Kaizen Event Report-Out Presentation Right Sizing Linen New England Rehab Hospital

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1 Kaizen Event Report-Out Presentation Right Sizing Linen New England Rehab Hospital November 14-15, 2011 Jeanine s Green Belt! 1

2 Kaizen Definition The word Kaizen is a Japanese word that simply means Change for the Good! Most importantly, Kaizen is about making change happen with continuous incremental improvement with empowered teams! 2

3 Kaizen Process 3 3 November: Preparation Nov 14 (8-noon): Training, Discovery & Analysis Nov 14 (noon-4pm): Solution Brainstorming Nov 15 (8-noon): Idea Validation & Implementation Nov 16 +: Result Follow Up

4 Special Thanks! Floor Staff Surveying rooms Housekeeping Jim, Tom Kaizen participant managers Nurse Manager, EVS, Linen Services 4 Other Pam Cline, Scott (Marketing), Richard (MMC Engineering)

5 Team Members James Mangini, Linen Services Clyde Ramsdell, Linen Services PetroniloRodriguez (Pete), EVS Lead Associate Jesse Gage, RNT II Hannah Maltby, RNT I Aline Schultz, RNT II Debora Mambuca, InfControl Practitioner Courtney Webb, Physical Therapist 5 Wendy Dibrigida, Occupational Therapist

Maltby, RNT I Aline Schultz, RNT II Debora Mambuca, InfControl

6 Kaizen Overview Our Team s Goal: Improve linen costs & implement sustainable systems Problem Statement The proper amount of clean linen is not always available Linen is being used for non-linen uses Linen inventory levels have never been "right sized causing excess cost for storage or excess complaints for lack of linen Patient use area linen storage has never been standardized to maximize efficiencies and reduce searching/obtaining linen 6

levels have never been "right sized causing excess cost for storage or excess complaints for lack of linen

7 Kaizen Overview Scope Clean Linen with NERHP Dock to stock Departments involved are Environmental Services, Nursing and Therapy Metrics Reduce inventory levels from 26,000 lb/month and $14,000/month Reduce the # of retrievals thus allowing Nurses to do other things Reduce the # of complaints from 50 per week 7 Increase patient and staff satisfaction from complaining to proclaiming

lb/month and $14,000/month Reduce the # of retrievals thus allowing Nurses to do other things

8 Discovery What did we observe? 3 Teams. 2 hours in the GEMBA. 1.Data & Process (Clyde, Aline, Courtney) 2.Patient Rooms (James, Wendy, Hannah Vanna ) 3.Linen Rooms/Closets (Pete, Jesse, Debora) 4.Kaizen discovery coordination (Jeanine, Matt) 8

9 Discovery What did we observe? Wrong size for the job (opportunity for soiling more linen$$) Inadequate quantity, stock-out, in wrong place, clutter Throwing away excess & not using the best linen for the job 9

10 Discovery What did we observe? 1. Excess motion:30 retrievalsin one hour. Etimated300 retrievals per day * 2 minutes per retrieval = 10 hours per day. 5 of those hours are waste. 18 delivery locations serviced3 times daily and 6 days per week 2. Excess delivery time that inhibits proper response time, causes complaints, increases the cart s safety hazard time and may result in stock-out s 10 Gym: 2 spots PT: 2 spots 1 st floor: 4 spots 2 nd floor: 10 spots

18 delivery locations serviced3 times daily and 6 days per week 2.

11 Discovery What did we observe? Shower rooms: Rod is less than 18 below ceiling (fire hazard) No shelving for staging (avoid infection/soiled linen) Room is too small (causing staff to bring in a large batch of linen waste!) Not every room had a trash or sharps container (no standardization) Inadequate drainage & curtain containment (causing a lot of linen to be used on floor) Mopping with linen (increasing soiled linen cost) 11

infection/soiled linen) Room is too small (causing staff to bring in a large batch of linen waste!

