UTILIZAÇÃO DA LEAN METODOLOGIA. Desmistificando Aplicações Reais Para CME. Apresentado por John Kimsey

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1 UTILIZAÇÃO DA METODOLOGIA LEAN Desmistificando Aplicações Reais Para CME Apresentado por John Kimsey

2 STERIS LEAN CME SIMULATION SAO PAULO, RIO, PORTO ALEGRE 2

3 STERIS LEAN CME SIMULATION SAO PAULO, RIO, PORTO ALEGRE 3

4 STERIS LEAN CME SIMULATION SAO PAULO, RIO, PORTO ALEGRE 4

5 5 LEAN FOR HEALTHCARE

6 TODAY S AGENDA What is Lean? Understanding the CME Environment 6 Real Applications of Lean in CME

7 WHAT IS LEAN? Lean is a one word catch phrase to summarize operational best practices developed by Toyota focused on maximizing efficiencies. Lean is about maximizing customer value while using minimal resources. You don t have to only use the Toyota principles you can create your own best practices! 7

8 WHAT IS LEAN? R$ Hours 8 3 Phone Calls Un-Happy Customer Different Inputs for Same Output? R$80 7 Hour 0 Calls Happy Customer

9 WHAT IS LEAN? Lean CME is developing an operational plan to minimize resource use to produce a product or service that meets the Customer s requirements. 9

10 WHAT IS LEAN? With your lean operational plan in hand, you ll need to measure your performance to know if you re on or off plan. Backlog Trays in Assembly Trays in Backlog # Trays Processed Jul 1-Aug 7-Jul 8-Jul 9-Jul 10-Jul 11-Jul 12-Jul 13-Jul 14-Jul 15-Jul 16-Jul 17-Jul 18-Jul 19-Jul 20-Jul 21-Jul 22-Jul 23-Jul 24-Jul 25-Jul 26-Jul 27-Jul 28-Jul 29-Jul 30-Jul # Trays

11 WHAT IS LEAN? Lean also realizes that every process must be actively managed or else things tend to fall apart. What am I supposed to do? Your Leadership Team Your Staff Clear leadership routines are a must for every business! 11

12 WHAT IS LEAN? Lean is not a one-time event, doesn t have a final destination, and isn t something you ll finish. Toyota got it right when they decided to continuously strive to be a better car maker never being satisfied with their performance. 12

13 WHAT IS LEAN? One more important point lean is a team effort! Employee engagement is critical if you want to unleash the total potential of your operations 13

14 LEAN IS Meeting Customer Requirements Developing a Lean Plan Measuring Performance Implementing Leadership Routines Engaging Your Team Minimizing Resource Use Improving Continuously 14

15 WHAT IS LEAN? Do I need Green Belts and Black Belts and all day training sessions? NO! What you do need is people dedicated to finding a better way to do the work and a system to sustain the improvements. Experienced or knowledgeable facilitators can help start the process. 15

16 LEAN CME 16 Lean CME Measurement & Leadership Routines Minimize Resource Use Employee Engagement Continuous Improvement Lean Operational Plan Customer Requirements

17 THE CME ENVIRONMENT A quick review of the CME environment. Transport to Storage Transport Dirty Instruments to CME Clean / Disinfect Instruments Sterilize Instruments Re-assemble Instruments 17

18 THE CME ENVIRONMENT Know your environment you really are running a small business. Surgical Instrument Reprocessing Services 100% Complete, 100% Sterile, 100% On-Time, all at a Reasonable Price!!!!!! 18

19 THE CME ENVIRONMENT Running your small business. What are your customer requirements? What resources are you using? Are you improving your performance? Are you measuring your performance? How engaged is your staff? Not working in CME? The same principles apply to your department as well! 19

