U Of I Slides 11 09


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U Of I Slides 11 09

  1. 1. Industrial Engineering in an Unusual Healthcare Setting Richard Blackwell Project Director, Process Quality Cermak Health Services November, 2009
  2. 2. Summary <ul><li>Brief history of IE and Quality </li></ul><ul><li>Background on Cermak Clinic </li></ul><ul><li>Describe the problem: distribution and administration of medications to CCJ detainees </li></ul><ul><li>Discuss the approach taken, results to date, and expected outcomes </li></ul><ul><li>Outline other IE projects being considered at Cermak </li></ul><ul><li>Discuss the potential impact of IE in healthcare and other service industry applications </li></ul>
  3. 3. Goals <ul><li>Discuss and demonstrate use of several IE techniques in an unusual healthcare setting </li></ul><ul><ul><li>Value Stream Analysis and process mapping </li></ul></ul><ul><ul><li>Six Sigma process improvement (DMAIC) </li></ul></ul><ul><ul><li>Quality Management System support of accreditation audits </li></ul></ul><ul><li>Suggest possible career directions for IE students </li></ul>
  4. 4. Who I Am <ul><li>Graduated from U of I with MSIE in 1978 </li></ul><ul><li>Career trajectory </li></ul><ul><ul><li>Manufacturing and distribution applications of OR/MS techniques </li></ul></ul><ul><ul><li>Owned my own consulting and software development company </li></ul></ul><ul><ul><li>Telecommunications from 1997 to 2009; Project and Product Management; Marketing; Quality </li></ul></ul><ul><ul><li>Currently Project Director for Process Improvement at the Cermak Clinic of Cook County Jail </li></ul></ul><ul><li>After 30+ years in Industry, I still consider myself an IE; everything else is just what I happen to be working on </li></ul>
  5. 5. Quality Management Systems - Quick Background <ul><li>Industrial Engineers (as Scientific Managers) basically invented the Quality discipline – Walter Shewhart, Joseph Juran, W. Edwards Deming </li></ul><ul><li>Starting in the 1970s, traditional Quality Control shifted to more comprehensive Systems approaches </li></ul><ul><ul><li>Good Manufacturing Practice (GMP) driven by the FDA </li></ul></ul><ul><ul><li>International Standards Organization (ISO) Certification </li></ul></ul><ul><ul><li>Malcolm Baldridge Award (Motorola the first winner in 1988) </li></ul></ul><ul><ul><li>Motorola’s Six Sigma methodology </li></ul></ul><ul><li>During the 1990s, an expansion of formal QMS Certification into new areas </li></ul><ul><ul><li>Software Engineering Institute’s Capability Maturity Model -> CMMI </li></ul></ul><ul><ul><li>ISO “Variants” (TL 9000, QS 9000, AS 9000, …) </li></ul></ul>
  6. 6. Our Approach <ul><li>Starts with Six Sigma as a structured problem-solving approach </li></ul><ul><ul><li>Methods (e.g. DMAIC) </li></ul></ul><ul><ul><li>Tools: statistical and process/problem analysis </li></ul></ul><ul><li>Uses Quality Management System certification as a goal and a club to drive organizational change </li></ul>
  7. 7. Cermak Health Services <ul><li>Part of the Cook County, Illinois Health & Hospitals System </li></ul><ul><li>Located in the Cook County Jail </li></ul><ul><li>The largest single-site correctional healthcare facility in the US </li></ul><ul><ul><li>Provides comprehensive care for ~10,000 detainees </li></ul></ul><ul><ul><li>150,000 sq ft in 129 bed infirmary plus satellite facilities within the jail </li></ul></ul><ul><ul><li>Responding to Department of Justice findings from 2008, Cermak is currently upgrading service delivery capacity and methods </li></ul></ul>
  8. 8. Industrial Engineering in Healthcare <ul><li>IEs (as Management Engineers) and other healthcare professionals have often used IE/OR/MS techniques </li></ul><ul><ul><li>Process simplification and re-engineering </li></ul></ul><ul><ul><li>Process automation </li></ul></ul><ul><ul><li>Patient safety </li></ul></ul><ul><li>Both IIE and ASQ have divisions that focus on healthcare </li></ul><ul><li>Opportunities will expand as healthcare cost containment efforts ramp up </li></ul>
  9. 9. Case Study - Medications Administration <ul><li>20% of detainees receive medication, with many receiving more than 1 </li></ul><ul><li>Patients are dispersed </li></ul><ul><ul><li>129-bed Infirmary for acute care </li></ul></ul><ul><ul><li>3 step-down intermediate care units </li></ul></ul><ul><ul><li>General population is in 247 small living units (~50 per unit) in 17 stand-alone Divisions </li></ul></ul><ul><li>A court has determined that detainees are to receive all prescribed meds within 24 hours of prescription </li></ul>
  10. 10. Complications <ul><li>Detainees move around </li></ul><ul><ul><li>Transferred at short notice, or may be in Court or school at meds admin time </li></ul></ul><ul><li>Meds distribution methods vary </li></ul><ul><ul><li>Dose by dose administration of TB, HIV, psychotropics, and controlled substances </li></ul></ul><ul><ul><li>7-day self-packs when appropriate </li></ul></ul><ul><li>Dispensed from central pharmacy and also from meds rooms in some units </li></ul>
