Objectives

1. Lean Inventory Improvements in Surgical ServicesMcCullough-Hyde Hospital Theresa Via RN, MS, CPHQKathy Orschell RN, MSN, CNOROctober 15, 2009

2. Objectives • Introduction to the BASICs of Lean in Healthcare • Understand our experience applying Lean tools in the Operating Room

3. Lean in Healthcare

4. Lean is a systematic approach to eliminate waste or non value –added activities from a process thus allowing an organization to improve the customer (patient, staff, physicians) experience & create a culture of continuous improvement. Reasons of Lean Implementation in Healthcare Continuous rise in health care costs Workforce shortages Need to improve patient safety / quality Silos of care and communication Almost all health care process includes non-value added activity Lean philosophy and tools easily understandable Defining Lean

5. Definitions Value Added Any activity that changes or elevates the product or service in the customer’s eyes. These are things a knowledgeable customer is willing to pay for and can be done right the first time. Non-Value Added or Waste Any activity that does not change or elevate the product or service in the customer’s eyes. These activities should be eliminated. Non-Value Added but Necessary Any activity that does not change or elevate the product or service in the customer’s eyes, but is necessary with the current process. These activities should be eliminated, simplified, or reduced.

6. Identifying the Eight Wastes 50% of all healthcare is WASTE Non-Value Added but Necessary Non-Value-Added Defects/Errors Overproduction Waiting or Delays Not Utilizing Employees K,S,A,C Transport Inventory/backlog Motion or Movement Excess Processing Value Added

7. Our Story • 45 bed Acute Care Hospital • Located in Oxford, OH • 600 Employees • 2008 activity • 2715 Discharges • 1829 Surgeries • 2304 Endoscopies • Our reason for Lean • Cost Savings - OR Inventory • Cost avoidance - staffing • Improve staff satisfaction and efficiency • Improved space utilization

8. Our Approach • Training • Project Kickoff • Planning • S.I.P.O.C. • Value Stream Analysis • Process Mapping • Spaghetti Diagrams • Implementation • Kaizen Events • 5S • Kanban • Error Proofing - Standard Work Instruction

9. Training • All day workshop • Attended by Administration & Lean Team Leaders • 3 hour Lean overview for management and all OR staff • 4 sessions over 2 days • Attended by 50+ employees

10. Project Kickoff • Our TEAM • Kathy Orschell • Hope Crowell • Tammy Rosenberger • Kathy Neel • Carolyn Saunders • Theresa Via • Jason Coons • Initial TEAM meeting • Developed Project Charter • Established TEAM Expectations • Set TEAM Ground Rules • Established Project Timeline • Established Resource Needs

11. Lean in the MHMH’s OR Operation M.O.R.E.

12. Planning - SIPOC • Identify the Key Suppliers, Inputs, Processes, Outputs & Customers

13. Planning - Value Stream Mapping Value Stream Mapping Value Stream Mapping: A map of all the actions (both value added and non-value-added) currently required to produce a product or service from the customer’s perspective. It helps you see the flow of materials, patients, and information. Current State Drawing Future State Drawing Implementation Plan Implementation of Improved Plan

14. Planning-Current State Map / Workflow

15. Future State Guiding Principles • Set standard par, min, max, and re-order quantities • Ability to order by inventory location and arrive by location from Central Supply • Organization throughout the OR • Open shelving • Decreased clutter • Exchange carts for everyday supplies • Visual knowledge of inventory needs

16. Future State Guiding Principles • Big stock items stored in central supply (primary location) • Easier transition to the new HIS • Ability to order from inventory locations with use of a COW • Color coding of kanban cards • Catalogue of inventory (search by item to find location) • Reduction in supply locations • No more hoarding • Daily rounding for orders

17. Planning - Future State Map

18. Anticipated Impact to Process Central Supply Items: 46% impact Current State: 519 min Future State: 279 min 34% impact Non-stock Items: Current State: 921 min Future State: 612 min

19. Implementation – Kaizen Events • Kaizen Events enable a team to learn & implement improvement processes (i.e. Lean tools) by a TEAM to a targeted area within a specified time period • Usually lasts 1-3 days Kai - zen “Take apart” “Make good”

20. Sort – Sort through and sort out Set-in-Order – Set locations for everything Shine – Make it “like new” Standardize – Control the first 3S’s Sustain – Make it habit Implementation – 5S

21. Implementation – 5S Before Lean After Lean

22. Implementation – 5S Before Lean After Lean

23. Implementation – 5S Before Lean After Lean

24. Exchange Carts – 108 high use items Implementation -5S After Lean Before Lean

25. Implementation - Kanbans • The word can be broken into two parts to define its meaning: • “Kan” = Visual • “ban” = Card • Key Advantages • Simple and understandable process • Provides quick and precise information • Low costs associated with the transfer of Information • Control can be maintained • Delegates responsibility to staff

26. Implementation - Kanbans • The task at hand • Getting the data! • Many items not in the system • Kanban Card Development • Over 1,000 cards made and implemented

27. Implementation - Kanbans

28. Impact • On-Hand Inventory • Staff Satisfaction • Baseline 2.4 out of 5 (post analysis to be completed) • Other Areas of Impact • Travel distance / time necessary to pick cases • Space utilization • Creation of inventory catalog system • Preparation for new IT system • Created a process driven not people driven process 35% reduction

29. Lesson Learned • Communication was essential • Created a departmental cultural shift • Time management • Time & resources needed to obtain supply data from current HIS system • Data format • Pricing data • Ordering levels • Time needed to fully implement cards

30. Any Questions?