20 20 REAL APPLICATIONS OF LEAN

21 REAL APPLICATIONS OF LEAN Step #1a: Customer Requirements Surveys Measurable Indicators Service, Quality, Cost Instruments and Trays - # of Responses by Score Instrument trays are clean 2. Instrument trays are assembled correctly 3. Instrument trays are complete and accurate 4. Instrument in the trays work properly 5. Turn around time for trays is acceptable 6. Tray packaging is in tact (no holes, tears etc) 7. Instrument trays are labeled correctly 8. Instrument sheets are completed & signed 9. Trays have appropriate chemical indicators 10. Trays have appropriate labels w/ descriptions % of Respondent Anwers 50% 11. Trays seem to be delivered sterile on time 40% OR Customer Survey Summary 2014 OR Survey Results 2013 Desired Results Excellent Good Average Fair Poor 30% 20% 10% 0% Excellent Good Average Fair Poor 21

22 REAL APPLICATIONS OF LEAN Step #1b: Develop a CME Charter Measurements Everything you do should tie back to your Charter General Medical Center CS Charter Patient Expectations Complete, Sterile, and Working Supplies, Equipment, and Instrumentation Ready for Surgery When Required Operating Room Satisfaction Survey Average Customer Satisfaction greater than 4.1. Average Customer Perception of CS Service greater than 8.0. Operating Room Expectations 100% Instrument Trays Complete 100% Instrument Trays Clean and Sterile 100% Instrument Trays On-Time 100% Case Carts Complete 8 Hour Turn Around for Normal Processing 4 Hour Turn Around for Terminal Sterilization Quick Turns 1 Hour Turn Around for Immediate Quick Turns Hospital Floors & Clinics 100% Complete, Clean, Sterile Instrumentation Orders Fulfilled Within 4 Hours of Receipt CS Operational Expectations Zero Work Place Injuries or Health and Safety Issues < 10 Trays on the Shelf Waiting to be Assembled at 7am < 50 Trays on the Shelf Waiting to be Assembled at 3pm < 20 Trays on the Shelf Waiting to be Assembled at 11pm 100% Compliance to Work Instructions and Department Policies > 90% Productivity 22 CS Staff Satisfaction Survey Average Staff Satisfaction greater than 4.1. Average Staff Perception of CS Service greater than 8.0.

23 REAL APPLICATIONS OF LEAN 23 Step #2: Develop a Lean Operational Plan

24 REAL APPLICATIONS OF LEAN Step #2a: Determine Customer Demand / Volume Activities Frequency Month, Week, or Day Volume per Frequency Decontamination of OR Items (5.6 trays per case) Week 2499 Decontamination of Clinics and Floor Trays (220 per week) Week 220 Daily Decontamination clean up Day 2 Daily washer and detergent checks Day 1 Daily washer tests and record results Day 1 Endoscopy tower cleaning Day 2 24

25 REAL APPLICATIONS OF LEAN Step #2b: Determine Resource Requirements Activities Frequency Month, Week, or Day Volume per Frequency Standard in Minutes (per 1 volum e) Decontamination of OR Items (5.6 trays per case) Week Decontamination of Clinics and Floor Trays (220 per week) Week Daily Decontamination clean up Day Daily washer and detergent checks Day Daily washer tests and record results Day Endoscopy tower cleaning Day Setting Time Standards: Start with something doesn t have to be perfect or fastest but set a baseline and then improve. FTE's 25

26 REAL APPLICATIONS OF LEAN Step #2c: Create a Balanced Process 29 Average Incoming Items Line Balancing: Items Per Hour 43 Peak Incoming Items 30 Prep Sink Capacity 48 Washer Capacity 31 Assembly Capacity 59 Sterilizer Capacity Average Incoming Items Line Balancing: Items Per Hour Peak Incoming Items Prep Sink Capacity 48 Washer Capacity 40 Assembly Capacity Balancing the Process: Start with the basics don t get too complicated. 45 Sterilizer Capacity 26

27 REAL APPLICATIONS OF LEAN Step #2d: Build a Value Stream Workflow: Series of activities / processes through which a product or service passes. Example: A workflow may encompass 15 activities taking 12 hours to complete. 27

28 REAL APPLICATIONS OF LEAN Step #2d: Build a Value Stream Value Stream: Activities required to add value to the product or service to meet customer requirements and changes the fit, form or function of the item. Example: The value stream within the workflow may encompass 10 activities taking only 6 hours to complete. 28

29 REAL APPLICATIONS OF LEAN Step #2d: Build a Value Stream Lean: Removes the gap between current workflow and the value stream. Example: Moving from 15 activities to 10 activities and reducing processing time from 12 hours to 6 hours. 29