12 Discovery What did we observe? Patient rooms: No standard location to store linen in each room Excess is automatically giventoeach new patient (and typically stored on window sill) No consistency on how much linen per new patient (2 pillows, 2 pads, warm blanket in cold season) 12 Used under chairs to move (preventing floor scratches, but increasing soiled linen cost)

giventoeach new patient (and typically stored on window sill) No consistency on how much

13 Discovery What did we observe? Non-linen uses: Spill & condensation prevention Under chairs to move across floors & prevent scratching Foot, Ankle, Knee, Back, Neck 13 Crash Cart liner/ cover

14 Discovery What did we observe? No adequate policy or procedure or adherence to a consistent process: Ambulatory 2. Ripped johnny s 3. Bed bugs 4. Preventing stock-out s 5. Preventing linen from falling off carts 6. Setting up a new patient s room 7. Changing linen during stay 8. Cleaning a shower room 9. Stocking the 9 2nd floor linen closets Ambulatory taking linen 10. Getting stocked-out linen (call, page, housekeeping, go to another room or floor or area)

Setting up a new patient s room 7. Changing linen during stay 8. Cleaning a shower room 9.

15 Analysis What tools did we use? Process mapping Waste identification Standard Work training Affinity diagram Priority Payoff matrix Time/Motion study 15

16 Analysis What did our data tell us? 30 key issues Tools, methods, habits & policies 2 Parking Lot ideas Linen color & larger bath towels 2 future kaizen ideas Linen cart swapping, Pin Notebook More than $16,000 in annualized inventory cost savings Reducing PAR levels, right sizing par levels 16

color & larger bath towels 2 future kaizen ideas Linen cart swapping, Pin

17 Solutions What did we validate? We validated many ideas with staff Right number of linen for a new patient & caring for a patient (under-pad, blankets) New process for distributing linen New process for managing soiled, heavily soiled & ripped linen Patient related process changes, for example, unoccupied beds, room transfers, positioning, shower room

a patient (under-pad, blankets) New process for distributing linen New process for

18 Solutions What did we implement? Training aids: Laminated placards: Window sill On bathroom wall On patient bulleting board Inside each PIN (patient information notebook) On window sill Door Pt Bulletin Board PIN

19 Solutions What did we implement? Training aids: Communication flyer s: Upstream to hospital liaisons Staff handout What s changed (toeach shift, RN manager & signed) On staff bulletin board Linen tip of the month PIN Bulletin Board

20 Solutions What did we implement? Adjust inventory: Updated Par Levels in the computer system MaineMed will supply only the PAR level and sorted Right Sized each linen storage area Labeledshelvesin linen closets/cabinets with item name and PAR quantity (not to exceed #) Straightened and labeled nurse unit linen carts

supply only the PAR level and sorted Right Sized each linen storage area

21 BEFORE AFTER

22 Solutions What did we implement? Linen solutions for non-linen use: Paper clothing protectors Sternal Pillows Spill clean up Cart Covers No personal use of linen Water pitcher coasters Patient positioning Shower & spill clean up Teen Johnny s instead of cutting them

23 Solutions What did we implement? Process changes: No distributing to patient rooms (except new patient setup) New patient setup with standard linen Nurses stock 9 R2 linen closets only to PAR levels No using tape on linen Use a moist hot pack to avoid burn and excess linen use Heavily soiled & damaged linen have a new bag Sorting linen in basement (distributing time will be shorter)

24 Solutions What did we implement? New patient care tools: Propping/positioning will be done with blanket in a pillow case Project pads for mopping floors after patient showers & general spill clean up Bath mat s for shower floors Cart covers for linen carts Paper towel use for water pitcher coasters Project pad bag for soiled project pad s Clean, damaged Navy blue bag Future Alex machine for ambulatory dispensing Towel bars in shower rooms for staging [less] linen Teen johnny pants will be in circulation in January Linen picture & spec glossary at Nurse station

How to Conduct a Physical Inventory. Instructions. Forms. And. Sample Memos

How to Conduct a Physical Inventory Instructions Forms And Sample Memos Produced for NAILM Audio Conference Program July 20, 2006 CIRCULATING INVENTORY The total amount of linen required to operate a healthcare