Concord Hospital ASQ Meeting May

Transcription

1 Concord Hospital ASQ Meeting May

2 About Us Mission & Values Charitable Organization: we exist to meet the health needs of individuals within the communities we serve Leadership Caring Stewardship Integrity Continuous Improvement Statistics Opened in 1891 FY12: $38 million in total community benefits (incl. financial svcs, subsidized health svcs, education and community health svcs) Approximately 3300 employees 295 Licensed beds 17K+ admissions (fy 2012) 40 Medical Specialties & Subspecialties ~67K Emergency visits / year busiest ED in New Hampshire

3 Lean Journey 2010 CH selects staff: Belmont University Lean Certification CH hires PRHI (Pittsburgh Regional Health Initiative) for Lean consultancy 2011 (fall) Hand-off to (new) Director of Lean Operations

4 Lean Approach & Philosophy Lean is a management strategy, a way of thinking Method for redesigning systems to focus on the patient Emphasis on continuous improvement, teamwork, learn by doing, process/systems, and elimination of waste Ultimate goal is perfection VALUE is realized through Mutual Respect, Shared Responsibility, and developing people/partners; it enables higher performance. RIGHT PROCESS, RIGHT RESULTS RIGHT PROCESS, RIGHT RESULTS is fortified in a Culture of Improvement Standardization affords the basis of improvement. CONTINUOUS IMPROVEMENT drives organizational learning; mental models are changed through Deep Personal Experience. LONG TERM PHILOSOPHY in seeking Perfection in the Patient Experience delivering value on demand.

5 Current Framework A3 Process 8-Wastes ( DOWNTIME, or TIM WOODS ) Defects, Over-production, Waiting, Not best use of human creativity, Transportation, Inventory, Extra-processing 9 Basic Lean Tools Takt time, Time Observation, Bar Chart, Spaghetti Diagram, Communication Diagram, Pull, Standard Work, 6S, Flow Value Stream Analysis FMEA (brand new concept to CH, focus: Patient Falls) Partner with Organizational Development Department

6 A3 as an Improvement Strategy: Management System Strategy & Objectives Defined specific to the Value Streams identified Quality /Safety Cost Human Dev & Satisf n Time Growth Examples of Organizational Value Streams: INPATIENT CARE DIAGNOSTIC CARE REVENUE CYCLE PERI OP CARE A3 Plan for Work Priority Developed Examples of Value Stream Analysis A3 s: VSA ED 2P Unit Redesign VSA Discharge Readiness VSA PeriOp /URO A3 at the Tactical Level Examples of Front Line A3 s: Specialty Beds A3 RN Assignmt A3 ITS New Hire A3 IV Pump Handling A3 Emergent Blood A3 Pain Mgmt A3

7 Value Stream: Perioperative Svcs

8 Value Stream: Emergency Dept.

9 EXAMPLE: A3 WORK Emergency Department Environmental Services Expectations

10 CURRENT STATE overall picture or summary data ED Cleaning Coverage v. Rooms Discharged per Hour Peak discharge time (3pm 2am) averages 8-11 discharge per hour

11 Identified Current State: Target metrics TIED to ED Value Stream, System Level as well as discrete metrics specific to the Environmental Services process within the ED Standard v. Non-Standard Work V.O.C.: Patient Satisfaction (Press Ganey Standardized Survey Questionnaire, target questions) Staff Satisfaction (adhoc survey/targeted colleague audiences) Investigate adherence to Safety guidelines Timeliness & Effectiveness Measures (Audit Data)

12 Gaps in Standard Work: ED Room Turnover Process Main Cleaning Tasks Steps involved in each task Barriers to completion of task

13 Gap Analysis: Room Cleaning Video OBSERVATIONS: No Standard Room Turnover Practice No logical order to completing the steps Hygiene opportunities Colleague personal protection & handling safety issues Disinfectant dwell time opportunities (timing vs. need for room) Infection Control training opportunities

14 Developed Future State Standardized Room Cleaning Checklists for each Schedule

15 Assignment Plans

16 Experiments/Completion Plans 1. ED staff meetings would include Environmental Services adhoc/as need arises 2. Effective Infection Control Training (mission/purpose the WHY ) 3. Staff empowerment to hold one another accountable for quality of work 4. Vocera for Staff 5. Change cleaning agent (expedite dwell) 6. Pro-active linen removal 7. Parallel process (pre-made stretchers during busy hours 8. Documented standardized work, laminated reference for Staff 9. Training for RN-ES Staff for efficient Communication and Visual Cues (action at-a-glance) 10. Map of assigned areas (Visual Management/6S)

17 RESULTS Process Flow Metric Current State Future State (expected results) Change # Steps % Flow Time (total time) 8-15 mins 5-10 mins 33 % # Gaps Identified # Computer Systems (accessed) 1 1 No Change CONTRIBUTED TO 10 MIN REDUCTION, PATIENT ARRIVAL ROOM ROOM TIME

18 Insights & Learnings (team) Positive Having nursing and and ES ES involved together to to see see big big picture Mapping out out discharges on on an an hourly basis. Helped to to see see the the needed eded allocation of of resources and and gaps gaps of of resources. Having a mentor to to guide guide us us through the the A3 A3 process. Video Video highlighted inefficiencies with with the the initial initial process which led led to to infection control consult Learned a lot lot about about the the Lean Lean process and and how how to to apply apply it it to to other r processes Negative Not enough ED and ES ES staff involved to to properly identify all all the assigned task time and roles elongated the experiment phases Neutral Time Time it it took took to to carry carry out out the the process

19 OTHER LEAN WORK 1. 6S, various office/clinic 2. Nursing flow 3. Patient Quality focus, Core Measures 4. Expedited Blood processes 5. Walk-in Care patient flow 6. Inventory Reduction 7. New Hire process 8. Revenue Cycle value stream 9. Performance Improvement Data reporting 10. Medication Prior Authorization process 11. many more A3 s!!!

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