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What Providers Need To Prosper The Next 50 Years: Planning

Meets Operations

October 4, 2012

8:00 – 9:00 AM

Craig L. Miller, CCMSenior Project Manager

JacobsNYC and Long Island Office

Craig.Miller@Jacobs.com

Safety Minute

CPR/AED or 1st Aid Classes are available at your local American Red Cross or hospital.

According to the American Red Cross:

• Sudden cardiac arrest, leading cause of death in adults, accounts for 325,000 deaths per year.

• Treatment delay of 4-5 minutes decreases survival rate as much as 40%; 10 minutes or longer results in 95% chance death.

• More information can be found at: www.redcross.org/

Learning Objectives

1) Strategize, plan, integrate, and design logistics and operational needs to

deliver over the long term a high performance healthcare facility.

2) Measure and evaluate the results, value, and performance received from

various solutions.

3) Explore how new trends, best practices, and approaches can be used to plan a high performance hospital, and how they differ from traditional practices.

4) Asses, build, and balance goals with available resources.

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Understanding Your Roles and Challenges

• Typically involved early with planning

• From a logistics/operations perspective, your asked to:

– Optimize performance / improve efficiency

– Reduce waste

– Incorporate flexibility, provisions/infrastructure

– Create system wide logistics vision, leverage standardization

– Investigate off-site service/support center options

• Tight budgets

• Space restrictions / constrained sites

• Other?

Industry Wide Challenges• 32-million newly insured Americans as a result

of health care reform (Modern Healthcare magazine)

• Cuts in Medicare and Medicaid funding

• Aging workforce

• Over-crowded ED’s, and Trauma Centers

• Cutting edge clinical technology, and

procedures

• Mergers, acquisitions, and private entities

• Lower operating budgets; a “do more with less”

approach

• The list goes on……..

Typical Hospital Org. Structure

Human

ResourcesFinance Information

Technology

LegalSecuritySafety

MCE /

Facilities

Leadership

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Developing the Plan and Paving the Way

� What do Providers Need To Prosper The Next 50 Years?

� How will Planning Meet Operations?

Strategy

• C-Suite (CEO, CFO, COO) and stakeholders

• Imperatives/Drivers

• Logistics and operational vision

• Interoperability

• Goals and objectives

• Guiding Principles

• Key Performance Indicator's (KPI's)

• Service Levels

• Identify measures

• Sustainability

• Flexibility

Integrated Planning

• Master Planning

• High level ROI Analysis

• Develop Basis of Design for Logistics and Operations

• Application of Process, Distribution, Storage/Retrieval, IT, and Purchasing

• Identify systems

• Integrate industry best practices

• Develop road map

• Dashboards

Execution

• All phases of design including Concept, Schematic, Development, and Construction

• Develop detailed business cases for systems considered

• Link/network systems for interoperability

• Commissioning/ Activation

• Measure performance

• Make adjustments

• Existing Hospitals• Newly Planned

• Mergers and Acquisitions• Individual Buildings and

Departments

• Systems with multiple Hospitals and Clinics

Medical

Supplies

Medications

Linen

F&N Supplies

Administrative

Supplies

Lab Testing

Lab Samples

Soiled Food

Trays

Trash

Bio-Waste

Returns

Expired

Medication

Recalls

Soiled Linen

Housekeeping

Supplies

Food Trays

Blood

Minor Medical

Equipment

Mail & Parcels

Medical

Records

Medical

Records

Minor Medical

Equipment

Staff

Patients

Med – Surg Floor

Logistics can be defined as “resource” management.Stated another way, logistics strategy is applying the 5 rights:� Right resources (drug)� Right time (frequency)� Right quantity (dose)� Right location (patient)� Right path (route)

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Trends in Logistics / Resource Management

• Automation

– Robotics

– Integrated Software Systems

– Pneumatic Transport

• Service Center vs. Off-

Site Warehouse

• Simulation

• GS1 Data

Standardization

• Interoperability

– Connects Clinical, Support Services, Operations

– Includes EMR and Compliance

– Process Efficiency (e.g. Lean) with a view to the outside

Automation• Robotics

• Pneumatic Transport – Moving away from

elevators, less FTE’s, more efficient, less touch

points

• Integrated Systems

• Examples: Supply Chain / Materials

Management, Pharmacy, EVS, Dietary, Labs,

SPD

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Automated Waste Collection

Fan Room

Central Collection Plant

Central Processing

and Monitoring

Air Intake

Air Exhaust

Trash in

Trash out

Velocity monitoring

� Trash� Soiled Linen� Recycle

Simulation

Optimize, While Balancing Resources & Goals / Objectives

ResourcesGoals /

Objectives

Current & Future

Schedule

Utilization

Volumes

Supplies

Staff

Equipment

Rooms

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Automated Guided Vehicle Example

Pharmacy

•Resources?

•Goals?

Sterile Processing

•Resources?

•Goals?

Dietary

•Resources?

•Goals?

EVS

•Resources?

•Goals?

Mail and Parcels

•Resources?

•Goals?

RespatoryTherapy

•Resources?

•Goals?

Materials Management

•Resources?

•Goals?

