managing the future ver.b

STERIS Sterilization Forum 2010

Clinical Education Services2

Managing for the Future

Planning and Managing Future Space, Equipment and Human Resources

Dan Johnson SterilTek, Inc.


OBJECTIVES

1. Planning the Future-State: Identify and use tools for future space, equipment and staffing needs

2. SPD Management Tools For Today and Tomorrow: Use of KPIs’ to analyze and improve performance

Hope is Not a Strategy


Invent the Future

“The best way to predict the future is to invent it.”

Alan Kay, Creator of the Dynabook

“The worst way to predict the future is to deny it.”


Management Operating System

Active Supervision

Communication

Standards & Objectives

Compliance

Motivation


Department & IndividualPerformance to Reasonable

ExpectanciesProductivity + Quality

Equipment Capacity Demonstrated

vs. Rated

Instrument Management

Metrics ManagementRemote Monitoring


Resource PlanningEquipment•Workload•Time available•Capacity

Staff•Workload•Work Standards (R/Es)•Performance

Space•Layout and Workflow•Staging•Sterile Stores

•OR Procedures•Instruments per Procedure•Processing Window•Equipment Capability and Performance

•Demonstrated versus Rated•Up-time

--------------------------------------------------------------------------------------------

•Equipment quantities•Workstation quantities and utilization•Material Requirements•Instrumentation Needs•Case Carts Staging and Storage------------------------------------------------------------------------------------------

•Activities•Volumes•Reasonable Expectancies•Productivity and Quality

Instrumentation•Usage / Frequency•Scheduling


What do you need to know to prepare your CS?

Capacity Planning Requirements•OR Cases by Service Line•CS Workload by Area and Service Line

•Instrument Sets•Containerized or Wrapped•Singles•Basins. Linens, etc.

•Loaner Volumes•Equipment Cycle Times•Peak Load Periods

Growth Plans•New Surgeons and or Services•Acquisitions or area hospital closures•Changes in Service Line Mix


Capacity Analysis - OR Case ForecastFORECASTED PROCEDURES HOSPITAL

Hosp

Service AreaCurrent Annual

Procedure Volume

2010 2011 2012 2013 2014 2015 2016 2017 2018 2019%

INCREASE

GeneralGeneral (Combined Services) 2520 2646 2778 2917 3063 3216 3377 3546 3723 3909 4105 63%

PlasticsPlastics 3672 3856 4048 4251 4463 4687 4921 5167 5425 5696 5981 63%

VascularVascular 1908 2003 2104 2209 2319 2435 2557 2685 2819 2960 3108 63%

Orthopedics Inpatient MajorOrthopedics Inpatient Major 180 189 198 208 219 230 241 253 266 279 293 63%

Orthopedics Inpatient Minor 1628 1709 1794 1884 1978 2077 2181 2290 2405 2525 2651 63%

Orthopedics Outpatient Major 389 408 428 450 472 496 521 547 574 603 633 63%

Orthopedics Outpatient Minor 3456 3629 3810 4001 4201 4411 4631 4863 5106 5361 5629 63%

0 #DIV/0!

13752 14440 15162 15920 16716 17551 18429 19350 20318 21334 22401 63%

% Over Prior 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0% 5.0%

AnyTown Hospital

TOTALS

STEP #2: Forecasted Procedures

Enter the Year Labels For The Next 10 Years and Then Enter the Forecasted Procedures by Year.


