process improvement through use of lean six sigma methods 110609
TRANSCRIPT
Amanda Duling, MS Team Leader, QualitySaint Luke’s Hospital
Process Improvement Through Use of Lean/Six Sigma Methods
Kendall CobbArea Business ManagerMissouri Enterprise
Introductions
Amanda DulingKendall CobbYou!
Saint Luke’s Hospital
Flagship hospital in 11 hospital system 629 beds 3,996 employees Not for profit Tertiary care referral Protestant Episcopal Church Primary teaching hospital – UMKC School of Medicine Level I Trauma Center Level III Neonatal Care Centers of Excellence
Missouri Enterprise
More than 25 years of experience in process improvement training and implementation.
Specific areas of expertise in Quality Management, Lean, Six Sigma, business growth and product development.
Six offices throughout the state Part of the one of the largest consulting
organizations in America. Not for profit
How We Began
Missouri Enterprise AMSTP Program 301 students 97 companies Part of NIST Network
Saint Luke’s Participation Over 10 Participants from Quality, Administration, Surgery, Home Care, etc. At least 8 Projects
Blood Management Admit to Bed Placement Specimen Labeling Operation First Starts Lean Lab
Baldrige Award Criteria Category Six – Process Management
“The process management category examines how your organization determines its core
competencies and work systems and how it designs, manages and improves key processes for implementing those work
systems to deliver customer value and achieve organization success and sustainability
(Blazey, 2007, p. 185).” Blazey, Mark L. (2007). Insights to Performance Excellence 2008: An Inside Look at the 2008 Baldrige Award Criteria. Milwaukee, WI: ASQ .
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Waste Overview
Lean = Removing Waste
Non-Value Added
• Waiting
• Adding extra steps (Overprocessing)
• Incorrect Action (Defect)
• Too much… Too soon…(Overproduction)
• Transportation
• Inventory or Supplies (Excess)
• Motion
• Employee utilization
Value Added
Waste Exercise
What kind of waste, non-value added activities, do you see in your organization?
List potential waste in small groups for the following topics:1. Waiting2. Adding extra steps (Overprocessing)3. Incorrect Action (Defect)4. Too much… Too soon…(Overproduction)5. Transportation6. Inventory or Supplies (Excess)7. Motion8. Employee utilization
Lean Six Sigma Overview
Lean manufacturing or lean production, which is often known simply as "Lean", is the practice of a theory of production that considers the expenditure of resources for any means other than the creation of value for the presumed customer to be wasteful, and thus a target for elimination.
Rid a process of NON VALUE ADDED ACTIVITIES. Uses systematic tools such as TPM, Poke Yoke, Kanban, 5S,
Kaizen etc.
Six Sigma is a systematic, scientific, fact based, customer driven, data driven problem solving process.
The term “six sigma” defines an optimum measurement of quality: 3.4 defects per million opportunities.
Uses a systematic methodology called DMAIC.
SLHS Applications of Tools
Reduced the number of inappropriate blood transfusions by 80% and increased patient safety
Reduced the number of duplicate HNE/CPI patient accounts from an average of 78 per month to 30
Reduced SLH overall printing costs without compromising patient privacy and regulatory standards by $74,000
Reduced 50% of the cost associated with fall prevention tools (Hi/Low Beds, Patient Sitters) while sustaining patient safety
Standardized the cleaning process in Environmental Services Increased cross-functional awareness/understanding Opened up lines of communication Increased Leadership’s awareness of staff activities Educated Leadership/Staff on systematic process
improvement tools
SIPOCR Overview
SIPOCR stands for…Suppliers InputsProcessesOutputsCustomersRequirements
Typically done at the beginning and end of project (current vs. future)
SIPOCR Example
AdmitAdmit patient to
unit.
ProcessLIP process to
be able to administer drug.
AdministerRN administers
the drug.
Suppliers Inputs Processes Outputs Customers RequirementsED Staff, Patient, Patient Families, Other Facilities,
Medical Records, Admitting MD, Other Unit
(TCI/East 8), PCP
STAR, pt history / physical complaint / diagnosis/ pt demographics, orders, medications, allergies,
medication reconciliation, pt height/weight
Patient is admitted to the floor. Orders, belongings, family
members, Heparin Drip/Medicine, Patient Chart
RN, PCT, Admitting MD
Patient
MD, LIP
Patient is evaluatedWrite H&P
Nurse Admitting Database completedNutrition Screen form completed
ConsultationTreatment plan is decided on
(orders, labs, etc.)
