY VALUE?
  10. 10. What does the client want to solve?
  11. 11. Everyone having a seat at the table
  12. 12. Consensus building
  13. 13. Sharing of all documents
  14. 14. Value analysis throughout design </li></ul>Creating a New Level of Collaborative Design Environment<br />
  15. 15. Page 6<br />Project Flow – Key Elements<br />Value Stream Modeling / Narravtive<br />Simulation Modeling<br />“What if’s” – Case Study <br />Application of Metric <br />Tools in the Tools Box<br />
  16. 16. Page 7<br />Changing the typical project flow will result in dividends by reducing first time building cost and continuing of operations <br />Simulation<br />Modeling<br />Functional / <br />Space <br />Program<br />Strategic<br />Planning<br />Delivery Care<br />Models<br />Schematic<br />Design<br />Design &<br />Construction<br /><ul><li>Balance # of rooms versus utilization
  17. 17. Define functional adjacencies
  18. 18. Determine optimal departmental area allocations
  19. 19. Detail room-by-room / needs
  20. 20. Identify key trends and growth patterns
  21. 21. Define program & facility priorities
  22. 22. Feasibility Study
  23. 23. Identify service line configurations
  24. 24. Prepare workload projections
  25. 25. Quantify staffing needs
  26. 26. Value Stream Modeling
  27. 27. Blocking and stacking diagrams
  28. 28. Internal and external department flows
  29. 29. Project oversight
  30. 30. Risk assessment
  31. 31. Draw flow charts
  32. 32. Data collection
  33. 33. Pilot program
  34. 34. Test “what-if” scenarios
  35. 35. Optimize adjacencies based on care delivery efficient </li></ul>Simultaneously <br />Project Flow<br />
  36. 36. Page 8<br />Defining Key Elements of Patient Encounter<br />Encounter<br />Check-Out<br />Post-Encounter<br />Pre-Encounter<br />Arrival<br />Encounter<br /><ul><li>Scheduling
  37. 37. Pre-registration
  38. 38. Pre-certification
  39. 39. Financial counseling
  40. 40. Clinical information capture
  41. 41. Patient instruction transmission
  42. 42. Appointment confirmation
  43. 43. Chart preparation</li></ul>Building<br /><ul><li>Drop off/greeting
  44. 44. Way finding
  45. 45. Orientation/directions
  46. 46. Building amenities
  47. 47. Elevator protocols</li></ul>Destination<br /><ul><li>Registration/check-in
  48. 48. Financial/business services
  49. 49. Patient & family waiting
  50. 50. Consent for service
  51. 51. Rooming
  52. 52. Prep or assessment
  53. 53. Chaperoning
  54. 54. Clinician notification
  55. 55. Care delivery
  56. 56. Clinical documentation
  57. 57. Ordering/ prescribing
  58. 58. Education & research
  59. 59. Patient tracking
  60. 60. Schedule follow-up:
  61. 61. Visits
  62. 62. Patient referrals
  63. 63. Testing or procedures
  64. 64. Urgent consultations
  65. 65. Sub-acute care or therapies
  66. 66. Patient satisfaction survey
  67. 67. Chart completion
  68. 68. Billing
  69. 69. Results reporting
  70. 70. Referring physician communication
  71. 71. Patient communication
  72. 72. Patient monitoring
  73. 73. Prescription management</li></ul>Areas to Consider for Modeling Key Flows<br />
  74. 74. Page 9<br />Operational Benefits<br /><ul><li>Eliminates waste
  75. 75. Decreases handoffs
  76. 76. Reduces steps and cycle times
  77. 77. Increases predictability of workflow
  78. 78. Decrease staffing requirements
  79. 79. Improves quality of outcomes
  80. 80. Defines constraints and enablers
  81. 81. Reduce errors</li></ul>Facility Impacts<br /><ul><li>Space requirements reduced
  82. 82. Fewer dedicated spaces
  83. 83. Removes walls that create silos
  84. 84. Minimizes patient movements
  85. 85. Increases opportunity to “Broadband”</li></ul>Current State - From this…..<br />Future State- to this!<br />Value Streaming Patient Flow<br />
  86. 86. Overall VSM- Patient Access to Treatment Mall- Future State<br />Page 10<br />
  87. 87. VSM- Single Clinic Visit<br />Page 11<br />
  88. 88. VSM to Design Implications<br />Page 12<br />
  89. 89. Recommendations<br />Page 13<br />
  90. 90. Page 14<br />Inside Simulation Modeling<br />
  91. 91. Page 15<br />Simulation Model - Example<br />
  92. 92. Page 16<br />Simulation Model - Example<br />
