Avera McKennan Putting the Patient First: What Toyota Would Do If It Ran Your Hospital

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Avera McKennanPutting the Patient First What
Toyota Would Do If It Ran Your Hospital

• Presented by Steve Statz, R.Ph, M.B.A.
• Senior Vice President Hospital Operations
• Presentation for
• Premier Conference Orlando, Florida
• June 2006

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Presentation Outline

• Avera History and Background
• What is LEAN
• Managing Change Getting Buy-in
• Avera McKennan Process Excellence Projects and
  Results
• Lessons Learned

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Avera McKennan Hospital and University Health
Center

• 490 bed facility located in Sioux Falls, South
  Dakota

• More than 3,100 employees 19,000 discharges
  265 employed physicians in 26 specialties and 73
  mid-level practitioners located in 50 sites

• Member of Avera Health, a regional healthcare
  family
• of more than 100 healthcare facilities in the
  five state
• region of South Dakota, North Dakota, Minnesota,
  Iowa and Nebraska

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Patient waited 32 of her hospital stay.
Patient walked 1,646 feet (5.5 Football Fields)
during her hospital stay.
Patient was very pleasant and understanding
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Avera McKennans Goal

• To achieve the financial benchmark, we must
  achieve at least a 3 productivity improvement
  each and every year.
• To achieve the clinical and patient satisfaction
  goals, our productivity improvements must come
  through process improvements.

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What is LEAN?

• Toyota Production System started by Taiichi Ono
• Add Value to the Customer
• Recognize and Identify Waste
• Have the Courage to Call it Waste
• Have the Desire to Eliminate It
• Eliminate waste
• Understand that waste simply
• Raises Costs
• Produces no corresponding benefit
• Threatens all of our jobs

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Why LEAN?

• Lean attacks waste!
• Lean reduces or eliminates errors
• Standard work
• Error proofing
• Frees up valuable space
• Lean produces prompt results
• Results in 1 to 16 weeks vs. 4 to 6 months or
  more with other methods

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Generic Lean Development Timeline Fifteen Week
Project
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2
3
4
5
6
7
8
9
10
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12
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14
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Legend
Training Weekly Briefings Analysis Implementation
Performance Monitoring
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Implementing Lean

• Value stream mapping
• Demand data
• Activity of the patient or product
• Activity of the operator
• Activity of the Equipment - Workstation design
• Performance measurements

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LEAN Concepts

• Standard work (Lab, ED, OR)
• Synchronization (Lab, OR)
• First in/First out (All)
• Unified layout (Carts, ED, Ambulatory)

• One-piece flow (Lab)
• Demand based staffing (Housekeeping)
• Visual management control (OR)
• Mistake proof (All)

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Resources Needed For Success
Getting Buy-In
Lean Team Resources Team members - your best and
brightest.
Lean will require extensive resources from the
maintenance and construction areas.
ITC Resources Time is of the essence. Lean is
data driven and will consume ITC resources.
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Manager/DirectorLean Letter of Understanding
Getting Buy-In

• Establish expectations and obligations
• Ongoing process that does not end
• Best staff considered for the team
• Visit Lean Room daily
• Monitor performance metrics
• Promote and enforce Standard Work
• Signed by the Director and Manager

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Director/Manager Lean OrientationProject Prior
to Own Department
Getting Buy-In

• Attend first week of training
• Attend weekly briefings
• Participate in one
• Video and analysis
• Develop Standard Work
• Layout design
• 5S project
• Visual Management Control Mistake Proofing
• Follow Before Lean timeline of activities in
  prep for project in their area
• Identify dedicated Lean Room for project.

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Avera McKennan Projects

• Laboratory
• Histology
• Emergency Department
• Telemetry
• Operative Services
• Supplies
• Patient Flow
• Housekeeping
• Behavioral Health
• CSR Case Carts
• Pharmacy
• Registration to Zero Claim
• Medical Surgical Nursing

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Owning Lean
Before
After
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Phlebotomy Trays Before
Owning Lean
Phlebotomy Standardized
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Laboratory Turnaround Time Results
Results of Lean

• Before After LEAN LEAN
• Potassium 62 30.75
• Hemoglobin 53 21
• Protime 51 25.75

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Activity of the Patient ED Care
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Nurse Walk Patterns
Triage
chair
Registration
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ED Patient Flow
Results of Lean
Previous Process
Triage Registration RN MD Orders
Waiting
Current Process
Triage RN
MD Registration
Orders Waiting
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Workstation Layout?
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Prototype ED Room
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ED Layout Design

• Improved flow allows for less rooms
• Larger and more flexible rooms
• Specialty brought to the patient
• Supplies at bedside
• Improved patient confidentiality

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Improvement Highlights

• Patient Safety
• Identification
• Allergies
• Patient Satisfaction
• Patient see physician early in visit
• Average time 22 minutes
• Mode time 12 minutes
• Patient receives care before financial query

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ED LOS by Month
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Press Ganey Scores
Apr-2006
96
84
96
98
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Staffing to Patient Demand
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Sort, Segregate, Shine, Strengthen, Standardize
BEFORE
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Shower Curtains

• Classic Example Hoarding Hiding Hunting
• Weekly we heard Need more Shower Curtains!!!
• 72 Rooms use shower curtains
• 150 new shower curtains ordered in past year

• 562 Shower curtains found during inventory (does
  not include those in laundry)

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Housekeeping Schedule

• Schedule to patient demand
• Traditional Schedule
• 0700 to 1500
• Process Excellence Schedule
• Three begin at 0900
• Two begin at 1000

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Standard Patient Prep Room
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OR Patient Flow

• RN Assessment Time
• Reduced from 45 minutes to 22 minutes
• 3356 hours of nursing time per year
• Patient received uninterrupted care
• Standard assessment ensures accuracy
• RN Walk Time
• Reduced from 260 feet to 27 feet

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Preparing for Total Knee - Before
0.55 miles
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Preparing for Total Knee - After
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Cross-Training Team
Owning Lean
Angie Olson
Kristi Beck
Teresa Schoenfelder
Alan Regynski
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OR Supply Outcomes
Results of Lean

• Suture inventory reduction
• Increased turns to 4 and 14 for Top 80
• Savings at 182,000
• OR storeroom improvements
• Linen enhancement
• Reduced material handling
• OR suite linen standardization
• Innovation creativity
• Garbage bag dispensers being made
• Glove dispenser construction
• Stadium shelving

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Administration as a Lean Team
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Take Aways

• Senior Management and Department Buy-in
• Major Culture Change
• Change Management
• Organization wide communications
• Scope of projects will grow
• Continuous process
• Dedicated resources
• Consultant to mentor/guide/train
• Wonderful investment with high returns, but not
  cheap

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Performance Measures
Owning Lean

• If you cant measure, you cant improve.
• Dr. Taguchi
• You get what you expect
• and you deserve what you tolerate!