Profit = Price - Cost. TAKT Time Map Capacity Tables. Total Productive Maintenance. Visual Control. Poka-yoke (mistake proofing) Kanban.

Transcription

1 GPS Mod 4 Patient PQA MUDA MUDA Cost Reduction By Eliminating Waste Just-in-Time Profit = Price - Cost GPS Depth Study NVA/VA- Functions/Mgrs Quality Cost Delivery Safety Measures Morale TAKT Time Map Capacity Tables Patient- R e d e p l o y m e n t Jidoka (human automation) Setup Reduction Changeover Multi-process Operations Standard Operations Heijunka (Leveling) Continuous Flow Total Productive Maintenance Poka-yoke (mistake proofing) Kanban Visual Control Andon Procedure/ Quantity RPIW 7 Flows Factory Kaizen Kaikuku Product/Patient Quantity Analysis 3P Prod Prep 7 Flows Medicine Analysis 4 No s Sorting Simplifying 5S Sweeping Standardizing Self Discipline 7 Wastes Module 4 Value Stream Mapping ONE PIECE FLOW TAKT TIME PULL PRODUCTION Global Production System , John Black and Associates LLC (modified from Hiroyuki Hirano, Productivity Press). 04 Patient PQA v Committed Leaders 1

2 Patient Procedure/Quantity Analysis: Key Points The purpose of Patient/Procedure Quantity analysis is to separate patients and procedures into common groups in order to: Assist in identification of a specific process or area of focus for improvement work. Provide a health care facility-level macro design for cellular service provision. Patient/procedure families are determined based on criteria such as patient grouping, process routing, procedure similarity and volume. Patients and procedures are grouped into families and displayed on a Pareto diagram. 04 Patient PQA v

3 Patient-Procedure/Quantity Analysis Purpose: This module is designed to help a team of health care providers group patients/procedures, to assist in the prioritization of a specific group of patients/procedures requiring primary focus, to assist in the design for cellular service, or to improve flow. The details of how the service is provided are covered in other modules (Continuous Flow, Pull Production, etc). Only enough detail is needed at this time to learn how to apply this method of analysis. 04 Patient PQA v

4 Prerequisites Before beginning this module, some information will need to be collected. Information on business objectives for the area. A printout of patient/procedure numbers sorted by common routings. Representative patient/procedure numbers may be sufficient. Forecasts of future work. Drawings showing current equipment layout. Blank drawings of the area. A list of available equipment. 04 Patient PQA v

5 Deliverables Description of each patient/procedure family. Drawing showing rough area layout. Flowchart showing past assignment logic. Steps: The flowchart below provides an overview of the Patient- Procedure Quantity Analysis (PQA) process. The following pages explain how to lead a team through each step. If PQA is being done to assist in identification of an area of the process needing primary focus, all of these steps may not be needed. In this case, steps 4-6 can be eliminated 1. Develop a Guiding Vision 2. Determine Services and Current Routings 3. Group Patients/Procedures Into Families 4. Identify Cells To Provide Service groupings 5. Create a Rough Area Layout 6.Outline Logic For Assigning New Patients/Procedures to Cells 7. Develop Projects and Assignments 04 Patient PQA v

6 Step 1: Develop a Guiding Vision Challenge the team to suggest new general operating characteristics of the facility that would provide a vision of the future state. Characteristics might include: Reduced lead time for standard procedures. Shorter cycle times. Implementation of a pull system. Post the vision on a wall to help guide future decisions. Review Business Objectives for the area Establish a Rough Vision for the Area 04 Patient PQA v

7 Step 2: Determine Services Provided and Current Routings Mod 4 Patient PQA The purpose of this step is to get a picture of what is happening now and what is expected in the future. We want to know what services we need to provide and how the patients are routed. Once we understand what is happening, we will have the data we need to group patients/procedures into families. Review Current Patient Routing Information Check Forecasts to Ensure Information Is Current Validate Routings to Ensure Information Is Accurate Update Routing Information Print Updated Routings to Ensure Information Is Accurate 04 Patient PQA v

8 Patient-Procedure/Quantity (PQ) Analysis Patients can be grouped into families based on common routing. The PQ Analysis process can also help to determine shared equipment needs. 04 Patient PQA v

9 Patient/Procedure Routings Used with permission of Saskatchewan Ministry of Health 04 Patient PQA v

10 % Patients Cumulative % Mod 4 Patient PQA PQ Analysis by Acuity Level Emergency Department Acuity Level 0.00 Used with permission of Joan Wellman and Associates, Inc. 04 Patient PQA v

11 PQ Analysis by Acuity Level Emergency Department Used with permission of Joan Wellman and Associates, Inc. 04 Patient PQA v

12 Step 3: Group Patients/Procedures into Families The purpose of this step is to group patients and procedures into families. Each family will share the same or a similar routing or characteristic, such as diagnosis or lab test requirements. Similar routings means that patients go through most of the same machines or processes in the same sequence. One might skip a process/machine. Another might go to an additional process/machine. Patients that backtrack through the routing at any point are less desirable. Backtracking makes cell operation more complex. Display Routings In A Pareto Diagram Group Patients/Procedures Into Families that Share The Same Routings Group Patients/Procedures Into Families that Share Similar Routings Display Updated Routings in a Pareto Diagram Identify Major Differences between Patients/Procedures In the Same Family Update Patient/Procedure Families Display Patient/Procedure Families in a Pareto Diagram Write a Description Of each Patient/Procedure Family 04 Patient PQA v