  93. 93. Page 17<br />The principal value of the simulation modeling proved to be in three areas:<br />Testing of physical capacity at peak demand conditions<br />Testing alternative operational configurations and concepts for the prep/recovery function<br />Participation of service line directors and key staff in modeling to obtain informed buy-in<br /><ul><li>Involvement of key staff to identify opportunity for improving intra-departmental and inter-departmental patient flow
  94. 94. User participation to improve project buy-in and staff morale
  95. 95. Test program with changes in operational assumptions (e.g. extended hours, increased volume)
  96. 96. Identify prep/recovery configuration that can adequately support peri-operative areas
  97. 97. Quantifying the number of rooms and resources needed to staff the new hospital
  98. 98. Identify amount of room within space program for future growth</li></ul>Case Study Benefit and Value<br />
  99. 99. Page 18<br />~ 2.5 miles<br />Lincoln Park<br />Lake Michigan<br />CMH Current Facility<br />Northwestern University Feinberg School of Medicine<br />Navy Pier<br />New CMH Campus/ Medical School<br />Case Study – Children’s Memorial Hospital<br />
  100. 100. Page 19<br />Facility Entrance <br />Point<br />Critical Care<br />How many trauma and urgent care rooms are needed? How often does each room type reach capacity? What are the implications of a bi-level ED?<br />Emergency<br />Dept.<br />What are the average wait times for a machine? How many prep and recovery spaces are needed per modality/floor?<br />Critical Care<br />NICU/PICU<br />Diagnostic<br />Imaging<br />What is the max number of rooms demanded? How often is the max reached? <br />What prep/recovery configuration is most economical? How many spaces are required? What efficiencies are gained by sharing prep and stage II areas?<br />Prep/Recovery/Obs<br />Acute<br />Procedure<br />Suite<br />What is the max number of rooms demanded? How often is the max reached? What happens to the ED when the Acute IP is full? What is the average and max wait times for a bed? <br />What time will the OR’s finish their cases at the end of the day? What operational issues arise from a bi- or tri-level operating room?<br />Psych<br />Medical<br />Patients<br />Surgical<br />Patients<br />IP Units<br />Questions Asked<br />
  101. 101. Page 20<br />Inpatient Max Utilization<br />Acute<br />Census<br />Will the IP units reach capacity during peak months? How much space is there for program growth? <br />What are the implications of adding another machine or extending operating hours on wait times? <br /> What is the impact of a full IP on the ED? <br />How late will ORs need to stay open to finish projected caseloads? <br />What is the impact of reducing turnaround? <br />Questions Answered<br />
  102. 102. Page 21<br />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 : <br />Staffing & Budgeting<br />Equipment Planning<br />Ongoing Operational <br />Analysis<br /><ul><li>Accurately account for variable costs by tracking usage rates and assigning cost information into the model
  103. 103. Printed reports of value added, business value added, and non-value added classifications
  104. 104. Quantification of staff required to maintain certain utilization rates and to ensure proper staffing resources
  105. 105. Lean value stream mapping to understand which processes add value to a work flow
  106. 106. Identify opportunities in reducing turnaround times, cost implications of standardizing medical instruments, ideal departmental adjacencies, and recovery configurations
  107. 107. Effectively track equipment utilization patterns across time
  108. 108. Illustrate outcomes of utilizing resources with different treatment times
  109. 109. Count the number of scans machines in radiology will incur in defined set of time for capital planning purposes</li></ul>Conclusions<br />
  110. 110. Page 22<br />Comments<br />Your Comments & Questions<br />For additional information or case studies please call<br />Debbie Hoffman<br />949 395-1482<br />Or Email Debbiedetech@gmail.com<br />

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