  11. 11. The Project <ul><li>Develop a single, documented process that will be followed for all detainees in the system </li></ul><ul><ul><li>Eliminate non-Value Add steps </li></ul></ul><ul><ul><li>Shorten the fulfillment cycle to 24 hours or less </li></ul></ul><ul><ul><li>Reduce/eliminate missed or incorrect meds </li></ul></ul><ul><ul><li>Institute control of drug inventory </li></ul></ul><ul><ul><li>Reduce returns </li></ul></ul><ul><li>New process is the basis for the implementation of a new campus-wide computer system </li></ul>
  12. 12. The Approach – Six Sigma <ul><li>DMAIC process improvement </li></ul><ul><ul><li>D efine the problem </li></ul></ul><ul><ul><li>M easure the scope of the problem </li></ul></ul><ul><ul><li>A nalyze process data to understand the root causes of the problem </li></ul></ul><ul><ul><li>I mprove the system performance </li></ul></ul><ul><ul><li>Implement C ontrol system to monitor performance and prevent re-occurrence of the problem </li></ul></ul>
  13. 13. D efine Stage <ul><li>Form project team(s) and develop project charter </li></ul><ul><li>Map & document current processes </li></ul><ul><ul><li>With groups of stakeholders </li></ul></ul><ul><ul><li>By direct observation </li></ul></ul><ul><li>Develop a measurement plan </li></ul><ul><ul><li>Anecdotal data from stakeholders not usually sufficient </li></ul></ul><ul><ul><li>Six Sigma requires independent data to ensure objectivity </li></ul></ul><ul><ul><li>Measurement allows you to develop and pre-test the metrics employed in the Control plan </li></ul></ul>
  14. 14. A Process (“Swimlane”) Map Dept Process Logic Sub-Process Operation
  15. 15. Value Stream Analysis <ul><li>A more elaborate form of process mapping used in Lean </li></ul><ul><ul><li>Any step that does not add customer value is a candidate for elimination </li></ul></ul><ul><ul><li>Rich vocabulary of symbols for process steps </li></ul></ul><ul><ul><ul><li>Moves </li></ul></ul></ul><ul><ul><ul><li>Delays </li></ul></ul></ul><ul><ul><ul><li>Etc. </li></ul></ul></ul><ul><ul><li>Guides the development of a desired “Future State” from the “Current State” </li></ul></ul>
  16. 16. M easure Stage <ul><li>Based on Define stage results, Mean Prescription Flow Time and Delivery Errors per Encounter selected as targets </li></ul><ul><ul><li>In order to meet 24-hour requirement, need to know current state </li></ul></ul><ul><ul><li>Analysis of Flow Time will support determination of root causes for delays </li></ul></ul><ul><ul><li>Delivery Errors cause rework, increase mean flow time, and affect patient safety </li></ul></ul>
  17. 17. Unfortunately… <ul><li>No data is available in current computer systems </li></ul><ul><li>Current paperwork inconsistently filled out, results not tabulated </li></ul><ul><li>Measurement plan – limited sampling </li></ul><ul><ul><li>Observe meds pass and note results </li></ul></ul><ul><ul><li>Work backwards through pharmacy records to determine what was prescribed and when </li></ul></ul><ul><ul><li>Analyze monthly nursing records for actual delivery </li></ul></ul>
  18. 18. A nalyze & I mprove <ul><li>DMAIC is not strictly linear; phases often overlap </li></ul><ul><li>In this case, some of the required improvements are known </li></ul><ul><ul><li>We can use the data analysis to validate required process improvements after we start them </li></ul></ul><ul><ul><li>“ Surprises” can be leveraged as they occur </li></ul></ul>
  19. 19. Process Results to Date <ul><li>Pharmacy capacity is limited by several bottlenecks </li></ul><ul><ul><li>Manual entry of Prescriptions </li></ul></ul><ul><ul><li>Label printing & manual sort </li></ul></ul><ul><ul><li>Staging of meds for delivery to Divisions </li></ul></ul><ul><li>Administration in the Divisions contains significant non-Value Added steps </li></ul><ul><ul><li>Redundant manual data transcription </li></ul></ul><ul><ul><li>“ Unnecessary” validation of delivered meds against patient’s medical profile </li></ul></ul><ul><li>Impossible with current processes to verify that correct meds have been administered </li></ul><ul><li>Improvement approach is to document and implement one standard process </li></ul>
  20. 20. An Implementation Plan <ul><li>Present plan to Senior staff </li></ul><ul><li>Form Working Group – CQI, Pharmacy, Nursing, Medical </li></ul><ul><ul><li>Draft Context document, review with staff and Software Vendor for accuracy </li></ul></ul><ul><ul><li>Combine existing documents and process flows and adapt </li></ul></ul><ul><ul><ul><li>Eliminate non-value adding steps </li></ul></ul></ul><ul><ul><ul><li>Leverage Software capabilities </li></ul></ul></ul><ul><ul><ul><li>Define and implement metrics support elements in Software </li></ul></ul></ul><ul><ul><li>Review and revise with Senior staff </li></ul></ul><ul><ul><li>Pilot </li></ul></ul><ul><li>Review with Dept of Corrections and revise as required </li></ul><ul><li>Final approvals </li></ul><ul><li>Develop training materials </li></ul><ul><li>Train </li></ul><ul><li>Monitor & mentor </li></ul>