13 We looked at 100 patients and found the following: Mod 4 Patient PQA 30 patients with upper respiratory infection symptoms 50 patients with congestive heart failure 20 patients with urinary tract infection symptoms Patient goes to x-ray Patient goes to lab 04 Patient PQA v

14 Quantity of Patient/Procedure Numbers Quantity of Patient/Procedure Numbers Mod 4 Patient PQA First, create a Pareto diagram to graphically display patient/ procedure routings. The purpose of the Pareto diagram is to be able to quickly see which routings are common to the majority of patients/procedures and which are unique. The goal is to reduce the number of unique routings. Before Pareto Routing Type After Pareto A B C D E F Family Example: A= Routings 1,7,9, and Patient PQA v

15 Quantity of Patients/Procedures Per Month Cost of Patients/Procedure s Per Month x1000 Mod 4 Patient PQA Step 4: Identify Cells to Service Patient Groupings The objective of this step is to identify cells to provide service to each patient group that was identified in Step 3. Cells should be formed to service those groupings with the greatest quantities and the highest cost first. Analysis A B C D E F A B C D E F 04 Patient PQA v

16 Perform a Patient-Procedure Quantity Analysis and a Dollar Value Analysis Prioritize Patient/Procedure Groupings for Cell Formation Allocate Equipment to Service Each Patient Grouping Determine Shared Equipment Determine the Number of Cells The following are some common ways to form cells: 1. Patient Grouping Similar patients provide a logical cell grouping. The patients for these cells often require common procedures. 2. Similar Process Routing Cells are formed by grouping patients that flow through similar process sequences. For example, patients that require knee surgery and shoulder surgery. 3. Patient Exceptions These cells are generally less efficient than patient or process cells, but they may be necessary where volumes of similar patients or processes are too low to support a cell. 04 Patient PQA v

17 a. Volume Cells may be formed for low volume (specialty) patients. High-volume patients may support a cell of their own. b. Unique Patients Cells may be dedicated to specific patients where the number is small or the volume is high. The design of cells in a facility may include various types in combination: - Cell A for a specific patient grouping. - Cell B and C for typical patients. - Cell D for special patients. The process of designing cells is an iterative process. There may be considerable trial and error involved in selecting a design that balances business goals against available equipment. 04 Patient PQA v

18 Step 5: Create a Rough Layout The objective of this step is to construct a layout of the cells. It is helpful to have representatives from Support Services (Facilities, IT, Biomedical Engineering, etc.) participate in this step to discuss the feasibility of moving equipment. Perform a Utility Analysis Determine the Location of Each Cell Create a Blueprint of the New Layout 04 Patient PQA v

19 04 Patient PQA v Mod 4 Patient PQA Consider the following when planning to move equipment to form cells: Will moving the equipment: Eliminate distance to allow one-piece processing? Decrease or increase staff waiting time? Reduce other wastes such as movement, excessive handling, or inventory? Make it easier to move the equipment again to accommodate changing requirements? Impact the external environment with discharges such as wastewater, steam, dust, or smoke? Be prohibitively expensive? Impact the work environment with heat, noise, vibrations, light, or dust? Create or ease ergonomic problems, such as requiring the operator to lift, reach, bend, or engage in other repetitive or uncomfortable motions?

20 Step 6: Outline Logic for Assigning New Parts to Cells An approach for capturing the logic for assigning patients to a cell is to create a flowchart, based on the similarities and differences that have been identified. See the following example: Identify Significant Similarities Between Patients/Procedures Assigned to Each Cell Identify Significant Similarities Between Patients/Procedures Assigned to Different Cells Create a Blueprint of the New Layout 04 Patient PQA v

21 Start UTI = Urinary Tract Infection URI = Upper Respiratory Infection CHF = Congestive Heart Failure UTI Patient? Yes Assign to Cell 1 No URI Risk? Yes CHF Patient? Yes Assign to Cell 2 No No CHF Patient? No Assign to Cell 4 Assign to Cell 3 04 Patient PQA v

22 Step 6: Develop Projects and Assignments The objective of this step is to identify the actions that are needed to ensure that the results of this exercise are achieved. Review Module Deliverables Develop Projects and Assignments 04 Patient PQA v

23 The action plan form is a way to document the actions. See the example below. It is important that a process be established to follow-up, review status, and provide help if necessary. Without such a process, the objectives and the associated savings will not be achieved. Action Plan Form What Who How When Comments Action Items Primary Responsibility Support Responsibility Deliverables Process Check Dates Completion Date Further Action Patient PQA v

24 Patient-Procedure/Quantity Analysis Summary PQ Analysis is a process that can help prioritize improvement focus, design cellular service, or improve flow. Regardless of the goal, it always starts with a guiding vision and ends with projects and assignments. 04 Patient PQA v