Capacity Analysis - SPD WorkloadWORKLOAD HOSPITAL

Case Carts Singles Basins

Standard 2' x 4'

Small 12" x 12"

Medium 12" x 18"

Large 12" x 24"

Small 12" x 12"

Medium 12" x 18"

Large 12" x 24"

Peel Pack 1"x8"

Basin Set

Two Drape Pack

Four Towel Pack

General (Combined Services) 1.0 0.1 0.2 0.8 0.3 0.4 1.5 2.0 1.0 1.0 2.0

Plastics 0.5 0.2 1.1 0.2 0.2 0.1 0.2 2.0 1.0 1.0 2.0

Vascular 0.5 0.5 0.4 0.4 0.5 0.4 0.7 1.0 2.0 1.0 2.0

Orthopedics Inpatient Major 2.0 2.4 1.1 2.1 2.1 1.0 1.9 2.0 1.0 2.0 2.0

Orthopedics Inpatient Minor 1.0 0.5 0.4 0.9 0.5 1.0 0.7 2.0 1.0 1.0 2.0

Orthopedics Outpatient Major 1.0 1.2 1.0 1.1 1.1 1.0 1.0 3.0 1.0 1.0 2.0

Orthopedics Outpatient Minor 1.0 0.5 0.4 0.9 0.5 1.0 0.7 2.0 1.0 1.0 2.0

Service Area

AnyTown Hospital

Linens

For Each Service Area, Enter the Number of Items Used on Average for One Procedure.

STEP #4: Workload

Containerized Instrument Trays

Wrapped Instrument Trays


Capacity Analysis -Equipment Current State – 13,752 Annual Cases

Instrument

Washers

3 Single Chamber, 45 Min, 3 Level

Assembly 8 Workstations

Sterilizers 3 60” Platform, 3 Level


Capacity Analysis -Equipment Future State – 22,391 Annual Cases

Instrument

Washers





Capacity Analysis -Equipment Future State – 22,391 Annual Cases, Ortho Concentrated Instrument

Washers





Capacity Analysis - Space PlanningSTERILE PROCESSING SQUARE FOOTAGE REQUIREMENT HOSPITAL

Blue = Step #'s

Tan = Input

General Decontamination Area 503 Sterilizers & Loading Car Area 278 Men’s Locker Room 120

Double Wide Cart Washer 0 Double Doors Sterilizers? 134 Men’s Toilet 120

Single Wide Cart Washer 381 Cool Down Area 270 Women’s Locker Room 120

Single Chamber 30 Min 394 Sterrad Room – Capable of two units 100 Women’s Toilet 120

Single Chamber 30 Min 0 EO Room - Two 3017/One Aerator 0 Receiving Area 0

Multi Chamber 8 Min 0 BI Incubator Area / Work Area 50 Breakout Area 0

Washer Auto Load / Unload? 120 Transportation Carts 0

3 Well Sink & Clinical Sink 40 Dispatch Area 0

Pass Thru Window Area 30 10% Common Space, Walls, Etc 84 Telephone/Computer Room 60

Detergent Room 100 Total Sterilizers Sq. Ft. 915 Mechanical Room 0

Housekeeping Room Decontam 30 Electrical Room 0

DME Decontam Area (Input Sq Ft)

Sterile Stores 400

Instrument Storage (Input Sq Ft) 10% Common Space, Walls, Etc 54

10% Common Space, Walls, Etc 160 DME Storage (Input Sq Ft) Total Support Sq. Ft. 594

Total Decontamination Sq. Ft. 1758 1100

Req'd Current10% Common Space, Walls, Etc 150 Decontamination Sq. Ft. 1758 1330

General Assembly Area 1197 Total Storage Sq. Ft. 1650 Assembly Sq. Ft. 3236 2528

Cart Washers Assembly Side 381 Sterilization Sq. Ft. 915 1015

Instrument Washers Assembly Side 164 Storage Sq. Ft. 1650 1500

Pass Thru Window Area 30 Director’s Office 225 Administrative Sq. Ft. 670 360

Sterilizers Assembly Side 411 Shift/Lead Office 144 Support Sq. Ft. 594 550

Instrument Assembly Stations 728 Reception Area 0 8823 8011

Linen Assembly Stations 0 Lunch Room 240

Housekeeping Room Clean Side 30 Conference Room 0

Avg Cost per Sq. Ft. =

Total Cost Req'd =

10% Common Space, Walls, Etc 295 10% Common Space, Walls, Etc 61

Total Assembly Sq. Ft. 3236 Total Administrative Sq. Ft. 670

Anytown Hospital

Sterilization Sq. Ft.

