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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
A Faster Hospital in Five Days
The 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
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
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
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
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
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
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
A Faster ED in Five Days




Press Ganey:
ED TAT Times                    4+ hours (Press Ganey)

               38 Min        Discharged
RWJ 2005:
                90 Minutes
                    Admitted
  © MMIX KnowWarewww.qimacros.com                  9
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
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
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
My Kitchen




© MMIX KnowWarewww.qimacros.com   13
Spaghetti Diagram
         to Reduce Movement
Purpose: To understand
   the current process.
1. Layout the existing
   processing stations
2. Become the product
3. Show the flow of the
   product through the
   process.


© MMIX KnowWarewww.qimacros.com   14
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
Original Lab Design

            CHEM             COAG
           500/day           80/day


              UA

           100/day           HEMO

                             500/day
                     MICRO
             100/day
© MMIX KnowWarewww.qimacros.com        16
Lab Redesign
                Auto


              CHEM                UA
              HEMO
              COAG


               CHEM
               HEMO
                              Micro
               COAG
               Manual



© MMIX KnowWarewww.qimacros.com        17
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
Use Lean For Faster, Better
          Healthcare
            Lean          Simplify
                          Streamline

         Faster = Better
  Lean reduces mistakes by 50%

© MMIX KnowWarewww.qimacros.com   19
Free Resources and Contact Info
Lean Six Sigma Money Belt Training: www.lssmb.com
Lean Six Sigma for Hospitals Linkedin Group
30 Day Eval Copy of the QI Macros –qimacros.com/freestuff.html
Action Plan: qimacros.com/pdf/six-sigma-action-plan.pdf
Lean Six Sigma Reference Card: qimacros.com/JobAid.pdf
Dirty 30 Process for Six Sigma Software: qimacros.com/pdf/dirty30.pdf
Handout: qimacros.com/pdf/faster-better-cheaper-healthcare.pdf




Jay Arthur
KnowWare® International
2253 S. Oneida St. Ste 3D
Denver, CO 80224
(888) 468-1537
jay@qimacros.com
www.qimacros.com

© MMIX KnowWarewww.qimacros.com                                         20

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A Faster Hospital in Five Days

  • 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. A Faster Hospital in Five Days The 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. 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. 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. 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. 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. 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. 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. A Faster ED in Five Days Press Ganey: ED TAT Times 4+ hours (Press Ganey) 38 Min Discharged RWJ 2005: 90 Minutes Admitted © MMIX KnowWarewww.qimacros.com 9
  • 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. 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. 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. My Kitchen © MMIX KnowWarewww.qimacros.com 13
  • 14. Spaghetti Diagram to Reduce Movement Purpose: To understand the current process. 1. Layout the existing processing stations 2. Become the product 3. Show the flow of the product through the process. © MMIX KnowWarewww.qimacros.com 14
  • 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. Original Lab Design CHEM COAG 500/day 80/day UA 100/day HEMO 500/day MICRO 100/day © MMIX KnowWarewww.qimacros.com 16
  • 17. Lab Redesign Auto CHEM UA HEMO COAG CHEM HEMO Micro COAG Manual © MMIX KnowWarewww.qimacros.com 17
  • 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. Use Lean For Faster, Better Healthcare Lean Simplify Streamline Faster = Better Lean reduces mistakes by 50% © MMIX KnowWarewww.qimacros.com 19
  • 20. Free Resources and Contact Info Lean Six Sigma Money Belt Training: www.lssmb.com Lean Six Sigma for Hospitals Linkedin Group 30 Day Eval Copy of the QI Macros –qimacros.com/freestuff.html Action Plan: qimacros.com/pdf/six-sigma-action-plan.pdf Lean Six Sigma Reference Card: qimacros.com/JobAid.pdf Dirty 30 Process for Six Sigma Software: qimacros.com/pdf/dirty30.pdf Handout: qimacros.com/pdf/faster-better-cheaper-healthcare.pdf Jay Arthur KnowWare® International 2253 S. Oneida St. Ste 3D Denver, CO 80224 (888) 468-1537 jay@qimacros.com www.qimacros.com © MMIX KnowWarewww.qimacros.com 20

Editor's Notes

  1. Lean Quick Reference Card