MD – Pt H &P, Med Rec, RN Database completed, contact information, ER T-Sheet (if needed), Triage SheetRN – Phone call f/ ED, fax KardexPCT – Time to complete height/weight, allergies, blood sugar
ManageLIP manage drug therapy.
STAR, pt history / physical complaint / diagnosis/ pt demographics, orders, medications, allergies,
medication reconciliation, pt height/weight
RN Admit Database 8 hrsH/P 24 hrsConsults 24 hrsOrders w/in x hrs
RN, PCT, Admitting MD,
Patient, Pharmacy, Consultants
Patient
Evaluate LIP evaluate the
patient
OrderMD order drugs/
labs/etc.
ReevaluateLIP reevaluate order (drugs/
labs,etc).
Turn light on next to the chart on the floor
Order is scanned to PharmacyIA send order to Lab
EducateLIP educate patient on drug(s).
DischargeLIP discharge
the patient.
MD, LIPOrtho Per Pharmacy
Order created in chart for medication and labs.Parts of various order
sets.
PharmacyIA
LabNursingPatient
TAT for STAT is around 15 minutesRegular order is around 2 hoursChange heparin bag every 24 hours
Change heparin bag every 24 hrs from IV initiation
Must have patient allergies in HMM to process orderIf weight based heparin protocol, must have weight for patient orderLIP/ Prescriber signed the order to processPharmacy double checks what the Pharmacy Tech pulled to verify drug, dose, route, refill/new script, expiration date
Nursing, Pharmacy
Labs (platelets, INR)Physician Portal
AllergiesHome Medications
H&P
If issue, notify ordering MDIf no issue, reevaluation is complete
PharmacyNursing
MDLab
Patient
No requirements for this step
Order scannedDrug name, route
directions for order.Computer System (HMM)
Drugs
Drugs stocked in Accudose or delivered to Med Cart
Label printed out for Pharmacy TechIf label is printed, a charge is posted
on pt account for medication
NursingPharmacy
Billing(Coding)Patient
Nursing, Pharmacy, Lab
IV access (Heparin)Tubing & Bag, Pump, Accudose,
Medication CartProfile Information
Chart, MAR
Signed off in chart/MARDocument on flowsheet
Document on anticoagulation flowsheetMonitor pt for adverse drug interactions
Dose adjustmentsRechecked labs
Documentation in chartNotify MD if significant change
occurs
NursingPharmacy
MDPatient
Any IV accessDrug compatibility reviewed
Lab (antixa level, platelets, protime, INR, hgb, hct, APTT)Signs/symptoms of bleeding Recheck labs with 6 hours
NursingPharmacy
MDPatient
Heparin hold for 5 minutes for lab drawsOne hour for levels that are high
Nursing, Pharmacy, Lab
Nursing, Pharmacy, Lab
Pt Chart, Warfarin bookletVideo
Past lab values (at least that day’s INR)
Pharmacy
Nursing, MD
Sticker placed in chart to document pt understanding
Answered questions Received educational materials
Pharmacy documents teaching/non-teaching completed in HMM
NursingPharmacy
PatientPatient Families
Only educate on “new starts” or consults (never been on warfarin before)
Med Rec, Chart, Discharge Sheet, Discharge Pt Status,
Scripts, Educational Materials, Referrals,
Appointments, STAR, Transportation Request
STAR status updated (PHL)Medical Records collects charts
HIM, NursingPatient
Discharge is open depending on when patient has ride/able to leave
S I P O C R
SIPOCR Exercise
Select a process In the following order complete…
1. 5-10 high level process steps
2. Inputs
3. Outputs
4. Supplier
5. Customers
6. Customer Requirements
Questions
Contact Information
Amanda Duling, MS• Team Leader Quality
Saint Luke’s Hospital• (816) 932-8151• [email protected]
Kendall Cobb• Area Business Manager
Missouri Enterprise• (417) 350-2119• [email protected]