A Faster Hospital in Five Days

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How to use Lean principles to accelerate patient flow and reduce turnaround times in a hospital lab.

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  • Lean Quick Reference Card
  • A Faster Hospital in Five Days

    1. 1. A Faster Hospital In Five Days Lean Six Sigma for Hospitals! Jay Arthur (888) 468-1537 Webinar:www.qimacros.com/training/qi-macros-webinar/#healthcare© MMIX KnowWare www.qimacros.com 1
    2. 2. A Faster Hospital in Five DaysThe Economies of Speed Rule #1: To accelerate your speed, eliminate delay. •The 3-57 Rule – Employees only work with the patient for 3 minutes out of every hour. The other 57 minutes are delay. •The 15-2-20 Rule – 15 minute/hr reduction in delay will double productivity and increase profits 20% $ •The 3X2 Rule - grow three times faster than average and double your profit margins Source: Competing Against Time© MMIX KnowWarewww.qimacros.com 2
    3. 3. A Faster Hospital Using Lean Simplify with 5S  Sort, Straighten, Shine, Standardize, Sustain Streamline with Lean  Value Stream Mapping  Spaghetti Diagramming  Inventory Reduction© MMIX KnowWarewww.qimacros.com 3
    4. 4. Simplify Your Business with 5S Sort Organizing, separating the needed from the unneeded Straighten A place for everything and everything in its place. Make it visual and self-explanatory. Shine Cleaning and looking for ways to keep it clean Standardize Maintain and monitor the first 3 S’s Sustain Discipline, stick to the rules / continuous improvement of all principles© MMIX KnowWarewww.qimacros.com 4
    5. 5. 5S Team Lab Before Lab After Clutter 5S Team removed two dumpsters of clutter Other items were red tagged and moved out of the lab.© MMIX KnowWarewww.qimacros.com 5
    6. 6. Remove the Speed Bumps of Lean•Delay•Overproduction•Waste and Rework (Defects)•Non-Value Added processing•Transportation•Inventory•Motion•Employees Unused Creativity© MMIX KnowWarewww.qimacros.com 6
    7. 7. Redesigning the Work Flow What is the current flow?  Value Stream Mapping (time)  Spaghetti Diagrams (space) What flow would reduce the speed bumps? Tools for Lean:© MMIX KnowWarewww.qimacros.com 7
    8. 8. Value Stream Mapping To Eliminate the Delays Log Evaluate Get 25 days 120 days 60 Min Request Request Backup 10 Min 45 Min Valid? Cancel Varies 45 Min Treat 1 day Diagnose 7 days Schedule 10 Min Hint: Most of the Delay is in the arrows Most of the Defects and Deviation are in the boxes Hint: Make Your Product Faster, Not Your People.© MMIX KnowWarewww.qimacros.com 8
    9. 9. A Faster ED in Five DaysPress Ganey:ED TAT Times 4+ hours (Press Ganey) 38 Min DischargedRWJ 2005: 90 Minutes Admitted © MMIX KnowWarewww.qimacros.com 9
    10. 10. A Faster OR in Five Days Copenhagen University Hospital investigating if the patient got required information from the surgeon (10 minutes), unpacking individual sterile disposables (30 minutes), waiting for missing devices (5 trips per surgery), waiting for the patient to regain consciousness (20 minutes) waiting for transport to recovery (10 minutes) Countermeasures to save 60 minutes: Surgeon draws an “X” on patient’s wristband when patient informed Prepackaged sterile disposables saved two nurses and 30 minutes. Standard checklists ensure that all materials available before start. Anesthetic depth was adjusted to wake patient when finished. 60 Hospital orderlies move patients to recovery immediately.Minutes© MMIX KnowWarewww.qimacros.com 10
    11. 11. Faster Medical Imaging in Five Days North Shore University Hospital Average turnaround time (TAT) was 20.7 hours and varied from 8-to-34 hours CT tech travel to requisition printer (6,480 feet per day) Countermeasures to save 14 hours: Relocate printer saving over 6,000 feet per day of unnecessary travel. Dedicated CT transporter Excel-based schedule maintained and viewable by all nursing units. “Pull system” adjusted patient transport to handle STAT scans. Contrast preparation was reassigned to the evening shift One CT dedicated to complex procedures to optimize patient flow. Staffing was adjusted to demand. Results: Average TAT fell from 20.7 hours to 6.45 hours 200 additional inpatient scans per month 14 60 additional outpatient scans per month Hours $375,000 in additional revenue Cancellations due to improper prep dropped from 30.6% to 22.7%. © MMIX KnowWarewww.qimacros.com 11
    12. 12. You Already Understand Lean “Cell” Design for Kitchens SINK REFRIGERATOR Rule #2: Walking is Waste! You already understand Lean! STOVE© MMIX KnowWarewww.qimacros.com 12
    13. 13. My Kitchen© MMIX KnowWarewww.qimacros.com 13
    14. 14. Spaghetti Diagram to Reduce MovementPurpose: To understand the current process.1. Layout the existing processing stations2. Become the product3. Show the flow of the product through the process.© MMIX KnowWarewww.qimacros.com 14
    15. 15. Lab Redesign Lab Before Lab In Process Reagent Refrigerator Walking Is Waste! Trash Reagent Refrigerator Spaghetti Diagram of too much travel was here.© MMIX KnowWarewww.qimacros.com 15
    16. 16. Original Lab Design CHEM COAG 500/day 80/day UA 100/day HEMO 500/day MICRO 100/day© MMIX KnowWarewww.qimacros.com 16
    17. 17. Lab Redesign Auto CHEM UA HEMO COAG CHEM HEMO Micro COAG Manual© MMIX KnowWarewww.qimacros.com 17
    18. 18. Lean Lab Results Reduced • Floor Space 17% (Goal 10%) • Staff Movement 54% (Goal 30%) • Phlebotomist Travel 55% (4 miles ~ 1.5 FTE) • Tech Travel 40% (2,304 feet 0.15 FTE) • Sample Travel 55% 23,400 feet 7 hours of delay per 24 hours© MMIX KnowWarewww.qimacros.com 18
    19. 19. Use Lean For Faster, Better Healthcare Lean Simplify Streamline Faster = Better Lean reduces mistakes by 50%© MMIX KnowWarewww.qimacros.com 19
    20. 20. Free Resources and Contact InfoLean Six Sigma Money Belt Training: www.lssmb.comLean Six Sigma for Hospitals Linkedin Group30 Day Eval Copy of the QI Macros –qimacros.com/freestuff.htmlAction Plan: qimacros.com/pdf/six-sigma-action-plan.pdfLean Six Sigma Reference Card: qimacros.com/JobAid.pdfDirty 30 Process for Six Sigma Software: qimacros.com/pdf/dirty30.pdfHandout: qimacros.com/pdf/faster-better-cheaper-healthcare.pdfJay ArthurKnowWare® International2253 S. Oneida St. Ste 3DDenver, CO 80224(888) 468-1537jay@qimacros.comwww.qimacros.com© MMIX KnowWarewww.qimacros.com 20

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