Focus Conference 2014 Orlando Florida. Angela Lorenzo, MS, RRT, RPFT VA NY Harbor Healthcare System Long Island University

Transcription

1 Focus Conference 2014 Orlando Florida Angela Lorenzo, MS, RRT, RPFT VA NY Harbor Healthcare System Long Island University

2 Desk Set (1957)

3 Desk Set (1957)

4 The computer generated pink slips for every employee in the organization

5 Improving Healthcare Delivery Manufacturing led the way in terms of process improvement Early processes in healthcare involved LOS and cost On the surface it seems the bottom line is quite different But is the bottom line all that different? In a good organization: No

6 Evolution of LEAN Methodology The Venetians standardized the production of ships as early as the 1600 s using interchangeable parts and a production line These ships Not These From Venipedia

7 Evolution of LEAN Methodology 1799 Eli Whitney s musket manufacturing business standardized parts so they were interchangeable At the same time Simeon North was doing the same in the same industry in the same area

8 Evolution of LEAN Methodology Frederick W. Taylor ( ) known as the Father of Scientific Management Time and motion studies lead to innovations that improved productivity (published 1911) This is his greatest accolade and his greatest criticism

9 Evolution of LEAN Methodology Standardization of management and production processes Tools Work methods Instruction/Task cards for workers

10 Evolution of LEAN Methodology Taylor s 4 Principles of Management 1. Developing a true management science 2. Scientifically selecting the workforce 3. Scientifically developing the workforce 4. Intimate and friendly cooperation between management and labor From: Talyor s book titled Scientific Management provided by

11 Evolution of LEAN Methodology Henry Ford: Sakichi Toyoda: 5 Whys and Jikoda or Intelligent Automation: Have production equipment shut down the production line if a defect is detected Kiichiro Toyoda: Sakichi s son, began Toyota Motor Corporation 1937

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13 Evolution of LEAN Methodology Kiichiro Toyoda began the Just in Time philosophy. Produce What is needed When it is needed How much is needed Reduce Waste in all aspects of process Simplify Redesign

14 Evolution of LEAN Methodology Taichii Ohno: put JIT production together at Toyota: Toyota Production System and LEAN thinking

15 Evolution of LEAN Methodology Kaizen: change for the better More value to end user of product Reduces waste Improves quality Reduces costs Continues improvement Similar efforts were made in U.S. during wartime to increase production to meet needs

16 7 Types of Waste 1. Transportation: excessive movement of staff, information, equipment Think of the location of equipment staff need and where it is located. Do they have to leave patient care areas where they provide care, i.e. value to the patient, i.e. customer? How have we reduced this? How can we reduce it more?

17 7 Types of Waste 2. Waiting Staff Supplies Equipment Information

18 7 Types of Waste 3. Motion Motion of people that doesn t add value Tools to reduce wasted motion: 5S Workplace Organization Sort Straighten Scrub Standardize Sustain

19 7 Types of Waste 4. Inventory Cost: space, cash flow, work in process Have what you need Need to assess what

20 7 Types of Waste 5. Over-processing Does anyone use all the stuff in a ventilator circuit package? We re paying for it!

21 7 Types of Waste 6. Defects Time What are they What is causing them

22 7 Types of Waste 7. Overproduction Producing more product/having more services than the customer/patient/doctor/facility is ready for Creates the other types of waste!

23 5S A place for everything and everything in its place

24 Why 5S Promotes teamwork: shared work, resources which can be readily identified, less waste Promotes effectiveness: less waste when organized in a manner in which all are familiar Promotes positive impressions: potential employees, Reduces stress: have resources ready when needed, when not.. By the way, the words of 5s originated in Japanese and are translated. May vary depending upon resource you are using

25 5S and Shared Workspace Most useful in a shared workspace environment Can be wasteful and counterproductive if not shared Use a blood gas lab as an example

26 Sorting Chances are if you can t even remember what something was used for you don t need it anymore Are some of your coworkers emotionally attached to stuff that hasn t been used since the MA-1? What if I really need it one day? Not likely

27 Sorting Red Tag items that are not being used and most likely will never be used Tag should identify item and review date Leave tag for a specified time frame (id d on tag) Have all users review red tags, a kind of red tag sale! Identify who will move these items out if unclaimed Some items are trash, some have use to others in the organization. Do you have a red tag area?

28 Sorting: Red Tag

29 Red-Orange-Green Tags Red tag: goes to trash Orange tag: not needed, someone might have use Green tag: keep Visual management: need to see what you have Re-organize inventory Danger: everyone needs to know what is where-don t make this an evolutionary process Shelving: not enough or too much

30 Value Stream Lets you see where your waste is Sequence services provided to patients Going to the Gemba Map out all the steps/actions/processes from start to finish Spaghetti diagrams

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32 Breezetree.com

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34 Examples of Value Stream Mapping

35 3 Types of Work Value-Added Beneficial to patient, facility, Incidental No way around it, needed for process Pure Waste Ouch

36 Value Stream Process Specify value Select the team Select the process Collect data and map it Analyze data/current state Design future map Create action plan Measure benefits

37 Kaizen Improvement Change for the best Countless management, data collection, process evaluation tools in Kaizen

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39 Oxygen Delivery Supplies Hospital encompasses an entire NYC block 20 N-S blocks per mile (short blocks) E-W blocks (long blocks) on an average make up three short blocks Supplies at one end only per floor Oxygen supplies provided by Central Supply Central Supply also stocked Clean Utility Rooms Needed to get Oxygen Delivery Supplies added to Clean Utility Rooms

40 Patient in CCU Needs Pre-op PFT including Spirometry and DLCO Patient is brought to PFT Lab by RN and MD in a bed with a monitor

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