GS1

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10

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Best Practices

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Distribution

Store /

Retrieve

&

Enter / Exit

Store /

Retrieve

&

Enter / Exit

Purchasing

Process Flow

Information Technology

Distribution

Store /

Retrieve

&

Enter / Exit

Store /

Retrieve

&

Enter / Exit

Purchasing

Process Flow

Information Technology

Simulation

Optimization and

Improvement Strategies

Process and Value

Stream Mapping

Just In Time Delivery

Handoff

Infection Control

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AGVS

ATL&Recyc

P-Tube

Automated, Semi Auto,

Manual

Gravity Chutes

Vertical Transport

Point-Of-Use

Systems

Carousel Systems

Mini-Load AS/RS

Low Unit Of

Measure

Product Slotting, Storage, Retrieval

Vertical Lift

Modules

Integration

IT Management

Data Standard-

ization

Data Synchron-

izationData Mining

RFID

Data Cleansing

PPI

Standardization

Software & Hardware

Value Analysis

Assessments

Product Selection

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Ancillary ServicesPlanLayoutDesignOrganizeEquip

Operationalize

Clinical ServicesIntegrate

TailorOrganize

EquipOperationalize

Ancillary ServicesPlanLayoutDesignOrganizeEquip

Operationalize

Clinical ServicesIntegrate

TailorOrganize

EquipOperationalize

Operating Efficiency Patient Safety

Expenses and Waste

Case Studies & Value Propositions

Clinical Modeling CasesDiagnostics Platform

$4.5M Value Added Highlights

Reduced original program by:

1 MRI

1 PET-CT

Identified early in the process the need to add:

12 centrally located Prep / Hold /

Recovery Bays

1 Echo

1 ECG / Holter

1 Stress Lab

Additional value opportunities were identified

early in the process for spaces which could be

deferred:

2 Neuro-diagnostic room

1 Device Clinic room

2 Ultrasound

2 Nuclear Med

More than $4.5 Million worth of opportunities was

realized by Rush in the form of optimized patient

throughput, space reductions, staff, equipment,

construction, and resources which could either be

eliminated or reallocated to other programs.

Emergency Department$1.5M Value Added Highlights

Validated patient throughput for initial move-in and

future volumes

Confirmed optimum distribution of room types in

order to achieve waiting room times of less then

30 minutes

Quantitative results which supported optimizing

the number of Critical Care rooms to 9

Identified early in the process an opportunity to

defer outfitting or utilize for back-up / surge the

following rooms:

Acute

Isolation

Confirmed department could integrate pediatric

with adult care, thus eliminating the need for a

separate pediatric pod. Modeling assisted in ROI

analysis of a pediatric pod.

Over $1.5 Million worth of strategic decision-

making capabilities and opportunities was realized

by Rush in the form of space allocation,

equipment, and resources which could be

deferred, eliminated, or reallocated to other

programs.

“Simulation modeling was very

beneficial for planning our new ED. It really added great value by

helping us understand the

appropriate balance of rooms while achieving our level of service goals. This tool will serve us well for future

operational plans whether related to expansions, financial opportunities,

or expanding surge capabilities ”

Dr. Dino Rumoro

Chairperson

Associate Professor

Department of Emergency Medicine

“Simulation is a very effective

way to test and vet operational assumptions

before committing capital or

resources. I found it to be invaluable in creating an

efficient operational model”

Bernard F. Peculis, MS, MBA

Administrative Director

Department of Diagnostic

Radiology and Nuclear

Medicine

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Out Of Control Returns = WasteOut Of Control Returns = Waste

Eliminate Annual Write-Offs: >$650K/Year

Some of the Issues

• No Reverse Logistics plans– Hiring and Resigning

– Expiration

– Return processing

– Recalls

• Limited IT integration

• Limited schedule alignment with Clinical needs

• Loss of trust and confidence between clinical and support

• Rogue purchasing, and limited procurement process

Solutions

• Develop and Implement Reverse Logistics Program

• Integrate IT with RFID, GS1 Data Standardization, and Systems (Finance, HR, Supply Chain, Clinical, etc)

• Service agreements, schedules, and procurement procedures

Results

• Reduced write-offs by ~$425K/Year; still improving

• Developed and Implemented system wide logistics program

• Rolled-out 1st phase GS1

• Re-established trust and confidence

AutomationSome of the Issues

• Tight budget - Expand & Build New Hospital while Reducing Expenses

• Long horizontal travel distances

• Aging work force

• Infection Control

• Safety

• Limited funds to add FTE’s

• Maximum 20 Minute delivery of Food Trays

Solutions

• Develop and determine if there is a favorable business case

• Explore available systems

• Develop Simulation Model to optimize systems

• Design systems, and issue RFP to vendors

Results

• Reduced Annual Operating Expenses by over $2.5Million

• 2-4 Year payback

• Improved Patient & Staff Safety

• Used to distribute almost all resources across campus

• Re-established trust and confidence

Instrument LossesEliminate Annual Re-Purchasing Surgical Instruments: >$750K/Year

Some of the Issues

• Instruments, accessories missing after surgery

• Limited IT integration

• Rogue purchasing, and limited procurement process

• No reverse logistics in place

Solutions

• Develop and Implement Reverse Logistics Program

• Integrate IT with RFID, GS1 Data Standardization, and Systems

• Develop new equipment

• Other

Results

• Reduced write-offs by ~$675K/Year; still improving

• Developed and Implemented system wide logistics program

• Rolled-out 1st phase GS1

• Deployed new equipment

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Strategy

• C-Suite (CEO, CFO, COO) and stakeholders

• Imperatives/Drivers

• Logistics and operational vision

• Interoperability

• Goals and objectives

• Guiding Principles

• Key Performance Indicator's (KPI's)

• Service Levels

• Identify measures

• Sustainability

• Flexibility

Integrated Planning

• Master Planning

• High level ROI Analysis

• Develop Basis of Design for Logistics and Operations

• Application of Process, Distribution, Storage/Retrieval, IT, and Purchasing

• Identify systems

• Integrate industry best practices

• Develop road map

• Dashboards

Execution

• All phases of design including Concept, Schematic, Development, and Construction

• Develop detailed business cases for systems considered

• Link/network systems for interoperability

• Commissioning/ Activation

• Measure performance

• Make adjustments

Thank You and Get Home Safe

Craig.Miller@Jacobs.com