  21. 21. Why Is Implementation So Hard? <ul><li>Most Process Improvement Efforts Fail </li></ul><ul><ul><li>One study shows that 60% of Six Sigma projects end in partial or complete failure </li></ul></ul><ul><li>The reasons are not surprising </li></ul><ul><ul><li>People don’t like to change </li></ul></ul><ul><ul><li>Organizations change all the time, making long-term committed efforts difficult </li></ul></ul><ul><ul><li>Management commitment is hard to get and keep </li></ul></ul><ul><ul><li>Some projects just don’t make sense </li></ul></ul>
  22. 22. Improving the Odds <ul><li>Techniques exist to improve the odds </li></ul><ul><ul><li>Stakeholder & Force Field analysis: understand the management setting and risks before starting a project </li></ul></ul><ul><ul><li>Scope Management: </li></ul></ul><ul><ul><ul><li>Avoid over-commitment and “creep” by clearly documenting realistic objectives and goals </li></ul></ul></ul><ul><ul><ul><li>Avoid projects lasting > 6 months </li></ul></ul></ul><ul><ul><li>Change Management: a toolkit for overcoming resistance to change </li></ul></ul>
  23. 23. The C ontrol Phase <ul><li>Implemented using standards-compliant process documentation </li></ul><ul><ul><li>Must be supported by senior AND line management </li></ul></ul><ul><ul><li>Will face scrutiny by employee unions </li></ul></ul><ul><li>Includes key elements of a standard Quality Management System </li></ul><ul><ul><li>A performance measurement system </li></ul></ul><ul><ul><li>Internal Audit (Self-monitoring) </li></ul></ul><ul><ul><li>Management Review; Corrective/Preventive Actions </li></ul></ul><ul><li>Verified by an independent accreditation body (NCCHC) </li></ul>
  24. 24. <ul><li>Management Involvement </li></ul><ul><ul><li>Management commitment to all aspects of the Quality System </li></ul></ul><ul><li>Customer Focus </li></ul><ul><ul><li>Management is focused on Customer satisfaction, relationship development and communication </li></ul></ul><ul><li>Documented Management System </li></ul><ul><ul><li>Documentation is available that provides policy, responsibilities and records in accordance with the Quality System </li></ul></ul><ul><li>Internal Audit </li></ul><ul><ul><li>Periodically conducted to verify effectiveness of Quality System </li></ul></ul><ul><ul><li>Document / communicate audit plan and ensure independence of auditors </li></ul></ul><ul><ul><li>Reviewed by Management </li></ul></ul><ul><li>Improvement Processes </li></ul><ul><ul><li>Monitor, measure and analyze processes for conformity and improvement to products </li></ul></ul><ul><ul><li>Corrective/Preventive Actions </li></ul></ul>Continual Management Dynamics Customer Focus Documented Management System Management Involvement Improvement Processes Internal Audit Quality System
  25. 25. Other IE Projects <ul><li>Map & Streamline the sick call process </li></ul><ul><li>Map & Streamline the Mental Health care delivery processes </li></ul><ul><li>Design meds administration automation processes </li></ul><ul><li>Analyze and optimize layout and throughput of a proposed detainee admitting facility </li></ul>
  26. 26. Common IE Skills Used <ul><li>Process analysis </li></ul><ul><li>Statistical analysis of process data </li></ul><ul><li>Process design, documentation & implementation </li></ul><ul><li>Design of management metrics systems </li></ul><ul><li>Support of certification/accreditation </li></ul><ul><li>Design & implementation of process automation </li></ul><ul><li>Cross-disciplinary team leadership </li></ul>
  27. 27. Career Ideas for New IEs <ul><li>Healthcare – it’s exploding </li></ul><ul><li>Public Sector – Lord knows they can use us… </li></ul><ul><li>Software/Consulting – draw on IE training, & gets you into the game </li></ul><ul><li>Project Management – a natural step up from entry-level, and there are never enough PMs </li></ul><ul><li>Six Sigma – a natural for IEs; you already know most of this stuff </li></ul><ul><li>Lean – IE with a different name </li></ul>
  28. 28. Links and Resources <ul><li>www.punshui.com : my slides and other materials </li></ul><ul><li>www.lean.org : lots of ideas and resources re Lean methods and tools </li></ul><ul><li>www.asq.org : starting point for Six Sigma and many other directions in Quality </li></ul><ul><li>http://www.iienet2.org/SHS/Community/Default.aspx : IIE Society for Health Systems </li></ul><ul><li>http://www.asq.org/healthcare-use/why-quality/overview.html : ASQ Healthcare Division </li></ul><ul><li>www.pmi.org : professional certification for Project Managers and lots of tools </li></ul>
  29. 29. Questions?