how organizing linen and supplies turned morning care from frantic to meaningful

How Organizing Linen & Supplies Turned Morning Care from Frantic to Meaningful

Ngaire Woodroffe Brown, RQHR and Jill Forrester, 3sHealth

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Faculty/Presenter DisclosureFaculty: [Ngaire Woodroffe Brown & Jill Forrester]

Relationships with commercial interest: • [Grants/Research Support: none]• [Speakers Bureau/Honorarium: none• [Consulting Fees: none]• [Other: none]• No relationships to disclose? Not Applicable

Disclosure of Commercial Support• This program has received financial support from [n/a] in the form of [n/at]

• This program has received in-kind support from [n/a] in the form of [n/a]

Potential for Conflict(s) of Interest: • [N/a] has received [n/a] from [n/a]• [n/a ][developed/licenses/distributes/benefits from the sale of, etc.] a product

that will be discussed in this program: [n/a]

Mitigating Potential Bias• [Explain how potential sources of bias identified in slides 1 and 2 have been

mitigated – n/a]

Before We Begin… Linen & other supplies have a huge impact

Standard work is a powerful tool

Use strong processes, replicate thoughtfully

Communication is vital

The enormity of the improvement to care through something so simple!

The importance of thinking and acting as one

Context: 2 RPIWs March 2013 Potential BiasLinen Infection Prevention & Control throughout its trip through the facility

Housekeeping + Unit 3-5 (Joint Process Owners)

AM Care Routines & Supplies: Unit 2-5 (Process Owner)

Sponsors: Ngaire Woodroffe Brown, Director, Extended Care/Veterans ProgramJim Crawford, Director, Provincial Linen Services, 3sHealthSteve Adkins, Director, Support Services, RQHR

SuccessesDefects Eliminated

Soiled Room 5S• Touches of soiled linen to clean linen bags in soiled room and clean care givers

New Process for Gathering Supplies for AM Care • Touches to linen prior to use • Pre-kaizen - only 16% of linen tracked used in less than 48 hours after exposure

Number of times care givers left the room to get supplies during am care • Pre-kaizen – care givers left rooms 27 times in 2.5 hour time span for 10 residents

But We Weren’t Happy…

Audit Results

9 months had passed

Daily visual management in place

Sponsor had long term replication plan

Commitment from process owners and team members

Replication at Wascana RehabUnit M-5 M-6 2-5 2-6 3-5 3-6

5S Chart Room (as part of RPIW) 5S

5S Clean Supplies 5S 5S 5S 5S 5S 5S

5S Soiled Room RPIW (Joint Start)

RPIW (Joint Start)

AM Care Infection Control RPIW

AM Care Supplies RPIW

Tena Kanban Kanban

Bento Kanban Kanban

Clean Supplies Kanban Kanban Kanban

Replication #1 March 2013

Replication #2May 2014

Replication #4June 2014

Stage 1 Replication: January 2014gating Potential Bias

Care Aides : Willy Aubon, Erica Church and Tammy WatsonKaizen Support: Tyler Chiddenton (MoH), Bob Parker (RQHR) and Jennifer Fetch (3sHealth) Sponsor : Ngaire Woodroffe Brown, Director, Extended Care/Veterans Program, WRC (absent)

Soiled Room 5S

Pre 5S

You Know They Were Keen….

Soiled Room

Replication attempt

Pre-Kaizen Linen Carts• Linen sits exposed and

touched for days/weeks

Cart sits in hall 24 hours/dayOnly 16% of linen used within 48 hours

Care givers going in and out of room 27 times in 2.5 hour period looking for supplies

New AM Care StandardRounding cart prepared each morning then cleaned and put away Defects eliminated:

Linen exposed for minutes/hours Linen touched once prior to resident use Care givers do not leave room during

care

Variation Unit can decide whether to bundle or stack

linen

Tena Kanban

AfterRight amount, right time in right

location. Residents & families aware.

Before Cluttered. Right amount?

At right time? In right location?

Tena Kanban – Our Tena Cupboard

Insert photo of regular products in cupboard Special OrderProducts

Stock / Regular Order Products

Principles for Replication Plan

Use JBA tools and processes

Keep it as simple as possible

Engage team members from original RPIW (“pay it forward”)

Learn from workers on the gemba – update standard work where needed.

Build partnerships – “think and act as one”

Replication Event Agenda

What Happens - Preparation Week1. Kick Off Meeting

Sponsor comments

High level Lean review; Source team talks about wastes removed with new

processes

Fear & expectations with group

Preparation Week cont’d2. Current State at Source & Receiving Sites

Observe new standard work in action

Can’t simply replicate – need to integrate learnings and update standard work

3. Start Data Gathering

Identify 2-3 targets from RPIW target sheet

Gather the data in Receiving site to get baseline

Preparation Week cont’d4. Document Implementation Steps

Build detailed implementation plan for event week• Standard work for implementation• Photos, posters, communications• Measurement tools

5. Communicate

Share plans and results through daily visual management

Tour teams through source gemba

And Then Event WeekMonday

• Reaffirm standard work and prepare for implementation

• Communicate with team

Tuesday and Wednesday

• Implement the new standard work

• Communicate, train, begin post-kaizen data gathering

• Plan audit

Event Week con’tdThursday

Team members go back to work

KPO and TL document, troubleshoot, build report out

Daily check ins with team, sponsors and process owners

Friday: Report Out 1 p.m.

Replication Components

RPIW Stage 1 rep

Stage 2 rep

Build Package for Each Process• Standard work • Standard steps for implementation• Photos, signage and communication tools• Data gathering tools

Stage 2 rep

Stage 2 repReadiness Assessments

Cascading Replication Plan

Reporting and Tracking Audits

Lean Foundation:DVM, VSM

Communication of Plans by Sponsor

Learnings Liked the prep week, event week and report out; add 5S

3 day prep event worked; give at least 3 days for event week (ie. extra day)

Need Team Lead and and Sub Team Lead – KPO can’t do it all

Review current state – there will be changes….

Used waste wheel as starting point for discussion

Engage original team members in replication ( use the “pay it forward” approach)

Invite future replication partners to RPIWs and replication events

Clarify partnership arrangements & roles

Replication Wall

Lastly, keep your “eye on the prize”….

Questions?

Contact Us:Ngaire Woodroffe Brown, Director, Extended Care/Veterans Program, WRC or

Jill Forrester, Director, KPO, 3sHealthNgaire.Woodroffebrown@rqhealth.ca ; Jill.Forrester@3sHealth.ca

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