STEP #13a: Square Feet RequiredCheck or Enter Area and Square Feet Required.

Decontamination Sq. Ft.

Entire VolumeEnter Report Name Here

White = Information Year

2019

Area

Grey = Input Not Allowed

Support Sq. Ft.

Storage Sq. Ft.

Assembly Sq. Ft.

Cost of Space Req'd

Case Carts

Square Feet Summary

Total Square Feet Req'd

Administrative Sq. Ft.

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

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Yes

Save Sq Ft Req's to New Tab

Yes

Yes


Capacity Analysis; Activity-Based Staffing• Customer focused method to determine

Human Resource requirements• Translates customer-related work volumes or

forecast in labor requirements• Highlights opportunity to improve staff

utilization• Provides a first step in level-loading the

workflow• Results in realistic productivity standards and

improved Customer service


Capacity Analysis; Activity-Based StaffingInformation Requirements• Activity List• Historical Volumes / Frequency• Reasonable Expectancies (R/E) – Time

Standards• Non-Productive Time liability

• Vacations, Holidays, Absenteeism• Establish a functional area productivity level


Capacity Analysis; Activity-Based StaffingStaffing Guide Hospital

Updated

Items DescriptionMonthly Volume

Decontam Standard

Assembly Standard

QA Wrap Sterilize Standard

Monthly Hours Required Per

SiteTrays Small Trays 5131 3.0 12.0 2.0 1454Trays Medium Trays 5131 3.0 14.0 2.0 1625Trays Large Trays 6842 3.0 19.0 2.0 2737Trays Loaner Trays - second decontam 1745 3.0 0.0 0.0 87

Singles Singles 3507 0.5 0.5 0.5 88Basins Basins 84 0.5 2.0 1.0 5Carts Case Carts 1890 1.0 12.0 0.0 410

6405

Frequency (Month,

Week, or Day Only)

Volume per

Frequency

Time Standard

in Minutes

Monthly Hours Required Per

Site

Sterilizer Drain Cleaning Day 4 1 1Washer drain cleaning Day 4 1 1Clean Sterilizer carts Week 8 2 1Sterilizer Cleaning Week 4 10 3

Week 15 1 1Dart Test OR Sterilizers Day 20 3 22

Day 16 3 170

433

6838

YourTown

Technician Instrument Monthly Hours Required

Technician Activities Per Site(Volume is for Entire Site)

Technician 16-May

ATTEST and Document

Technician Site Monthly Hours Required

Technician Instrument and Site Hours Required

Change washer detergent

698190%77562578013

12%1093

910656

Technician Monthly Break Hours Required One 15-minute breaks per day)Technician Monthly Workload Hours Required Including Breaks

Technician FTE's Required

Technician Absence / Vacation Non-Productive PercentageTechnician Absence / Vacation Non-Productive Monthly Hours

Total Technician Monthly Paid Hours

Productivity PercentageTechnician Monthly Workload Hours Required

Technician Monthly Workload Hours Required


Capacity Analysis; Activity-Based StaffingStaffing Guide HospitalSummary Updated

VolumesTotal Monthly Procedures 2016Total Monthly Trays Processed 18849

Work Hours

Technician Monthly Productive (At Work) Hours Required 9330Technician Absence / Vacation Non-Productive Monthly Hours 1272Total Technician Monthly Paid Hours 10602

Management Services Monthly Productive (At Work) Hours Required 522Management Services Absence / Vacation Non-Productive Monthly Hours 0Total Management Services Monthly Paid Hours 522

Admin / Mgt Monthly Productive (At Work) Hours Required 348Admin / Mgt Absence / Vacation Non-Productive Monthly Hours 0Total Admin / Mgt Monthly Paid Hours 348

