akron children’s hospital 1st year lean six sigma journey

WCBF Lean Six Sigma in Healthcare Summit

Akron Children’s Hospital 1st year Lean Six Sigma Journey

Chris Weisbrod, MBA, Lean Six Sigma Project LeaderAnne Musitano, RPh, PharmD, Lean Six Sigma Project Leader

Do we have any of these problems at Akron Children’s Hospital?

•Deliveries of supplies delayed because of improper ordering•Mix ups in getting supplies•Articles returned by other departments because they were not made correctly•Employees have difficulty handling new type of equipment•Limited storage space not properly used•Minor injuries or illness not reported•Correct procedures not followed•Safety equipment not being used•Employees leave to go to other hospitals•Employees pass the buck

Document publis

hed in 1944

Document publis

hed in 1944

Source: Graban, Lean Hospitals

2Process improvement through people development™Copyright Children's Hospital Medical Center of Akron


Henry Ford – 1922“In the ordinary hospitalthe nurses must make useless steps. More of their time is spent inwalking than in caring for the patient.”

Source: Key Concepts of Lean Healthcare, Lean Enterprise Institute



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Process improvement through people development™Copyright Children's Hospital Medical Center of Akron

January 2008 – February 2009•Who’s initiative and why Lean?•Training•Setup of the department:

oStaffing oSpace oPurchases

•Consultants•Meetings and interviews•1st year projects•Partnerships

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Chief Operating Officer (COO)• Wanted to better the patient experience (decreasing

patient wait times, access times)• Looked for a sustainable way for a hospital to

improve operations• Chose 6 internal candidates from separate areas of

the hospital to go to training

Who’s Initiative and why Lean Six Sigma?

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Training• January 2008

oJohns Hopkins Lean Sigma Prescription for Healthcare

• June 2008oCancer Treatment Centers of America

• August 2008oJoan Wellman and Associates Inc, Lean Leader Training

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Staffing, Space, and Purchases• October 2008

o 2 Lean Six Sigma Project Leaders started in the COE

• January 2009o 2 additional Lean Six Sigma Project Leader (4 total) joined the COE

• March 2009o Data analyst and office coordinator joined the COE

• July 2009o 1 additional Lean Six Sigma Project Leader (5 total) joined the COE

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ConsultantsInterviewed two firms

• Initial needs from consultants were to work with the COE to:oDeploy the Akron Children’s Operating SystemoDevelop mission and vision statementsoEstablish rewards and recognitions program for

Lean Six Sigma programsoEstablish a financial scorecard in conjunction with

the Finance Department

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Spreading the word Meetings with many different departments to :

• Present Lean Six Sigma concepts and ideas usually at departmental meetings

• Present results of projects (A3, Green Belt, and Kaizen)

• Inform the Board of Trustees of the project results (A3, Green Belt, and Kaizen)

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Interviews with ExecutivesMet with C -Level, Vice Presidents, and

Key Physician Leaders and asked :• What was their prior knowledge of Lean Six

Sigma concepts?• What was their prior project work with Lean

Six Sigma?

• What keeps them up at night?

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PartnershipsEstablished relationships with other organizations

practicing Lean, Six Sigma, and Lean Six Sigma• Goodyear Tire and Rubber• Timken Company• Little Tikes• Planned Parenthood• University of Akron• Other hospitals

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The Akron Children ’s HospitalOperating System





DMAIC Methodology (Define, Measure, Analyze, Improve, Control)

•Kaizen Events• Rapid Process Improvement Week- anywhere from 2 to 5 day events • Strategically driven by Executives• Belts = project leaders; team of 5 – 10 from dept & from dept’s customers

•Green Belt and Black Belt Projects• 3 – 6 month projects • Strategically driven by Executives – VPs, C suite, etc. • Project leaders are COE staff or trained belts• Team of 5–10 from the department

•A3 Projects• 8-week long projects, usually within the boundaries of the participants’ home dept• Driven by the line staff doing the work, and supported by their manager

•Blue Belt• Manager training to include Gemba Walks, implement daily metrics boards and daily

huddles, coaching for staff, etc.