30 REAL APPLICATIONS OF LEAN Step #2d: Build a Value Stream Simple Value Stream Map Instrument Processing Transport to CME Transport to Storage Wait Wait Decontam Sterilize Wait Wait Assembly Missing Item 30

31 REAL APPLICATIONS OF LEAN Step #2d: Build a Value Stream 31 Detailed Value Stream Map Instrument Processing

32 REAL APPLICATIONS OF LEAN Step #2e: Implement Standard Work Standard Work is key to: Ensuring staff are performing tasks The Way We Do It not The Way I Do It Ensuring regulatory compliance Creating a culture of adherence Involving staff participation Improving Supervisory follow-up 32

33 REAL APPLICATIONS OF LEAN Step #2e: Implement Standard Work Standard Work is The Wedge Without standardization, all my improvements will disappear over time Standardization is a tool that ensures your improvements will be sustained. 33

34 REAL APPLICATIONS OF LEAN Step #2f: Drive for Continuous Flow Process Cycle Time: Continuous Flow OR Case Ends Wait Transport Tray to CS Wait Prep for Washer Wait 256 Minutes Processing Time or Cycle Time (4 hrs 16 mins) Washer Cycle 0 Mins 0 Mins 10 Mins 0 Mins 6 Mins 0 Mins 35 Mins Wait Assemble Wait Sterilize 0 Mins 15 Mins 0 Mins 60 Mins Cool Down 120 Mins Wait Transport to Storage 0 Mins 10 Mins Activities = 256 Mins Wait = 0 Mins 34

35 REAL APPLICATIONS OF LEAN Step #2f: Drive for Continuous Flow Example - Broken Continuous Flow OR Case Ends Wait Transport Tray to CS Wait Prep for Washer Wait 847+ Minutes Processing Time or Cycle Time (14 hrs 07 mins) Washer Cycle 0 Mins 15 Mins 15 Mins 30 Mins 10 Mins 32 Mins 35 Mins Wait Assemble Wait Sterilize 360+ Mins 25 Mins 30 Mins 70 Mins Cool Down 120 Mins Wait Transport to Storage 90 Mins 15 Mins Activities = 290 Mins(+34) Wait = 557 Mins 35

36 REAL APPLICATIONS OF LEAN Step #2f: Drive for Continuous Flow Align Staff Schedules with Incoming Workflow CS Staff Required vs Scheduled Decontam Req'd Assembly Req'd Sterilize Req'd Staff Scheduled 12.0 Creating Backlog Catching Up :00 8:00 9:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:00 21:00 22:00 23:00 0:00 1:00 2:00 3:00 4:00 5:00 6:00

37 REAL APPLICATIONS OF LEAN 37 Step #3: Measure Performance

38 REAL APPLICATIONS OF LEAN Step #4: Implement Leadership Routines Now I know what to do! Your Leadership Team Your Staff Ensuring real time operations are performing to plan. 38

39 REAL APPLICATIONS OF LEAN Step #5: Engage Employees Develop Self Directed Work Teams Provide Clear Mission and Vision Believe in the Charter and Performance Measures Measurements of Success # Improvement Suggestions per Month per Staff # Implemented Suggestions per Month Lean Improvement Suggestions # Suggestions # Implemented Jan Feb Mar Apr May June 39

40 REAL APPLICATIONS OF LEAN Step #6: Eliminate Waste Step #7: Continuously Improve Only after building the foundation and roof and engaging the staff, can a department truly be ready to begin the Lean journey of Eliminating Waste and Continuous Improvement. 40

41 REAL APPLICATIONS OF LEAN Step #6: Eliminate Waste Removing the non-value added activities, motions, clutter and other items that slow down the process, waste resources, cause poor quality, and inhibit meeting customer expectations. Step #7: Continuously Improve Changing how activities are performed to improve performance and set new standards. 41

42 REAL APPLICATIONS OF LEAN Waste In order of importance to CME Waiting Products and people Defects Excess Motion Products and people Transportation Products and people Underutilized People Excess Inventory Overproduction Excessive Processing 42