Other Monthly Productive (At Work) Hours Required 436Other Absence / Vacation Non-Productive Monthly Hours 0Total Other Monthly Paid Hours 436

Total Monthly Productive (At Work) Hours Required 10636Total Monthly Non-Productive Hours Required 1272Total Monthly Paid Hours Required 11908

Key Volume Indicators

Productive Monthly Hours Per Tray 0.56Non-Productive Monthly Hours Per Tray 0.07Total Monthly Paid Hours Per Tray 0.63

Staffing

Technician and Case Cart FTE's Required 65.0Management Services FTE's Required 3.0Admin / Mgt FTE's Required 2.0Other FTE's Required 2.5

Total FTE's Required 72.6Current FTE's 75.0FTE Variance (Positive = overstaffed, Negative = understaffed) 2.4

YourTown16-May


Workflow Management

Highways designed to handle a "steady volume of traffic”throughout the day (24 hours)????

BUSY TIME OF DAY (Peak Period)….

…results in congestion, traffic backed-up for miles


Cycle Chart is a “snap shot” simulation of workload arriving each hour of the day and, the equipments’ ability to processing the workload.

-Hours of the Day the department is Open - Peak processing hours of the day when the bulk of the total workload arrives.- Workload Arrival/Equipment processing capacity, each hour in terms of cycles - Identifies when workload arrival exceeds the equipment processing capacity

(cycles In Queue)

Workflow Management


SLOW processing period of day

Workflow Management


PEAK PROCESSING Period

Workload arrives from surgery

(10:00am to 6:00pm)

Workflow Management


Measuring Process PerformanceWhy?

• We don’t know what we don’t know

• We can’t act on what we don’t know

• We won’t know until we search

• We won’t search for what we don’t question

• We don’t question what we don’t measure


Measuring Process Performance



• Two purposes for developing consistent metrics and measurements within CS– Ensure performance meets expectations

while driving accountability– To measure the impact of any improvement

while driving additional improvement efforts


27


• Measure what you value• Differentiate between perception and

reality• Measure based on facts• Identifies process issues and bottlenecks• Evaluates customer satisfaction level• Provide a baseline to monitor

improvement


Key SPD Metrics– Quality: Defects per total items produced– Customer Experience: Positive experiences per total

experiences– Schedule Attainment: 1st and 2nd Case Completion

Rate– Productivity: (Input vs. Output)

– High-level: CS Labor Hours per Tray– Detailed: Earned Time / Worked Time

– Overtime– Skill mix and competency– Vendor Performance


Key Performance Indicator Dashboard Definitions

Key Performance Indictor (a.k.a. KPI)Quantifiable measurement, or metrics, that reflect the critical success factors of an organization.

Dashboard Provides a high-level view of performance and measures your department’s productivity and quality performance

Proper use of the KPIs will assist you in identifying areas of primary concern and focus for process improvement.


Typical Productivity and Quality Dashboard


Benefit of TrendingVisibility of Slippage


Measuring Process Performance• Track, post, discuss, and take action based on the

performance factors being measured• Timeliness of measurement and feedback is of utmost

importance• Employees should have a clear understanding of what the

customer and management expects of them for every task they perform – quality, timeliness and productivity

• Without measurement, true improvement cannot be made; will not be sustained

“The Problems that Exist in the World Cannot be Solved by the Same Level of Thinking that Created Them”

Albert Einstein


Real-Time Workflow Management

Effective Instrument Management Systems•Monitor Process and Workflow•Identify Bottlenecks and Line Imbalances•Provide you information for Real-Time adjustment

Tied into the OR Scheduling System•Align Priorities•Identify and Manage Conflicts


Managing for the Future

Planning and Managing Future Space, Equipment and Human Resources

Capacity Analysis and PlanningManagement Metrics

Workflow Management

managing the future ver.b

Health & Medicine

capacity planning requirements

level assembly

total workload

process performance

customer satisfaction

future planning

service line cs workload

future space