Park Nicollet Health Services

1. Park Nicollet Health Services 5S & 3P Lean Case Study in a Healthcare Environment - Facilities

2. Park Nicollet Vision

3. Our Core Strategy Passionate about best possible outcomes A world-class continuum of care Broad base of primary care Value-added seamless handoffs with excellent specialty programs New value (and revenue) streams by medical condition

4. Health Care - A Crisis of Value 

5. The crisis in value is recognized globally as a business opportunity Global market for health care Health care is growing as a percent of the world�s economy �The World Is Flat� dynamics include the digitization of services Entrepreneurial opportunities Massive investment lining up GE AOL Target Microsoft Private capital

6. �World is Flat� global competition coming to health care Nighthawk radiology Apollo Hospitals - India Cleveland Clinic E-consults NHS Admissions to the US e-mobile medical records still to come

8. Why Toyota? Most advanced management system in the world Effective in removing all 7 forms of waste: motion time (Waiting) inventory over-production transportation defects processing It is a system of productivity & Quality It keeps on ticking; 40+ year history at Toyota

9. LEAN � the 7 �sees�: See for yourself (�go to the �gemba��) See what people do (standard work) See how people spend their time (stopwatch, time observation sheet) See where people go (spaghetti chart) See what really happens to your patients (value stream maps) See who your teammates really are (value stream maps) See the wasted effort (muda)

10. Our Commitment Kaizen Promotion Office (KPO) staffed (11) Kaizen Operation Teams (KOT) staffed (25) 135 leaders pursuing Certification (This includes experiences on factory floor at Genie and Japan gemba kaizen) 100 leaders pursuing Certification Maintenance Intern program in place 5 /W 12 completed

11. Our Commitment (cont.) 250 RPIWs completed Over 1200 staff members have participated 9 �3P� workshops completed (TRIA, Chanhassen, HVC, Endoscopy, Chronic Disease, OB, Cancer Center, EDI, Methodist Hospital) Visibility Room operational 5S Campaigns - 10 projects per month

12. 3 Main Methods for implementing Lean 5S � making our workspaces clean, organized and visual RPIWs � �Rapid Process Improvement Workshop� weekly workshops aimed at eliminating waste, in its many forms 3P � �Production Preparation Process� � used to create a new process or totally redesign an existing process; �PDCA�

13. 5S & 3P Integrated Timeline

14. 5S � Creating a physical environment in support of Lean 5S is a strategy for organizing the workplace to minimize waste of time. Having everything clean, neat, and in the proper location enhances quality and productivity because it helps make things easier to find and problems more visible. �A place for everything, and everything in its place, clean and ready for use�

15. 5S � Workplace Organization Sorting�- Remove excess or unused products, furniture and equipment. Keep only what is needed. Simplifying�- Make the workplace easy to understand where products and equipment can be found. Place products used to do the work close to the worker to avoid steps. Sweeping - Visual checks will help indicate that everything is in its place and in sufficient quantity. Establish simple signals to assure inventories are replenished in small quantities. Standardizing�- Make the workplace the same in layout and products used in the work. Self-discipline�- Adopt the habit of making regular visual checks to maintain the improvement.

22. 5S Results for 2006 94 teams Involving 397 employees A total of 14,414 red tagged items were sent to the 5S warehouse. Items re-deployed, sold, donated or thrown away Items valued at $1.2 million

23. 3P �Production Preparation Process� Model process for designing quality service Used when demand dictates increased capacity required or new product introduced Process design or service delivery changes

24. 3P �Production Preparation Process� (cont.) Patient (customer) the focal point Programming and Space Planning condensed into one week. 15-20 Participants (stakeholders, decision makers, customers, lean experts, patients, architect) Outcome sets project scope � no work around (stick to the plan)

25. Approach to Construction Traditional Lean Progress from 3P, Cost Estimate 5d 5d Schematic Design 35d 20d Design Development 40d 30d Contract Documents 50d 30d Bid and Award 15d 15d Construction 100d 90d Move-in 5d 5d 250d 195d

26. 3P Tools Patient Quantity Analysis (PQA) 7 flows (Yarn measurements) 7 ways (think like 12 year old) Simulation/Modeling (post-it notes & Lego's) Mock-ups Layouts

27. 7 Flows Flow of Patients Flow of Providers Flow of Medications Flow of Supplies Flow of Information Flow of Equipment Flow of Instruments/Processes

28. Steps Define scope and team membership Fishbone current process Create preferred process flow; examine alternatives (from nature) Develop and evaluate 7 options Narrow selection and present results Complete equipment design and layouts

29. Involving Patients 3P patient participation Patient Provider Council

30. 3P: �Intelligent Design� of our workspaces (mockup, try, practice)

31. 3P Tools (fishbone diagram)

32. 3P Tools (string model)

33. 3P Tools (string model)

34. 3P Tools (string model)

35. 3P Tools (simulation)

36. 3P Tools (mockup/layout)

37. 3P Results - Chanhassen Decrease walking: For patient reduced 27% For nurse reduced 27% For clinician reduced 42% Reduce inventory: Reduced 21 exam rooms Reduced 1 procedure room Reduced construction cost $196,200 Total project reduction $357,300 20% reduction of square footage: Created flexibility, team work among disciplines; lean concept of 'open room'; less steps for patient and staff; improved flow and visual control.

38. 3P Results - HVC Patient walking distance decreased 73% in nuclear, interventional and chest x-ray Staff walking distance decreased 30% Estimated cost of changed $400,000 including design, change orders, materials/equip Cost avoidance of $140,000 in staffing assumptions Capacity gains result in opportunity for additional $2.5 million in gross charges

39. 3P Results - TRIA We could have institutionalized poor processes in the facility design & customers (external &internal) would not always be served well. Good data is essential. Next room available increases capacity. "Expert" opinions are often wrong. Data and modeling proved this. By using 3P, movement could be cut by 50%, patient time in facility by 30%, labor costs by 20% and time to patient payment by 30%

40. Summary of 3P�s Lessons Learned Have defined scope/goal from the start Clearly articulate/communicate your scope/goal to team Measurement and good data are critical to the process Participation from patients is essential Standard work is necessary for efficiency Flexibility is achieved by breaking down department barriers Interdisciplinary groups should always design facilities Visualization is a key to understanding flow and processes Simulation is enlightening, it changes peoples� views on flow

41. Lessons LearnedDavid Wessner, CEO ��� it�s humbling that I have to admit we�re relearning how to get everyone involved in taking the waste out of work. The more you learn about waste, the more you see it.�

42. Lessons LearnedSam Carlson, MD Chief Medical Officer �Standard work and reducing variation in processes are key components of safe and productive work practices and conflict with professional autonomy.� �Accept the challenge!"

43. Lean Resources

44. Thank You