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A3 Program•Started in January of 2009•8-week Lean Six Sigma class designed for front-line employees•Follow DMAIC on A3 paper

oProblem statementoGoaloCurrent state VSMoRoot cause analysisoFuture state VSMoImplementation planoControl

•Meet weekly for 2 hours of class time•Each participant is assigned a coach from the COE


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A3 ProjectsJackie Fuller-Human Resources

•Problem StatementoHuman Resources staff spends 60 minutes per week searching for supplies in the Human Resources Work Room

•SMART GoaloDecrease the amount of time spent searching for supplies from 60 minutes to 23 minutes per week by October 12, 2009

•ResultsoDecreased amount of time spent searching for supplies from 60 minutes to 10 minutes per week


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A3 ProjectsJackie Fuller-Human Resources


Video

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A3 ProjectsHeidi Kline-Infectious Disease

•Problem StatementoAn increasing number of calls of various types coming into Infectious Disease are creating a large volume of non-Infectious Disease patient-related work for the nurse, medical assistant and secretary.

•SMART GoaloComplete an evaluation of all calls coming into the Infectious Disease department and develop a mechanism to appropriately route the calls that are not related to Infectious Disease patients.

•ResultsoMultiple improvement ideas implemented. Overall 67% improvementon project.


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A3 ProjectsHeidi Kline-Infectious Disease


Video

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A3 ProjectsDeborah DePree-Patient Accounts

•Problem StatementoFaxed information related to insurance, divorce, Dr. change of codes, and updated BCMH information is received and not distributed to the correct person in a timely manner. This results in a delay in claims processing and lost faxes.

•SMART GoaloBy March 4, 2009, reduce the number of faxes received in patientaccounts to be distributed each morning from 25 to 5.

•ResultsoNumber of faxes waiting to be distributed went from 25 to an average of < 5 per day


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A3 ProjectsDeborah DePree-Patient Accounts


Video

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A3 ProjectsMatt Hirsh-Maintenance

•Problem StatementoThe mechanics have difficulty locating materials and parts for plumbing fixture repairs.

•SMART GoaloReduce the time for material procurement for plumbing fixture repairs by 50% by March 4, 2009

•ResultsoReduced part location time from 15 minutes to 7.5 Minutes for a 50% improvement


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A3 ProjectsMatt Hirsh-Maintenance


Video

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A3 Projects 2009 review•Goal is to train entire front line staff•119 front-line staff participated in the program•295 patient wait days eliminated•155,138 hours of lead time reduced•Mean of 69% project improvement•$411,557 indirect financial impact•$641,996 direct financial impact


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Green Belt Program•18 employees sent to Johns Hopkins Lean Sigma Prescription for Healthcare training•10 certified Green Beltso8 through Johns Hopkinso2 hired with Green Belt certification


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Green Belt ProjectsCytogenetics Laboratory

•Problem statementoIncreased test volume in Cytogenetics has resulted in the need for staff to put in an average of 71 overtime hours per week

•SMART GoaloBy March 6, reduce recorded and silent (supervisor) overtime hours per week by at least 40% (from 71 hours to 43 hours)

•ResultsoOvertime reduced from 71 hours per week to 6 hours per week


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09/12/09

08/22/09

07/25/09

06/27/09

05/30/09

05/02/09

04/04/09

03/07/09

02/07/09

01/10/09

12/13/08

11/15/08

10/18/08

09/20/08

08/23/08

07/26/08

06/28/08

05/31/08

05/03/08

120

100

80

60

40

20

0

Week Ending

Overtime Hours

_X=6.0

UCL=11.8

LCL=0.3

Baseline DefMeasAnal Improve Control

1

1

1

Paid Overtime

Phase = 83.6%

From Baseline through Improve

Improvement in Tech Overtime

Mean = 55.4 Mean = 44.8Mean = 9.1

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Green Belt ProjectsFlash Sterilization

•Problem statementoThe Sterile Processing Department cannot currently meet case demand for surgical instruments without a weekly 13.1% flash sterilization rate

•SMART GoaloReduce weekly flash sterilization rate in the OR to ≤ 3%

•ResultsoReduced weekly flash sterilization rate from 13.1% to 2%


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71645750433629221581

0.25

0.20

0.15

0.10

0.05

0.00

_P=0.1307

_P=0.1132

_P=0.0483

UCL=0.1967UCL=0.1895

UCL=0.0906

LCL=0.0648

LCL=0.0368

LCL=0.0061

Pre-Implementation/ Implementation ControlControlBaseline

Flash Sterilization Rate by LSS Project Phase (P Chart)[Excl Procedures Outside ORs; Oct 2007-present; Target < 3%]

Tests performed with unequal sample sizes

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Green Belt ProjectsResident Rounding

•Problem statementoResidents are currently limited to working a maximum of 80 hoursper week, and this limit will likely be reduced to 55-60 hours in the next 2-3 years. In order to provide excellent patient care and drive educational value, the entire resident rounds process, which comprises roughly 50% of the day, must be improved in terms of efficiency.