43 REAL APPLICATIONS OF LEAN Waiting Eliminate It! Implement continuous flow Align staff schedule to workload Increase staff skills Ensure staff never have to wait to start a task, move to a secondary task, or ask what to do next Maximize uptime on bottleneck operations 43

44 REAL APPLICATIONS OF LEAN Defects Eliminate Them! Prevent Errors at the Source Create standard work Ensure documented instructions are current Create visual controls to ensure compliance Ensure proper training and follow-up is in place Measure errors and address root causes Utilize technology to provide information and error proofing visual aids at point of work 44

45 REAL APPLICATIONS OF LEAN Excess Motion Reduce It! Movement of people, material, or products that does not add value Layout department to minimize movements Move required supplies, materials, products closer to the work stations Avoid double handling of items one touch is the goal cut your touches in half Set up Workstations ergonomically to minimize walking, reaching, bending 45

46 REAL APPLICATIONS OF LEAN Excess Motion Reduce It! Simple everything routinely used within easy reach Streamlined and Simplified in Decontamination 46

47 REAL APPLICATIONS OF LEAN Transportation Reduce It! Design the workspace to minimize the distance for work to be moved, remove cross-flow, minimize handling Clean up the preference cards to eliminate 30% return unused rates from case carts Never walk to or from someplace without taking or bringing back something Cut floor runs or restocking trips in half and save the walking 47

48 REAL APPLICATIONS OF LEAN Decontamination Eliminate Waste People or instruments waiting Instruments not cleaned Supplies not close by Excess movement OR mixes dirty and clean instruments Visual management Manage productivity Continuously Improve Match staff to workflow Navigator position Linear flow / inline sinks Technology for information 48

49 REAL APPLICATIONS OF LEAN Decontamination Examples Navigator staff handles carts, scans, delivers work to stations and maintains flow Wash technicians stay at stations working to improve throughput Inline Sinks with Sonic Close to Washer Low Temp Assembly and Sterilization with Windows Hand Wash with Two Pass Through Windows Vendor Room with Windows 49 Scope Room

50 REAL APPLICATIONS OF LEAN Assembly Eliminate Waste Supplies not close by Reduce interruptions Looking for missing instruments Work assignments Visual management Manage productivity Quality inspections Incorrect incomplete count sheets Continuously Improve Match staff to workflow Navigator position Wrapping position Linear flow Separate low temp Reduce # of instruments in trays Technology for information 50

51 REAL APPLICATIONS OF LEAN Assembly Examples 51 Conveyor to move trays to sterilizer person

52 REAL APPLICATIONS OF LEAN Sterilization Eliminate Waste Supplies not close by Reduce interruptions Visual management Manage productivity Secondary work assignment Continuously Improve Match staff to workflow Linear flow Technology for record keeping Technology for quality systems 52

53 REAL APPLICATIONS OF LEAN The Three D s of a Lean Journey DELAY: Remove delays, backlogs, and waiting from your process DEFECTS: Remove errors, defective products DEVIATION: Remove variance in processes and how staff perform their work 53

54 REAL APPLICATIONS OF LEAN Real Life CME Results: Reduced Delay, Defects, and Deviation Performance Measurements Baseline Min-Avg-Max Results Min-Avg-Max Trays Waiting to be Assembled 7am % Complete Instrument Trays 90% - 96% - 99% 93% - 97% - 99% % Complete Case Carts 42% - 76% - 96% 89% - 97% - 100% # of Quality Errors per Day Insufficient Data CS Productivity = Hours Per Tray

55 % of Respondent Anwers REAL APPLICATIONS OF LEAN Real Life CME Results: Improved OR Satisfaction OR Customer Survey Summary OR Survey Start of Project OR Survey End of Project Desired Results 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Excellent Good Average Fair Poor 55

56 REAL APPLICATIONS OF LEAN 56 Real Life CME Results: 7AM Before Lean

57 REAL APPLICATIONS OF LEAN 57 Real Life CME Results: 7AM After Lean

58 QUESTIONS Copies of Principles of LEAN CME available at the STERIS booth. Lean CME Measurement & Leadership Routines 58 Minimize Resource Use Employee Engagement Continuous Improvement Lean Operational Plan Customer Requirements

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