•SMART GoaloReduce the non-value-add time, including necessary non-value-add, currently present in the pre-rounding and rounding process by 25% in 6 months

•ResultsoTime spent rounding has been reduced by 50%


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53%

16%

10%

6%

6%

3%2% 1%1%

Family Centered CareAdministrativeWalkingPersonalSignoutPhysician InteractionData CollectionEducationWaiting

Interaction with physicians and nurses, as well as education, now occurs with the family present

* 5 rounding sessions covering 86 total patients, including family-centered care for 8 primary patients covered by the observed residentsSource: Resident rounds observation data, Spring/Summer 2009



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Green Belt ProjectsHospitalist-Dr. David Chand


Video

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Green Belt Projects•6200 Central Supply

oReduce the NVA time nurses spend searching and gathering supplies

•Out Patient PharmacyoIncrease in the percentage of prescriptions completed under 30 minutes


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Green Belt Projects•Rehabilitation Retention

oIncrease the yearly retention Therapists and Assistants in Rehabby 3.0 people before August 7th


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Green Belt Projects 2009 review•7 projects completed•5 started and ongoing

oRehab RetentionoProphylactic AntibioticsoOR Special Orderso6200/Central SupplyoHBS Abandon Call Rate

•53% improvement percentage per project•$42,650 of indirect financial impact•$301,248 of direct financial impact


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KaizensSterile Processing

•Problem statementoEquipment, layout, staffing levels, and inventory in Sterile Processing are not sufficient to support current and future surgical volumes at Akron Children’s Hospital.

•SMART GoaloRedesign Sterile Processing to meet the future surgical volumes within the existing footprint from 13,000 cases annually to 16,000 cases annually along with satisfying AMMI and AORN environmental standards.


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Sterile Processing Kaizen Results Decontamination


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Sterile Processing Kaizen Results Assembly


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KaizenSterile Processing Department-Jim Seymour


Video

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KaizensCentralized Core Lab

•Problem statementoThe Processing Area of the Centralized Core Lab is the intake area for the seven value streams within the CCL as well as the other clinical laboratories. Backlogs within the Processing Area have a direct impact on the throughput of specimens and the subsequent reporting of laboratory test results delaying clinical decision making.

•SMART Goal oBy November 1, reduce the median lead time per specimen within the CCL Processing Area (from the time the specimen is picked up by the processing staff to delivery and staff return from value stream) from an average of 125 seconds to 75 seconds.

•Resultso 5 out of 5 test categories have seen statistically significant reduction in median lead time

.


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CCL Kaizen Results


Andon lights installed

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CCL Kaizen Results


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KaizensMRI

•Problem statementoThere is currently capacity for additional patients to be scanned on MRI #1 and MRI #2.

•SMART Goal oIncrease the number of weekly exams performed on MRI #1 and MRI #2 from 86 to 112 by August 24th.

•Resultso Increased weekly exams performed by 19%

.


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Kaizens•MRI

.


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Kaizens Projects 2009 Review•3 completed Kaizens•$1,631,000 in direct financial impact•$3,569,000 in indirect financial impact

.


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Developing Hoshin Konri in the Radiology Department

•Completed 8 A3 projects•1 Green Belt project•1 Kaizen•One of the more engaged departments throughout Akron Children’s Hospital•COE decided to roll out Blue Belt program in Radiology.


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Developing Hoshin Konri in Radiology Radiology Department-Diane Tarray

.


Video

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Goals of Blue Belt Certification•Visibility

oProblems/Opportunities are transparent so that they can be fixed

•AccountabilityoFor operations, safety and quality

•MetricsoHave to know what you are measuring

•Environment of continuous learning and coaching•Gemba walks

oDaily walks through the work areas•Daily huddle around metric boards•Teach ideas of waste and basic Lean Six Sigma tools


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Developing Hoshin Konri in Radiology Radiology Department-Terry Tarray

.


Video

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Challenges• Time for Green Belt projects

oWorking full time and doing projects• Managing change • Full engagement of middle management• Validating data, especially to leadership• Control phase

oSustaining the gains• Support services

oMaintenance oIS oEnvironmental services


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Keys to success•C-level support of the Lean Six Sigma initiative•Dedicated full time staff•Front line engagement•Middle management engagement•VP level engagement•Experienced Lean Six Sigma consulting firm for first 2 years

.


Outside the box thinking



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Questions?


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